20160505090411.pdfMr DEVELOPMENT SERVICES
City of Edmonds
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip):
Parcel #:
1423 8TH AVE S, EDMONDS 98020
PLUMBING, MECHANICAL, TANK, & DEMOLITION
Associated Permit #:
PERMIT APPLICATION
APPLICANT:
MM COMFORT SYSTEMS
1215"' Avenue N, Edmonds, WA 98020
Address (Street, City, State, Zip):
E -Mail Address:
Phone 425.771.0220 Q 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 #:
1423 8TH AVE S, EDMONDS 98020
00393100001300
Associated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes ❑ No ❑
APPLICANT:
MM COMFORT SYSTEMS
Phone: Fax:
425-881-7920
Address (Street, City, State, Zip):
E -Mail Address:
18103 NE 68TH ST, C-200 REDMOND, WA 98052
JWELLS@MMCOMFORTSYSTEMS.COM
PROPERTY OWNER:
Phone: Fax:
CAROL ROBINSON
425-778-4247
Address (Street, Cit , State, Zi )):
1423 8TH AW S, EDMrONDS 98020
E -Mail Address:
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
A State License #/Exp. Date:
*Contractor must have a valid City of Edmonds business license prior to doing work
MM(',OMCS8.�564 09/24/2017
in the City. Contact the City Clerk's Office at 425.775.2525
City Business License #/Exp. Date:
NR -022651 12/31/16
PLUMBING I MECHANICAL "4K
1)EMOLITION i
DETAIL THE SCOPE OF WORK: m. _.._............
GAS FURNACE REPLACEMENT AND INSTALL NEW HEAT PUMP
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.
il `� A EISTE
Print Name:�A GDR Owner ❑ Agent/Other specify):.... ...,.._�...__...._ .. _...
Signature: 5/1/16
_.m , .d.. Date:
FORM C LABuilding New Folder 2010\130NE & x-ferred to L -Building -New drive\Fotm C 2014.doex
Updated: 1/17/2014
Fixture Type (new a7relocated)7Total 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
.... W ._.�.
Dishwasher Clothes Washer
.................................. . . _ .w.w. ..... .� ..................... .......
Hose Bib Backflow P
mm ^ revention Device (e.g. RBPA, DCDA, AVB)
�- W ....._ .........� -...........................................
Water Heater Tankless? Yes ❑ No Hydronic Heat in: Floor ❑ Wall ❑
Floor Drain/Floor Sink Other:
Refrigerator water supply (for water/ice dispenser) Other -
Equipment Type
_____ -- ---------- -
Appliance/Equipment Information (new and relocated)
Appliance/Equipment Information (new and relocated)
Total #
Furnace
Gas #7"1aec #_Other:
# BTUs: <100k >100k
Location(s)__
1
Air Handler / VAV
Gas # Elec tt
)fleet:-.
# CFM: <lOk >10k,,,,,,
Locations)
Boiler
(circle selected)
Location(s):-._...__.__
W_
Other t
BTUs
Location(s):. -
AC / Compras_ p "
"
BTUs: -...
Location(s): _.. .r..,..._ .. ... .....��„� �_... _m
�
Boiler cart i ttn�
Gats # �9: tee tk
Other:
# B"ft.is:.... <LOl)�,
I011k-*t101t, 5(ittk-lMii
�
tlo+af 1 obi Cdtr 1
HP: <3,
3-15, 15-30
Location(s)
_ ,..
1
(circle selected)
Hydronic Heating
Gas #Elec #
In -Floor _Wall Radiant I Boiler BTUs:
i ^cavo^
Exhaust Fans (single
Bath # Kitchen # Laundry #
Other:
#
duct)
, �
Fireplace
Gas # Elec #_Other:
# Location(s) , .. ... ......
... ..................... ....
Dryer Duct
Appliance Type
_____ -- ---------- -
Appliance/Equipment Information (new and relocated)
Total #
AC Unit
BTUs:.....��............._..a�................. .......
_. Location(s): ..� _.
Furnace
BTUs: ,el .,ql � __,
Location(s): ,,. m....m__ __ ____. _----
Water HeaterS'
BlUs: _. _
- _
Location(s):
......_....
Boiler
BTUs: v. ...
Location(s):-._...__.__
W_
Other t
BTUs
Location(s):. -
FireplaceAnsert
BTUs: -...
Location(s): _.. .r..,..._ .. ... .....��„� �_... _m
Stove/Range/Oven
Dryer
.. ........
_.
.........
Outdoor BBQ
TOTAL OUTLETS
FORM C LABuilding New Folder 2010\DONE & x-ferred to L -Building -New drive\Form C 2014.doex Updated: 1/17/2014
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