FIR2023-0026_Application_3.27.2023_10.18.19_AM_3444558CITY OF EDMONDS M BuildingPermit.com
Fire Application #1289003 - 21419 95th PL W
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
21419 95TH PL W
City Zip Code County Parcel Number
EDMONDS 98020 00528200000100
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
Marvin C & Esther Anderson
Number Street Apartment or Suite Number
21419 95TH 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: 3/27/2023 Submitted By: Heather Hendricks
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CITY OF EDMONDS MyBuildingPermit.com
Fire Application #1289003 - 21419 95th PL W
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 Activity Type Scope of Work
Single Family Residential Decommission Other
Project Name: 21419 95th PL W
Description of Work: Pump, rinse and fill in place (1) 300-gallon UST previously containing home
heating oil.
Project Details
Storage Tank Work
Date of Decommissioning 4/6/2023
Tank Decommission
Contact Information
Owner Email Address paulsons42@comcast.net
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