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FIR2025-0014_Application_2.20.2025_9.48.18_AM_4770921CITY OF EDMONDS M BuildingPermit.com Fire Application #1616490 - Headley Applicant First Name Last Name Company Name Heather Hendricks Tanks by Dallas Number Street Apartment or Suite Number E-mail Address 17552 Ballinger Way NE tanksbydallas@tanksbydallas.net City State Zip Phone Number Extension Lake Forest Park WA 98155 (206) 365-0291 Contractor Company Name Tanks by Dallas Number Street Apartment or Suite Number 17552 Ballinger Way NE City State Zip Phone Number Extension Lake Forest Park WA 98155 (206) 365-0291 State License Number License Expiration Date UBI # E-mail Address tanksd*001 kf 5/6/2025 FD1 q7941 R tanksbydallas@tanksbydallas.net Project Location Number Street Floor Number Suite or Room Number 21628 98TH AVE W City Zip Code County Parcel Number EDMONDS 98020 27032500109400 Associated Building Permit Number Tenant Name Additional Information (i.e. equipment location or special instructions)_ Work Location Property Owner First Name Last Name or Company Name Shepard P & Schwartz Stacy M Headley Number Street Apartment or Suite Number 9903 227TH PL SW City State Zip EDMONDS WA 98020 Certification Statement - The applicant states: I certify that I am the owner of this property or the owner's authorized agent. If acting as an authorized agent, I further certify that I have full power and authority to file this application and to perform, on behalf of the owner, all acts required to enable the jurisdiction to process and review such application. I have furnished true and correct information. I will comply with all provisions of law and ordinance governing this type of application. If the scope of work requires a licensed contractor to perform the work, the information will be provided prior to permit issuance. Date Submitted: 2/20/2025 Submitted By: Heather Hendricks Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Fire Application #1616490 - Headley Project Contact Company Name: Tanks by Dallas Name: Heather Hendricks Email: tanksbydallas@tanksbydallas.net Address: 17552 Ballinger Way NE Phone #: (206) 365-0291 Lake Forest Park WA 98155 Project Type Activity Type Scope of Work Single Family Residential Decommission Underground Storage Tank Removal Project Name: Headley Description of Work: Pump contents, triple -rinse and decommission in place (1) 300 gallon UST. Project Details Storage Tank Size Tank Size 300 Work Location Work Description/Location (example: 1 st floor, Front yard Master Bath, Garage) Type of Work Other Contact Information Owner Email Address p.headley@icloud.com Page 2 of 2