HomeMy WebLinkAboutPermit File BLD-2023-0317 2110 Creekside Lane (2) City of Anacortes Invoice/Permit#: BLD-2023-0317
904 6th Street Applied date: 05/18/2023
P.O.Box 547 Issue date: 0 5/1 812 0 2 3
07:. Anacortes, WA 98221-0547 Expire date: 11113/2024
�w (360) 293-1901
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Job Address: 2110 CREEKSIDE LN Permit Type: Mechanical Permit
ANACORTES WA 98221-2400 Project:
APN: P83766
Remarks: Install A/C
Owner: PAULA EISENSTEIN Contractor: RONK BROS INC
Address: 2110 CREEKSIDE LN Address: 210 NORTHERN AVE
ANACORTES WA 98221-2400 SEDRO-WOOLLEY WA 98284-1453
Phone: (503) 314-0884 Phone: (360) 855-1025
License#:
General Information: Fees:
#of Air Conditioning Units 1 Mechanical Permit Fees 34.15
Total Calculated: 34.15
Deposits/Receipts: 0.00
Total Due: 34.15
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 applica' and know the same to
be true and correct. �ia�
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SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSUED BY 67-�
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PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT
+ Mailing Address: P.O. Box 547,Anacortes, WA 98221
y _ Office Location: 904 6th Street,Anacortes WA 98821
Phone: (360) 293-1901
PLUMBING & MECHANICAL PERMIT APPLICATION
Please complete all applicable information and submit to buildini;aermit@cityofanacortes.ore
PROPERTY INFORMATION
PROJECT ADDRESS ASSESSOR''^worm NUMBER
P S3 7
PROJECT VALUATION
I V PRESIDENTIAL COMMERCIAL
PROPERTY OWNER OWNER PHONE
OWNER ADDRESS OWNER EMAIL
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APPLICANT INFORMATION
❑PROPERTY OWNER CONTRACTOR OTHER:
NA E rPHONE
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ADDRESS EMAIL
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CONTRACTOR INFORMATION
NAME Q PHONE
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CONTRACTOR'S BUSINESS LICENSES* STATE LICENSE# EXPIRATION
*All Contractors & Subcontractors must have a valid L'?O y D to 64-) 1/3i
City of Anacortes business license prior to doing work UBI LICENSE# EXPIRATION
in the City.
ADDRESS(STREET,CITY,STATE,ZIP) EMAIL
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PROJECT INFORMATION
DESCRIPTION OF PROPOSED WORK:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? YES S�2NO
If YES,provide the permit/application number.
Plumbing/Mechanical Permit Application
Updated December 2021 Page 1 of 3
MECHANICAL
APPLIANCE/EQUIPMENT INFORMATION(NEW AND RELOCATED)
EQUIPMENTTYPE 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 l
Radiant/Hydronic Heating
Exhaust Fans
Range Hood
Fireplace
Clothes Dryer&Duct
Stove/Range/Oven
Refrigeration Unit
Gas Piping/Outlet(s)
Boiler BTUs:
Other
TOTAL MECHANICAL OUTLETS
PLUMBING FIXTURES
FIXTURE TYPE(NEW AND RELOCATED) TOTALI FIXTURE TYPE(NEW AND RELOCATED) TOTAL
Toilets Refrigerator water supply
Kitchen Sink Pressure Reduction Valve/Regulator
Utility Sink Water Service Line
rub Water Piping
Hand Sink Washing Machine
Shower Electric Water Heater:Tank-less? Yes❑ No❑
Dishwasher 113ackflow Prevention Device
Urinal lHose Bib
Floor Drain/Floor Sink Drinking Fountain
ydronic Heat in:❑Floor ❑Wall Grease Interceptor
Other-please specify:
TOTAL PLUMBING FIXTURES
Plum bing/MechanicaI Permit Application
Updated December 2021 Page 2 of 3
PLUMBING & MECHANICAL PERMIT APPLICATION CHECKLIST
COMMERCIAL RESIDENTIAL
o SUBMITTAL KI:QUIRE�ENTS` = 3 i n
Z Z W Z T m
D D fZ 0 m
r r
Plumbing&Mechanical Permit Application or or ✓ ✓
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 ✓ ✓ ✓ ✓
New Floor Plan ✓ ✓ ✓ ✓
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.
SIGNATURE DATE
Plumbing/Mechanical Permit Application
Updated December 2021 Page 3 of 3