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20160914103318.pdfn DEVELOPMENT SERVICES PLUMBING, MECHANICAL, TANK, & DEMOLITION PERMIT APPLICATION '�Itt�ti 121 51h Avenue N, Edmonds, WA 98020 Phone 425.771.0220!k Fax 425.771.0221 City of Edmonds O THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS PROJECT ADDRESS (Street, Suite #, City State, Zip): Parcel #: �_2- 3 S I �✓- ��►�, �5 Llr Associated Permit #. IS THIS WORK ASSOCIATED WI'T'H ANOTHER PROJECT? Yes ❑ NoE] APPLICANT: II 11 7- f� Lel 1 CSI Phone: Fax: l > � 7 Address (Street, City, State, Zip o E -Mail Address: PROPERTY OWNER: Phone„ Fax: Address (Street, City, State, Zip): E -Mail Address: LENDING AGENCY: Phone: Fax. Address (Street, City, State, Zip): E -Mail Address: CONTRACTOR:* Phone: Fax: 7,4 -7-M 7Ts- Address (Street, City, St e, Zip):Ia i s-1 s� ids>� I4,.,k+ it t�✓i� q�0_q.. dd ss: *Contractor must have a valid City of Edmonds business license prior to doing work WAStatep. e: z h/�t if xDate: /l P in the City. Contact the City Clerk's Office at 425.775.2525 City B tq~%ipiess Iicense #/Exp. Date: PLUMBING MECHANICAL TANK DEMOLITION DETAIL THE SCOPE OF WORK: %t.," i( C........�.___ 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 ., C_ l� ��( Owner ❑ Agent/Other © (specify). Signature�.m.— �......... �".,^`�� "� �Y�u.-... Date: ........�...." FORM C L:\Building New Folder 2010\130NE & x-ferred to 1 -Building -New drive\Fonn C 2014.docx Updated: 1/17/2014 Equipment Type MECHANICAL Appliance/Equipment Information (new and relocated) Total # Furnace Gas #Elec #_Other: Location(s):_---.... .. .................. �...� �. # BTUs: <100k_ >100k Location(s) ..,.. Air Handler / VAV Gas #___Elec #m_0tlra,t:_,-m .._ ...-.. Water Heater #_______CFM: <lOk_>lOk Location(s) ..,.._,..... Location(s):... .. .... (circle selected) .Boiler �.... �w..m........m _. BTUs:�... �a ..... Locations) ....._ ._ _ Other: Cher: AC / Compressor / ......-.. BTUs: _ ..._ Location(s):........m, .r.. .........- Fireplace/Insert __. BTUs:. Boiler / Heat Pump / Gas #............ _Elec # �iltlrel':__-------- - #. - ....... BTUs: ...... .........<100k. ....__,_ ............. ,I00k-500k. _............................... 500k-IMiI Roof Top Unit HP:- <3 . .............. 3-1g- --15-30 Location(s). ......_ .... Outdoor BBQ (circle selected) TOTAL OUTLETS Hydronic Heating Gas #_------ Elec N.................In-Floor ..............Wall Radiant .......... Boiler BTUs: ............... _.... — Location .. Exhaust Fans (single Bath #y Kitchen �Rt—Laundry # ....�...-Otl��r„t �.... ...__.... .m�.. w_ - .#....�..�. duct) Fireplace Gas #_Elec # _ Other:_... Dryer Duct Appliance Type Appliance/Equipment Information (new and relocated) Total # AC Unit BTUs: �.� Location(s):_---.... .. .................. �...� �. _. Furnace ---- BTUs: ,._ ..._ Location(s)�_.._.....w..................._ .._ ...-.. Water Heater BTUs: _ ..,.._,..... Location(s):... .. .... .Boiler �.... �w..m........m _. BTUs:�... �a ..... Locations) ....._ ._ _ Other: Cher: _ ......-.. BTUs: _ ..._ Location(s):........m, .r.. .........- Fireplace/Insert __. BTUs:. ,y --- ... Location(s):_ Stove/Range/Oven Dryer Outdoor BBQ TOTAL OUTLETS FORM C L:\Building New Folder 2010\DONE & x-ferred to L -Building -New drive\Fonn C 2014.docx Updated: 1/17/2014