FIR2023-0038_Application_4.20.2023_2.05.36_PM_3495819CITY OF EDMONDS M BuildingPermit.com
Fire Application #1302465 - 9220 192nd PI SE
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
9220 192ND PL SW
City Zip Code County Parcel Number
EDMONDS 98020 00434600005302
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
Frederick G Gouge
Number Street Apartment or Suite Number
9220 192ND PL SW
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: 4/20/2023 Submitted By: Heather Hendricks
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CITY OF EDMONDS MyBuildingPermit.com
Fire Application #1302465 - 9220 192nd PI SE
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
Project Name: 9220 192nd PI SE
Description of Work: Pump, rinse and fill in place (1) 300 gallon oil tank
Project Details
Storage Tank Work
Date of Decommissioning
Tank Decommission
Contact Information
Owner Email Address
4/26/2023
Scope of Work
Other
tanksbydallas@tanksbydallas.net
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