HomeMy WebLinkAboutBLD-2010-0293 - RESIDENTIAL REMODEL 1020203-1 0024 0 ,/21/2010 001 9
Perffdt Fees 008769 $754.23
f Y J City of Anacortes Permit#: BLD-2010-0293
904 6th Street Issue date: 07/21/2010
P.O.Box 547 Expire date: 01/17/2012
`CO Anacortes, WA 98221-0547
* � (360) 293-1901
Job Address: 1019 16TH ST Permit Type: Single Family Alteration/Repair Permit
ANACORTES WA 98221-2220 Project:
APN: P55148
Remarks:
Owner: GABRIEL OLMSTED Contractor:
Address: 1019 16TH ST Address:
ANACORTES WA 98221-2220
Phone: (360)588-1941 Phone:
License#:
General Information: Fees:
Building Valuation 45000 Building Permit Fee 479.00
#of Hose Bibbs 1 Plan Review Fee 169.33
#of Showers 1 State Building Code Fee 4.50
#of Lavatories 1 Mechanical Permit Fees 53.40
#of Kitchen Sinks 1 Plumbing Permit Fee 48.00
#of Gas Piping 1 Total Calculated: 754.23
#of Gas Water Heaters 1 Deposits/Receipts: 0.00
#of Ventilation Fans 2
Total Due: 754.23
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�OWNER OR AUTH RIZED AGENT ISSUED BY
ti x Residential Building Permit Application
- Building Department
P.O. Box 547 Anacortes, WA 98221
Phone No.: 360-293-1901 FAX: 360.293.1938
SITE ADDRESS: WA T9 -LI
Q TFRACTJQWN -- pplicant k 'IIQ,T �T„TIE +GRLRL 'TI".OAT..
Name A,5eyy,,s L Gt/LGF" OCOTWO,061—
Address 40 4 d $%
City/State/Zip jo� V1,,4 Jr811/
Phone360 402-I? / FAX
State License#406MtyISC014QL Exp / (/
T. PAGET.NUMBER
City of Anacortes License
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Name 4i M53 elE•t QL,,ff Sr -0
Address /p/q !G 14 $T
City/State/Zip o4/Y-*tWW 126 I' UATIO
Phone IQ'f! FAX 580 -1?1t 35,600 st 00c)
Number of Dwelling Units I
E-Mail Address y/1S W GO tttCa�ST/Y Number of Stories_
7 Building Area:
L7 A"rc YeCt C7 Designer 1] ngLne pLC2ti I't Floor s.f. 2"d Floor s.f,
Namt Yd Floor s.f. Basement s.f.
Address Garage s.f. Carport . s.f.
City/State/Zip Deck s.f. Lot Area s.f.
Phone FAX
E-mail Address
LENDER INFORMATION MUST BE PROVIDED FOR PROJECTS OVER$5,000
Name "Is IN VALUATION PER RCW.
Address -Name d 4YNE�C
City/State/Zip Address
Phone Zd?. • (Q& FAX City/State/Zip
E-mail Address Phone No.
CONTINUED ON THE BACK
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P.
Residential Mechanical Fixtures
Fuel Type
B Natural Gas B-Tlectric ❑ Wood ❑ Propane Gas ❑ Other
Type of Equipment Number of Type of Equipment Number of
Fixtures Fixtures
Furnace<=100K BTU Clothes Dryer
Boilers/AC/Heat Pump Gas Water Heater c7*_y,, 1i ,<
Gas Outlets Gas Fireplace
Ventilation Fans / Fireplace Insert
Stove,Appliance Other Units
Ran a Hood /
Residential Plumbing Fixtures
Type of Fixture Number of Type of Fixture Number of
Fixtures Fixtures
Toilet Clothes Washer
Bathtub Electric Water Heater
Shower x /? Utility Sink
Dishwasher f "le L'0 6A Hose Bibb 1 ,.
Hand Sink / 7?%� Water Piping
Kitchen Sink wADisposai :'<' r Additional Fixtures
I HEREBY ACKNOWLEDGE IF HAVE READ THIS PERMIT APPLICANT AND STATE THE INFORMATION IS CORRECT,AND AGREE TO COMPLY
WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING ACITIVIES COVERED BY THIS PERMIT APPLICATION. WITH THIS PERMIT ALL
CONTRACTORS AND SUBCONTRACTORS SHALL HAVE A CURRENT WASHINGTON STATE CONTRACTORS LICENSE AND A CITY BUSINESS
LICENSE. STOP WORK ORDERS WILL BE ISSUED ON JOB SITES WHERE CONTRACTORS/SUBCONTRACTORS ARE WORKING WITHOUT
PROPER LICENSE.
6. 2a/c)
APPLI 'S SIGNATURE DATE
Last Updated 11-29-05
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(This form Is to be completed prior to issuing the building permit)
Site Address: 10\(\ \ k9 Date: t1DW%L
Owner: oLy- `\-S-t-1
Assessors No.� S S/ I/Y Lot Block Addition
OK NA OK NA
❑ Fire Department Access ❑ f Fire Hydrant Located within 250 feet
❑ C Fire Flow Required ❑ C Covenant Not to Oppose Future LID
❑ Water Extension Sewer Extension
❑ General Road Improvements ❑ $ Shoreline or Wetlands
§' ❑ Drainage Plan Approved ❑ Site Plan
❑ Variance Required ❑ Q Covenant Approval
❑ Plat Facts and Findings Compliance ❑ Regulated Slopes
❑ I Fill on Site ❑ Survey in File
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Zoning:
Lot Size: (p Coo S
Coverage Allowed: SV 1�10
Actual Coverage:
Plans Examiner. _ _Date:
_ (Signature ..
i.