FIR2024-0060_Applicant_Response_7.18.2024_1.30.30_PM_4387239BUILDING PERMIT
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: htto://www,edmondswa.goy/
JOB SITE INFORMATION/LOCATION: lWhere the work Is taking place)
Job Site Address:19803 81 st PL W Edmonds, WA 98026
Parcel: 2910869
Lot /Unit/Suite #:
PROPERTY OWNER:
Name: James West
Subdivision:
Mailing Address: 19803 81 st PL W
City/State/Zip: Edmonds. WA 98026
Phone #: 206-571-2279
Email: iames(a),tri-countcabulance.com
OWNER INSTALLATION: 'If yes, read and sign`
Will work be performed by the property owner? ❑ Yes 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: Filco Company, Inc.
Mailing Address: PO BOX 31228
City/State/zip: Seattle, WA 98103
Phone #: _0 6-547-8347
E-mail: info filcoinviro.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: -Filco Co m any, Inc.
Mailing Address: PO Box 31228
City/State/Zip: _Seattle WA 98103
Phone #: 206-547-8347
E-mail: info cDfilcoenviro.com _
'vVA STATE CONTRACTOR L & i # (CCB) & EXPIRATION DATE:
601 276 033 12/31 /2024
('_!T 0 1 - E,DMVf0N95 t;tf iNa 7, NR-022028
Permit #:
❑ Accessory Structure/
Detached Garage
❑ Addition
(Mechanical
❑ Demolition
❑ New Single Family / Duplex
❑ Plumbing
❑ Fire Sprinkler
❑ Remodel
❑ New Commercial/ Mixed Use
❑ Re -Roof
❑ Signs
❑ Tank
❑ Tenant Improvement ❑ Other
Remodel Permit fees are based on:
the nearest dollar) of all equipment, materials, labor, overhead,
and the profit for the work indicated on this application.
truwmtun:
PROP(DsFr) NEW SQU,5RE VIDOTAGE FOR 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 ft:
PROJECT
Pump out triple rinse and fill with foam
one 300 gallon underground heating
oil tank.
I
I certify that the information I have provided on this form/application is true,
correct and complete, and that i am the property Owner of duly autheroaed
agenl of thr_ property owner to suomii a permit application to the City of
�drnond�.
fr-int Name_ Melinda Hess
s e!,a ,ir t� q 'A i,3a=7/18/2024
Occupancy Group(s): Occupant Load(s):
Types) 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
BTUs Gas / Elec / Other City
A/C Unit /Compressor
Air Handier /VAV
Boller
Dryer Duct
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
COUNTSPLUMBING FIXTURE or • r
Qty Qty
Clothes Washer
Tub/ Showers
Dishwasher
Backflow Device (RPSA, DCDA, AVB)
Drinking Fountain
Pressure Reduction/ Regulator Valve
Floor Drain/Sink
Refrigerator Water Supply
Hose Bibs
Water Heater-Tankless? Y or N
Hydronic Heat
Sim
ik-dl
Water Service Line
Qther:
ILIRNIMLIKIMMIIIIIIIIililill
BTUs Qty BTUs City
77
A/C Unit
Outdoor BBQ/ Fire pit
Boller
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace Other:
MEDICAL•
(New, Relocated or re-pipcd)
Qty
Qty
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 q:
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver O
Fill in Place Fill Material: FOAM
Removal ❑ Size of Tank (Gallons) 300
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver ❑
• •
Grading: Cut cubic yards
Fill cubic yards
Cut / Fill in Critical Area: Yes ❑ No ❑
GENERAL PROV15IONS
APPLICATIONS. Applications are valid for a maximum of 7 year.
F.SLHA Applications, 2 years.
IICENS;NG: All contractors and subcontractors ale r-_quirca to be
licen:;ed
Nrth Washini;tai 'itate Depart,nent of Labof & ies and have
a
current hc6•ns,
FILCO COMPANY INC. LICENSE#FILCOCIO80RU EXP: 12/31/2024
PO BOX 31228 ICC LICENSE # 5050940
SEATTLE, WA 98103
SITE PLAN
HEATING OIL TANK DECOMMISSIONING
JOB SITE: 19803 81s' PL W Edmonds, WA 98026
OWNER: James West
PHONE: 206-571-2279
ACTIVITY: Pump out triple rinse and fill in place with foam one 300 gallon underground heating oil
tank.
81 SL PL West Edmonds, WA