FIR2024-0125_Site_Plan_12.24.2024_11.10.31_AM_46858330 EOnjG BUILDING PERMIT
�o APPLICATION
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
°C. t F") 425.771.0220
For handouts, submittal requirements, permit status and Inspection
scheduling information go to: htta://vAvw.edmondswa.gov/
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job site Address:1123 9th Ave S Edmonds, WA 9802C
Parcel: 27032500111100
Lot /Unit/Suite #: Subdivision:
PROPERTY OWNER:
Name: _Laurance & Monterey Robertson
Mailing Address: 1123 9th Ave S
City/State/zip: Edmonds. WA 98020
Phone #: 805-403-2710
I 1-M-a 9Ioe I! •II
OWNER INSTALLATION: *If yes, read and sign*
Will 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: Filco Company, Inc.
Mailing Address: PO BOX 31228
City/State/Zip: Seattle. WA 981.03
Phone M 206-547-8347
E-mail: info(c_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: info a@filcoenviro.com
WA STATE CONTRACTOR L & I # (CCB) & EXPIRATION DATE:
601 276 033 12/31 /2025
CITY OF EDMONDS BUSINESS LICENSE #: NR-022028
Office Use Only
TYPE OF PERMIT (Provide Details on Page
❑ Accessory Structure/
❑ Addition
Detached Garage
❑ Demolition XMechanical
❑ 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 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•O•• THIS APPLICATION
Basement sq ft: Finished ❑ Unfinished ❑
1st Floor, sq ft:
2nd Floor, sgft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
Other sq ft:
PROJECT
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one 500 gallon underground heating oil
_tank. Cust vent and fill below grade
caD and seal.
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: Melinda Hess
Signature: Date 12/19/�024
GENERAL COMMERCIAL
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
EQUIPMENTMECHANICAL •
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 . .. .
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
Sinks
Other:
Toilets �—
Other:
GAS/FUEL• •COUNTS
BTUs Qty BTUs Qty
A/C Unit
Outdoor BBQ/ Fire pit
Boller
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace
Other:
MEDICAL•
or re -piped)
Qty
Qty
Carbon Dioxide
Nitrous Oxide
Helium
Oxygen
Medical Air
Other:
Medical - Surgical Vacuum Other:
rr • •
Type of structure to be demolished:
Square footage of structure to be demolished:
AHERA Survey done? Y / N I PSCAA Case #:
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver ❑
Fill in Place Fill Material: FOAM
Removal ❑ Size of Tank (Gallons) 500
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver ❑
GRADE/EXCAVATE
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.
FILCO COMPANY INC.
PO BOX 31228
SEATTLE, WA 98103
LICENSE#FILCOCIO80RU EXP: 12/31/2025
ICC LICENSE # 5050940
SITE PLAN
HEATING OIL TANK DECOMMISSIONING
JOB SITE: 1123 9th Ave S Edmonds, WA 98020
OWNER: Laurance & Monteray Robertson
PHONE: 805-403-2710 -Heath Shockman
ACTIVITY: Pump out triple rinse and fill in place with foam one 500 gallon underground heating oil
tank.
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9th Ave S Edmonds,
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