HomeMy WebLinkAboutPermit File BLD-2019-0473 1614 12th Street (2) T ,0_1(..,.
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Finance Department
019284-0110 Erin W. 07/24/2019 04:16PM
PERMITS AND INSPECTIONS
TRI COUNTY PLME1G ANACORTES LLC
BLD-2019-0473
Plumbing Permit
issued
2019 Item: BLD-2019-0473
Plumbing Permit Fee 27.00
Payment Id: 251910
27.00
Subtotal 27.00
Total 27.00
03FINANCE CREDIT CARD 27.00
Visa ************4727
Ref,:41483730558
Auth054254
4727
1
Change due 0.00
Paid by: RICHARD PERKINS
Hill13011111111111111111111111111111111111111
Signature: /:Thank you you for your payment
COPY
DUPLICATE RECEIPT
` PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT
PLUMBING & MECHANICAL PERMIT APPLICATION
?41 ►4 Mailing Address: P.O. Box 547, Anacortes, WA 98221
o‘t~ 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:
Subdivision/Lot#: RESIDENTIAL ❑ COMMERCIAL ❑
APPL ANT:
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Imo! COuNt y �� �� Pho eL
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Address S eet City,State,Zip,), Email Address:
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PROPERTYt.J o ER e 2,' ,j Phone: T /e a 3 T 3 7 S �u
AddreAddress(S�eq,Cii,Late Zip):j Email Address:
CONTACT PERSON: Phone:
Address(Street, City, State,Zip): Email Address:
CONTRACTOR:* Phone:
ft 'AA CAner
Address(Street, City, State,Zip): Email Address:
*All Contractors& subcontractors must have a valid City of Professiep8l n e p Exp.Date:
Anacortes business license prior to doing work in the City. usi � a M� 7,4 Z'
Busipe�se#: Exp.Date:
Contact the CiO's Finance Department at(360)299-1968. Y
Is this work, associated with another �'project? Yes El No
No ❑ IIf yes, specify:
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PROPOSED WORK: / ", �/1 I s Nh �' u
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 er r duly authorized agent of the property owner to submit a permit
application to the Ci Anacort .
Print Name: I e ` �'� Owner ❑ Agent ❑ (specify):
Signature: Date: `7 .
MECHANICAL:
Equipment Type: 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): If
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):
Refrigeration Unit: Elec#: Other:#: Location(s):
Gas Piping/Outlet(s): #: Location(s):
Boiler: Gas#: Elec#: BTUs: Location(s):
Other: #: Location(s):
TOTAL MECHANICAL OUTLETS:
PLUMBING FIXTURES:
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:
Tub: Water Piping:
Hand Sink: Clothes Washer:
Shower: Electric Water Heater: Tank-less? Yes ❑ No 0
Dishwasher: Backflow Prevention Device:
Urinal: Hose Bib:
Floor Drain/Floor Sink: Drinking Fountain:
Hydronic Heat in: Floor ❑ Wall ❑ Grease Interceptor:
Other: Other:
TOTAL PLUMBING FIXTURES: