FIR2023-0095_Site_Plan_9.22.2023_9.09.24_AM_3798600oti t:vti,U BUILDING PERMIT
v
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; hno:!/www.edmondswa. ov
JOB SITE INFORMATION/LOCATION: (Where the work Is taking place)
Job Site Address: 24031 79th PL W Edmonds, WA 980
Parcel: 00511600000700
Lot /Unit/Suite #: Subdivision:
PROPERTY OWNER:
Name: _1Nina ChChe_nTa _
Mailing Address: 24031 79th PL W
city/state/zip: Edmonds, WA 98026
Phone u: 857-334-0259
Email: whitPwinghk4Vahoo_com _
OWNER INSTALLATION: *If yes, read and sign*
WIII 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: Fjco Company, Inc.
Mailing Address: PO BOX 31228
City/State/Zip: Seattle, WA 98103 _
Phone tl: 206-547-8347 _
E-mail; info(cD-filcoinviro.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor Filco Company, Inc.
Mailing Address: PO BOX 31 228
Clty/state/zip: Seattle, WA 98103
Phone #: 206-547-8347
info filcoenvirocom
WA STATE CONTRACTOR I. & i 9 (CCB) & EXPIRATION DATE:
601 276 033 12/31 /2023 -
Perrnfl $:
❑ Accessory Structure/
Detached Garage
❑ Addition
❑ Demolition
(Mechanical
❑ New Single Family / Duplex
❑ Plumbing
❑ Fire Sprinkler
❑ Remodel
❑ New Commercial/ Mixed Use
❑ Re -Roof
❑ Signs
❑ Tenant Improvement
i_
❑ Tank
❑ Other
i nernuoei rerma tees are ousea on;
The value of the work performed, Indicate the value (rounded to
the nearest dollar) of all equipment, materials, labor, overhead,
and The profit for the work indicated on this application.
Valuation:
PROSQUARE FOOTAGE POSED NEW • THIS APPLICATION
Basement sq ft: Finished ❑ Unfinished ❑
1st Floor, sq ft:
2nd Floor, sq ft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
Other sq it:
PROJECTDESCRIPTION
- Pump out triple rinse and fill with foam
one 300 gallon underground heating
oil tank. Cut vent and fill tube below grad
cap and seal.
I
1 certdy that the information I have provided on this form/application is true,
correct mid Complete, and that I am the property owner or duly authorized
ar;ent of the property owner to submit a permit application to the City of
Ldmond
Print Name: Melinda Hess a
t rfv Or cuMOr•!oa m�jlfv °» i_Ic I�iS ft NR-022028 sigoature, 1,��1/l� Date 9/22/2023
1
G[NI:kAI.('(._)I'VllVILRCIA1 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 WSEC 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
MECHANICAL EQUIPMEN F COUNTS (New and Relocated)
BTUs Gas / Elec / Other Qty
A/C Unit /Compressor
Air Handler/VAV
Boiler
Dryer Duct
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
Hydronlc Heating
Roof Top Unit (Provide eleva-
tions If a Commercial Bldg)
Other:
COUNTSPLUMBING FIXTURE .. .. .
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
O:her.
Sinks
'Jilets
Oilier
GAS/FLIEL CONNECTION coui\j'r� (New, or re -piped)
BTUs City BTUs City
A/C Unit
Outdoor BBQ / Fire pit
Boiler
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace Other:
MEDICAL+COUNTS
(Now, Relocated or re -piped)
City
City
Carbon Dioxide
Nitrous Oxide
Helium
Oxygen
Medical Air
Other:
Medical - Surgical Vacuum Other:
Type of structure to be demolished:
Square footage of structure to be demolished:
AHERA Survey done? Y / N PSCAA Case N:
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver ❑
Fill in Place Fill Material: FOAM
Removal ❑ Size of Tank (Gallons) 300
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver ❑
GRADE/ LLJEXCAVATE
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.
ESL HA Applications, 2 years.
LICENSING: All contractors and subcontractgrs are required to be licensed
with Washington Slate Departrnent of labor & Industries and have a
clirro"t Cir,/ of Edm;3nds Business I_ir; ;;se.
FILCO COMPANY INC. LICENSE#FILCOCIO80RU EXP: 12/31/2023
PO BOX 31228 ICC LICENSE # 5050940
SEATTLE, WA 98103
SITE PLAN
HEATING OIL TANK DECOMMISSIONING
JOB SITE: 24031 79th PL W Edmonds, WA 98026
OWNER: 24031 79th PL W Edmonds, WA 98026
PHONE: 857-334-0259
ACTIVITY: Pump and triple rinse and fill with foam one 300 gallon underground residential oil tank.
N
24031- House
79th PL W