HomeMy WebLinkAboutPermit File BLD-2019-0671 3810 S Avenue 1'Tz a'`' _ City of Anacortes Invoice/Permit#: BLD-2019-0671
904 6th Street
Applied date: 10/11/2019
P.O.Box 547 Issue date: 10/11/2019
:>" Anacortes, WA 98221-0547
(360) 293-1901 Expire date: 04/08/2021
Job Address: 3810 SAVE Permit Type: Single Family Alteration/Repair Permit
ANACORTES WA 98221-3645 Project:
APN: P58865
Remarks: Remove and replace siding on south side of house with fiber cement siding.
Owner: RAFNSON DAVID R Contractor: IAN CLARK CONSTRUCTION
Address: 3810 SAVE Address: 2517 W 2ND ST
ANACORTES WA 98221-3645 ANACORTES WA 98221-1338
Phone: Phone: (360)420-1759
License#:
General Information: Fees:
Building Valuation 8000 Building Permit Fee 153.25
Plan Review Fee 99.61
State Building Code Fee Resi 6.50
Total Calculated: 259.36
Deposits/Receipts: 0.00
Total Due: 259.36
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 REG NG NSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
SIGNATURE OF OWNER R AUTHORIZED AGENT ISSUED BY
Permits and Insp... - BLD-2019-0671 - 2019
01 941 1-0036 Carla Br... 10/1112019 04:23PM
12547 - IAN CLARK CONSTRUCTION
BLD-2019-0671 Single Family Alteration/Repair Permit
Payment Amount: 259.36
Transaction Amount: 259.36
03FIN CC: *******Al.J .*1614
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OCT 112019
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FORM BP-1: RESIDENTIAL BUILDING PERMIT APPLICATION
1. PROPERTY INFORMATION
Project Address(Street,Suite#): Assessor Parcel Number:
?Ib S Av& ,4NArcS
Subdivision/Lot#: Zoning Designation: Lot area (size):
sq.ft.
2. TYPE OF PROJECT
❑ New SFR ❑ New Accessory Dwelling Unit: ❑ Deck/porch (new/repair)
❑ New Du lex ❑ Attached to Primary Unit
p ❑ Detached from Primary Unit ❑ Interior remodel
❑ New Addition to SFR ❑ Garage,carport or accessory building ❑ Fence or retaining wall
or duplex (new/repair)
xr Other:
Project Summary:
Z��S I lf•f 6 O NYE L) -C, b 14D-0
Project Valuation: $ g k
3. PROPERTY OWNER INFORMATION >�t
Name:+1 e j nfSpcJ Phone:( , ) 2519- o 1(•
Address(Street,City,State,Zip): Email Address:
'-I D S .li Je ,
4. CONTRACTOR INFORMATION
me:trete LuPr Phone:
Contractor's Business Licenses State License#:� City License#:
*All Contractors&Subcontractors must have a valid City ()GO (b3Qp3 I
of Anacortes business license prior to doing work in the Expiration Date: Expiration Date:
City. OLN-I ?' -Z,o•z,d 3.0
l y 3 I 7_U-z v
Address(Street,City,State,Zip): Z517 2''e Email Address: Iq, C IcktriCC.dA.S+ftiC.--11.04\Q_ w-eki(•c
5. CONTACT PERSON V
Select one person the city will contact for anything
related to this project: ❑ Applicant El Owner Ig Contractor
❑ Other(list below)
Name: Phone: 31,:z.d)1.4.ZO. 1-)c,--n,
Address(Street,City,State,Zip): Email Address: . J
a •_C\o,r l�ccsnS Jc'h'or`C�� 1.
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 Li below.
Name: Phone:
Address(Street,City,State,Zip): ' 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:
g__ 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.
42 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.
I understand and acknowledge that financial securities could be required as part of the work I am
(IQ completing and I agree to provide the items needed for the City to calculate these securities and to
provide the securities themselves.
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.
I hereby declare that I am either the owner of the property listed on this application or the owner of
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 comple o the best of knowledge and belief.
/v/r/ J 7
Signature Date
CI,P► ieLc_
Printed Name
Res.Building Permit Application Submittal Checklist
Updated September 12,2019
Page 6 of 18