FIR2022-0066_Application_6.30.2022_3.01.01_PM_2965239CITY OF EDMONDS M BuildingPermit.com
Fire Application #1167245 - ROOSENDAAL tank decommissioning
Applicant
First Name Last Name Company Name
Heather Hendricks Tanks by Dallas
Number Street Apartment or Suite Number E-mail Address
17552 Ballinger Way NE tanksbydallas@tanksbydallas.net
City State Zip Phone Number Extension
Lake Forest Park WA 98155 (206) 365-0291
Contractor
Company Name
Tanks by Dallas
Number Street Apartment or Suite Number
17552 Ballinger Way NE
City State Zip Phone Number Extension
Lake Forest Park WA 98155 (206) 365-0291
State License Number License Expiration Date UBI # E-mail Address
tanksd*001 kf 5/6/2023 FD1 q7941 R tanksbydallas@tanksbydallas.net
Project Location
Number Street Floor Number Suite or Room Number
24132 102ND PL W
City Zip Code County Parcel Number
EDMONDS 98020 00555000004100
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
DARRYL ROOSENDAAL
Number Street Apartment or Suite Number
24132 102ND PL W
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: 6/30/2022 Submitted By: Heather Hendricks
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CITY OF EDMONDS MyBuildingPermit.com
Fire Application #1167245 - ROOSENDAAL tank decommissioning
Project Contact
Company Name: Tanks by Dallas
Name: Heather Hendricks Email: tanksbydallas@tanksbydallas.net
Address: 17552 Ballinger Way NE Phone #: (206) 365-0291
Lake Forest Park WA
98155
Project Type
Single Family Residential
Activity Type
Decommission
Scope of Work
Other
Project Name: ROOSENDAAL tank decommissioning
Description of Work: Pump out, triple rinse, fill in place (1) 500-gallon UST with sand/slurry mixture.
Project Details
Storage Tank Work
Date of Decommissioning
Tank Decommission
Contact Information
Owner Email Address
7/13/2022
darrylr50@frontier.com
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