HomeMy WebLinkAboutPermit File BLD-2021-0339 3902 Rock Ridge Parkway Y
Cityof Anacortes BLD-2021-0339
Invoice/Permit #: BLD 2021 0339
904 6th Street
Applied date: 05/03/2021
P.O.Box 547 Issue date: 0 12 s _ 5/03 021
ti 0; Anacortes, WA 98221-0547
z (360) 293-1901 Expire date: 10/30/2022
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Job Address: 3902 ROCK RIDGE PKWY Permit Type: Mechanical Permit
ANACORTES WA 98221-4515 Project:
APN: P125844
Remarks: INSTALLA GAS LINE FORA GENERATOR.
Owner: GARY & BONNIE DEWITT Contractor: ARLINGTON ELECTRIC INC
Address: 3902 ROCK RIDGE PKWY Address: 13310 240TH ST NE
ANACORTES WA 98221-4515 ARLINGTON WA 98223-4818
Phone: (360) 202-8709 Phone: (360) 403-0515
License #:
General Information: Fees:
# of Gas Piping 1 Mechanical Permit Fees 28.25
Total Calculated: 28.25
Deposits/Receipts: 0.00
Total Due: 28.25
The issuance or granting of this permit shall not be construed to be a permit for, or approval of, any violation of this Code or any other ordinance or order of
the City, of any state or federal law, or of any order, proclamation, guidance advice or decision of the Governor of this State. To the extent the issuance or
granting of this permit is interpreted to allow construction activity during any period of time when such construction is prohibited or restricted by any state or
federal law, or order, proclamation, guidance advice or decision of the Governor of this State, this permit shall not authorize such work and shall not be
valid. The building official is authorized to prevent occupancy or use of a structure where in violation of this Code, any other City ordinances of this
jurisdiction or any other ordinance or executive order of the City, or of any state or federal law, or of any order, proclamation, guidance advice or decision of
the Governor. The building official is authorized to suspend or revoke this permit if it is determined to be issued in error or on the basis of incorrect,
inaccurate or incomplete information, or in violation of any City ordinance, regulation or order, state or federal law, or any order, proclamation, guidance or
decision of the Governor. This permit becomes null and void if work or construction authorized is not commenced within 180 days or if construction work is
suspended or abandoned for a period of 180 days at any time after work is commenced. I have read and exa '--•"this application and know the same to
be true and correct.
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SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSUE► •
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Gt T PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT
PLUMBING & MECHANICAL PERMIT APPLICATION
w Mailing Address:P.O. Box 547, Anacortes, WA 98221
' coR Office Location: 904 61 Street, Anacortes WA 98821
Phone: (360) 293-1901
PLEASE REFER TO THE PLUMBING&MECHANICAL PERMIT CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS(Street,Suite#): PAR CEL(S)#: PROJECT VALUATION:
10a (� e, -e f j SBL/LI
Sub�ivision/Lot#: RESIDENTIAL Qk COMMERCIAL 0
APPLICANT: Phone:
(W fvl_ , ag 07W c 1nlc. o VQ30 ) 5
y
Address(Street,City,State Zip): / Email Address:
10 t�31 o dt- "1 34-N7 M i 1�+-� a,1(1,lnc e eJ 0 info .<;
PROPERTY OWNER: Phone:
Ga ,�) �3too dot) P709
Address(Street,C , State Zip): Email Address:
�39Da e,c ( `av9 v j,cro1 S 1,4e.K7;-a rZ la, c1P,1A)A4,C;c v,
CONTACT PERSON; J Phone:
eAASs 7 Jv1{-. 300 (10 651S
Address(Street,City,State,Zip): Email Address:
1, -31Q) y Dn\`S N AA 1 i w44 mod,?3 ci,IC vo el ch-4`uD rrtsn ,(, yv-)
CONTRACTOR:* Phone:
1 q Iec ivi, lic . 31aC L-!D3 D j
Address(Street,City,State,Zip): Email Address:
13.310 a1ID S-) rv( A,Il. * iA- 98 a,)- a u ,Pkcii`_C Wkcyi C 111
*All Contractors&subcontractors must have a valid City of Profession License#: Exp.Date:
Anacortes business license prior to doing work in the City. s AvAd N + a�`�
Contact the City's Finance Department at(360)299-1968. Business License#: Exp.Date:
Is this work,associated with another project? Yes 0 No' If yes,specify:
PROPOSED WORK: .e, iv-cdw- /r'1,('�c.,,.11
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 lAjnacortes.
Print Name: ceil! 7a Owner 4 Agent (%.(specify):( 1-yekdr:71-
Signature: is ? Date: Y'-24--2/
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): i
Boiler: Gas#: Elec#: BTUs: Location(s):
Other: ee,y6-4j,-F7 #: 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 ❑ Wall ❑ Grease Interceptor:
Other: Other:
TOTAL PLUMBING FIXTURES: