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City of Anacortes
Invoice/Permit #: BLD-2022-0774
904 6th Street
Applied date: 09/29/2022
P.O.Box 547
Issue date: 09/29/2022
_� t►� : Anacortes, WA 98221-0547
Expire date: 03/27/2024
(360) 293-1901
Job Address: 1419 30TH ST
Permit Type:
Mechanical Permit
ANACORTES WA98221-3821
Project:
APN: P57284
Remarks: Moved meter 6'.
Owner: JULIE MARQUEZ
Contractor:
Address: 3607 W 6TH ST
Address:
ANACORTES WA 98221-1233
Phone: (425) 350-4678
Phone:
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 examined this application and know the same to
be true and correct.
t
SIGNATURE OF OWNER OR AUTHORIZED AGENT
ISSUED BY
�'v YPLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
Mailing Address: P.O. Box 547, Anacortes, WA 98221
Office Location: 904 6t" Street Anacortes WA 98821
Phone: (360) 293-1901
PLUMBING 87- MECHANICAL PERMIT APPLICATION
Please complete all applicable information and submit to buildinlzpervnit(@citvofanacortp.s_nru
PROPERTY INFORMATION
PROJECT ADDRESS
ClI 30f h &-fTe e
ASSESSORS PARCEL
NUMBER
PROJECT VALUATION
RESIDENTIAL
COMMERCIAL
PROPERTY OWNER
J W L i N1 R (A'�� C �
OWNER P ONE
(�I Z1-) 0
V7 �
OWNER ADDRESS
PO �)0 102 1AVIWA �118Z73
OWNER EMAIL
APPLICANT INFORMATION
f�qPROPERTY
OWNER CONTRACTOR OTHER:
NAME
PHONE
ADDRESS
EMAIL
CONTRACTOR INFORMATION
NAME
PHONE
CONTRACTOR'S BUSINESS LICENSES*
*All Contractors & Subcontractors must have a valid
City of Anacortes business license prior to doing work
in the City.
STATE LICENSE #
EXPIRATION
UBI LICENSE #
EXPIRATION
ADDRESS (STREET, CITY, STATE, ZIP)
EMAIL
PROJECT INFORMATION
DESCRIPTION OF PROPOSED WORK:
�1C�frr�
WAS S�ci�
d
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT?
If YES, provide the permit/application number:
] YESNO
Plumbing/Mechanical Permit Application
Updated December 2021
Page 1 of 3
MECHANICAL
EQUIPMENT TYPE
APPLIANCE/EQUIPMENT INFORMATION (NEW AND RELOCATED)
Indicate the number of fixtures for each equipment type
TOTAL
GAS
ELECTRIC
OTHER - Please specify
COMMENT
Furnace
Wall Heater
Water Heater
Heat Pump
Air Conditioner /Handler
Radiant /Hydronic Heating
Exhaust Fans
Range Flood
Fireplace
Clothes Dryer & Duct
Stove/Range/Oven
Refrigeration Unit
Gas Piping/ Outlet(s)
Boiler
BTUs:
Other
TOTAL MECHANICAL
OUTLETS
PLUMBING FIXTURE
FIXTURE TYPE (NEW AND
RELOCATED)
TOTAL
FIXTURE TYPE (NEW AND RELOCATED)
TOTAL
Toilets
Refrigerator water supply
Kitchen Sink
Pressure Reduction Valve/ Regulator
Utility Sink
Water Service Line
Tub
Water Piping
Hand Sink
Washing Machine
Shower
Electric Water Heater: Tank -less? Yes ❑
No
Dishwasher
Backflow Prevention Device
Urinal
Hose Bib
Floor Drain / Floor Sink
Drinking Fountain
Hydronic Heat in: ®Floor
['+Nall
Grease Interceptor
Other - please specify:
TOTAL PLUMBING FIXTURES
Plumbing/Mechanical Permit Application
Updated December 2021 Page 2 of 3
PLUMBING & MECHANICAL PERMIT APPLICATION CHECKLIST
COMMERCIAL
RESIDENTIAL
0
SUBMITTAL REQUIREMENTS
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Plumbing & Mechanical Permit Application
✓
✓
�'
✓
Mechanical Plans
✓
Structural Calculations
✓
State Non -Residential Energy Code Compliance Form
✓
Manufacturer's Specifications /Cut Sheets
✓
✓
✓
Plumbing Plans
✓
Listed & Tested Fire Stopping Assemblies
✓
Elevation View for Roof Mounted Equipment
✓
✓
Existing Floor Plan
✓
✓
�/
a/
New Floor Plan
V/
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NOTE:
1. Handouts and standard details may be found on the City's Planning, Community, & Economic
Development website or can be obtained at city hall during normal business hours.
2. Plans, calculation, & reports prepared by state licensed architects or professional engineers must
be stamped and signed by the design professional.
3. If installing a backflow prevention device, it will need to pass test results of which will need to be
submitted to the city for review.
ACKNOWLEDGEMENTS & SIGNATURE
By affixing my signature hereto, I certify that I am the owner, or am acting as the Owner's authorized
agent, and that the application and documents contained with this submittal are complete and
accurate to the best of my knowledge and abilities.
k) 0" L 61 2
SI , N URE DAT
Plumbing/Mechanical Permit Application
Updated December 2021 Page 3 of 3