HomeMy WebLinkAboutPermit File BLD-2019-0401 4605 Queen Ann Way City of Anacortes Invoice/Permit#: BLD-2019-0401
• 904 6th Street
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Applied date: 06/27/2019
`_ P.O.Box 547 Issue date: 06/27/2019
Anacortes, WA 98221-0547 Expire date: 12/23/2020
(360) 293-1901
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Job Address: 4605 QUEEN ANN WAY Permit Type: Plumbing Permit
ANACORTES WA 98221-3211 Project:
APN: P59235
Remarks: Repair water service
Owner: MIRIAM LEVI Contractor: CPI PLUMBING& HEATING
Address: 4605 QUEEN ANN WAY Address: 1900 RAILROAD AVE
ANACORTES WA 98221-3211 MOUNT VERNON WA 98273-4957
Phone: (917) 572-9719 Phone: (360)428-5636
License#: CPIPLPH850MN
General Information: Fees:
#of Water Piping 1 Plumbing Permit Fee 27.00
Total Calculated: 27.00
Deposits/Receipts: 0.00
Total Due: 27.00
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 O OTHER STATE OR
LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSUED BY
Permits and Insp... - BLD-2019-0401 - 2019
019257-0032 Carla Br... 07/05/2019 03:52PM
12447 - MIRIAM LEVI
BLD-2019-0401 Plumbing Permit
Payment Amount: 27.00
Transaction Amount: 27.00
CHECK: 020625
C PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
r z PLUMBING & MECHANICAL PERMIT APPLICATION
., . Mailing Address: P.0. .Box 547, Anac^oue.s, WA 98221
}
` . Office Location: 904 Et Street, Anaeo)•t 's WA 98821
Phone: (3.60) 2.3-1'901
PLEASE REFER TO THE,PLUMBING& MECHANICAL PERMIT CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street,Suite#): P cE (S) �, PROJECT VALUATION:
0 . ..-.tom "1 - .. ', .
subdivision/Lot#:
RESIDENTIAL COMMERCIAL 0
I APPLICANT: Phone:
Address (Street, City, State, Zip): Email�a Address:
:A/4 sT � irA�..cAz...d 9 •. a i'k >,.,i ..-�\e
PROPERTY OWNER: Phone:
Address (Street, City. State, Zip): Email,Address:
'O l -ri Ab1 vvAcy viz cisi-m _A
CONTACT PERSON: Phone:
Address (Street, City, State,Zip): Email Address:
CONTRACTOR:* Phoney} ,b tira
p (/,
Address (Street, City, State, Zip): Email Address:
�Al! contractors & subcontractors must have a valid City of Professional Licen5.5se #: Ex , iSat :
0 pi Anacortes business license prior to doing work in the City. - `
Contact the City's Finance Department at(360)299-1968
Business License#: Exp. Date:
Is this work, associated with another project? Yes 0 No34, If yes, specify:
PROPOSED WORK:
I I declare under penalty of perjury that the information I have provided on this formlapplication 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: .mil * ,..' .' Owner 0 Agent .0 (specify):
,frSinatur• .Date: 4 l 7
MECHANICAL
Equipment Type: I Appliance/Equipment Information (new and relocated): Total #:
Furnace: Gas.# Elec#: Other#: Location(s):
Wall Heater: Gas. : Elec#:. Other:#: Location(s):
Gas Water Heater: #:: Location(s):
Heat Pump: Bee.#.: Other#: Location(s):
Air Conditioner./Handler: Elec.#: Other: #: Location(s):
Radiant IHvdronic Heating: Gas #: El.ec#: Other #:: Location(s):
I Exhaust Fans: Bath#: Laundry#: Kitchen#: Other#:
RanngeHood: #: Type 1 or 2 (Circle which one) Location(s):
Fireplace: Gas#: Elec#: Other: #: Location(s):
Clothes Dryer &Duct: Gas#: Elec#: Other: #: Locatian(s):
Stove/Range/Oven: Gas#: Elec#: Other: #: Location(s):
Refrigeration Unit: Flee#: Other: #: Location(s):
Gas Piping/Outlet(s): #: Location(s):
Boiler: Gas#: Elec#: BTUs: Location(s):
, Other: #: Location(s):
TOTAL MECHANICAL OU'lTLETS:!
,
- `_-i M -BINC FIXTURE._ .
Fixture Type (new and relocated): 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: I
Tub: Water Piping:
Hand Sink: Clothes Washer:
Shower: Electric Water Heater: Tank-less? Yes 0 No 0
Dishwasher: Backflow Prevention.Device:
Urinal: ' Hose Bib:
Floor Drain /Floor Sink; .Drinking Fountain:
Hydronic Heat in: Floor O Wall D Grease Interceptor:
Other: Other:
l
. T TAl , PLUMBING FIXTURES