HomeMy WebLinkAboutPermit File BLD-2021-0768 3915 Copper PondPLANNING, COMMUNITY, &ECONOMIC DEVF,LOPMENT DEPARTMENT
PLUMBING A MECHANICAL PERMIT APPLICATION
Mailing Address: P.O. Box 547, Anacortes, WA 98221
Office Location: 904 f �' Street, Anacortes WA 98821
Phone: (360) 293-1901
PLEASE REFER TO THE PLUMBING &MECHANICAL PERMIT CHECKLIST FOR SUB1l�lITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #):
PARCEL(S) #:
PROJECT VALUATION:
��
Subdivision/L t #:
RESIDENTIAL
CONIII�ERCIAL ❑
APPI.ICANThe pl ' 6
1
Phone:
_ r
.., W
''Address (Street, City, State, Zi • '
a
Email Address:
PROPERTY OWNER:
Phone:
-S -16
A Sress (Street, City�State, Zi ): ' -h
1
Entail Address:
CONTAC ERSON:
n�o
Phone:
Address (Street, City, State, Zip):
Email Address:
�S �
CONTRAC •*
� I+�+�►b;
Phone:
- 9 �
Address (Street, City, State, Zip :
is 2- 9
Email Address:
*All Contractors &subcontractors must have a valid City of
Anacortes business license prior to doing work in t{re City.
Contact the City's Finance Department ut (36D) 299-19d$,.
Professional License #:
Al 9 J
Exp. Date:
Business License #:
Exp. bate:
` I
Is this work, associated with another project? Yes
❑ No PJ If yes, slsecify:
PRO. , �`�POSED WORK:
o�.S Wa�P.C'_�__
I declare under penalty of perjury that the information
I have provided on this formlapplication is true, correct, and
complete, and that I am the property owner or duly authorized
agent of the property owner t submit a permit
application to the City of Anacortes.
Print Name: �tn.S}��n }iP,Si��
_Owner ❑Agent
(specify):
Signature: ,�_���,
Date: ¢-+ ��—'�`
City of Anacortes
904 6th Street
P.O.Box 547
Anacortes, WA 98221-0547
(360) 293-1901
Job Address: 3915 COPPER POND
ANACORTES WA 98221-1150
APN: P108222
Remarks: Replace gas W/H Like for like
Permit Type
Project:
Invoice/Permit #: BLD-2021-0768
Applied date:
Issue date:
Expire date:
Mechanical Permit
09/13/2021
09/1312021
03/12/2023
Owner: DARNTON JOHN C Contractor: THE PLUMBING GUYS INC.
Address: 3915 COPPER POND Address: 2901 TAVE
STE 2
ANACORTES WA 98221-1150 ANACORTES WA 98221-2898
Phone: Phone: (360) 293-1878
License #: PLUMBG1961 NJ
General Information: Fees:
IF of Gas Water Heaters <= 100k 1 Mechanical Permit Fees
Total Calculated:
Deposits/Receipts:
Total Due:
38.20
38.20
0.00
38.20
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 examined this application and know the same to
be true and correct.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
ISSUED BY