FIR2024-0062_Site_Plan_7.24.2024_9.55.48_AM_4397791�A t �� C' BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 Sth Ave N / Edmonds, WA 98020
'no t aq0 425.771.0220
For handouts, submittal requirements, permit status and inspection
scheduling information go to: htti)://www.edmond$wa.gov
108 SITE INFORMATION/LOCATION: (Where the work is taking place)
Job site Address: 8105 Sierra Dr Edmonds, WA 98026
Parcel: 0057260000600
Lot /Unit/Suite #: Subdivision
PROPERTY OWNER:
Name: Ronald Den Adel
Mailing Address: 8105 Sierra Drive
City/State/Zip: Edmonds, WA 98026 _
Phone#: -A2L:3-44-1371
Email; svhb11 @gmail.com
OWNER INSTALLATION: 'If yes, read and sign'
Will work be performed by the property owner? ❑ Yes lX 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: Fllco Company, I nc.
Mailing Address: PO Box 31 228
City/State/Zip: Seattle. WA 98103
Phone #: 206-547-8347
E-mail -info@filcoinviro.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: Filco Company, Inc.
Mailing Address: PO Box 31 228
City/State/zip: Seattle, WA 98103
Phone #: 206-547-8347
E-mail: infoCcb-filcoenviro.com
'vUA STATE CONTRACTOR L & I it (CCO) & EXPIRATION DATE:
601 276 033 12/31 /2024
! I E Y Elfi:iP1= dit SlJ iflE:: LiE.Fi:l:i� ip NR-022028
Permll 7#�7
❑ Accessory Structure/ ❑Addition
Detached Garage
❑ Demolition !(Mechanical
❑ New Single Family / Duplex I ❑ Plumbing
❑ Fire Sprinkler ❑ Remodel
❑ New Commercial/ Mixed Use ❑ Re -Roof
❑ Signs
❑ Tank
❑ Tenant Improvement 1 ❑ Other
1 Remodel Permit fees are based on:
I
The value of the work performed. Indicate the value bounded to
the nearest dollar) of all equipment, materials, labor, overhead,
and the profit for the work indicated on this application.
Valuation:
Basement sq ft: Finished ❑ Unfinished ❑
1st Floor, sq ft:
2nd Floor, sq ft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
Other sq ft:
Pump out triple rinse and fill with foam _
one 300 gallon underground heatin0_
oil tank.
I certify that the information I have provided on this form/application is true,
correct and complete, and that I am the property owner or duly authorized
agent of the property owner t.o .sobrnit a permit application to the City of
Edmonds,
Print Name:
7/24/2024
Signature- ,atx,
C-5.LNERALCOMMERCIAL 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 EQUIPMENT COUNTS (Neiv and Relocated)
BTUs Gas / Elec / Other City
A/C Unit /Compressor
Air Handler /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 . re -piped)
Qty City
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
Sinks
___
OI P.tS
F__
Water Service Line
Other
- -_ -_ -_ -_
(nlw,
E
BTUs Qty BTUs Qty
A/C Unit
Outdoor BBQ / Fire pit
Boller
Stave/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace
Other:
MEDICAL+COUNTS
(New,
Relocated
or re -piped)
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 #:
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver ❑
Fill in Placed Fill Material: FOAM
Removal ❑ l Size of Tank (Gallons) 300
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver ❑
i
I 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.
CSLI-IA Applications, 2 years
LICcNISING. All rontrac tors ind subcontractors aie requii ed Lc be licensed
with W:is'ninr ron ,;rate D_=oartrien[ of Labor EQ Industries and hav,,, a
f Ili :'f'llt i_ ,' C-'1 F:ii'ICi''lJ'•
i
FILCO COMPANY INC. LICENSE#FILCOCI080RU EXP: 12/31/2024
PO BOX 31228 ICC LICENSE # 5050940
SEATTLE, WA 98103
SITE PLAN
HEATING OIL TANK DECOMMISSIONING
JOB SITE: 8105 Sierra Drive Edmonds, WA 98026
OWNER: Ronald Den Adel
PHONE: 425-344-1371
ACTIVITY: Pump out triple rinse and fill in place with foam 300 gallon heating oil tank.
tv'n k'
Sierra Drive Edmonds