170109 MAD (Form C - MEP).pdfDEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
121 5`h Avenue N, Edmonds, WA 98020
Est 1g90 Phone 425.771.0220 0 Fax 425.771.0221
City of Edmonds
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PROJECT ADDRESS (Street, Suite #, City State, Zip):
Parcel #:
9300 236TH ST. SW, EDMONDS, WA 98020
27033600404600
Associated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes No
APPLICANT: Erik Oftn PE Metrix Engineers
Phone:
Fax:
(206) 772-2777
Address (Street, City, State, Zip): 725 Powell Aire SW #1 0 Renton, WA 98057
E-Mail Address:
eriko etrixen _cc
PROPERTY OWNER:
Twine Wilton, Edmonds School District
Phone:
Fax:
(425) 431-7172
Address (Street, City, State, Zip): 20420 68th Avenue W, Lynnwood, A 98036
E-Mail Address:
Wilton''t' edmontls,we n t,edu
LENDING AGENCY:
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Address:
CONTRACTOR:*
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Address:
WA State License #/Exp. Date:
*Contractor must have a valid City of Edmonds business license prior to doing work
City Business License #/Exp. Date:
in the City. Contact the City Clerk's Office at 425.775.2525
PERMIT APPLICATION FOR:
PLUMBING MECHANICAL TANK LJ
DEMOLITION LJ
DETAIL THE SCOPE OF WORK: New HVAC and plumbing for Madrona Scho6. Mechanical work to include
hydronic heating water system with gas -fired bailers and pumps. 100% outside air HRU's and radiant floor
heating to serve classroorns. VAV AHU to serve admin area, constant velurrie AHU's to serge ether spaces,
Fiat water provided by gas -fired water heaters and electric water beaters at each iearninp prod.
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 duly authorized agent of the property owner to submit a permit application to the City of
Edmonds.
Print Name: Erik Olnon; PE Owner Agent/Other Z (specify): Mechanical Engineer
Signature: Date:01 '
FORM C L:\Building New Folder 2010\DONE & x-ferred to L-Building-New drive\Form C 2014.docx Updated: 1/17/2014
PLUMBING
Fixture Type (new and relocated)
Total #
FIXTURE COUNT
Fixture Type (new and relocated)
Total #
Water Closet (Toilet)
50
Pressure Reduction Valve/Pressure Regulator
1
Sink (kitchen, laundry, lavatory, bar, eye wash, etc.)
74
Water Service Line
1
Tub/Shower
0
Drinking Fountain
11
Dishwasher
2
Clothes Washer
Hose Bib
12
Backflow Prevention Device (c.g. RBPA, DCDA, AVB)
5
Water Heater Tankless? Yes ❑ No Z 5 gas, 5 elec
Hydronic Heat in: Floor Z Wall ❑
45
Floor Drain/Floor Sink
71
Other:
Refrigerator water supply (for water/ice dispenser)
4
Other:
MECHANICAL
Equipment Type
Appliance/Equipment Information (new and relocated)
Total #
5
it Handler / VAV
Gas #_Elec # 3 Other: Hydronic # 12 CFM: <10k 15 >10k Locations) Meth Rooms
17
(circ
C �hisso
Boi
Gas #Elec # 13 Other: #BTUs: <100k, 1r100k-SOOk, 1 SOOk-1Mi11Roo
HP: <3, 3-1.5, 1 1.5-30 Location(s) ryi Y rd ((`�)30 BH Air to ater Heat
(circle selected)
Pump))
Hydronic Heating
Gas #_Elec #_In -Floor 45 Wall Radiant_ Boiler BTUs:677k Location Learning Areas
45
Exhaust Fans (single
Bath # 10 Kitchen # 5 Laundry # Other: Science, Fume Hood, Boier, Esec # 4
1 �
duct)
5
Dryer Duct
5
FUEL GAS
Appliance Type
Appliance/Equipment Information (new and relocated)
Total #
Water Heater
BTUs: (2)199k Location(s): Bailer Roorn
Boiler
BTUs: (2)1500k Location(s): Bailer Roam
Stove/Range/Oven
Doutee Stack Convection Ovens, 0k each
5
TOTAL OUTLETS
5
FORM C LABuilding New Folder 2010\130NE & x-ferred to L-Building-New drive\Form C 2014.docx Updated: 1/17/2014
TANK #1
TANK #2
Method o ment
Method onment
Fill in Place
Fill Material
Fili i Fill Material
Removal ❑
Remova
Number of Gallons:
Number of Gallons:
Critic
etermination: Study Required ❑
Conditional Waiver ❑ Waiver
rT"ype!o=sbe molished (e.g. house, shed, garage, etc.):
Floor area of structure to be demo sq. ft.
Critical Areas Determination: Study Required ❑ Con i r Waiver ❑
PSCAA Case No.
AHERA Survey done. ❑
Additio s:
FORM C LABuilding New Folder 2010\DONE & x-ferred to L-Building-New driveTorm C 2014.docx Updated: 1/17/2014
DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT CHECKLIST
121 5'h Avenue N, Edmonds, WA 98020
Phone 425.771.0220 JR Fax 425.771.0221
City of Edmonds
PROJECT ADDRESS:
Plans shall be of sufficient clarity to indicate the location, nature, and extent of the work proposed, and conform to the provisions of
the adopted International Codes and City Ordinances.
°
SUBMITTAL REQUIREMENTS
?
The number indicates the number of copies for submittal( if
c
(71
applicable). Check marks indicate additional submittal
E W
W
requirements that may apply to your project.°
Application Form C
1
I
1
I
Site Plan
3
1
Mechanical Plans
2
Manufacturer's Specifications/Cut Sheets
0
0
2
2
Elevation View for Roof Mounted Equipment
0
0
2
2
Structural Calculations
✓
Plumbing Plans
2
Listed and Tested Fire Stopping Assemblies
2
Washington State Contractors License
✓
✓
✓
✓
Contractor's City of Edmonds Business License
✓
✓
✓
✓
Critical Areas Determination or Checklist
1
✓
State Non -Residential Energy Code compliance forms
2
• Handouts and Standard Details may be found on the City's website www.edmondswa.gov or can be obtained at City Hall
during normal business hours.
• Plans/calculation/reports prepared by state licensed architects or professional engineers must be stamped and signed by the
design professional.
FORM C LABuilding New Folder 2010\DONE & x-ferred to L-Building-New driveTorm C 2014.docx Updated: 1/17/2014