HomeMy WebLinkAboutPermit File BLD-2019-0163 2008 10th Street PLANNING,COMMUNITY. &ECONOMIC DEVELOPMENT DEPARTMENT
`� r PLUMBING & MECHANICAL PERMIT APPLICATION
Mailing Address:P.O. Box 547, Anacortes, WA 98221
.c0 Office Location: 904 6th Street, Anacortes WA 98821
Phone: (360)293-1901, Fax: (360)293-1938
PLEASE REFER TO THE PLUMBING&MECHANICAL PERMIT CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS(Stye t,Suite# • Parcel(s)#:
Subdivision/Lot#:
(7 1 se Residential L Commercial ❑
APPLICANT: ! €„ Phone: Fax:
Address(Street,City!State,Zip):, E-Mail Address:
J 2 c y d5 '2 P A'f-/ 'trrt` is '4 {' or e cYv s' s..5-x., :-'-
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PPERTY OWNER: , Phone: Fix:
Adds(Street,City,State,Zip): _ E-Mail Address:
CONTACT PERSON: Phone: Fax:
Address(Street,City,State,Zip): E-Mail Address:
CONTRACTOR:*` L j( , . r Phone: Fax:
Address(Street,City,State,Zip): E-Mail Address
Contractor's License# Exp.Date:
*All Contractors&subcontractors must have a valid City of :- 614A- it_1 b-
�a%f
Anacortes business license prior to doing work in the City. Business License#: Exp.Date:
Contact the City's Finance Department at(360)299-1968. oil 1-7 ,-i
Is this work,associated with another project? Yes ❑ No b'.' If yes,specify:
PROPOSED WORK:
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 Cityof 4nacortes.
P
Print Name: c Owner ❑ Agent s ecify): G' `"I '
Signature: ` �`(Date: °tll .
MEC HANICAL;
Equipment Type: Appliance/Equipment Information(new and relocated): Total#:
Furnace: Gas#t Elec#_Other: # BTUs:<100k >100k_Location(s)
Wall Heater: Gas#_Elec#_Other: # BTUs:<100k>100k_Location(s)
Air.Handler: Gas# Elec#_Other: # BTUs:<100k>100k Locations)
Water Heater: Gas# Elec# Other: # BTUs: <100k>100k Location(s)
AC Unit/Boiler/
Heat Pump/.Roof Gas#Fee# Other: # BTUs: <100k, 100k-500k, 500k-
Top Unit(Circle IMil HP: <3, 3-15,_15-30 Location(s)
selected):
Hydronic Heating: Gas# Elec## In-Floor__Wall Radiant Boiler BTUs: Location
Exhaust Fans Bath# Kitchen#_Laundry# Other:
(single duct):
Fireplace/Insert: Gas#_Flee#__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:
PLUMBING FIXTURES:
Fixture Type(new and relocated): Total#: Fixture Type(new and relocated): Total#:
Water Closet(Toilet): Pressure Reduction Valve/Pressure Regulator:
Urinal: Backflow Prevention Device:
Sink(kitchen,laundry, lavatory,hand,bar,slop,
eye wash,etc.): Water Service Line:
Tub/Shower: Drinking Fountain:
Dishwasher: Clothes Washer:
Hose Bib: Hydronic Heat in: Floor 0 Wall 0
Water Heater Tankless? Yes ❑ No ❑ Grease Interceptor:
Floor Drain/Floor Sink: Water Piping:
Refrigerator water supply(for water/ice Other:
dispenser):
TOTAL OUTLETS: TOTAL OUTLETS:
PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT
PLUMBING AND MECHANICAL PERMIT CHECKLIST
R Mailing Address: P.O. Box 547, Anacortes, WA 98221
' Office Location: 904 6th Street,Anacortes WA 98821
".,._ Phone: (360)293-1901, Fax: (360)293-1938
PROJECT ADDRESS: 25
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.
PERMIT TYPE:
a
SUBMITTAL REQUIREMENTS: 2 r
n The number indicates the number of
copies for submittal(if applicable).
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 nomial business hours.
2. Plans/calculation/reports prepared by state licensed architects or professional engineers must be stamped
and signed by the design professional.
1v-VC. City of Anacortes Invoice/Permit#: BLD-2019-0163
904 6th Street
Applied date; 03/26/2019
`'r P.O.Box 547
t ` WA 98221-0547 Issue date:
Anacortes,
ram` Expire date: 09/21/2020' ii� a (360) 293-1901
Job Address: 2008 10TH ST Permit Type: Mechanical Permit
ANACORTES WA 98221-1422 Project:
APN: P56124
Remarks: replace Gas Furnace, like for like
Owner: ROGER NEWPORT Contractor: FOSS HEATING AND COOLING
Address: 2008 10TH ST Address: 333 E BLACKBURN RD
ANACORTES WA 98221-1422 MOUNT VERNON WA 98273-9006
Phone: (360)899-5251 Phone: (360)336-1517
License#: FOSSHCI983QA
General Information: Fees:
#of Boilers<= 100,000 BTU 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 WITHIN-11180 DAI;S,' I '
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK I4i COMMENCED:- tf'
HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECY.ALL PR dIC N
OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR 19 II,rrtiL-'
GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER'ST/F nP
LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. ••.0 CI,
p.y 0SIAATURE OF O 15ER O "" J RIZED AGENT ISSUED BY r �i :> ~
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