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FIR2022-0031_Application_3.21.2022_12.41.53_PM_2750509CITY OF EDMONDS M BuildingPermit.com Fire Application #1111121 - 7419 300 gallon Decom Applicant First Name Last Name Company Name Paul Anderson Fuel Tank Installation Co Inc Number Street Apartment or Suite Number E-mail Address 11536 Seola Beach Drive SW FTICompanyinc@gmail.com City State Zip Phone Number Extension Seattle WA 98146 2062448020 Contractor Company Name Fuel Tank Installation Co Inc Number Street Apartment or Suite Number 11536 Seola Beach Drive SW City State Zip Phone Number Extension Seattle WA 98146 2062448020 State License Number License Expiration Date UBI # E-mail Address FUELTIC080138 6/11/2022 FD1 1 RF1 W FTICompanylnc@gmail.com Project Location Number Street Floor Number Suite or Room Number 7419 230TH ST SW City Zip Code County Parcel Number EDMONDS 98026 00441500200500 Associated Building Permit Number Tenant Name Additional Information (i.e. equipment location or special instructions)_ Work Location Property Owner First Name Last Name or Company Name Erik Daley EKD PROPERTIES LLC Number Street Apartment or Suite Number 23318 SE 225TH ST City State Zip MAPLE VALLEY WA 98038 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: 3/21/2022 Submitted By: Paul Anderson Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Fire Application #1111121 - 7419 300 gallon Decom Project Contact Company Name: Fuel Tank Installation Co Inc Name: Paul Anderson Email: FTICompanyinc@gmail.com Address: S1536 Seola Beach Drive Phone #: 2062448020 Seattle WA 98146 Project Type Activity Type Scope of Work Single Family Residential Decommission Other Project Name: 7419 300 gallon Decom Description of Work: Pump, rinse and clean, then fill tank. Project Details Storage Tank Work Date of Decommissioning 3/23/2022 Tank Decommission Page 2 of 2