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FIR2021-0036_Application_4.19.2021_4.18.48_PM_2152957CITY OF EDMONDS M BuildingPermit.com Fire Application #951584 - tank decommissioning 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 5/6/2023 FD1 q7941 R tanksbydallas@tanksbydallas.net Project Location Number Street Floor Number Suite or Room Number 22423 100TH AVE W City Zip Code County Parcel Number EDMONDS 98020 00450700500014 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 Richard A & Cynthia A Tomkins Number Street Apartment or Suite Number 211 5TH AVE N 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: 4/19/2021 Submitted By: Heather Hendricks Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Fire Application #951584 - tank decommissioning 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 Other Project Name: tank decommissioning Description of Work: pump out 15" oil , tripe rinse, fill in place (1) 300-gallon UST with sand/slurry mixture. Project Details Storage Tank Work Tank Decommission Page 2 of 2