20160331104614.pdfCity of Edmonds
2C)Lto0 31�,
DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
1215"' Avenue N, Edmonds, WA 98020
Phone 425.771.0220 4 Fax 425.771.0221
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip):
Parcel #:
815 14TH WAY, EDMONDS 98020
00393100000800
Associated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes ❑ No ❑
APPLICANT:
MM COMFORT SYSTEMS
Phone: Fax:
1425-881-7920
Address (Street, City, State, Zip):
E -Mail Address:
18103 NE 68TH ST, C-200 REDMOND, WA 98052
JWELLS@MMCOMFORTSYSTEMS.COM
PROPERTY OWNER:
P"LUb-$54-8544 Fax.
CRAIG MARTIN
Address (Street, City, State, Zip):
E -Mail Address:
815 1.4T14 WAY. EDMONDS 98020
LENDING AGENCY:
Phone: Fax:
Address (Street, City, State, Zip):
E -Mail Address:
CONTRACTOR:* MM COMFORT SYSTEMS
Phone: Fax:
425-881-7920
Address (Street, City, State, Zip):
E -Mail Address:
18103 NE 68TH ST, C-200 REDMOND 98052
JWELLS@MMCOMFORTSYSTEMS.COM
Swte 1 icoise #/Exp. Date:
*Contractor must have a valid City of Edmonds business license prior to doing work
M COMC 85564 09/24/2017
in the City. Contact the City Clerk's Office at 425.775.2525
City Business License #/Exp. Date:
NR -022651 12/3.1./16
PLUMBING ! MECHANICAL TANK
7DETAILHE
DEMOLITION
SCOPE OF WORK:.._
INSTALL NEW HEAT PUMP UNIT
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.
CONTRACTOR
Print Name: AMANDA J�'"ILR�,�� " TOR
Owner ❑ Agent/Other 0 (specify): R C...
,w
p„ ...
Signature: �� �`" � Date: 3/29/16
FORM C LABuilding New Folder 2010\130NE & x-ferred to L -Building -New drive\Form C 2014.doex Updated: 1/17/2014
tl�
Fixture Type (new and relocated) Total # Fixture Type (new and relocated) Total #
Water Closet (Toilet) Pressure Reduction Valve/Pressure Regulator
Sink (kitchen, laundry, lavatory, bar, eye wash, etc.) Water Service Line
Tub/Shower Drinking Fountain
............................. _
Dishwasher Clothes Washer
Hose Bib Backflow Prevention Device (e.g. RBPA...................
DCDA, AVB)
❑ ........y --------------
Water Heater Tankless? Yes No❑ H dromic Heat in: Floor❑ Wall❑
Floor Drain/Floor Sink Other:
...........m........................... ..._.....
JI
Refrigerator water supply (for water/ice dispenser) Other:
I! 1 101 111111111111111
Equipment Type
!1 IN 1 10 111
Appliance/Equipment Information (new and relocated) Total #
Furnace
Gas #_
Elec # ,,_Other:, # BTUs: <100k >100k
Location(s)
Air Handler / VAV
Gas #
Elec #_Other: #eO CFM: <10k,11111111 >10k
Location(s)
(circle selected)
Water Heater
® _
...
. . . .........
AC / Gout t ;e sor /. ,
I It
N
Gas #
Elec # -""Other: # BTUs: <100k,
100k -500k, 500k-1Mil
Roof « lr I p fC
HP:
<3, 3-15, 15-30 Location(s) .. ...
Location(s):
(circle selected)
Fireplace/Insert
BTUs: ,. ...
_ Location(s):,.
Hydronic Heating
Gas #
Elec # In -Floor _Wall Radiant Boiler BTUs:
Location, _...®......................,...........
Exhaust Fans (single
Bath #
Kitchen # Laundry # Offier.-I.
_ #
duct)
Outdoor BBQ
Fireplace
Gas #
Elec # Clther: # Location(s)
Dryer Duct
Appliance Typf
Appliance/Equipment Information (new and relocated)
Total #
BTUs:....,
1 ocation
Furnace
BTUs: ......�..�
............. _... Locations):_.m __ ....... �....
Water Heater
_.. -
BTUs:. ....................�......
Location(s):_._._,,,,, mm.
Boiler
BTUs:
Other:
BTUs:...
Location(s):
Fireplace/Insert
BTUs: ,. ...
_ Location(s):,.
Stove/Range/Oven
_W_.ww...... vvWWvvvvvv
Dryer
Outdoor BBQ
TOTAL OUTLETS
FORM C LABuilding New Folder 2010MONE & x -(erred to L -Building -New drive\Form C 2014.doex Updated: 1/17/2014