20161209135054.pdfC�
DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
^„
PERMIT APPLICATION
121 5"' Avenue N, Edmonds, WA 98020
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Phone 425.771.0220 9 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 #:
Associated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes No
AYYLI tV 1:
Address (Street, City, State, Zip):
7i A2c, -
PROPERTY OWNER: S_/
Address (Street, City, State, Zip): 1
LENDING AGENCY:
Address (Street, City, State, Zip).
CONTRACTOR:*
Street, City, State, Zip)n
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*Contractor must have a valid City of'Edmonds business license prior to doing work
in the City. Contact the City Clerk's Office at 425.775.2525
PLUMBING
DETAIL THE SCOPE OF WORK: _
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MECHANICAL I I TANK
L
Phone: Fax:
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Phone: Fax,
E-Mail Address:
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Phone: x:
E-Mail Address
Phone: Fax:
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E-Mail Address:
WA State License Il/fixp: Date:
City Business License #/Exp. Date:
DEMOLITION
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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.
Owner A ent/Other s ecif v
Print Name .,�_. �''".a r t,..........� � g (P Y)�
Signature: mm Date .../.t..._._
i
FORM C. L:\Building New Folder 2010\DONE & x-ferred to L Building -New drive\Form C 2014.docx Updated: 1/17/2014
MECHANICAL
Equipment Type Appliance/Equipment Information (new and relocated) Total #
Furnace I Gas # Elec #__Other: # BTUs: <100k_ >100k_ Location(s)
Air Handler / VAV
Gas #_Elec #_0tharr: #CFM: <lOk_ >lOk Location(s) ,m , ,�__,,w.....
(circle selected)�......
_
AC / Compressor /
Boiler / Heat Pump /
Gas #_Elec #_iltlaer: ,..., _ ..... # BTUs: m..., <100k, 100k-SOOk, 500k-1Mil
Roof Top Unit
HP: .. <3, . .3-15, 15-30 Location(s) _� .. ....
(circle selected)
..._.-._ ....
Hydronic Heating
Gas #_Elec #In -Floor _Wall Radiant Boiler BTUs:, Location
Exhaust Fans (single
Bath # Kitchen #_Laundry
duct)
.
Fireplace I Gas #_Elec#_01hc ,..,, ew,,,-,, # Location(s)
Dryer Duct
FORM C L:\Building New Folder 2010\DONE & x-ferred to L-Building-New drive\Form C 2014.docx Updated: 1/17/2014
F. Whom
It May Concern:
The Edgewood Condominium Board of Directors has approved Sharon StockeLr's
F- 4 Y M4 F4 $ i Dryer.
w
s
Chellore Knudtson,
P.O.
Box 1731, Woodinvifie,WA
980
♦ (425) 0,