HomeMy WebLinkAboutPermit File BLD-2019-0435 2804 Oakes AvenueCity of Anacortes
904 6th Street
P.O.Box 547
Anacortes, WA 98221-0547
(360) 293-1901
Job Address: 2804 OAKES AVE
ANACORTES WA 98221-1319
Invoice/Permit #: BLD-201IM435
Applied date: 07/11/2019
Issue date: 07/11/2019
Expire date: 01/06/2021
Permit Type: Mechanical Permit
Project:
APN:
P58283
P31570
Remarks:
Replacing existing
gas furnace with a new one to existing gas line,
replacing majority of ductwork, installing new gas
fireplace and stove
with new gas piping, and installing a new bath fan.
Owner:
DIANE & SAMUEL
HILL Contractor:
JACOBSON HEATING AND AIR CONDITIONING LL
Address:
2804 OAKES AVE
Address:
218 FRIDAY CREEK RD
ANACORTES WA
98221-1319
BELLINGHAM WA 98229
Phone:
(605) 890-0027
Phone:
(360) 631-1302
License #:
IIISKA]:l.L : w : ' �1
General Information: Fees:
# Appliance Modification/Rpr 1 Mechanical Permit Fees
# Forced Air Furnace <=100k 1
Total Calculated:
# of Gas Fireplace 1
Deposits/Receipts:
# of Gas Piping 2
# of Ventilation Fans 1 Total Due:
#_of_Gas Outlets 2
79.40
79.40
0.00
79.40
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.
OWNER OR AUTHORIZED AGENT
Permits and Insp... -BLD-2019-0435 - 2019
019265-0005 Carla Br... 07/11/2019 10:05AM
12381 - JACOBSON HEATING AND AIR COND...
BLD-2019-0435 Mechanical Permit
Payment Amount: 79.40
Transaction Amount: 79.40
03FIN CC: �*3809
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4,1 Y lylUr AIRRIO COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
G� PLUMBING & MECHANICAL PERM17 APPLICATION
Mailing Address: P.O. Box 547, Anacortes, WA 98221
` co Office Location: 904 6rh Street, Anacortes WA 98821
Phone: (360) 2934901
PLEASE REFER TO THE PL UMBING &MECHANICAL PERMIT CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #):
290q oekks
PARCEL(S) #:
PROJECT VALUATION:
Subdivision/Lot #:
RESIDENTIAL?
COMMERCIAL[, ❑
AP LICANT:
Phone:
Address (Street, City, State, Zip):
19 1'Cq M Nx ta
Email Address:
PROPERTY OWNER: . te\ �� 1
Phone:
Address (Street, City, State, Zip):
2 qq O c4e CAWf� � c �l Cj VA 9 2z
Email Address:
CONTACT PERSON:
Phone:
Address (Street, City, State, Zip):
Email Address:
COQNTRA TOR** j
Ck`065^, Cc 0Ti GrpjL �� LL1.
Phone:
�60 C3V
a
J OL
Address (Street, City, State, Zip):
O a 9 rn rnw 1 txv t O g 7 kq
Email Address:
CPO 3a,C 9 15 cq r,
NA ,
Sy�t C •1 , C -G
*All Contractors & subcontractors must have a valid Cityo
Anacortes business license prior to doing work in the City. f
Contact the City's Finance Department at (360) 299-1968.
`'P fessional ce
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6 2021
Business License#•
6 � _ � �
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Date: J®�
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Is this work, associated with another project? Yes ❑ No
❑ If yes, specify:
PROPOSED WORK:
15'
1
c
t e
1ii
1
I declare under penalty of perjury that the information I have provided on this form/application is true,
complete, and that I am the property owner or duly authorized agent of the property owner to submit a
application to the City of Anacortes.
Print Name: urtA �q L' 4 � '� Owner ❑ Agent /(specify):
Signature: /r Date: �1 ' i 1 � 19•
correct, and
permit
Equipment Type:
Appliance/Equipment Information (new and relocated):
Total #:
Furnace:
Gas #:
Elec ther #: Location(s):
Wall Heater:
Gas #:
Elec #: Other: #: Location(s):
Gas Water Heater:
#:
Location(s):
Heat Pump:
Elec #:
Other #: Location(s):
Air Conditioner /Handler:
Elec #:
Other: #: Location(s):
Radiant /Hydronic Heating:
Gas #:
Elec #: Other: #: Location(s):
Exhaust Fans:
Bath #:
Laundry #: Kitchen #: Other #:
Range Hood:
#:
Type 1 or 2 (Circle which one) Location(s):
Fireplace:
Gas #:
Elec #: Other: #: Location(s):
Clothes Dryer & Duct:
Gas #:
Elec #: Other: #: Location(s):
Stove/Range/Oven:
Gas #: '
Elec #: Other: #: Location(s):
1
Refrigeration Unit:
Elec #:
Other: #: Location(s):
Gas Piping/ Outlet(s):
#:
Location(s):
Boiler:
Gas #:
Elec #: BTUs: Location(s):
Other:
#:
Location(s): A6000
Fixture Type (new and
relocated):
TOTAL MECHANICAL OUTLETS:
Total #: Fixture Type (new and relocated):
Total #:
Water Closet (Toilet):
Refrigerator water supply (for water/ice dispenser):
Kitchen Sink:
Pressure Reduction Valve/Pressure Regulator:
Utility Sink:
Water Service Line:
Tub:
Water Piping:
Hand Sink:
Clothes Washer:
Shower:
Electric Water Heater: Tank -less? Yes ❑ No ❑
Dishwasher:
Backflow Prevention Device:
Urinal:
Hose Bib:
Floor Drain / Floor Sink:
Drinking Fountain:
Hydronic Heat in: Floor ❑ Wall ❑
Grease Interceptor:
Other:
Other:
MN610
TOTAL PLUMBING FIXTURES:
r
PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
PLUMBING AND MECHANICAL PERMIT CHECKLIST
7 y Mailing Address: P. O. Sox 547, Anacortes, WA coliL Office Location: 904 6rh Street, Anacortes WA 98821
Phone: (360) 293~1901
"1 � f ID III'I
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:
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: SUBMITTAL REQUIREMENTS
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The number indicates the number of
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CD
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copies for submittal (if applicable).CD
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Plumbing & Mechanical Permit Application
1
1
1
1
Mechanical Plans
1
0
0
0
Structural Calculations
1
0
0
0
State Non -Residential Energy Code Compliance Form
1
0
0
0
Manufacturer's Specifications /Cut Sheets
1
0
1
0
Elevation View for Roof Mounted Equipment
1
0
1
0
Plumbing Plans
0
0
1
0
Listed & Tested Fire Stopping Assemblies
0
0
1
0
Permit Fee
✓
✓
✓
✓
Existing Floor Plan
2
2
2
2
New Floor Plan
2
2
2
2
NOTES:
1. Handouts and standard details may be found on the City's Planning, Community, &Economic
Development website 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 si ngned by the design professional.
3. If installing a backflow prevention device, it will need to pass test results of which will need to be
submitted to the city for review.