HomeMy WebLinkAboutPermit File BLD-2019-0650 3618 Oakes Avenue ZT Y o''' City of Anacortes Invoice/Permit#: BLD-2019-0650
904 6th Street
Applied date: 10/04/2019
P.O.Box 547 Issue date:
Anacortes, WA 98221-0547 Expire date: 04/01/2021
(360) 293-1901
Job Address: 3618 OAKES AVE Permit Type: Single Family Alteration/Repair Permit
ANACORTES WA 98221-1210 Project:
APN: P58164
Remarks: Replace insulation and wall board in isolated locations of certain exterior walls.
All interior work, no dirtwork as part of project.
Owner: ELIZABETH BRAUN Contractor:
Address: 3618 OAKES AVE Address:
ANACORTES WA 98221-1210
Phone: (206)679-5696 Phone:
License#:
General Information: Fees:
Building Valuation 5000 Building Permit Fee 111.25
Plan Review Fee 72.31
State Building Code Fee Resi 6.50
Total Calculated: 190.06
Deposits/Receipts: 0.00
Total Due: 190.06
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THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, 6R:-1F�s
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORKS COMMENCED. 1,=;
HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIO4S.a
OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, TIE
GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL T E PROVISIONS OF ANY OTHER STATE O..,5
LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. _n
SIGNATURE OF OWNER OR AUTHORIZED AGENT ISS D BY
T.
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FORM BP-1 : RESIDENTIAL BUILDING PERMIT APPLICATION
1. PROPERTY INFORMATION
Project Address (Street, Suite # : Assessor Parcel Number:
141 6 CAE ? GeiVi
Subdivision/Lot#: Zoning Designation: Lot area (size):
fz - AA % gill (dor sq. ft.
2. TYPE OF PROJECT
❑ New SFR ❑ New Accessory Dwelling Unit: ❑ Deck/porch (new/repair)
CI New Duplex ❑ Attached to Primary Unit Interior remodel
❑ Detached from Primary Unit
❑ New Addition to SFR ❑ Garage, carport or accessory building ❑ Fence or retaining wall
or duplex (new/repair)
❑ Other:
Project Summary: h\ ,,t, Q t4, tev, , ,i; ,, ,,,,. ,„ ,, wa it 6 0 a if A 1 (.1
' Li "4" Ai *
ce t k (\. ._ ,a., . 4 SP&\ $ k
Project Valuation: $ 10 , bO '"IOW 1 ' 1.".1.2 U Hi te S X .2 -
3. PROPERTY OWNER INFORMATION
Name: Cuzestaii
to Phone: 12_04 eci
c 6641 6,"
Address (Street, City, State, Zip): 1NG >t W it E Address:
. i ! ' x ... * d" . \ et4UrotvtI (om ,
4. CONTRACTOR INFORMATION
Name:* 0 0 N £ ... o ) N Phone:
Contractor's Business Licenses � State License #: City License #:
*All Contractors & Subcontractors must have a valid City
of Anacortes business license prior to doing work in the Expiration Date: Expiration Date:
City.
Address (Street, City, State, Zip): Email Address:
5. CONTACT PERSON
Select one person the city will contact for anything
related to this project: Applicant Property Owner El Contractor
El Other (list below)
Name:13 vs4 „„j Phone: 2s_ot,,t211 - 5k)(3(f,
ddres (Street, ' , State, Zip): f-PA v4it• Email Address.
75& litit/ Oftft`. th‘Av. I 0 2°4' 1 laetki' 45it\'04 WO 6 6tisit Ai 14 all/
6. LENDER INFORMATION
RCW 19.27.095 requires the City to obtain information with regard to lenders. If there are no lenders involved with your project,
write "no lenders" on the Name Line below.
Name: Pr, Phone:
Address (Street, City, State, Zip): Email Address:
Res. Building Permit Application Submittal Checklist
Updated September 12, 2019
Page 5 of 18
7. ACKNOWLEDGEMENTS & SIGNATURE
Read and initial each of the following statements prior to signing this application:
I understand that when a building permit application is taken in over the counter it does not mean
the application has been deemed technically complete and sufficient for staff review.
I understand that if I submit incomplete, inaccurate, and/or erroneous information it will take the
City longer to process my permits.
I understand and acknowledge that I could be responsible for providing as-built drawings (on paper
or electronically) as part of the project's certificate of occupancy process.
I understand and acknowledge that Special Inspections could be required as part of my project,and
if needed I will be required to pay for the cost of these inspections.
v /` I understand and acknowledge that financial securities could be required as part of the work I am
\! completing and I agree to provide the items needed for the City to calculate these securities and to
provide the securities themselves.
40( I understand that if permits are reviewed concurrently such as design review,site plan,traffic
concurrency,etc., any required revisions to one permit may affect the entire plan set and could
add costs and time to the project.
owner of the property listed on this application or the owner of
I herebydeclare that I am either the
this property has authorized me to be their representative to act for them. I also declare under
penalty of perjury under the laws of the State of Washington that all of the statements and answers
contained herein, and the information submitted with this application form is in all respects,true,
correct, and complete to the best of knowledge and belief.
rolq I I
Signatur Date
5ra-v�n "
Printed Name
Res.Building Permit Application Submittal Checklist
Updated September 12,2019
Page 6 of 18
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