BLD20170183 (2).pdf(ITYOF EDMONDS
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1215TH AVENUENORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220'- FAX: (425) 771-0221
STATUS: ISSUED 02/07/2017131,11-1)[NG PERM IT
Expiration Date: 08/07/2017-910,11-01"„r ,;, ,, `,,, r'„r, r", l: r`��
Parcel No: 00767200110100
INVESTMENTS LLC BASS BRITTANY WILLIAMS
4418 MERIDIAN AVE N APT D 19705 11TH AVE NW
SEATTLE, WA 98103 SHORELINE, WA 98177
(Replace water heater
VALUATION: $0.00
GREENWOOD HARDWARE
C/O MICHAEL RADICE
7201 GREENWOOD AVE N
SEATTLE, WA 98103
(206)783-2900
LICENSE #: GREENTV950KJ EXP:07/2i
1/2017
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED
THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27,;
THIS APPLICATION ISNOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR H1S1H1 3E1'U°'C"Y AND ALL I ,i'ES ARE PAID,
Signature Print NaW Date Releaa ate
ATTENTION
ITIS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF
OCCUPANCY HAS BEEN GRANTED„ UBC109/ IBC110/ IRCI 10.
ONLINE APPLICANT = ASSESSOR OT TIER
DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
121 5`h Avenue N, Edmonds, WA 98020
` r j pk) Phone 425.771.0220 A Fax 425.771.0221
City of Edmonds
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip): i -°- ko i
Parcel #:
Associated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes ❑ No
APPLICANT.
honer, Fax:
te,
Address (Street, City, State,
yI
Zip), irr „, .
-`�
E -Mail Address:
,s
PROPERTY OWNER: i
Phone: Fax:
w..
Address (Street City, State,, Zip);
E -Mail Address:
LENDIAGENCY:
Phone; Fax:
(
ddress (Street, City, State, Zip).
E -Mail Address:
CONTRACTOR:*
Phone; Fax:
Aa11 9dress (Street City, State, Zip):
E -Mail Address:
W f State 1 r+�R fk Dat
* rk
Contractor must have a valid City of Edmonds business license prior to doing work
La
fiftim
in the City. Contact the City Clerk's Office at 425.775.2525
City Business License #/-u a d'r"•
PLUMBING MECHANICAL TANK
DEMOLITION
DETAIL THE SCOPE OF WORK ..,. !�` ....... _
" ii , �.., _. ,....
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 ` t r .. w._ Owner Agent/Other ❑ (specify):
Signature: m �..�,��� �"t _� .... Date '.W...���;. _�......
FORM C LABuilding New Folder 2010\130NE & x-ferred to L-Auilding-New driveTorm C 2014.docx Updated: 1/17/2014
Fixture Type (new and relocated)
Total #
Fixture Type (new and relocated)
Total #
Water Closet (Toilet)
Furnace
Pressure Reduction Valve/Pressure Regulator
BTUs: _.. .. -.. Ltica�tion(s):�u...., a..�...� �. ..........
.
Sinkkitchen, laundry, lavatory, e
( y bar, eye wash etc.)
...........��.m.
,...�..m._
'Water Service Line
Air Handler / VAV
Tub/Shower
Elec #
Drinking Fountain
Location(s)w.......,., .,.,.,..,�.
Dishwasher
(circle selected)
Clothes Washer
Hose Bib __......_
Dryer
Backflow Prevention Device (e.g. BBPA, DCDA, AVB)
...._ _ m
AC / Compressor /
Water Heater Tankless? Yes ❑ No
..... ..
Hydronic Heat in: Floor ❑ Wall ❑
_.. .....
Floor Drain/Floor Sink
Boiler / Heat Pump /
Other:
L
Refrigerator water supply (for water/ice dispenser)
100k -500k, ............... � 500k-1Mi1
Other:
�J
Equipment Type
BTUs:_ _ .m �..W.. Location(s): . .... �.. _ ._..... �_
Appliance/Equipment Information (new and relocated)
Total #
Furnace
Gas ®lec
BTUs: _.. .. -.. Ltica�tion(s):�u...., a..�...� �. ..........
.
®Other:—.- ... .,...m # BTUs: <100k_ >100k_
Location(s)m,_,...._.,
BTUs:�. .._ _,. _...
l,ocataaarlu(�*P .....�.....
Air Handler / VAV
Gas #
Elec #
Other: #_CFM: <10k_ >10k_
Location(s)w.......,., .,.,.,..,�.
BTUs:... .. L ticsftiallrO w... ._...------
(circle selected)
Stove/Range/Oven
Stove/Ran a/Oven
Dryer
AC / Compressor /
Outdoor BBQ
TOTAL OUTLETS
Boiler / Heat Pump /
Gas #_Elec
# ..................
Other:,— ,,,,,._,....._, # BTUs: .... .m. ....<100k,
100k -500k, ............... � 500k-1Mi1
Roof Top Unit
HP:... ...................
<3,
3-15, ...........................15-30 Location(s) w..............
(circle selected)
Hydronic Heating
Gas #_Elec
#_In
-Floor Wall Radiant ......... Boiler BTUs: .....,
. ......... Location
Exhaust Fans (single
Bath #
if.,_,_____Laundry # CIher: _ ..,.
duct)
-------
Fireplace
Gas #_Elec
#_Other:
# Location(s)_� _..M ..,,_, ,
_......
Dryer Duct
Appliance Type Appliance/Equipment Information (new and relocated) Total #
AC Unit
BTUs:_ _ .m �..W.. Location(s): . .... �.. _ ._..... �_
......_..
Furnace
BTUs:... ....,...... —...1.ocaturla(.$)_ _ - .��.....
Water Heater
BTUs: _.. .. -.. Ltica�tion(s):�u...., a..�...� �. ..........
.
Boiler
BTUs:�. .._ _,. _...
l,ocataaarlu(�*P .....�.....
Other: _
BTUs:................A..__ _..
_ r
__..._ .........
Fireplace/Insert
BTUs:... .. L ticsftiallrO w... ._...------
Stove/Range/Oven
Stove/Ran a/Oven
Dryer
Outdoor BBQ
TOTAL OUTLETS
FORM C LABuilding New Folder 2010\DONE & x-ferred to L -Building -New drive\Form C 2014.docx Updated: 1/17/2014