HomeMy WebLinkAboutPermit File 3808 Copper Pond (2) •
PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
." 4"C(' ` PLUMBING & MECHANICAL PERMIT APPLICATION
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Office Location: 904 6th Street, Anacortes WA 98821
Phone: (360) 293-1901, Fax: (360) 293-1938
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PLEASE PPP ER TO THE PLUMBING &MECHANICAL PERMIT CHECKLIST FOR SUBMITTAL REQUIREMENTS
( . A ()PROJECT AD TRESS (Street, Suite #): i Parcel(s)#:
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Subdivision/Lot#: —, it I
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APPLICANT:-, i ._
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PROPERTY OWNER: i Phone: Fax: 5
Address (Street, City, State, Zip): 7 .•tF.£,c 4 . ,c �'� C E-Mail Address:_ U�'w
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CONTACT PERS N: Phone: Fax: "
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.Address (Street, City, State, Zip): E-Mail Address:
CONTRACTOR:* Phone: Fax:
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Address (Street, City, State, Zip): '4 d1{ E-Mail Address
Contractor's License# Exp.rate:
*All Contractor's & subcontractors must have a valid City of cX5 (-IC T- ' 67Q ,, . ! f L
Anacories business license prior to doing work in the City.
Business License#: Exp. Date:
Contact the Citl%'s Finance Department at(360) 299-1968. _ 1 /30 I c
Is this work, associated with another project? Yes ❑ Noe. If yes, specify:
PROPOSED WORK:
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I declare under penalty of perjury 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 ity of Anacort s.
Print Name: 4 („e_,..Y704re-r-'t,------c , Owner ElAg t ,(specify):Citio-/;-% � =�
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1' Yid 47 City of Anacortes Invoice/Permit#: BLD-2019-0019
0904 6th Street
Applied date: 01/11/2019
14 +' P.O.Box 547 Issue date: 01/11/2019
0 • Anacortes, WA 98221-0547 Expire date: 07/09/2020
(360) 293-1901
Job Address: 3808 COPPER POND Permit Type: Mechanical Permit
ANACORTES WA 98221-1162 Project:
APN: P108199
Remarks: Gas furnace replacement, like for like.
Owner: SARA MARTINEZ Contractor: FOSS HEATING AND COOLING
Address: 3808 COPPER POND Address: 333 E BLACKBURN RD
ANACORTES WA 98221-1162 MOUNT VERNON WA 98273-9006
Phone: Phone: (360)336-1517
License#:
General Information: Fees:
# Forced Air Furnace<=100k 1 Mechanical Permit Fees 38.30
Total Calculated: 38.30
Deposits/Receipts: 0.00
Total Due: 38.30
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THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIr Z 180 DA' •S QP 6
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK I.1 COMMt=Npp` .II
HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISI(•it1
OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN 0144 ', FIZ
GRANTING OF A PERMIT DOES NOT PRESU E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHERF-Sl'1 r_CA
LOCAL LAW REGULATING CONST UCT R THE PERFORMANCE OF CONSTRUCTION. r" '-I!
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SIG RE f R AUTHORIZED AGENT ISSUED BY " '" 6