HomeMy WebLinkAboutPermit File 2316 12th Street (2) •S '
-',.._'-.A.' Y 0;. . City of Anacortes Invoice/Permit#: BLD-2018-0637
. 904 6th Street
Applied date: 10/10/2018
`"■ P.O.Box 547
Issue date: 10/10/2018
r fib;' Anacortes, WA 98221-0547
; Expire date: 04/07/2020
x~ (360) 293-1901
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Job Address: 2316 12TH ST Permit Type: Mechanical Permit
ANACORTES WA 98221-2014 Project:
APN: P56370
Remarks: Replace gas furnace with a like, in kind
Owner: SEAN NORONHA Contractor: FOSS HEATING AND COOLING
Address: 2316 12TH ST Address: 333 E BLACKBURN RD
ANACORTES WA 98221-2014 MOUNT VERNON WA 98273-9006
Phone: (937) 218-1932 Phone: (360) 336-1517
License#: FOSSHCI983QA
General Information: Fees:
# Forced Air Furnace<=1,000 1 Mechanical Permit Fees 38.30
Total Calculated: 38.30
Deposits/Receipts: 0.00
Total Due: 38.30
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THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIQ180 DA`..S, O8€ re
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK l:5! COMMqc449
HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL PRbVTSION8-
OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR MI,r ht `
GRANTING OF A PERMIT D ES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER T} is '
LOCAL LAW REGULATING CO _TRU.C. ION OR THE PERFQRMANCE OF CONSTRUCTION. -') CO 1
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SfiNATURE OF OWNER OR UTHORI D AGENT IS ED B '-.1 '
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PLANNING COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
�', "' PLUMBING & MECHANICAL PERMIT APPLICATION
" ,; ;.;. Mailing Address: P.O. Box. 547, Anacortes, WA 98221
1 ar, ' Once Location: 904 6111 Street., Anacortes WA 98821 '
Phone: (360) 293-1901, Fax: (360) 293-1938
PLEASE REFER TO THE PLUMBING & MECHANICAL PERMIT CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #): . Parcel(s) #:
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Subdivision/Lot#: r
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APPLICANT: r Phone: Fax:
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Address Stree City, State,.Zip): /-c.± Vc v o►-1 E-MailAddress:
'3�3 i cv -�.‘C`0 id,r (I A cr.t- `11 l 3 alCX �'' � Lam ., --/1 ,> - ,
PROPERTY OWNER: Phone: Fax:
`j-6,c rr Alb C - �t-L c-- d C 3 7 2- E 8 t`f
Address (Street, City, State, Zip): Al, 4 E-Mail Address:
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CONTACT:PERSON: ( Phone: Fax: ✓
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Address (Street, City, State,.Zip): E-Mail Address:
CONTRACTOR:* Phone: Fax:
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Address (Street, City, State, Zip): E-Mail Address
Contractor's License
Exp. . ate:
*All Contractors & subcontractors must have a valid City of -�.5.� �c ( f
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Anacortes business license prior to doing work in the Citta. Business License#: Exp. ate:
Contact the City's Finance Department at(360) 299-1968. r 07 t ( I / / 17
Is this work, associated with another project? Yes 0 No 10 If yes, specify:
PROPOSED WORK:
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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 A acortes.
Print Name: V L., jn.G^e-% Owner t3,.A en (specify): c v t- Lc ck
Signature: L �- Date: t o. ci (I
MECHANICAL:
Equipment Type: Appliance/Equipment Information (new and relocated): Total #:
Furnace: Gas # lElec #_Other: #61 BTUs: <100k_>I00k_Location(s)
Wall Heater: Gas #_Elec # Other.: # BTUs: <1 O0k>100k___Location(s)
Air Handler: Gas #_Elec #_Other: # BTUs: <100k>l 00k_Location(s)
Water Heater: Gas # Elec # Other: # BTUs: <100k>100k Location(s)
AC Unit / Boiler /
Heat Pump / Roof Gas # Elec #_Other: # BTUs: <100k, 100k-500k, 500k-
Top Unit (Circle 1.Mil HP:, <.3, 3-15,_15-30 Location(s)
selected):
Hydronic Heating: Gas # Elec #_In-FloorWal.l Radiant`Boiler BTUs: Location
Exhaust Fans Bath# Kitchen # Laundry # Other: #
(single duct):
Fireplace /Insert: Gas # Elec #_Other: # Location(s)
Stove/Range/Oven: Gas #_Elec#_Other:__# Location(s)
Range Hood: # Location(s)
Refrigeration Unit: Gas #_Elec. # Other.:_# Location(s)
Outdoor BBQ: Gas # Elec # Other:_# Location(s)
Clothes Dryer&Duct: Gas #_Elec.#_Other.:_# Location(s)
Gas Piping: # Location(s)
Other: # Location(s)
# Location(s)
TOTAL OUTLETS:
PLUMBING FIXTURES:
Fixture Type (new and relocated): Total #: Fixture Type (new and relocated): Total #:
Water Closet (Toilet): Pressure Reduction Valve/Pressure Regulator:
Urinal: Backflow Prevention Device:
Sink (kitchen, laundry, lavatory, hand, bar, slop,
Water Service Line:
eye wash, etc.):
Tub/Shower: Drinking Fountain:
Dishwasher: Clothes Washer: F
Hose Bib: Hydronic Heat in: Floor El Wall ❑
Water Heater Tankiess? Yes ❑ No D Grease interceptor:
Floor Drain /Floor Sink: Water Piping: