City Applicationor• EpMO BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 Sth Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements, permit status and inspection
scheduling information go to: hitwj/::-wv, c dm �ndsv_� ;Lnv
JOB SITE INFORMATION/LOCATION: (Where the work Is taking place)
Job Site Address: 8029 238th St SW Edmonds, WA 98,
Parcel: 00451900102000
Lot /Unit/Suite #: Subdivision:
PROPERTY OWNER:
Name: Bellevue Better Properties LLC
Mailing Address: 6619 132nd Ave NE (#127)
City/State/Zip: Kirkland, Washington 98033
Phone #: 425-985-9325 CJ Antonyuk
Email: CAfbellproperties.net
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: Fllco Company, Inc.
Mailing Address: PO BOX 31228
City/State/Zip: -Seattle, WA 98103
Phone #: 206-547-8347
E-mail: infoC@__filcoinviro.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: Filco Company, Inc.
Mailing Address: PO BOX 31228
City/State/Zip: Seattle, WA 98103
Phone #: 206-547-8347
E-mail: infoafilcoenviro.com
WA STATE CONTRACTOR L & I # (CCB) & EXPIRATION DATE:
601 276 033 12/31 /2025
CITY OF EDMONDS BUSINESS LICENSE #: NR-022028
Permit #:
(ProvideTYPE OF PERMIT .
❑ Accessory Structure/
❑ Addition
Detached Garage
— -I—
❑ Demolition XMechanical
❑ New Single Family / Duplex
❑ Plumbing
❑ Remodel
❑ Re -Roof
❑ Tank
❑ Other
❑ Fire Sprinkler
❑ New Commercial/ Mixed Use
❑ Signs
❑ Tenant Improvement
Remodel Permit fees are based 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:
PROPOSED NEW SQUARE FOOTAGE 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 remove one
300 gallon residential underground
heating oil tank. Haul tank away and
properly dispose of tank. Seattle Iron &
Metals.
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 to submit a permit application to the City of
Edmonds.
Print Name:
Signature: Date
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GENERAL COMMERCIAL 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
COUNTSMECHANICAL EQUIPMENT .Relocated)
BTUs Gas / Elec / Other Qty
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 . .. .
City City
Clothes Washer
Tub/Showers
Dishwasher
Backfiow 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
Sinks
Other:
Toilets
Other:
CONNECTIONor re-pil)Ld)
BTUs Qty BTUs City
A/C Unit
Outdoor BBQ / Fire pit
Boller
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace Other:
MEDICAL GAS, AIR VACUUM COUNTS
.. re -piped)
Qty
City
Carbon Dioxide
Nitrous Oxide
Helium
Oxygen
Medical Air
Other:
Medical - Surgical Vacuum Other:
DEMOLITION
Type of structure to be demolished:
Square footage of structure to be demolished:
AHERA Survey done? Y / N I PSCAA Case #:
l
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver ❑
Fill In Place ❑ Fill Material:
Removal I Size of Tank (Gallons) 300 gall
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver ❑
GRAD
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.
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.