HomeMy WebLinkAboutPermit File BLD-2019-0783 720 37th Street O . City of Anacortes Invoice/Permit#: BLD-2019-0783
904 6th Street
Applied date: 12/02/2019
P.O.Box 547
Issue date: 12/02/2019
<'�y 0;� Anacortes, WA 98221-0547
Expire date: 05/30/2021
(360) 293-1901
Job Address: 720 37TH ST Permit Type: Plumbing Permit
ANACORTES WA 98221-3462 Project:
APN: P56668
Remarks: Install an irrigation system and backflow device. THIS PERMIT IS NOT VALID UNTIL THE ENCROACHMENT
AGREEMENT HAS BEEN APPROVED.
Owner: VERRALL ROBERT L Contractor: GONZALES LANDSCAPING/MAINT LLC
Address: 720 37TH ST Address: 6973 STATE ROUTE 20
ANACORTES WA 98221-3462 ANACORTES WA 98221-8612
Phone: Phone:
License#:
General Information: Fees:
#of Backflow Devices 1 Plumbing Permit Fee 34.00
#of Water Piping 1 Total Calculated: 34.00
Deposits/Receipts: 0.00
Total Due: 34.00
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 SP CIFIED HEREIN OR NOT, THE
GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROV SIO S OF ANY OTHER STATE OR
LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
SIGNATURE OF OWNER OR AUTHORIZED AGENT ISS
Permits and Insp... - BLD-2019-0783 - 2019
019484-0008 Carla Br... 12/02/2019 08:42AM
12092 - GONZALES LANDSCAPING/MAINT LLC
BLD-2019-0783 Plumbing Permit
Payment Amount: 34.00
Transaction Amount: 34.00
03FINDEBIT: *'."A ,-r-,:*8922
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Y PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT
1 ,�.•w� PLUMBING & MECHANICAL PERMIT APPLICATION
%. Mailing Address: P.O. Box 547, Anacortes, WA 98221
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: j
-7;0 7- 6f rh i30,9
Subdivision/Lot#: RESIDENTIAL ❑ COMIVIERCIAL ❑
APPLICANT: Phone:
360 3 / 3v ,e
Address(Street,City, State,Zip): Email Address:
1 a 3 T As 4,4/v/gLorr &,4 `'-
PROPERTY OWNER: Phone:
UGL/i✓AR r
Address(Street,City, State,Zip): Email Address:
CONTNCT PERSON: Phone:
Address(Street,City, State,Zip): Email Address:
CO TRACJOR:* Phone:
h� i21.EleL / Nt?14Npt
ddress(Street,City, State,Zip). Email Address:
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*All Contractors&subcontractors must have a valid City of Professional License#: Exp.Date:
Anacortes business license prior to doing work in the City. Business License#: Exp.Date:
Contact the City's Finance Department at(360)299-1968.
Is this work, associated with another project? Yes ❑ No ❑ If yes,specify:
PROPOSED WORK: H-7'9 25;,✓
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 Ci of Anacortes.
Print Name: S( , k 6 0/7 ,"L-- Owner 12/Agent ❑ (specify):
Signature:4; I ti dY7pK _ C>r,i?4,,,,_ Date:
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:
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 0 Wall ❑ Grease Interceptor:
Other: Other:
TOTAL PLUMBING FIXTURES: