HomeMy WebLinkAboutPermit File BLD-2019-0437 2000 Down Jones Way Y C> City of Anacortes Invoice/Permit#: BLD-2019-0437
C.) 904 6th Street
Applied date: 07/11/2019
P.O.Box 547
Issue date: 07/17/2019
Anacortes, WA 98221-0547
4' (360) 293-1901 Expire date: 01/06/2021
Job Address: 2000 DOWN JONES WAY Permit Type: Mechanical Permit
ANACORTES WA 98221-2676 Project:
APN: P82138
Remarks: Replace furnace with like kind.
Owner: KEVIN RAFTER Contractor: FOSS HEATING AND COOLING
Address: 2000 DOWN JONES WAY Address: 333 E BLACKBURN RD
ANACORTES WA 98221-2676 MOUNT VERNON WA 98273-9006
Phone: (253) 347-1374 Phone: (360) 336-1517
License#: FOSSHCI983QA
General Information: Fees:
#Forced Air Furnace> 100K 1 Mechanical Permit Fees 41.70
Total Calculated: 41.70
Deposits/Receipts: 41.70
Total Due: 0.00
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 OF ANY OTHER STATE OR
LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSUED BY
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Permits and Insp... - BLD-2019-0437 - 2019 � za
019267-0003 Carla Br... 07/12/2019 10:57AM �'' m -` 0
6033 - FOSS HEATING AND COOLING � °
BLD-2019-0437 Mechanical Permit w = w 0
Payment Amount: 41.70 o Z tel 0
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Transaction Amount: 41 .70 -
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PLANNING,COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT
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4 0 ,• ,'e- PLUMBING 8, MECHANICAL PERMIT APPLICATION
:174 16104 Mailing Address:P.O. Box 547,Anacortes, WA 98221 7 1 Office Location: 904 661 Street,Anacortes WA 98821
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Phone: (360)293-1901, Fax: (360)293-1938
PLEASE REFER TO THE PLUMBING&MECHANICAL PERMIT CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS(Street,Suite#): Parcel(s)#:
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7Z.OW A...-.1.1 70v.A.--> trici,
Subdivision/Lot#:
Residential FC Commercial D
APPLICANT: ... i /- Phone: Fax:
Address;Street,City,State,Zip): `I 'ci 1-2_73 E-Mail Address: ,
3 VA0,-e,(c 6,,,,,,, (4,1 A-1-.V64,.., ci)-1-. 62("ae-irs Q Fc'S, -k-t-(-tht4
PROPERTY OWNER: Phone: Fax:
Address(Street,City,State,Zip): E-Mail Address:
pro)cc..:--4- re<C4--t-v t.s.k -0 44,c-L;r,c
CONTACT PERSON: ' Phone: 4' Fax:
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Address(Street,City,State,Zip): E-Mail Address:
CON IRACTOR:* Phone: Fax:
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Address(Street,City,State,Zip): E-Mail Address
Contractor's License# Exp.Date:
*All Contractors&subcontractors must have a valid City of F.5-5 t-Fc-p civ 4,4- t(- ( - 7-0
Anacortes business license prior to doing work in the City. Business License#: Exp.Date:
Contact the City's Finance Department at(360)299-1968. ;)( 7-( -. - (7
Is this work,associated with another project? Yes 0 No 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 ofAnacortes.
Print Name: i'((-77 (ck 4,,b-c.A.A...c_c-- Owner 0 Agent W(specify): C.,-ctrat
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Signature: ,-91--- '/ .'1€.--------- Date: 7- g---r-,.._ , i
MECHANICAL:
Equipment Type: Appliance/Equipment Information (new and relocated): Total #:
Furnace: Gas# i Elec #._Other: # BTUs: <l.00k_>100k_Location(s)
Wall Heater: Gas #_Elec#_,Other: # BTUs: <100k>100k_Location(s)
Air Handler: Gas # Elec 11 Other: # BTUs: <100k>100k__Location(s)
Water Heater: Gas # Elec # Other: # BTUs: <100k>100k Location(s)
AC Unit/Boiler /
Heat Pump I Roof Gas # Elec # Other: #. BTUs: <100k, 1.O0k-500k, 500k-
Top Unit:(Circle 1 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: 1
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 ID
Water Heater Tanlcless? Yes ❑ No ❑ Grease :Interceptor:
Floor Drain.! Floor Sink: Water Piping:
Refrigerator water supply (for water/ice
dispenser): ®then.::.
TOTAL OUTLETS: TOTAL OUTLETS: