BLD20160926.pdfDEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
"S 121 5a' Avenue N, Edmonds, WA 98020
Phone 425.771.0220 4 Fax 425.771.0221
City of Edmonds
1
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite#, City State, Zip): Parcel #:
23222 92nd Ave W, Edmonds, WA 98020 27033600108400
Associated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? YesE] No FV(
APPLICANT: Phone: =-548-9:352
Filco Company Inc. 206-547-8347
Address (Street, City, State, Zip): E-Mail Address:
PO Box 31228 Seattle, Washington 98103 info@filcoenviro.com
PROPERTY OWNER: Phone: Fax:
Tracey Trumbull 425-750-5557
Address (Street, City, State, Zip): E-Mail Address:
23222 92nd Ave W, Edmonds, WA 98020 ttrumbu1175@hotmail.com
LENDING AGENCY: Phone: Fax:
Address (Street, City, State, Zip): E-Mail Address:
CONTRACTOR:* Phone: V06-548-9352
ax:
Filco Company Inc. 206-547-8347
Address (Street, City, State, Zip): E-Mail Address:
PO Box 31228 Seattle Washington 98103 info@filcoenviro.com
WA State License #/Exp. Date:
*Contractor must have a valid City of Edmonds business license prior to doing work FILCOC1080RU 10/10/2015
in the City. Contact the City Clerk's Ojf1ce at 425.775.2525 City Bus'ine s License #Bx . ate:
N1 '32 3 1�2�31/2016
PLI111BING MECHANICAL TANK J DEMOLITION
DETAIL THE SCOPE OF WORK: PUMP, rif1Se and fill in �la�e t it l ftp i1'1, C'i"l.e 300 "all '1'1
residential heating oil tank. Cut vent and fill pipe below grade.
I declare under penalty of perjury laws that the information I have provided on this form/application is true, correct and complete,
and that I am the property owner or dully autlrorixed agent of thepropert r owner to submit a perwnd application to the City of
Edmonds.
Print Name: —7','(� 4 ye.
Signature: _. Date: -7/--U/ _k_ .
FORM C. T Pm iA ,)M MTVITTF R.—fnr A to T A ri..o\T— 0 10 A .1...... - —1-- 1 — Mme+ I
1111/ IL� �,,,
MnKA)f r T-\D..:IJ:_._wT.,_,. 1-1-1n1 M—(11— o_ _, 1 n —1 A 1- — r'1. ,n ., y 1 11,„w +^+ra» r
FILCO COMPANY INC. LICENSE#FILCOCI080RU EXP:10/10/2017
PO BOX 31228 ICC LICENSE #5002&0.....
SEATTLE, WA 98103
SITE PLAR
HEATING OIL TANK DECOMMISSIONING
JOB SITE ADRESS: 3222 92!—Ave W . E_, dmrd „ WA 9a020
OWNER: Tracey l"rurrrlbull�
PHONE: 425-750-5557
ACTIVITY: pump, rinse and fill in place with foam, one 300 residential heating oil tank. Cut fill pipe below
grade.
92nd Avenue W