BLD20160754.pdfDEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
's t 121 5`h Avenue N, Edmonds, WA 98020
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 #: d C) � 00
915 8TH AVE S, EDMONDS 98020
LID
Associated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes ❑ No ❑
APPLICANT;
Phone: Fax:
MM COMFORT SYSTEMS
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: Fax:
Richard & Evelyn Carter
206-321-8358
Address (Street, City, State, Zip):
E -Mail Address:
915 8TH AVE S. EDMONDS 98020
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
*Contractor must have a valid City of Edmonds business license prior to doing work
'4 A Slate License #/Exp. Date: 09/24/2017
MMCOMCS85564
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 TANK Lj
DEMOLITION
DETAIL THE SCOPE OF WORK: ,... _.
INSTALL A/C UNIT
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: AMANDA EISTER Owner ❑ A ent/Other ❑(specify): _._....................................................................... .................. ..._.
_................ ........_ _�.. g
6/2/16
Signature: ------------ —----- ...... Date:
FORM C LABuilding New Folder 20101DONE & x-ferred to LrBuilding-New driveTorm C 2014.doex Updated: 1/17/2014
Fixture Type (new and relocated)
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
Backflow Prevention Device (e.g. RBPA, DCDA, AVB)
__ ........ _._.
Water Heater Tankless? Yes ❑ No ❑
�..... _..--...........m.�.......... __.._.......
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 relocated) Total #
Furnace
Gas #
Elec #_Other:
# BTUs: <100k >100k Location(s)
Air Handler /)
Gas #
Elec #,
Other: # CFM• <10k >10k Location(s)
(circle selected)
BTUs:-...._.
...................................................... Location(s):—w-- ...
.. .., _ .________..,,_ .,.
AC / Compressor /
Location(s)-_... �,,.m-.....m.........
----
Fireplace/Insert
Fire lace/Insert
BTUs:
Boiler / Heat Pump /
Gas #
Elec #_Other:
_ # BTUs: <100k, 100k -500k, 500k-1 11
Roof Top Unit
HP:
<3,
3-15, 15-30 Location(s) OUTSIDE 1
(circle selected)
TOTAL OUTLETS
Hydronic Heating
Gas #,
Elec #In
-Floor _Wall Radiant I Boiler BTUs: _ ...._ Location
Exhaust Fans (single
Bath #
Kitchen
# Laundry # t) Iter:
duct)
Fireplace
Gas #
Elec#_Other:
# Loeatitln(s)....._.._,,, ®.
Dryer Duct
Appliance Type
Appliance/Equipment Information (new and relocated) Total #
AC Unit
BTUs:
_ Location(s): ,.j"-R0N'r LEFT CORNER. OF HOUSE 1
Furnace
BTUs: -
.- ...... _. Locations):.m.___ —
Water Heater
BTUs: ..............
_ ___ _._. Location(s):.. .......
Boiler
BTUs:-...._.
...................................................... Location(s):—w-- ...
Other:
BTUs: _.............
Location(s)-_... �,,.m-.....m.........
----
Fireplace/Insert
Fire lace/Insert
BTUs:
Location(s):
Stove/Range/Oven
Dryer
Outdoor BBQ
TOTAL OUTLETS
FORMC LABuilding New Folder 2010\DONE & x -(erred to L -Building -New drive\Form C 2014.docx Updated: 1/17/2014
Type of Gas/Air/Vacuum System (new and relocated) Total#
I
Oxygen
Nitrous Oxide
Medical Air
Carbon Dioxide
Helium
Medical – Surgical Vacuum
Other:
LITOTAL OUTLETS
TANK #1 TANK #2
Method of Abandonment Method of Abandonment
........... ___- ...
Fill in Place ❑ Fill Material Fill in Place ❑ Fill Material— .. _
... ....._..
Removal ❑Removal
....
Number of Gallons:
�. w................_..�..........................................m.__.. Number of allons:...................................................�......___��......................�.��..................
Critical Areas Determination: Study Required ❑ Conditional Waiver ❑ Waiver ❑
Type of structure to be demolished (e.g. house, shed, garage, etc.): ........... ._..a ...... ..............
._ ���_�.................................._ �, _�
Floor area of structure to be demolished:__ ............ ..._-sq. ft.
Critical Areas Determination: Study Required ❑ _ Conditional Waiver ❑ Waiver
PSCAA Case No. , _ AHERA Survey done? (required) ❑
Additional comments: ............................................... m...___. __.-_._...... ....... __ ------
FORM C LABuilding New Folder 2010\DONE & x-ferred to LrBuilding-New drive\Form C 2014.doex Updated: 1/17/2014
DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT CHECKLIST
e
1215"' Avenue N, Edmonds, WA 98020
s b Phone 425.771.0220 4 Fax 425.771.0221
City of Edmonds
PROJECT ADDRESS:915 8TH AVE SEDM 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.
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■on
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SUBMITTAL REQUIREMENTS
AD
The number indicates the number of copies for submittal( if
c
=
CM n
C
applicable). Check marks indicate additional submittal
requirements that may apply to your project.
I d
p
Alication Form Cm
........
1
1
.... ._..
1
1
.ww_ _
Site Plan
3
1
Mechanical Plans2
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
VI
............
ww. formss
State Non Residential Energy Code compliance
2
• Handouts
and Standard Details maybe found on the City's website
Vii, a i�,;°,u,1, �,lrawrp„a„c�,i
�,aml,w,�µ
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.
FO C LABuilding New Folder 2010\DONE & x-ferred to L -Building -New drive\F'orm C 2014.doex Updated: 1/17/2014
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