FIR2021-0034_Application_4.15.2021_9.22.59_AM_2146887CITY OF EDMONDS M BuildingPermit.com
Fire Application #949993 - 625 6th ave s
Applicant
First Name Last Name Company Name
vicki bloom CASCADE WEST TANK SERVICES
Number Street Apartment or Suite Number E-mail Address
18527 28th ave ne cascadewest@outlook.com
City State Zip Phone Number Extension
LAKE FOREST WA 98155 206683-3599
Contractor
Company Name
CASCADE WEST TANK SERVICES
Number Street Apartment or Suite Number
18527 28TH AVE NE
City State Zip Phone Number Extension
LK FOREST PARK WA 98155 (206)946-6910
State License Number License Expiration Date UBI # E-mail Address
CASCAWT862C8 8/28/2022 FD:3iR4g4F; cascadewest@outlook.com
Project Location
Number Street Floor Number Suite or Room Number
625 6TH AVE S
City Zip Code County Parcel Number
EDMONDS 98020 27032500205200
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
Zachary D & Terra R Mangum
Number Street Apartment or Suite Number
625 6TH AVE S
City State Zip
EDMONDS WA 98020-4007
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: 4/15/2021 Submitted By: vicki bloom
Page 1 of 2
i
CITY OF EDMONDS MyBuildingPermit.com
Fire Application #949993 - 625 6th ave s
Project Contact
Company Name: CASCADE WEST TANK
SERVICES
Name: vicki bloom
Address: 18527 28th ave ne
LAKE FOREST PARK WA
98155
Project Type
Single Family Residential
Email: cascadewest@outlook.com
Phone #: 206683-3599
Activity Type
Decommission
Scope of Work
Other
Project Name: 625 6th ave s
Description of Work: pump out contents and triple rinse tank and fill in place with sand. cut down fill pipe and
vent pipe and close with cement. There are no fuel lines
Project Details
Storage Tank Work
Tank Decommission
Page 2 of 2