HomeMy WebLinkAboutPermit File BLD-2021-0606 1606 12th Street •
__ - ' Cityof Anacortes
Invoice/Permit #: BLD-2021-0606
904 6th Street
Applied date: 07/20/2021
4._ P.O.Box 547 Issue date: 07/20/2021
Anacortes, WA 98221-0547 Expire date: 01/16/2023
1891 �,,_
(360) 293-1901
Job Address: 1606 12TH ST Permit Type: Mechanical Permit
ANACORTES WA 98221-2113 Project:
APN: P58002
Remarks: REPLACE GAS FURNACE FOR THE SAME.
Owner: KORBY M NIHART Contractor: FOSS HEATING AND COOLING
Address: 1606 12TH ST Address: 333 E BLACKBURN RD
ANACORTES WA 98221-2113 MOUNT VERNON WA 98273-9006
Phone: (425) 422-8973 Phone: (360) 336-1517
License #:
General Information: Fees:
# Forced Air Furnace <=100k 1 Mechanical Permit Fees 38.30
Total Calculated: 38.30
Deposits/Receipts: 0.00
Total Due: 38.30
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 e fined thi application and know the same to
be true and correct.
SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSUED BY
(N'V Y ry,, PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT
PLUMBING & MECHANICAL PERMIT APPLICATION
1 ��' ►�`' Mailing Address:P.O. Box 547, Anacortes, WA 98221
-, 00V.- Office Location: 904 6th Street, Anacortes WA 98821
Phone: (360) 293-1901
PLEASE REFER TO THE PLUMBING&MECHANICAL PERMIT CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRI $S(Street,Suite#): PARCEL(S)#: PROAECT VALUATION:
Subdivision/Lot#:
RESIDENTIAL lie- COMMERCIAL 0
APPLICANT: Phone:
FOSS: Nr-..ir/4 .qa'p CO's/,v (366)33. / /7
Address(Street, City,State,Zip): _ Email Address:
.3.3.E El. $t..RLte5v1r� '4 S r'f 4 A .i ve,f 4vv iis�f ` $z73 oralei^ a 10s 4 eof 2, c cr 1i
PROPERTY OWNER: 7 Phone:
IKORe/ .Nu/'4 j--- (1125) 11'22— gy73
Address(Street, City, State,Zip): Email Address:
I6O6 Ili r, AV4crat;rf WA yg.z2/ kor� , esei9ice @ C.001c.� S17, elef
CONTACT PERSON: /Q
.
Phone:
ANC, US5CL c. 066 3. 6•-1.517
Address(Street,City, State,Zip): Email Address:
333 E: CLkv,RietA/4,O, si A MT V1`ie zi, t Y 7,� 0±-cie n� �--Boss 1)ec:i iv y.- Cori CONTRACTOR:* / Phone:
5 ,!r A Pik,CAW
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. sines s License cir # i ilia
Contact the City's Finance Department at(360)299-1968. Business #: Exp.Date:
6o2 236 e:9t 7/3a-.2 j
Is this work,associated with another project? Yes 0 No 1-11. If yes, specify:
PROPOSED WORK: RE2 ct= ! ern v44c- wir,y L./till I.4' i�i,v,d
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: 41//),.et_=iV ,.J r IVS517,L. Owner 0 Agent g(specify): T 6Ss Ffi yrl,,1/6
Signature:
Date: 7720j2_1
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 ❑ Wall ❑ Grease Interceptor:
Other: Other:
a!
ir
TOTAL PLUMBING FIXTURES: