HomeMy WebLinkAboutPermit File BLD-2019-0337 4514 Queen Ann Way (3) City of Anacortes Invoice/Permit#: BLD-2019-0337
904 6th Street
Applied date: 05/28/2019
P.O.Box 547 Issue date: 05/28/2019
Anacortes, WA 98221-0547 Expire date: 11/23/2020
(360) 293-1901
Job Address: 4514 QUEEN ANN WAY Permit Type: Mechanical Permit
ANACORTES WA 98221-3226 Project:
APN: P59260
Remarks: Remove and then replace 50 gallon gas water heater in garage.
Owner: TROY CHAMPEAUX Contractor: FAST WATER HEATER COMPANY
Address: 4514 QUEEN ANN WAY Address: 11715 N CREEK PKWY S
ANACORTES WA 98221-3226 BOTHELL WA 98011-8807
Phone: Phone: (425)636-7084
License#: FASTWWH948BC
General Information: Fees:
#of Gas Water Heaters> 100k 1 Mechanical Permit Fees 50.65
Total Calculated: 50.65
Deposits/Receipts: 0.00
Total Due: 50.65
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I
HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS
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 PROVISIONS OF ANY OTHER STATE OR
LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSUED BY
g5lee
�Teo
PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT
% PLUMBING & MECHANICAL PERMIT APPLICATION
Ligkik lir Mailing Address:P.O. Box 547, Anacortes, WA 98221
\s'......41)Fre447 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
1�CT ten ( treat,Suite#): Parcel(s)#:i4nn kitul, cf1 /U/(;)
Subdivision/Lot#: Residential 0, Commercial ❑
APPLICANT: _ Phone: Fax:
fAs
I" Mr-F--- ,g- H-a,A-T 'g.. u129. teSii)---Mq
Address(Street, City, State,Zip): E-Mail Address: (/
KVIn ,fS & fir Gu Ju�G ' vr
PROPERTY OWNER: Phone: Fax:
GhamavX,"rruv -j W O ff.(,) )-s1 -22q
otilets (sNuet,City, State,Zip): 22 I E-Mail Address:
CONTACT PERSON: a Phone: Fax:
_________CtS , (\Q.— COWArd
Address(Street, City,State,Zip) ' E-Mail Address:
\\ Phone: Fax:
CONTRACTOR: (A- 7- wpiThe* °;c-FF-e ;
Address(Street,City, State,Zip): E-Mail Addr s
H y5 cy K 4t11.bLp1 i ,, V A-1Toi I Go a i�" -- i tuVr, (.i
Contractor's License# Exp.Date:
*All Contractors& subcontractors must have a valid City of �Q
Anacortes business license prior to doing work in the City. �e
u
Contact the City's Finance Department at(360)299-1968. � �siness License#: .Date:
Ex t— 1—i 3
Is this work, associated with another project? Yes ❑ Nog If yes, specify:
PROPOSED WORK:
er DVL'/ V? 1 t CL Vi 06 Jr LG i`e
gili -_- iOCar cn — e r
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 tb- �;+,,of Anacortes.
Print Nance: _ as Syy,r )f aCt Owner ❑ Agent (specify):
Signature: Date:
I -
MECHANICAL:
Equipment Type: Appliance/Equipment Information(new and relocated): Total#:
Furnace: Gas k 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 Location(s) _
Water Heater: (as#)Elec# Other: # BTUs: <100k>100k Location(s) Y` Y"
AC Unit/Boiler/
Heat Pump/ Roof Gas# Elec#_Other: # BTUs: <100k, 100k-500k, 500k-
� t r n � i �n Location(s)
Top Unit(Circle 1Mil FIP: <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# 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:
PLUMBING FIXTURES:
( Water
Type(new and relocated): Total#: Fixture Type (new and relocated): Total#:
Water Closet(Toilet): Pressure Reduction Valve/Pressure Regulator:
IUrinal: Backfiow 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 0 No 0 ( Grease Interceptor:
Floor Drain/Floor Sink: Water Piping:
Refrigerator water supply(for water/ice Other:
dispenser):
TOTAL OUTLETS: TOTAL OUTLETS: