20160411114114.pdfOV ED4
St. I c
City of Edmonds
DEVELOPMENT SERVICES
PLUMBING & MECHANICAL, TANK & DEMOLITION
PERMIT APPLICATION
121 5`" Avenue N, Edmonds, WA 98020
Phone 425.771.0220 Ja Fax 425.771.0221
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip):
Parcel #:
7542 243rd PI SW Edmonds98026
01140200000200
APPLICANT:
Rog: Fax:
Bob's Heatinq and A/C
80840-3346
Address (Street, City, State, Zip):
E -Mail Address:
14148 NE 190th ST Woodinville Wa 98072
lhonevcutt@bobsheatina.com
PROPERTY OWNER:
Phone: Fax;
Ci r) >7Anni Rerna__rd
206-617-6507
Address (Street, City, State, Zip):
E -Mail Address:
7542 243rd Pl SW Edmonds_, Wa 98026
LENDING AGENCY:
Phone:
Fax;
Address (Street, City, State, Zip).:.
E -Mail Address:
CONTRA CTOR:*
Ph n Fax„
?
Bob's Heating and A/C
(�0-840-3346
Address (Street, City, State, Zip):
License #/Exp. Date:
14148 NE 190th ST Woodinville Wa 98072
BOBSHHA853NO
*Contractor must have a valid City of Edntond,s business license prior to doing work in the
Citl�tts�nrs I..icense #/Exp Date:
City. Contact the City Clerk's Office at 425.775.2525
11 PLUMBING }MECHANICAL ❑ TANK ❑ DEMOLITION
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: 4/8/2016 A ❑Owner
-N Agent/Other (specify):,contractor
Signature: Date:
4/8/16
FORM C CADocuments and Settings\bjorback\Desktop\Form C.doc Updated: 10/2010
Equipment Type
Appliance/Equipment Information (new and relocated)
Total #
Furnace
# Gas c # Tt
BTUs: <100k >100k
Location
Air Handler/AC/VAV
# as # 1 Elec #O _ _.
_ CFM: <100k__l>100k_
Location
Boiler/Compressor/
#Gas #_„YElec #__Other:
BTUs: <100k,
100k-500k, 5001k-1Mil
Heat Pump/Roof Top
Unit
HP: <3, 3-15, 15-30
Location
Hydronic Heating
#_Gas #_Elec —in-Floor, _Wall Radiant, Boiler BTUs:___,,,,,,,,,,,,,,
Location
Exhaust Fans (single
Location: # Bath # Kitchen #_Laundry
#,Other:
duct)
.._ ---- ------------------ ____._._._
Fireplace
# Gas #—Elec #—Other:
Location__—_, __,_,_,_-
Other
Number of Outlets
Fixture/Appliance Type
AC Unit-------------- BTUs:
Location:.
Furnace-------------- BTUs:
Location:
Water Heater -------BTUs:
Location:
. ...._...._
_ .........�.�.
Boiler-----------------BTUs:
Location:
Fireplace/Insert BTUs:
Location;
Stove/Range/Oven:
Dryer
Outdoor BBQ:
Other:
TOTAL OUTLETS
FORM C C:\Documents and Settings\bjorback\Desktop\Fomi C.doc Updated: 10/2010