HomeMy WebLinkAboutPermit File BLD-2019-0155 2012 10th Street -c' Y.off PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT
PLUMBING & MECHANICAL PERMIT APPLICATION
4. 1, Mailing Address:P.O. Box 547, Anacortes, WA 98221
'ICoR Office Location: 904 6th Street, Anacortes WA 98821
Phone: (360) 293-1901
PLEASE REFER TO THE PLUMBING&MECHANICAL PERMIT CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS(Street,Suite#): PARCEL(S)#: PROJECT VALUATION:
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Subdivision/Lot#:
RESIDENTIAL 5,1, COMMERCIAL E
APPL CANT: Phone:
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Address(Street,City,State,Zip): Email Address:
PROPERTY OWNER: Phone:
Address(Street,City,State,Zip): Email Address:
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CONTACT PERM Phone:
Address(Street,City,State,Zip): Email Address:
CO TRACTOR:* Phone:
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Address(Street, City,State,Zip): Email Address:
*All Contractors&subcontractors must have a valid City of Professional License#: Exp.Date:
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 ❑ No E 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 City of Anacortes.
Print Name:(14- ° � --t ld
Owner [ Agent 0 (specify):
Signature:. ) Date: 2r;'ltA2/CI'
Ya' Cityof Anacortes
Invoice/Permit#: BLD-2019-0155
904 6th Street Applied date: 03/20/2019
P.O.Box 547 Issue date: 03/20/2019
Anacortes, WA 98221-0547 Expire date: 09/15/2020
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Job Address: 2012 10TH ST Permit Type: Plumbing Permit
ANACORTES WA 98221-1422 Project:
APN: P56123
Remarks: Replace elec.water heater like for like
Owner: PEARSON HERBERT C Contractor:
Address: 2012 10TH ST Address:
ANACORTES WA 98221-1422
Phone: Phone:
License#:
General Information: Fees:
#of Water Heaters 1 Plumbing Permit Fee 27.00
Total Calculated: 27.00
Deposits/Receipts: 0.00
Total Due: 27.00
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THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 480 DAYS', -
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK I47.tOMMENCED;:
HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL PR('}VISICt'JSy
OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, 1PBE!.
GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE 6Re-'-
LOCAL LAW G LATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. .•�,
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SIQNATURE OF OWNER OR AUTHORIZED AGENT ISSUED BY _ —