BLD2016-0518.pdfva " 1 I 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
City of Edmonds
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip):
Parcel #:
9621241ST PL SW, EDMONDS 98020
00450200000400
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: I Fax:
DAVID WILSON
206-396-6284
Address (Street, City, State, Zip):
9621 241 ST PL SW, EDMONDS 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
WA Slate License #/Exp. Date:
*Contractor must have a valid City of Edmonds business license prior to doing work
MMC''OMCS85564 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 MECHANICAL TAl4K
DEMOLITION
DETAIL THE SCOPE OF WORK:.....-....._�. r _.......
—---------..........................................................
GAS FURNACE REPLACEMENT IN SAME LOCATION
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: eI��.... _ ._ Owner ❑ Agent/Other ❑ (specify):...... .
I 4121116
Signature: : ...............�,.n. Date:
g
FORM C LABuilding New Folder 201000NE & x-ferred to LrBuilding-New driveTorm C 2014.docx Updated: 1/17/2014
Iiijill Mind
Fixture Type (new and relocated)
A 11
Total # 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
__"_. ........
....
Dishwasher
Clothes Washer
Hose Bib w _-.......... � ....
......
� ...... Backflow Prevention Device �A �,,,...m"...� ��....� �_."_""_ �.�........� ...... � ....
(e.g. RBPA, DCDA, AVB)
Water HeaterTankless? 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) Total #
Appliance/Equipment Information (new and relocate)
Total #
Furnace
Gas #
Elec #
Oihl:" , ," _ # _BTUs: <100k _ >100k„_„
Location(s)a"1/1l
BTUs:titltt(s):'....�.
Air Handler / VAV
Gas #__Elec
#
Other: # CFM: <10k >10k
Local'lo"(s)
BTUs: �_....,,.
(circle selected)
Fireplace/insert
BTUs: __
__ I
...................................
AC / Compressor /
Dryer
Outdoor BBQ
Boiler / Heat Pump /
Gas #Elec
#
Other: # BTUs: <100k,
100k -500k,
501
Roof Top Unit
HP:
<3,
3-15, 15-30 Location(s) _ _
,,,,,
,... ,,,,,
(circle selected)
Hydronic Heating
Gas #
Elec #
In -Floor _Wall Radiant.,,,"",", Boiler BTUs: , „
Loc. - on
Exhaust Fans (single
Bath #
Kitchen # Laundry # Other:—
#
duct)
_,
Fireplace
Gas # ,, I
Elec k.—Otheill
# Location(s)
Dryer Duct
Appliance Type
Appliance/Equipment Information (new and relocated) Total #
AC Unit
BTUs:........
,,... Location(s).-
Furnace
BTUs: _.
Water Heater
BTUs:titltt(s):'....�.
----------
BoilerBTUs:.......
Location(s):................................................................................................_.
........_
Other:. ,..�....
BTUs: �_....,,.
"""""_______. Location(s): .,."... m,
Fireplace/insert
BTUs: __
�__._____
Stove/Range/Oven
Dryer
Outdoor BBQ
TOTAL OUTLETS
FORMC L:\Building New Folder 2010\DONE & x-ferred to L -Building -New drive\Form C 2014.docx Updated: 1/17/2014
Type of Gas/AirNacuum System (new and relocated) Total#
Oxygen
Nitrous Oxide
.............
Medical Air
Carbon Dioxide
Helium
Medical — Surgical Vacuum
Other:
TOTAL OUTLETS
TANK #1 TANK #2
Method of Abandonment Method of Abandonment
WWW ..
�w
Fill in Place ❑ Fill Material Fill in Place ❑ Fill Material
............ _
Removal ❑ Removal ❑
Number of Gallons:................mm.AA m. _............................................... Number of Gallons:... — ..
Critical Areas Determination: Study Required ❑ Conditional Waiver ❑ Waiver ❑
Type of structure to be demolished (e.g. house, shed, garage, etc.):..._.
Floor area of structure to be demolished: sq. ft.
..... ...... _.....�
Critical Areas Determination: Study Required ❑ Conditional Waiver ❑ Waiver ❑
PSCAA Case No.„ _
AHERA Survey done? (required) El
Additional comments:
FORMC LABuilding New Folder 20101D0 & x-ferred to L Building -New driveTorm C 2014.docx Updated: 1/17/2014
City of Edmonds
PROJECT ADDRESS:_
9621 24„1ST PL SW, EDM NDS 98020 .................... .
Plans shall
DEVELOPMENT SERVICES
of the work
proposed,
PLUMBING, MECHANICAL, TANK, & DEMOLITION
to the provisions
of
PERMIT CHECKLIST
International Codes and City Ordinances.
1215'h Avenue N, Edmonds, WA 98020
Phone 425.771.0220 4 Fax 425.771.0221
City of Edmonds
PROJECT ADDRESS:_
9621 24„1ST PL SW, EDM NDS 98020 .................... .
Plans shall
be of sufficient clarity to indicate the location, nature, and extent
of the work
proposed,
and conform
to the provisions
of
the adopted
International Codes and City Ordinances.
W .............
dC"rord�
SUBMITTAL REQUIREMENTS
®
W
pThe
number indicates the number of copies for submittal( if
o
W
n
C;
applicable). Check marks indicate additional submittal
a
rS.
requirements that may apply to your project.
d
.....
Application Form C
1
1
1
1
Site Plan
3
1
_...W _
Mechanical Plans
2
Manufacturer's Specifications/Cut Sheets
0
0
2
2
Elevation View for Roof Mounted Equipment
0
0
2
2
Structural Calculations
✓
Plumbing Plans
2
Listed and Tested Fire Stopping Assemblies
2
Washington State Contractors License
✓
✓
✓
✓
_�.
....... ...... .._...... _
Contractor's City of Edmonds Business License
✓
_
✓
.....
✓
✓
Critical Areas Determination or Checklist
1
✓
....
-... . ,. ..
State Non -Residential Energy Code compliance forms
_ _.
__
w. ..
2
_m.._n..._......
• Handouts
and Standard Details may be found on the City's website
ww��m,r i�,ll�o
�g9w �� .lae
or can be
obtained at
City Hall
during
normal business hours.
• Plans/calculation/reports
prepared by state licensed architects or professional
engineers
must
be stamped
and signed
by the
design
professional.
FORM C L:1Building New Folder 2010UDONE & x-ferred to I—Building-New drive\Form C 2014.docx Updated: 1/17/2014