HomeMy WebLinkAboutBLD-2019-0670 - PLUMBING AND ELECTRIC WATER ` . 0 City of Anacortes Invoice/Permit#: BLD-2019-0670
904 6th Street
Applied date: 10/11/2019
P.O.Box 547 Issue date: 10/11/2019
' Anacortes, WA 98221-0547
(360) 293 1901 Expire date: 04/08/2021
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Job Address: 116 O AVE Permit Type: Plumbing Permit
ANACORTES WA 98221 Project:
APN:
Remarks: Replace existing water serice.
Owner: PACIFIC DREAM SEAFOODS Contractor: QUANTUM CONSTRUCTION INC
Address: 116 O AVE Address: 12761 QUANTUM LN
ANACORTES WA 98221 ANACORTES WA 98221-8364
Phone: Phone: (360)293-0656
License#:
General Information: Fees:
#of Other Fixtures 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 OF ANY OTHER STATE OR
LOCAL LAW REGULAT G CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
i2y�s‘SIGNA RE OF OWNER R AUTHORIZED AGENT ISSUE
Permits and Insp... - BLD-2019-0670 - 2019
019411-0027 Carla Br... 1 011 1/201 9 02:22PM
10779 - QUANTUM CONSTRUCTION INC
BLD-2019-0670 Plumbing Permit
Payment Amount: 27.00
Transaction Amount: 47.00
CHECK: 073167
ACT 112019
PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT
PLUMBING & MECHANICAL PERMIT APPLICATION
k7'� �h Mailing Address:P.O. Box 547, Anacortes, WA 98221
eon 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:
9l °WC
P55-A Toov.,00
Subdivision/Lot#:
RESIDENTIAL ❑ COMMERCIAL R(
APPLICANT: Phone:
Q00..A.i Can -rvt_A►on .113 06S6
Address(Street,City, State,Zip): Email Address;
a.-76 i L)�.,,�-, YN, 1`1 111--e.-lo (�') G)c."140MG-i; . c.uw1
PROPER Y 0 R: Phone:
4C-'Cr C_ P(CA141 Si �d tt2'/J , a13 s D
Address Street,City,State,Zip): AAA-toe/6
Address:
U�16 "0' a
CONTACT PERSON: Phone:
m;Le cvtoL/n, 213 —0 656
Address(Street,City, State,Zip): Email Address:
CONTRACTOR:* Phone:
Address(Street,City,State,Zip): Email Address:
* Professional License#: Exp. Date:
All Contractors& subcontractors must have a valid City of 4�4ni'cn l66 p F o2 Anacortes business license prior to doing work in the City. Business License#: Exp.Date:
Contact the City's Finance Department at(360)299-1968. 6 00 S/S 117$ , ,z, 1420
Is this work,associated with another project? Yes,nc, No 0 If yes, specify:
PROPOSED WORK: ['tit9 i 41.4-e_ Q,p1-4- t)ii LAJa ,fir- S oevc_,e
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: ti, I j—/ r 9 Owner ❑ Agent Xspecify):
Signature: gi/44 (
Date: iQ I /l 117
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):
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: Q
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:
TOTAL PLUMBiNG FIXTURES