application.pdfCity of Edmonds
DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
121 5`h Avenue N, Edmonds, WA 98020
Phone 425.771.0220 Q Fax 425.771.0221
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip): Parcel #:
8527 Madrona Ln, Edmonds WA 98026 00504700100700
�--� Associated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes ❑ No
APPLICANT: Phone: Fax:
MM COMFORT SYSTEMS
425-ss1-920
Address (Street, City, State, Zip): E -Mail Address:
18103 NE 68TH ST, C-200 REDMOND, WA 98052 JWELLS@MMCOMFORTSYSTEMS.COM
PROPERTY OWNER: Phone: Fax:
Dennis Pool 206-661-0060
Address (Street, City, State, Zip): E -Mail Address:
8527 Madrona Ln, Edmonds WA 98026 Dennispooll949@me.com
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
WA State 1 ieclise #/Exp. Date: 09/24/2017
Contractor must have a valid City of Edmonds business license prior to doing work MMCOMCS85564
in the City. Contact the City Clerk's Office at 425.775.2525 City Business License #/Exp. Date:
NR -022651 12/31I'16
PLUMBING MECHANICAL I X1 TANK DEMOLITION
DETAIL THE SCOPE OF WORK: Two stage furnace, Variable stage 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 Cityof
Edmonds.
5 �a OwnerE:1 Agent/Other pecilfy): —_..
Print Name: . �� � .m._ ...
,.,- ���..,_.,...�,,...r
Signature: -. _.. ..... Date:
... ,...... ... .....
FORM C LABuilding New Folder 2010\DONE & x-ferred to LrBuilding-New drive\Form C 2014.docx Updated: 1/17/2014
Total #
Fixture Type (new and r Fixture Type (new and relocated) Total #
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
. . .. ... ....... . .......... .
Dishwasher Clothes Washer
Hose Bib Backflow Prevention Device (e.g. RBPA, DCDA, AV111
..........
Water Heater Tankless? Yes ❑ NoE] Hydronic Heat in: Floor 0 Wall El . .................
. .....................
Floor Drain/Floor Sink Other:
.......... . .....
Refrigerator water supply (for water/ice dispenser) ILI Other: 11_�
Equipment Type
Appliance/Equipment Information (new and relocated) Total #
Furnace
(3as# flee #--,Other:
... ......... ... 4; _BTUs:<l()0k_ >100k.,_
Air Handier / VAV
Gas #—Elec
#—Other:
# CFM: <10k— >10k— Location(s) . . ................ ---
(circle selected)
...........
AC / Compressor/
Boiler / Heat Pump
Gas #—Elec
#—Other:—
#_ BTUs: <,100k, 100k -500k, 500k-IMil
Roof Top Unit
RP:
<3,
3-15, 1 15-30 Location(s) 0 y . .... .....
(circle selected)
Hydronic Heating
Gas #—Elec
#—In-F[oor
wall Radiant Boiler BTUs:_ Location
Exhaust Fans (single
Bath #;Kitchen
7K cl # Laundry #, , Mier -
duct)
Fireplace
Gas #—Elec
#—Other:—
# Location(s) .. ........ ........
Dryer Duct
. ............
Appliance Type
Appliance/Equipment Information (new and relocated) Total #
AC Unit
BTUs:
Location(s):,-,—. . .... .......
Furnace
. ....... . ....
BTUs: Location(s):, 6' (A s, 0,
Q "I
- TIL. �11111_�� . ... ......
. . . . . ....................
Water Heater
BTUs:
Location(s):,_,____,,__ ............
..... . ...... ....... . ........... ......
. .................
Boiler
BTUs:
Location(s):___
Other:
BTUs:
Location(s):_
. . . . .......................
Fireplace/Insert
.... .
BTUs:
..... ... — — ----
Lovation(s): - — ------
. ............. .
Stove/Range/Oven
Dryer
...............
Outdoor BBQ
TOTAL OUTLETS
FORM C LAB.ilding New Folder 2010\DONE & x-ferred to I—Building-New drive\Form C 2014.doex Updated: 1/17/2014