FIR2022-0113_Application_11.4.2022_8.31.11_AM_3203098CITY OF EDMONDS M BuildingPermit.com
Fire Application #1225430 - Werber
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 (206) 762-7500
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 11/3/2024 Fm49R7785 uai—kwm@yahoo.com
Project Location
Number Street Floor Number Suite or Room Number
23425 84TH AVE W
City Zip Code County Parcel Number
EDMONDS 98026 00576700002501
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
Mathew Werber
Number Street Apartment or Suite Number
23425 84TH AVE W
City State Zip
EDMONDS WA 98026
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: 11/4/2022 Submitted By: Kelly Mackay
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CITY OF EDMONDS MyBuildingPermit.com
Fire Application #1225430 - Werber
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 #: (206) 762-7500
Burien WA 98166
Project Type Activity Type Scope of Work
Single Family Residential Decommission Underground Storage Tank Removal
Project Name: Werber
Description of Work: Decommission 300 gallon Residential Heating Oil Tank in place by Foam Fill.
Project Details
Storage Tank Size
Tank Size 300
Type of Work
Other
Contact Information
Owner Email Address uai_kmw@yahoo.com
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