FIR2022-0015_Application_2.14.2022_9.47.08_AM_2675966CITY OF EDMONDS M BuildingPermit.com
Fire Application #1091397 - Boehlke
Applicant
First Name Last Name Company Name
Kelly Mackay LEFT COAST SERVICES LLC
Number Street Apartment or Suite Number E-mail Address
126 SW 148th St Suite C100 Box 4 uai—kwm@yahoo.com
City State Zip Phone Number Extension
Burien WA 98166 2067627500
Contractor
Company Name
LEFT COAST SERVICES LLC
Number Street Apartment or Suite Number
126 SW 148TH ST STE C100 BOX 4
City State Zip Phone Number Extension
BURIEN WA 98166 (206)762-7500
State License Number License Expiration Date UBI # E-mail Address
LEFTCCS829QB 11/3/2022 Fm49R7785 uai—kwm@yahoo.com
Project Location
Number Street Floor Number Suite or Room Number
19301 OLYMPIC VIEW DR
City Zip Code County Parcel Number
EDMONDS 98020 00434600008501
Associated Building Permit Number Tenant Name
BLD2021-1561
Additional Information (i.e. equipment location or special instructions)_
Work Location
Property Owner
First Name Last Name or Company Name
Robert L & Naki Jason H Boehlke
Number Street Apartment or Suite Number
19301 OLYMPIC VIEW DR
City State Zip
EDMONDS WA 98020
Certification Statement - The applicant states:
I certify that I am the owner of this property or the owner's authorized agent. If acting as an authorized agent, I further certify that I have full power and
authority to file this application and to perform, on behalf of the owner, all acts required to enable the jurisdiction to process and review such application. I
have furnished true and correct information. I will comply with all provisions of law and ordinance governing this type of application. If the scope of work
requires a licensed contractor to perform the work, the information will be provided prior to permit issuance.
Date Submitted: 2/14/2022 Submitted By: Kelly Mackay
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CITY OF EDMONDS MyBuildingPermit.com
Fire Application #1091397 - Boehlke
Project Contact
Company Name: LEFT COAST SERVICES LLC
Name: Kelly Mackay Email: uai_kwm@yahoo.com
Address: 126 SW 148th St Suite C100 Box 4 Phone #: 2067627500
Burien WA 98166
Project Type Activity Type Scope of Work
Single Family Residential Decommission Underground Storage Tank Removal
Project Name: Boehlke
Description of Work: CA Waiver: #CRA2021-0139. Decommission a 300 gallon residential heating oil
tank by REMOVAL.
Project Details
Storage Tank Size
Tank Size
Type of Work
Other
300
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