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APPLICATION�A �J 1-I�2,"�, BUILDING PERMIT APPLICATION v n Development Services Building Division 121 5th Ave N / Edmonds, WA 98020 �n` I goo 425.771.0220 For handouts, submittal requirements, permit status and inspection scheduling information go to: htto: bagi.pdmondswa,myl JOB SITE INFORMATIONAOCATION: (Where the work Is tall pin nn Job Site Address: (A algbn A • m w 11 Parcel: 00434209601300k Lot /Unit/Suite #: Subdivision: PROPERTY OWNER: Name: Mark Soleta Mailing Address: 640 Dayton St City/state/zip: Edmonds, WA 98020 Phone #: 509-218-4472 Email: msoleta@comcast.net OWNER INSTALLATION: *ff yes, read and sign* WIII work be performed by the property owner? Q Yes IXNo 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: Tim es Mailing Address: PO Box 31516 City/State/Zip: Seattle, WA 98103 Phone #: 206-938-2280 E-mail: infoi D_SeattleTank.com GENERAL CONTRACrOR. (If different from applicant) General contractor: Seattle Tank Services Mailing Address: PO Box 31516 City/State/Zip: Seattle, WA 98103 Phone #: 206-938-2280 E-mail: info SeattleTank.com WA STATE CONTRACTOR L & I # (CCB) & EXPIRATION DATE: SEATTTT012Q4 12/31 /2019 CITY OF EDMONDS BUSINESS LICENSE #: N R-026223 Permit *: ❑ Accessory Structure/ ❑ Addition Detached Garage ❑ DemolMon CKMechanical ❑ New Single Family / Duplex ❑ Plumbing ❑ Fire Sprinkler ❑ Remodel ❑ New Commercial/ Mixed Use ❑ Re -Roof Q Signs ❑ Tank ❑ Tenant Improvement ❑ Other Remodel Permi# fees are based am The volve of the work performed. Indicate the value (rounded to the nearest dollar) of all equlpmeM, materials, k bor overhead, and the profit for the work Indicated on this appltcafion. Valuatiat: Basement sq ft: Finished ❑ Unfinished ❑ 1st Floor, sq ft: 2nd Floor, sq ft: Garage/Carport, sq 8: Deck/Covered Porch/Patia: Other sq W. Pump, rinse and fill in place with foam, one 300 gallon residential heating oil tank. cut vent and fill a belomt grade. 1 certify that the Information 1 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 to submit a permit application to the City of Edmonds. Print Name: Meli a He s /I-f r _ 010n10n )nj GENERAL COMMERCIAL Occupancy Group(s(: Occupant Load(s): Type(s) of Construction: Fire Sprinklers: Yes ❑ No 0 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 Qty A/C Unit /Compressor Air Handler /VAV Boller Dryer Duct Exhaust fans Fireplace Furnace Heat Pump Unit Hydronk Heating Roof Top Unit (Provide eleva- tions if a Commerdal Bldg) Other. COUNTS 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 - Tankless7 Y or N Hydronic Heat Water Service Line Sinks Other: Toilets Other: GAS/FUEL CONNECTION COUNTS (N(2v,, Rt'lo(At-0 or w piped) BTUs Qty BTUs Qty A/C Unit Outdoor BBQ/ Fire pit Boller Stove/Range/Oven Dryer Water Heater Fireplace/ Insert Other: Furnace Other: I'OEDICAL GAS, • VACUUM COUNTS • r c-wocd) Qty Qtv Carbon Dioxide Nitrous Oxide Helium Oxygen Medical Air Other: Medcal-SurglcalVacuum Other. Type of structure to be demolished: Square footagie of structure to be demolished: AHERA Survey done? Y IN PSCAA Case if: Critical Areas Determination: Study Required D Conditional Walver ❑ Waiver 0 FIR in Place 6d FIN Material: Foam _ Removal © Size of Tank (Gallons) 300 Critical Areas Determination: Study Required O Conditional Waiver ❑ Waiver ❑ i .. Grading: Cut cubic yards Fill cubic yards Cut / Fill In Critical Area: Yes ❑ No ❑ GENERALa APPLICATIONS. Applications are valid for a maximum of 1 year. ESLHA Applications, 2 years. LICENSING: All contractors and subcontractors are required to be licensed with Washington State Department of Labor & Industries and have a current City of Edmonds Business License. BATTLE TANK SERVICE LICENSE# SEATTTT012Q4 EXP:12/31 /2020 PO BOX 31516 ICC LICENSE #8145449 SEATTLE, WA 98103 206-938-2280 SITE PLAN HEATING OIL TANK DECOMMISSIONING JOB SITE ADDRESS: 640 Dayton St Edmonds, WA 98020 OWNER: Mark Soleta PHONE: 509-218-4472 ACTIVITY: Pump, rinse and fill in place with foam, one 300 gallon residential heating oil tank. Cut vent and fill pipe below grade. 640 House Isfai }�iLrlaC n n� ArAA walk Dayton St Type: FIRE TANK Owner/ Business: DAYTON STREET INVESTMENTS LLC Status: ISSUED Subtype: TANK - RESIDENTIAL Parcel No: 00434209601300 Site Address: 640 DAYTON STEDMONDS,WA 98020-3432 Applied: 3/5/2020 Subdivision: 004342 Lot: 0 Issued: 3/5/2020 Fire Sprinklers: Lot Area: Zoning: Final: Valuation: $0.00 Occupancy Type: Construction Type: Expiration Date: 9/5/2020 Code Edition: 0 No. Stories: 0 # of Dwelling Units: 0 Issued by: NED Scope of Work: PUMP RINSE FILL IN PLACE 300 GALLON TANK WA State Contractor L & I #: SEATTTT012Q4 City of Edmonds Business License #: 602454996-001-0001 NAME TYPE NAME ADDRESS PHONE EMAIL APPLICANT SEATTLE TANK SERVICES PO BOX 31516, SEATTLE WA (206)938-2280 INFO@SEATTLETANK.COM 98103 CONTRACTOR SEATTLE TANK SERVICES PO BOX 31516, SEATTLE WA (206)938-2280 98103 OWNER DAYTON STREET PO BOX 9, EDMONDS WA 98020 INVESTMENTS LLC FEE INFORMATION DESCRIPTION ACCOUNT AMOUNT PAID PAID DATE RECEIPT # CITY TECHNOLOGY FEE CHARGED 001.000.321.99.100.00 $40.00 $0.00 PER PERMIT TANK - RESIDENTIAL FILL, REMOVE 001.000.322.10.000.00 $50.00 $0.00 OR INSTALL TANK - SUB RESIDENTIAL 001.000.342.40.000.00 $150.00 $0.00 TOTALS: $240.00 $0.00 CONDITIONS CONDITION TYPE STATUS NOTES Printed: Thursday, March OS, 2020 9:40:08 AM 1 of 2