HomeMy WebLinkAboutPermit File BLD-2019-0784 4814 Harbor View Place C3 City of Anacortes Invoice/Permit#: BLD-2019-0784
904 6th Street
>,' Applied date: 12/02/2019
`''■ P.O.Box 547
Issue date: 12/02/2019
Anacortes, WA 98221-0547
Expire date: 05/30/2021
etk (360) 293-1901
Job Address: 4814 HARBOR VIEW PL Permit Type: Mechanical Permit
ANACORTES WA 98221-4087 Project:
APN: P105267
Remarks: Replace furnace boiler.
Owner: JAMES GRANVILLE REVOCABLE TRUST Contractor:
Address: 3852 BRONCO HOLLOW LN Address:
MARIPOSA CA 95338
Phone: Phone:
License#:
General Information: Fees:
# Forced Air Furnace<=100k 1 Mechanical Permit Fees 65.45
#of Boilers> 100,000 BTU 1 Total Calculated: 65.45
Deposits/Receipts: 0.00
Total Due: 65.45
•
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 PR VI-St NS OF ANY OTHER STATE OR
LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
SIGI ATURt OF N OR AUTHORIZED AGENT IS E
Permits and Insp... - BLD-2019-0784 - 2019
019484-0050 Carla Br... 12/02/2019 10:07AM
12576 - JAMES GRANVILLE REVOCABLE TRU...
BLD-2019-0784 Mechanical Permit
Payment Amount: 65.45
Transaction Amount: 65.45
CHECK: 011461
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PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT, EPARTMENT
Ali1A69JKTEPLUMBING & MECHANICAL PERMIT APPLICAtIONAt
\� � Mailing Address: P.O. Box 547, Anacortes, WA 98221 rks
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:
ti 11LAfb dr VIA)
Subdivision/Lot#: RESIDENTIAL ❑ COMMERCIAL ❑
APPLICANT: Phone:
Lear G-rak v t 1 667 . 'c7/ -347/3
Address(Street,City, State,Zip): Email Address:
apt er,`c a, di-air/At 3£C'b4(cet St- .1-
PROPERTY OWNER: Phone:
G•�-ear 40AV i l C 5Ce4k.6
Address(Street,City,State,Zip): Email Address:
CONTACT PERSON: Phone:
C--€and et
Address(Street,City, State,Zip): Email Address:
CONTRACTOR:* Phone:
Address(Street,City, State,Zip): Email Address:
*All Contractors&subcontractors must have a valid City of Professional License#: Exp.Date:
Anacortes business license prior to doing work in the City. l �` j—
Business License#: Exp.
Date:
Contact the City's Finance Department at(360)299-1968.
Is this work,associated with another project? Yes ❑ No'l I If yes,specify:
PROPOSED WORK: H 4-
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: Owner D Agent ❑ (specify):
Signature: Date:
MECHANICAL:
Equipment Type: Appliance/Equipment Information(new and relocated): Total#:
Furnace: Gas#: r✓a/w. Elec#: Other#: Location(s): e
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#: 8,0;t6 Elec#: Other:#: Location(s): .A,
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 ❑
Dishwasher: Backflow Prevention Device:
Urinal: Hose Bib:
Floor Drain/Floor Sink: Drinking Fountain:
Hydronic Heat in: Floor 0 Wall ❑ Grease Interceptor:
Other: Other:
TOTAL PLUMBING FIXTURES: