20160413142028.pdfov, EDA41�
un DEVELOPMENT SERVICES
PLUMBING & MECHANICAL, TANK & DEMOLITION
PERMIT APPLICATION
121 5`h Avenue N, Edmonds, WA 98020
Phone 425.771.0220 1k Fax 425.771.0221
City of Edmonds
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip):
Parcel#:
9815 224th st sw Edmonds 98020
00450700400013
APPLICANT:
: Fax:
Bob's Heatinq and A/C
800-840-3346
Address (Street, City, State, Zip):
E -Mail Address:
14148 NE 190th ST Woodinville Wa 98072
cflalole@bobsheatinq.com
PROPERTY OWNER:
Phone: Fax„
Jerry Johnson
425-672-7039
Address (Street, City, State, Zip):
E -Mail Address:
9815 224th St SW Edmonds 98020
LENDING AGENCY:
Phone: Fax:
Address (Street, City, State, Zip):
E -Mail Address:
CONTRACTOR:*
Phn- :
`0-840-3346
Fax:
Bob's Heating and A/C
Address (Street, City, State, Zip):
License 4t/Exp. Date:
14148 NE 190th ST Woodinville Wa 98072
BOBSHHA853NO
*Contractor mast have a valid City of Edmonds business license prior to doing work in the
( se #/Exp, Date:
City. Contact the City Clerk's Office x1425.775.2525
F] PLUMBING %MECHANICAL Ul TANK 0 DEMOLITION
add ac to existing hvao s2stern
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: Lucinda Honeycutt ...... ..- ❑ Owner
X Agent/Other (specify):
Signature: J t Date: 4/13116
FORM C C:\Documents and Settings\bjorback\Desktop\Form C.doc Updated: 10/2010
TANK #1 TANK #2
Number of Gallons Number of Gallons
....._ ....................................... ... ....
Method of Abandonment Method of Abandonment
_..... ... .. _................................. ........ ......WWW .
Fill in Place FillMaterial _,_�_ww_,ww_..__ ❑ Fill in Place Fill Material
Pump, Rinse & Cap ❑ Pump, Rinse & Cap
Removal ❑Removal
.... _...._..�............. ._...........................
Critical Areas Determination: ❑Study Required ❑ Conditional Waiver C Waiver
Equipment Type
Fixture/Appliance Type
Appliance/Equipment Information (new and relocated)
Total #
Furnace
#
Gas #—Elec
#—Other:
BTUs:
w— BTUs: <100k >100k
, Location
Water Heater -------
Air Handler/AC/VAV
#_Gas
# 1_Elec
#_Other:
CFM: <100k__I__>100k_
Location olttsid'e
1
Boller/Compressor/
#_Gas
#_Elec
#
Other:
BTUs: <100k,
100k -500k, 500k-111VIil
Dryer
Heat Pump/Roof Top
_............................ .__
Outdoor BBQ:
Other:
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 OMocuments and Settings%jorbackMesktofform C.doc Updated: 10/2010
Number Fixture Type Number Fixture Type
Water Closet (Toilet) Refrigerator water supply (For water/ice dispenser)
_.,. ....... s_..�. _�.�......... ���...�..� .66666 ................._�. ........ ...�.�....� �k.�_
lnk (kitchen, laundry, lavatory, bar, eye wash, etc.) Water Service Line
Tub/Shower Drinking Fountain
Dishwasher Bidet/Urinal
Hose Bib Pressure Reduction Valve/Pressure Regulator
Water Heater Tankless. Yes No Ba a
� _ Backflow Prevention Device le.�. xsrA, DCDA, Avsl
p �..._..._��..... ......... .._...... _ _ ... �.... ��..........._
Expansion Tank for Water Heater Hydronic Heat in: Floor _ Wall_
Floor Drain/Floo.....�....._..__
r Sink Other:
Clothes Washer Other:
FORM C CADocuments and Settings\bjorback\Desktop\Form C.doc Updated: 10/2010
O1' hDAj
DEVELOPMENT SERVICES
PLUMBING & MECHANICAL, TANK & DEMOLITION
PERMIT CHECKLIST
1215 1h Avenue N, Edmonds, WA 98020
City of Edmonds Phone 425.771.0220 4 Fax 425.771.0221
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.
O
SUBMITTAL L R'l^ �l hFlfe"d MEN S
0
6
The number indicates' the number ref c'��pi s ,ior submittal( if
o
. �'
n a o
(71
applicable). Check marks indicate attld'llicanal submittal
�
o.
!=' � �
�
requirement
Cs
P—
Application Form C1
1
1 1
............................ .. ..........
Site Plan1
I
......
........
Mechanical Plans
2
_...�.
www .�..._...........�
Manufacturer's Specifications/Cut Sheets
0
0
2 2
Elevation View for Roof Mounted Equipment
0 .
0
2 2
. .....�...�
.... __ .._.......�
Structural Calculations
✓
Plumbing Plans2
...__... ......
Listed and Tested Fire Stopping Assemblies
2
�...._' ........
__m..
Washington State Contractors License
✓
✓
✓ ✓
Contractor's City of Edmonds Business License
✓
✓
✓ ✓
Critical Areas Determination or Checklist
1
✓
• Handouts
and Standard Details may be found on the City's website
wvwv�vwxuwt alat�c,ntclk
a
tt!, 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 C:\Documents and Settings\bjorback\Desktop\Form C.doc Updated: 10/2010