FIR2022-0073_Site_Plan_7.28.2022_1.07.54_PM_3018977BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements, permit status and inspection
scheduling information go to: http://www.edmondswa.gov/
JOB SITE INFORMATION/LOCATION: (Where the work Is taking place)
Job site Address: 19012 88th Ave W Edmonds, WA 98026
Parcel: 00434600002503
Lot /Unit/Suite #: Subdivision:
PROPERTY OWNER:
Name: Sandy Pond 1 LLC- Maragret Kelly
Mailing Address: Po Box 1104
City/State/zip: Issaquah, WA 98027
Phone #: 206-334-6281
Email: lnnovate023@gmail.com
OWNER INSTALLATION: "If yes, read and sign'
Will work be performed by the property owner? ❑ Yes IX No
I own, reside in, or will reside in the completed structure.
This installation is being made on property that I own which is
not intended for sale, lease, rent, or exchange according to
RCW 18.27.090.
Owner Signature:
APPLICANT / CONTACT INFORMATION:
Name of Applicant: Fllco Company, Inc.
Mailing Address: PO Box 31228
City/State/Zip: Seattle, WA 98103
Phone #: 206-547-8347
E-mail: info(@_filcoinviro.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: Filco Company, Inc.
Mailing Address: PO Box 31228
City/State/Zip: Seattle, WA 98103
Phone #: 206-547-8347
E-mail: infoaa filcoenviro.com
WA STATE CONTRACTOR L & I # (CCB) & EXPIRATION DATE:
601 276 033 12/31 /2022
CITY OF EDMONDS BUSINESS LICENSE #: NR-022028
Office Use Only
OF PERMIT (Provide
❑ Accessory Structure/
Detached Garage
DetailsTYPE
❑ Addition
❑ Demolition
IKMechanical
❑ New Single Family / Duplex
❑ Plumbing
❑ Fire Sprinkler
❑ Remodel
❑ New Commercial/ Mixed Use
❑ Re -Roof
❑ Signs
❑ Tank
❑ Tenant Improvement
❑ Other
Remodel Permit fees are based on:
The value of the work performed. Indicate the value (rounded to
the nearest dollar) of oil equipment, materials, labor, overhead.
and the profit for the work indicated on this application.
Valuation:
PROPOSED NEW SQUARE•• •• THIS APPLICATION
Basement sq ft: Finished ❑ Unfinished ❑
1st Floor, sq it:
2nd Floor, sgft:
Garage/Carport:, sq it:
Deck/Covered Porch/Patio:
Other sq ft:
PROJECTDESCRIPTION
Pump out triple rinse and remove one 275 gallon
Above Ground Heating Oil Tank (AST)
Haul tank away and properly dispose of tank.
I certify that the Information I have provided on this form/appllcadon is true,
correct and complete, and that I am the property owner or duly authorized
agent of the property owner to submit a permit application to the City of
Edmonds.
Print Name: 11ell da HeSE 4
Signature: / "I--Lr, Date ` 0
_Z
COMMERCIALGENERAL DATA
Occupancy Group(s): Occupant Load(s):
Type(s) of Construction: Fire Sprinklers: Yes ❑ No ❑
WA STATE ENERGY CODE: If your project affects the building envelope,
mechanical systems, and/or lighting, you must complete the
appropriate W5EC forms.
DEFERRED SUBMITTALS: All commercial building permits that will require
associated plumbing, mechanical, fire sprinkler, and/or fire alarm
permits are applied for separately.
TI / CHANGE OF USE / NEW BLDG: Include TRAFFIC IMPACT worksheet
EQUIPMENTMECHANICAL •
BTUs Gas / Elec / Other Qty
A/C Unit /Compressor
Air Handler /VAV
Boiler
Dryer Duct
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
COUNTSPLUMBING FIXTURE or re -piped)
Qty QtY
Clothes Washer
Tub/ Showers
Dishwasher
Backflow Device (RPBA, DCDA, AVB)
Drinking Fountain
Pressure Reduction/ Regulator Valve
Floor Drain/Sink
Refrigerator Water Supply
Hose Bibs
Water Heater - Tankless? Y or N
Hydronic Heat
Water Service Line
Sinks
Other:
Toilets
Other:
GAS/FUEL CONNECTION COUNTS (New, Relocated or re -piped)
BTUs Qty BTUs Qty
A/C Unit
Outdoor BBQ/ Fire pit
Boller
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace
Other:
COUNTSMEDICAL GAS, AIR VACUUM
Relocated .
Qty Qty
Carbon Dioxide
Nitrous Oxide
Helium
Oxygen
Medical Air
Other:
Medical - Surgical Vacuum Other:
DEMOLITION
Type of structure to be demolished:
Square footage of structure to be demolished:
AHERA Survey done? Y / N
PSCAA Case #:
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver ❑
Fill in Place ❑ Fill Material: FOAM
Removal 9 (AST)
Size of Tank (Gallons) 275
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver ❑
,•LL/EXCAVATE
Grading: Cut cubic yards
Fill cubic yards
Cut / Fill in Critical Area: Yes ❑ No ❑
GENERAL PROVISIONS
APPLICATIONS: Applications are valid for a maximum of 1 year.
ESLHA Applications, 2 years.
LICENSING: All contractors and subcontractors are required to be licensed
with Washington State Department of Labor & Industries and have a
current City of Edmonds Business License.
FILCO COMPANY INC. LICENSE#FILCOCIO80RU EXP: 12/31/2022
PO BOX 31228 ICC LICENSE # 5050940
SEATTLE, WA 98103
SITE PLAN
HEATING OIL TANK DECOMMISSIONING
JOB SITE: 19012 88th Ave W Edmonds, WA 98026
OWNER: Margaret Innovation Group
PHONE: 206-334-6281
ACTIVITY: Pump out, triple rinse and remove one above ground heating oil tank. Haul tank away and
properly dispose of tank.
N
19012— House
88 tn Ave W