HomeMy WebLinkAboutPermit File BLD-2019-0438 1815 10th Street City of Anacortes Invoice/Permit#: BLD-2019-0438
904 6th Street
Applied date: 07/11/2019
`,4010611 P.O.Box 547
Issue date: 07/25/2019
0' Anacortes, WA 98221-0547
(360) 293-1901 Expire date: 01/06/2021
Job Address: 1815 10TH ST Permit Type: Mechanical Permit
ANACORTES WA 98221-1417 Project:
APN: P56059
Remarks: Replace Gas boiler with like
Owner: ERIC &AMANDA BALTAZAR Contractor: FOSS HEATING AND COOLING
Address: PO BOX 922 Address: 333 E BLACKBURN RD
ANACORTES WA 98221-0922 MOUNT VERNON WA 98273-9006
Phone: (360) 293-5364 Phone: (360) 336-1517
License#: FOSSHCI983QA
General Information: Fees:
#of Boilers> 100,000 BTU 1 Mechanical Permit Fees 50.65
Total Calculated: 50.65
Deposits/Receipts: 50.65
Total Due: 0.00
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I
HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS
OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE
GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR
LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSUED BY
Permits and Insp... - BLD-2019-0438 - 2019
019267-0002 Carla Br... 07/12/2019 10:55AM
6033 - FOSS HEATING AND COOLING
BLD-2019-0438 Mechanical Permit
Payment Amount: 50.65
Transaction Amount: 50.65
03FIN CC: '**"********3971
PLANNING,COMMUNITY,&ECONOMIC DEVELOPMENT DEPARTMENT
PLUMBING Sr MECHANICAL PERMIT APPLICATION- Matlin Address:P.O. Box 547,Anacortes, WA 98221
* g
'' Office Location: 904 6'h Street,Anacortes WA 98821
V
Phone: (360)293-1901, Fax: (360)293-1938
PLEASE REFER TO THE PLUMBING&MECHANICAL PERMIT CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS(Street,Suite M: Parcel(s)#:
Subdivision/Lot#:
6 Residential ,L : Commercial. ❑
APPI CANrT. : 7{,. f / Phone Z r Fax:
! C57f ti—e-rc..ah"!v���yy rff1.ci\ (cie,l,1,,4c.� a£ 0 "-33• G- (Ge7 Address ss(Street,City,State,Zip):f.J. i f 1Q�./et �/ E-MafJ'1 Ad ss: /, s
33 r {i'lcit, j,,,„ ;C4, /"t,C.VLYkc l.( W Yi t? i7 5 ocp`--Vs- fU 14.2„d-a, , C:G
PROPERTY IRWNER:
}i // Phone: Faxf
f ean
(A4 ,tcl vas t-t t 2 „,-- 3/40 i-`Z 3 5 C
Address(Street,city, '`l State, ip): E Address:
f g (`5 ,•o' S' F- /ttc c e-4cs, J✓f- 2-z( i fy Ac-t. .e t� `(-c-
CONTACT PERSON: Phone: Fax:
Address(Street,City,State,Zip): E-Mail Address:
CONTRACTOR:*,,,„ Phone: Fax:
Address(Street,City,State,Zip). E-Mail Address
Contractor's License# Exp.Date:
*All Contractors&subcontractors must have a valid City of tro5S C X'q V 3(RA t(- ( - 2_0
Anacortes business license prior to doing work in the City. Business License#: Exp.Date:
Contact the City's Finance Department at(360)299-1968. CV t 7_(5_
17
Is this work,associated With another project? Yes ❑ No Al If yes,specify:
PROPOSED WORK: j]
V`L' (t� ,.e...t_ < c',te-ir• Lt!t (i-(C,c
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 Anacortes.
Print Name: 4.
° C -v„..,_ Owner ❑ Agent ffi(specify): 1..✓a {;,, ram
Signature: f .. — jam"_",_ Date: 7'....- to`t 1
MECHANICAL:
Equipment Type: Appliance/Equipment Information (new and.relocated): Total #:
Furnace: Gas # Elec# Other: :# BTUs::<100k_>100k_Location(s)
Wall Heater: Gas #_Elec#_Other: # BTUs: <i00k>100k Location.(s)
Air Handler: Gas # Elec#_Other: # BTUs: <100k>100k_Location(s)
Water Heater: Gas # Elec # Other: # BTUs: <1.00k>100k Location(s)
AC Unit/Boiler:/
Heat.Pump / Roof Gas•# Elec#_Other: # BTUs: <100k, 100k-500k, 500k-
Top-Unit (Circle IMil HP: <3, 3-.15,_15-30 Location(s)
selected):
Hydronic Heating: Gas #I_Elec # In-Floor )'Wall Radiant Boiler BTUs: 1 z.,(cl Location f ,
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: it 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: . B ackfl ow Prevention Device:
Sink(kitchen, laundry, lavatory, hand, bar, slop., Water Service Line:
eye wash, etc.):
Tub/Shower: Drinking Fountain:
Dishwasher: Clothes Washer:
Hose Bib.: Hydronic.Heat in: Floor ❑ Wall ❑
Water Heater Tankless? Yes- ❑ No ❑ Grease Interceptor
Floor Drain / Floor Sink: Water Piping:-
Refrigerator water supply (for water/ice Other:
dispenser):
TOTAL OUTLETS: TOTAL OUTLETS: