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PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT <br /> '411Y1a6 DEMOLITION & OIL TANK DECOMMISSIONING PERMIT APPLICATION <br /> l7 �, Mailing Address: P.O. Box 547, Anacortes, WA 98221 <br /> ykr w Office Location: 904 6th Street, Anacortes WA 98821 <br /> Phone: (360) 293-1901, Fax: (360) 293-1938 <br /> PLEASE REFER TO THE PERMIT CHECKLIST THAT FOLLOWS FOR SUBMITTAL REQUIREMENTS <br /> BUILDING DEMOLITION: ❑ N/A I COMPLETE BUILDING DEMOLITION <br /> ❑ PARTIAL DEMOLITION ❑ RESIDENTIAL ❑ COMMERCIAL <br /> ® FLOOR AREA TO BE DEMOLISHED: 2,249 l METHOD OF DISPOSAL: Construction Waste <br /> Disposal <br /> UNDERGROUND OIL TANK DECOMMISSIONING: X] N/A ❑ REMOVAL <br /> ❑ ABANDONMENT IN PLACE(FIRE DEPT.APPROVAL RQD) ❑ SIZE OF TANK: <br /> ❑ APPROXIMATE AGE OF TANK: ❑ DISPOSAL LOCATON: <br /> ❑ DATE OF PUMP&RINSE: ❑ ICC CERT#: <br /> O IF ABANDONED, SPECIFY TYPE OF INERT FILL: _ <br /> PROJECT ADDRESS(Street, Suite#): PARpCEIS : <br /> 1018& 1020 27th St 573 P57346 <br /> APPLICANT: Quantum Construction, Inc. Phone: <br /> 360-293-0656 <br /> Address(Street,City, State,Zip): E-Mail Address: <br /> 12761 Quantum Lane,Anacortes, WA 98221 joshb@quantumci.com <br /> PROPERTY OWNER: Anacortes Family Center Phone: 360-293-2993 <br /> Address(Street,City, State,Zip): E-Mail Address: <br /> 2702 Commercial Ave,Anacortes WA 98221 info@anacortesfamily.org <br /> Address(Street,City,State,Zip): E-Mail Address: <br /> CONTRACTOR/DECOMMISSIONER'S FIRM NAME: Phone: <br /> Quantum Construction,inc. 360-293-0656 <br /> Address(Street,City,State,Zip): E-Mail Address: <br /> 12761 Quantum Lane, Anacortes,WA 98221 joshb@quantumci.com <br /> *All Contractors&subcontractors must have a valid City of Anacortes Contractor's License#: Exp.Date: <br /> 6/2019 <br /> business license prior to doing work in the City. Contact the City's QUA License l: Exp. <br /> Finance Department at(360)299-1968. Businesss #: Exp.Date: <br /> 600-518-978 2/28/2019 <br /> PROPOSED WORK: Demolish existing homes and 1 garage to prepare for new family center construction. <br /> I declare under penalty of perjury that the information I have provided on this form/application is true,correct,and <br /> complete,and that I am the property owner or duly authorized agent of the property owner to submit a permit <br /> application to the City of Anacortes. <br /> Print Name: Josh Baldwin Owner CI Other Ca(specify): Contractor <br /> 7/12/18 <br /> Signature: •r --�. Date: <br /> °'._Jef7nl< CC "< Page 1 of 2 <br />