HomeMy WebLinkAboutPermit File BLD-2019-0086 3807 O Avenue 4V Y C '`,. Cityof Anacortes Invoice/Permit#: BLD-2019-0086
-., 904 6th Street
Applied date: 02/19/2019
P.O.Box 547
Issue date: 02/19/2019
,> `` Anacortes, WA 98221-0547
' (360) 293-1901 Expire date: 08/17/2020
Job Address: 3807 0 AVE Permit Type: Mechanical Permit
ANACORTES WA 98221-3926 Project:
APN: P58761
Remarks: Install ductless heat pump
Owner: BEIRNES ROBERT L Contractor: FOSS HEATING AND COOLING
Address: 3807 O AVE Address: 333 E BLACKBURN RD
ANACORTES WA 98221-3926 MOUNT VERNON WA 98273-9006
Phone: Phone: (360) 336-1517
License#: FOSSHC1983QA
General Information: Fees:
#of Heat Pumps 1 Mechanical Permit Fees 38.20
Total Calculated: 38.20
Deposits/Receipts: 0.00
Total Due: 38.20
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THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHII 180 DAYS Ct T
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK;.tt COMM NU;E,a F�--a
HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL P[3.OglS10NS
OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR=-'N T,;THg
GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER-;S 4TE C
LOCAL LAW REGU TIN NSTRUCTION HE PERFORMANCE OF CONSTRUCTION. I:' CO
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SIGNATURE 0 OWIJER-ORAUTHORIZEDAGENT ISSUED-BY — -s. '4'
PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
40:
PLUMBING & MECKANICAL FERMI APPLICA411
Mailing Addres.s.: P.O. Box 547, Anacortes, WA 98221
47 kf,
Office Location: 904 6th Street, .Anacortes WA 98821
Phone: (360) 293-1901, Fax (360) 293-1938
PLEASE REFER TO THE PLUM13ING &MECHANICAL PERMIT CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS Strut Sqite #): Parcel(s) #:
Subdivision/Lot#:
Residential Commercial [11
APPLICANT: le— Phone: Fax:
os u
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-scs (5-77
Address (Streets City, State,Zip): ‘.1 E-Mail Address: f,
1 3 I r- 15-1c,r' it"-baz..t tal I (I rcir-Pi (t.A c/172,T 60 .••
OPERTY OWNER: i Phone: Fax:
7oa 251'3 276 7
Address (Street, City, State, E-Mail Address:
CONTACT !•'ERSON: Phone: Fax:
6,a
Address (Street, City, State, Zip): E-Mail Address:
•CONTRACTOR:* , Phone: Fax:
TrAddress (Street, City, ate, Zip): E-Mail Address
Contractor's License # Dcy. Date:
ll*A Contractors & smb ei
contractors must have a valid City of --- -tcr.?7, oA ti
Anacortes business license prior to doing work in the City. •/- , • r
- Business License# E p. Date.
Contact the City's Finance Department at (360) 299-1968.
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Is this work, associated with another project? Yes El No Eyet If yes, specify:
PROP*SED 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 City of Anacortes.
Print Name: (1, 41 4,-1/1/144,6'C, Owner El Agent\CI (specify):
Signature: Sis , Date: '/71
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MECHANICAL
Equipment Type: Appliance/Equipment Information (new and relocated): Total #:
Furnace: Gas#__Elec #:Other: # BTUs: <100k_>100k_Location(s)
Wall Heater: Gas#__Elec.##-_Other: # BTUs: <=100k>100kiLocation(s)
Air Handler Gas# Elec # Other: # BTUs: <100k>100k. Location(s)
Water Heater: Gas# Elec # Other: # BTUs: <100k>100k Location(s)
ri
AC.aJnitl_poiler
Heat P ?Roof
Gas #_Elec#LOther # BTUs ��,4 <100k,
100k-500(c, 5001c-
fT op- t(Circle 1Mi1 HP <3, 3-15,_15-30 Location(s) t.
selected).:
Hy ionic-Heating. Gas#__Elec #_In-Floor -Wall Radiant_Boiler.BTUs: Location
Exhaust Fans
Bath # Kitchen # Laundry# Other:
(single duct):
Fireplace /Insert Gas:#_Elec # Other: # Location(s)
Stove/Range/Oven: Gas #__Elec #_Other: # Location(s)
Range Hood: # Location(s)
Refrigeration Unit: Gas #_Elec#_Other_#_: Location(s)
Outdoor BBQ: Gas#_Elec# Other # Location(s)
Clothes Dryer&Duct Gas #.,_Elec #___Other;_# Location(s)
Gas Piping: #_ Location(s)
Other: # Location(s)
Location(s)
TOTAL OUTLETS: k
PLUMBING FIXTURES:
Fixture Type (new and relocated): Total #: Fixture Type (new and relocated): Total ##
Water Closet Toi Iet .
( ) Pressure Reduction Valve/Pressure Regulator:
t�ririal: _
Backflow Prevention Device:
Sink (kitchen, laundry, lavatory, hand, bar, slop,
Water Service Line:.
eye wash, etc )
Tub/Shower: Drinking Fountain:
Dishwasher: Clothes Washer:
Hose Bib: Hydronic Heat in Floor D Wall D
Water Heater Tankless? Yes D No o Grease Interceptor:
Floor Drain / Floor Sink Water Piping:
Refrigerator water supply (for water/ice
dispenser): Other:.
TOTAL OUTLETS: TOTAL OUTLETS: