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20170105164619.pdfE It DEVELOPMENT SERVICES PLUMBING, MECHANICAL, TANK, & DEMOLITION PERMIT APPLICATION " 121 5`h Avenue N, Edrzzonds, W 98020 'st, acy4t Phone 425.771.0220 V Fax 125.77 P.0221 City of Edmonds PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUF3MI7TAL REQUIREMENTS PROJECT ADDRESS (Street, Suite #, City State, Zip): Parcel #: (o -7 A"\�N Associated Permit #: IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes ❑ No .. APPLICANT: vtt Phone:Fax: i%S %37 —% Fax: Address (Street, City, State, Zip): 1S (,,017 —7' j i., �,kjez W E-Mail Address: PROPERTY OWNER: Y,\ Phone: Fax: Address (Street, City, State, Zip): % (r` WQl W �1 E-Mai] Address: LENDING AGENCY: Phone: Fax: Address (Street, City, State, Zip); E-Mail Address: CONTRACTOR:* Phone: Fax: 'ZS _7-75_73�_7 Address (Street, City, State, Zip): Ga � JG � tNA " E-Mail Address f l AState �License itiN":xl . Date: —3Q V6 *Contractor must have a valid City of Edmonds business license prior to doing work V' e Z. in the City. Contact the City Clerk's Office at425.775.2525 ('"rp BusirreS+, I,peelese:; #/Exp. Date: �. 2„ PLUMBING MECHANICAL TANK DEMOLITION DETAIL THE SCOPE OF WORK t l ,„may " \ . ........\xi...........:. 1 �� .... . 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 ��^°�� ������,.�..,. ..........,__ Owner ❑Agent/Other .._,'(speci*ry): -- Signature;_ _...... ....� Date: _ 1 ._ FORM C LABuilding New Folder 2010\DONE & x-ferred to L-building-New drive\Form C 2014.doex Updated: 1/17/2014 Equipment Type MECHANICAL Appliance/Equipment Information (new and relocated) Total # Furnace Gas #_........Flee # .....Other: ............................#.........,.,.-,- BTUs: <100k...........>100k Location(s)_..........._...,.............................. Air Handler / VAV Gas #,, # Other # CFM: <lOk >lOk Location(s) (circle selected) ,__Elec -_ -- --- .._. AC / Compressor / Boiler / Heat Pump / Gas #------- „Elec #,..... -- .... Other, _ ........... it BTUs: . ...._<100k, . ,. 100k-500k, 500k-IMil Roof Top Unit HP: <3, 3-15, 15-30 Location(s) (circle selected) Hydronic Heating Gas #---_.-Elec # In -Floor ,,,,,, Wall Radiant.,,,.,- Boiler BTUs w, Location ----- ,_m __ . Exhaust Fans (single Bath # Kitchen # Laundry # Other:_ # duct) ...._. ..... .. .............. Fireplace Gas # Elec # Other: # Laaca tii an(b._ _....._... _. -w.w .... �......W...... Dryer Duct Appliance Type Appliance/Equipment Information (new and relocated) Total # AC Unit BTUs: _.._.._ Location (s):.... _--- .. _..._ ......._ u... n�.. Furnace BTUs; ... Location(s):-- . ........................ .—. - -- - - - - - - ----------------- _.... Water Heater -.-...n BTUs. Location(s): .........--------� - .......... Boiler BTUs. - Other m-. BTUs:.. ..--- __ _ �. Location(s):..... ........... .................... _ . Fireplace/Insert Fireplace/I , m. BTUs:........ . .--Locations):,....... _... �� �� Stove/Range/Oven Dryer Outdoor BBQ TOTAL OUTLETS FORM C L,:\Building; New Folder 2010\GONE: & x-ferred to L-Building;-New drive\Form C 2014.docx Updated: 1/17/2014