HomeMy WebLinkAboutPermit File BLD-2019-0098 1213 4th Street C City of Anacortes Invoice/Permit#: BLD-2019-0098
904 6th Street
",•10 P.O.Box 547 Applied date: 02/27/2019
�` Issue date: 02/27/2019 Cry;' Anacortes, WA 98221-0547
(360) 293-1901 Expire date: 08/25/2020
Job Address: 1213 4TH ST Permit Type: Mechanical Permit
ANACORTES WA 98221-1514 Project:
APN: P55380
P55381
Remarks: Remove existing stove and install free standing gas stove to existing gas line.
Owner: JOHNSON ALAN A Contractor: CRAFT STOVE INSTL OF MV WA LLC
Address: 1201 4TH ST Address: 900 W DIVISION ST
ANACORTES WA 98221-1526 MOUNT VERNON WA 98273-3226
Phone: Phone: (360)336-3532
License#: CRAFTSI831CH
General Information: Fees:
#of Gas Fireplace 1 Mechanical Permit Fees 34.15
Total Calculated: 34.15
Deposits/Receipts: 0.00
Total Due: 34.15
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THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DA.S';'5Ol iF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCEDQ. ;}
HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL PI bWSE
OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR:NOT,":THe
GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIO F A1ttFkLER6T1Oi
LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
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SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSUED BY Cr! ;il y '4)
- - PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT
PLUMBING & MECHANICAL PERMIT APPLICATION
"` -"-_ Mailing Address:P.O.Box 547,Anacortes, WA 98221
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47 Office Location:904 6tI Street,Anacortes WA 98821
--4 Phone: (360)293-1901, Fax: (360)293-1938
PLEASE REFER TO THE PLUMBING&MECHANICAL PERMIT CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street,Suite#): P arcel(s)#:
12 t" LI-fi. St- rhrti L cfr=4c-s -1P 55 3S'
Sub division/Lot#:
P"-CCP4-51 Q10G .. 1 Z Wes" l -6 f CO+ -fr)t.) Residential Commercial ❑
APPLICANT: Phone: Fax:
re - . VI2 SOb-33(e-753-2 3ieb--gg2--zaczS-
Address(Street,City,State,Zip): E-Mad Address:
100 vAi . Zk.kJ stern µ AjerroA. w� t 15 excti slo\res s'kPcofriccis{ Az-
PRO ERTY OWNER: Phone: Fax:
Awn Veb b—Ni1°+
Address(Street,City,State,Zip): E-Mail Address:
t 20k L t \ St- krCLC N-krs \ 2Z
CONTACT PERSON: Phone: Fax:
Address(Street,City,State,Zip): E-Mail Address:
CONTRACTOR:* Phone: Fax:
CArack \ie_ vzit.11ahcsY) 36()-331e 2- 32 (J-L24----/Lt
Address(Street,City,State,Zip): E-Mail Address
6l.06 vu ' 0i tsly yy .a-klc--. \Jef rof\ wN\ Z�t 3 CXGS-k-slczyf e5i W-tc c,$. v, 7t
Contactor's License# Exp.Date: _
*All Contractor's&srthconfractors'must have a valid City of eiwsz tcA". 4rt3 t 1 l e
Anacortes business license prior to doing work in the City. Business License#: Exp.Date:
Contact the City's Finance Department at(360)299-1968.
Is this work,associated with another project? Yes 0 No DI) 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 apermit
application to the City of Anacortes. {�
Print Name: X1�W N SWsak- \a 11 Owner 0 Agent (specify),M( 0
Signature: C��`��f J ' A
Date: 2- k9"� 'I
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Equipment Type: Appliance/Equipment'Information(new and relocated): Total#:
Furnace: Gas# Elec# Other: # BTUs:<100k >100k Location(s)•
Wall Heater: Gas# Elec# Other: # BTUs:<I00k>100k Location(s)
Air Handler: Gas#___Elec# Other: # . BTUs:<100k>100k Location(s)
Water Heater: Gas# Elec# Other: # BTUs:<100k>100k Location(s)
AC Unit/Boiler/
Heat Pump/Roof Gas# Elec# Other: # BTUs: <100k, 100k-500k, 500k-
Top Unit(Circle 'Mil HP: <3, • 3-15,_IS-30 Location(s) .
selected):
Hydronic Heating: Gas#_Elec# In-FloorrWall Radiant B oiler BTUs: Location
Exhaust Fans Bath# Kitchen# Laundry# Other: #
(single duct):
Fireplace/Insert: Gas#.i__Elec# Other: # Location(s) LA \/`1
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)
. R MI:.T-W'3:� .�.�vV)ip'e i• ���mY-ni:-C'=fi r_V"�3c•T,Oa..!s.•.T.,.-.�4AL OUTLETS:
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:
+ir r �4r41 A^"P � vthai ,qY= L ems kcn.
Fixture
Type(new and relocated): Total#: Fixture Type(new and relocated): Total#:
Water Closet(Toilet): Pressure Reduction Valve/Pressure Regulator: •
Urinal: B ackfiow Prevention Device:
Sink(kitchen,laundry,lavatory,hand,bar,slop,
eye wash,etc.): Water Service Line:
Tub/Shower: Drinking Fountain:
Dishwasher: CIothes Washer:
Hose Bib: Hydronic Heat in: Floor ❑ Wall 0
Water Heater Tankless? Yes 0 No 0 Grease Interceptor:
Floor Drain/Floor Sink. Water Piping.
Refrigerator water supply(for water/ice
dispenser): Other.
TOTAL OUTLETS: TOTAL OUTLETS:
PLANNING,COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT
PLUMBING AND MECHANICAL PERMIT CHECKLIST Mailing Address:P.O. Box 547, Anacortes, WA 98221
` = 6w Office Location: 904 6th Street,Anacortes WA 98821
Phone: (360)293-1901, Fax: (360)293-1938
PROJECT ADDRESS: Z 3 y 5-- Ana(CJY ZZ
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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Plumbing&Mechanical Permit Application 1 1 1 1
Mechanical Plans 1
Structural Calculations 1
State Non-Residential Energy Code Compliance Form 1
Manufacturer's Specifications/Cut Sheets 1 1
Elevation View for Roof Mounted Equipment 1 1
Plumbing Plans 1
Listed&Tested Fire Stopping Assemblies - 1
1. Handouts and Standard Details may be found on the City's website at www.cityofanacortes.org or can
be obtained at City Hall during normal business hours.
2. Plans/calculation/reports prepared by state licensed architects or professional engineers must be stamped
and signed by the design professional.
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