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FIR2023-0053_Application_5.31.2023_12.54.23_PM_3578777CITY OF EDMONDS M BuildingPermit.com Fire Application #1325165 - 22831 102nd 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 5/6/2025 FD1 q7941 R tanksbydallas@tanksbydallas.net Project Location Number Street Floor Number Suite or Room Number 22831 102ND PL W City Zip Code County Parcel Number EDMONDS 98020 00610700200102 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 *TALLEN LLC TALLEN LLC Number Street Apartment or Suite Number 21629 88TH 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: 5/31/2023 Submitted By: Heather Hendricks Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Fire Application #1325165 - 22831 102nd 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: 22831 102nd Description of Work: Pump, rinse and fill in place (1) 300 gallon underground oil tank. Project Details Storage Tank Work Date of Decommissioning 6/9/2023 Tank Decommission Contact Information Owner Email Address tysonlin@kw.com Page 2 of 2