HomeMy WebLinkAboutPermit File 4304 Queen Ann Way 1.
oy.e Residential Building Permit Application
". Building Department
'�f'" w P.O. Box 547 Anacortes, WA 98221
4aoss Phone No.: 360-293-1901 FAX: 360.293.1938
SITE ADDRESS: 4130 c ( 0 _,P o �1 ,iNto
CONTRACTOR _ , App ' ant. PR T D SCRIPTION ', 1
Name ��r \ C)c J�S� - t..,� '� 1 C C�
AddresV 70�7 PO-Ceti
T7� "
City/State/Zip I—/O-C f l
l�A .
Phone?c —C—5 7�FAX
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State License# 4.� 2lekt?f Exp..,�//6/O/q
PARCEL NUMBER
City of Anacortes License
PROPER (�VY�N/EJ$_ ❑Applicant LEGAL DESCRIPTION" ,
Name V 1 c ex.-E?v\ - —
Address tl30CI (204240.4, AA .
City/State/Zip ,N " °g) PROJECT VALUATIG c—
Phone FAX ''�
Number of Dwelling Units
E-Mail Address Number of Stories
J Building Area:
❑"Architect 0 Designer D'Engineer D'Applicsnt 1'Floor s.f. 2nd Floor s.f.
Name V 3`d Floor s.f. Basement s.f.
Address Garage s.f. Carport s.f.
City/Sta,,, Zip'' I ----' Deck s.f. Lot Area s.f.
Phone FAX
E-mail Address
:CO . . AC "Applicant LENDER
LA'` �� LENDER INFORMATION MUST BE PROVIDED FOR PROJECTS OVER$5,000
Name IN VALUATION PER RCW.
Address Name
I
City/State/Zip Address
Phone T 1??._ ?32 FAX City/State/Zip
E-mail Address Phone No.
CONTINUED ON THE BACK
Residential Mechanical Fixtures
Fuel Type
❑ Natural Gas ❑ Electric ❑ Wood ❑ Propane Gas ❑ Other
Type of Equipment Number of Type of Equipment Number of
Fixtures Fixtures
Furnace<=100K BTU Clothes Dryer
Boilers/AC/Heat Pump Gas Water Heater
Gas Outlets Gas Fireplace
Ventilation Fans Fireplace Insert
Stove,Appliance Other Units
Range Hood
Residential Plumbing Fixtures
Type of Fixture Number of Type of Fixture Number of
Fixtures Fixtures
Toilet Clothes Washer
Bathtub Electric Water Heater
Shower Utility Sink
Dishwasher Hose Bibb
Hand Sink Water Piping
Kitchen Sink w/Disposal Additional Fixtures
I HERE AC " WLEDGE IF HAVE READ THIS PERMIT APPLICANT AND STATE THE INFORMATION IS CORRECT,AND AGREE TO COMPLY
WITH LL CIT ORDINANCES STATE LAWS REGULATING ACITIV IES COVERED BY THIS PERMIT APPLICATION. WITH THIS PERMrI ALL
CONTRACT° AND CONT ORS SHALL HAVE A CURRENT WASHINGTON STATE CONTRACTORS LICENSE AND A CITY BUSINESS
LIC NSE. TOP WO E WILL BE ISSUED ON JOB SITES WHERE CONT CTORS/SUBCONTRACTORS ARE WORKING WITHOUT
PR ER SE
A J ANT'S SIGNATURE DATE
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. e‘cA a4,� N
.. �IIOFFiNON1L41/4
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WrluNlTt CERTIFIED 'd
" II1511 I8110n
JK, aA Conlld Clof .,
t s "1yEM�E„45 ._ contractor services' 2-1 A ' ,
a MASCO Company /�' �1�
P.O. Box 225 • Marysville,WA 98270
Marysville(360)659-7674•Bellingham(360)676-9969•Seattle(206)622-5185
Tacoma(800)657-1122
Installed Insulation Certificate
- - • 'We certify visulafoh material listed herein meeting applicable federal,state and lojal
specifications has been installed at the following residence surro conditioned space.
R FACTOR AREA TYPE ,e.. .INCHES/BAGS (BLOWN)
R-38 SCISSOR TRUSS BLOW / CT SYSTEM 5 $LOW 15 . 25 1 % t48AO -
R--38 ATTIC / CT SYSTEM 5 BLOW / 15 . " S /�1{)}
R-21EXTERIOR WALLS / FG' BATTS I + / •
/
R 36 ' UNOERFL00R / FG BATT
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n 1405 QUEEN,; ANN ,WAY ANACORTES a
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Y - s, „p % Address r Lot umber 'I
Title Office Manager ' 03/24/04 Phase
I 1 Date Installed r -.!I
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