BLD20161415.pdf�- DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
I �� PERMIT APPLICATION
] 21 S's Avenue N, Edmunds, WA 98020
Phone 425.771.0220 2 Fax 425.771.0221
City of Ednionds
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMI77AL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip):
Parcel #:
23610 107TH PL W
00689500004100
Associated Permit #:
1S THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes ❑ No
APPI 1CANT
MM COMFORT SYSTEMS25-881-7920
Phone
����'�N' _.. _�W� .ow.owo�.o�����.
Address (Street, City, State, Zip):
o���o...r�omn�
E -Mail Address:
18103 NE 68TH ST, C-200 REDMOND, WA 98052
JWELLS@MMCOMBORTSYSTEMS.COM
PROPERTY OWNER!
THERESA WALTER
20 533-9311
0n"w 't�. Cit , State, ZIP):
E -Mail Address:
3(°)i 1ONPLW
LENDING AGENCY
Phone 1�'rtx
Address (Street, City, State, Zip):
E -Mail Address:
TRACTOR:," MM COMFORT SYSTEMS
Phone �I ax
425-881-792,
�a
Address (Street, City, State, Zip):
E -Mail Address:
18103 NE 68TH ST, C-200 REDMOND 98052
iWELLS@MMCOMIORTSYSTEMS.COM
11 w4 A SI s l o -G , ose #/Exp bate 09/24/2011
*Cuntractrtrmuss have a valid Cttv of Edmonds hu>siness license prior to doing }Work
11� tt(u9ti5564
� _ rvmPo��
in the City. Contact the City Clerk's Office at 42.5.775.2525
t"ity Business License #/Exp. Date:
NR -022651 Q i t t i 16
1�1,1�'(I11C�� )1��;("Il�"t.11��1"�I T4l"(�.
llEMOLITION
DETAIL THE SCOPE OF WORK:
GAS FURNACE REPLACEMENT
1 declare ander penalty of perjury laws that the information I have provided on this formlapplication 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 ❑ Agent/Other ❑ (specify):
Signature:10/20/16
Date:
FORM C I.M.ilding New Felder 20,1000NE & x-Ierred to I.-Huildinp-New drivOFunn C 201 Aocx Updated: ll1712014
q
EqWpmami Type
ApplimiceAsquipment fulfoirrmation (mm and relocated)
Inforinmation (view and reluirsted)
ToWl #f
Hmiiiiqim
Furnacl>
(As # Ewc 4 Oumn 0 HIM 400k >look
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it linvulfer / VA
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Ewc 0
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LorafloaMs)
Locadoas,,m mu
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................
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.
. . . ...................
AC / Compriessoir I
fleater
jsm�
LiwaOon(sj:
Railer I fleat 1:11"aimP4
GaAs 9
ERec:g
Other 0, mm VIII < 100111,
101011I-501111III�, 500111C IMH
................ . ....... . ..
Rour'fop I :T idt
ma.
<3,
15-30 1111,4wagiolim(s)
'(dmk mWd ed
Fireplacell nscri,
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I'mation(s):
......
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I"dmnklkMMg
um V
IQM #
lwmmw WWI Ill 1113(ffler KFUN:
. ...................
IIILmmvOUuFm
. . . . . ................ .............. .. ........ .. ......
ExIlRairst Fmis (singlie
..... .
HMhR
. . . .......
KHdm
4 Immm" I fmwII
m...........®.®,........ --- - - -- - -
OUWMV BRQ
Om mmmmV
. . ....... . .
Fimphice
Gas #
Me, 0
Offitir: 0 lummmo)
thyer MCI
FORM ' L+Bufldviig Aw RMU DHNX Nk & x Wmd w L MAIN, dMa%m C MOM Ur'&,mcdL MVIOH
ApplimiceAsquipment fulfoirrmation (mm and relocated)
Tale! #
I
Locadoas,,m mu
.. .......
................
........... . . . . ...... . ..... ..... . .... . .. .....
.. .
fleater
jsm�
LiwaOon(sj:
................ . ....... . ..
.. ........ ... ...
Omer:
HT I N:
Fireplacell nscri,
HTUS.
I'mation(s):
......
SLuveAlangeRIven
................ ..
Myer
m...........®.®,........ --- - - -- - -
OUWMV BRQ
Om mmmmV
L- — — ------ m",-, - - - - -
- - - -
"VYYAL OUTLETS
FORM ' L+Bufldviig Aw RMU DHNX Nk & x Wmd w L MAIN, dMa%m C MOM Ur'&,mcdL MVIOH