HomeMy WebLinkAboutPermit File BLD-2019-0542 1120 4th Street City of Anacortes
904 6th Street Invoice/Permit#: BLD-2019-0542
Applied date: 08/15/2019
P.O.Box 547 Issue date: 08/15/2019
10 Anacortes, WA 98221-0547
.'_' �� ,Cqt (360) 293-1901 Expire date: 02/10/2021
Job Address: 1120 4TH ST Permit Type: Mechanical Permit
ANACORTES WA98221-1513 Project:
APN: P55347
Remarks: Replace furnace with like, and install ductless heat pump.
Owner: DOREEN ZIMMERMAN Contractor: FOSS HEATING AND COOLING
Address: 816 PEACE PORTAL DR Address: 333 E BLACKBURN RD
BLAINE WA 98230 MOUNT VERNON WA 98273-9006
Phone: (604) 531-9313 Phone: (360) 336-1517
License#:
General Information: Fees:
# Forced Air Furnace<=100k 1 Mechanical Permit Fees 53.00
#of Heat Pumps<=3 Hp 1
Total Calculated: 53.00
Deposits/Receipts: 0.00
Total Due: 53.00
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THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN +.,t/30 DAY u ORR' F,
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCE 5.•=__
HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL PRC I ijD ;S, '
OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR EJD7;ZT 1E•-y'
GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER SPATE ciR+.1
LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
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SIGN URE OW THORIZED AGENT ISSUED BY _' .a
\',`i PLANNING,COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
' iUMBING & MECHANICAL PE=-zMIT APPLICATION
5:2019
Mailing Address:P.O. Box 547,Anacortes, WA 98221
�""'�" S7ir 6 a .
Office Location: 904 6thStreet,Anacortes WA 98821
4-." Phone: (360)293-1901, Fax: (360)293-1938
PLEASE REFER TO THE PLUMBING&MECHANICAL PERMIT CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT °ADD S(Street,tSuite#): Parcel(s)#: 5 6 3 4-7
Subdivision/Lot#:
( ( (2 Residential fit Commercial ❑
APPLICANT: Phone: Fax:
Address(Street,City,State,Zip): ,..1 E-Mail Address:
333 ( t,,( R-( h14-.t 1 G,I✓--`( sZ-73 Ortc,c e- n Fa .c,c.
PROPERTY OWNER: Phone: Fax:
7- \, ,,K1..:C4, Co4- 5 3( '1313 l
Address(Street,City,State,Zip): E-Mail Address:
6 R -t_ RA- (Pr- Pt.'14.E t U./A cl n 30 .o, --44. -z i wC 14,16 0-,t 1. C 601
CONTACT PERSON: Phone: Fax:
,.--v G3t.v1-1..A-#-
Address(Street,City,State,Zip): E-Mail Address:
CONTRACTOR:* Phone: Fax:
Address(Street,City,State,Zip): E-Mail Address
Contractor's License# Exp.Date:
*All Contractors&subcontractors must have a valid City of cow HG r cr n 42..4 {t- ( - 2.-cl
Anacortes business license prior to doing work in the City. Business License#: Exp.Date:
Contact the City's Finance Department at(360)299-1968. e1 c)( c(--t 3- (7
Is this work,associated with another project? Yes ❑ No Jlj, If yes,specify:
PROPOSED WORK:
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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 City of Anacortes.
Print Name: (c «, Owner ❑ Agent IR(specify):(,t,.c,v-c.>Lv,,3-�
Signature: ,_ Date: f— (6—(- 7
MECHANICAL:
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 Location(s)
Water Heater: Gas# Elec# Other: # BTUs:<100k>100k Location(s)
AC Unit/Boiler/
eat Pum /Roof Gas#_Elec# lOther: # BTUs: <100k, 100k-500k, 500k-
LG" Circle ]Mil 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#_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: -2-
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 ❑
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: