HomeMy WebLinkAboutPermit File 820 34th Street __._._. -_ _ 3003 C/0:3 201 001 1
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Engineering and Development Services �t�0 q
G81Y 0..4 PO Box 547,Anacortes,WA 98221 �''
TN:360.293.1920 FAX 360.293.1938 �'L
EMAIL: engineering@cityofanacortes.org v /';, \ -<
? u) RIGHT-OF-WAY PERMIT APPLICATION a Q Q
,�W RCW 19.122 Underground Utilities .!
`�CO3- CALL BEFORE YOU DIG -(800)424-5555 'q•p W• '
Ap cant hall submit application 5 days prior to start of work and application shall include:
(1 ayment of assessed fee
2) Drawing illustrating proposed work and its location. See checklist on
e2of2.
Ily
3) Liability insurance CG 2026 or similar. City named as additional insured. Minimum$1,000,000 each
c rrence,$2,000,000 general aggregate and$2,000,000 products-completed operations aggregate limit.
4) Proof of both state and city business licenses
ond—Construction cost x 150%before work begins
ment Agreement Required To be completed by City: ❑ Yes ❑ No
Site Address: City Approved Exemption 0 Yes ❑ No
6'2 .3�l'4 J/ EN ASSIGNED PEfTj UMBER:
Parcel No. / W aZ/I v1 - OO
• j
Owner Information (Required) Contractor Information (Required)
Name Name
r frlC Cwv 17sr� L 4-64w,7/✓6.
Address Address
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City City
( ) Phone Phone c G -7.0r-- Z//, //_
Email Email
Address Address
Work Includes(check all that apply)
❑ Curb Cut ❑ Water Sewer ❑ Storm ❑ Street Cut ❑ Sidewalk ❑ •Phone ❑ Other
Describe Work to be Performed: (Notification of Utility Companies is Required)
/ -re we c fix /5r/4 s&----1,/�9 -
•
City Approval Signature Date
B signature below Applicant concurs that the Applicant shall defend,indemnify and hold the City, its officials,em-
ployees and volunteers harmless from any and all claims,injuries,damages,losses or suits including attorney fees,
arising out of or in connection with activities or operations performed by the Applicant or on the Applicant's behalf
out o issuance of this Permit,except for injuries and damages caused by the sole negligence of the City.
Applicant'Si nature D to .
9
Final Inspection Approval Signature Date {
NON-REFUNDABLE PERMIT FEE: (To Be Completed by City)
❑ Curb Cut $50.00
❑ Street Cut $50.00
❑ Inside Travel Way $50.00
❑ Outside Travel Way $20.00
l� Sewer Inspection Fee $50.00
❑ Sewer Re-Inspection Fee $25.00
. TOTAL FEE ASSESSMENT $ .00
A Site Plan(to scale) must be attached that include all of the following:
This checklist will aid the applicant in preparing a site plan. Permits that require installation of substantial improve-
ments may require plans drawn and designed by a licensed engineer. Please check with City staff prior to submit-
ting your application.
• Draw the plan to a standard Engineering Scale[1"=10', 1"=20"etc.]on a minimum size sheet of 8'/x 11
and a maximum size of 11x17.
• Include the owners name,the parcel ID number,site address, north arrow,drawing scale and date.
• Include the contractor's name,address and phone number.
• Existing Right-of-Way lines,property lines,edge of pavement,curb/gutter,sidewalks,driveways and plant-
ing strips with dimensions between each.
0
• Adjoining street name(s)to the reference property.
• All existing public and private utilities in the area of the proposed project(Water, Sewer,Storm, Phone,TV,
Gas and Power),dimensioned to the edge of pavement,curb/gutter,sidewalk,driveways,planting strips.
• If applicable show easements,critical areas such as streams,wetlands and steep slopes.
• Proposed new construction.The proposed improvements shall be shown in heavier line type than the ex-
isting information
• Dimension the proposed new construction to the edge of pavement,curb/gutter,sidewalks,driveways,
planting strips,or another identifiable site feature that will help identify the proposed improvements in the
field.
• Erosion Control Plan.
• Traffic Control Plan per current MUTCD(See standard drawings at htta://mutcd/fhwa.dot.cov).If the work
requires any lane or street closures,the City of Anacortes Public Works Inspector must be notified a mini-
mum of 48-hours prior to scheduled work for proper public notification by the City of Anacortes.
Work within the City Right-of-Way is permitted by approval of the City Engineer. All work in the right-of-way must be
bonded. The applicant and owner must use warning signs,traffic control,and barricades as necessary to ensure
public safety in the work area. The applicant and owner must restore the right-of-way to previous condition. Perma-
nent restoration may include overlays of portions of the right-of-way and restoration of landscaping which have been
disrupted by excavation work. The applicant and owner are liable for damage to public and private property.
Page 2 of 2 1111/
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MECHANICAL PERMIT
CITY OF ANACORTES PERMIT NO. : MEC98-0072
P.O. BOX 547 APPLIED: 10/02/98
ANACORTES, WA 98221 ISSUED: 10/05/98
(206) 293-1901 EXPIRES : 10/05/99
SITE ADDRESS : 820 34TH ST
ASSESSOR' S PARCEL NO. : 3775-009-013-0003
PROJECT DESCRIPTION: Install gas forced air furnace and gas pipe.
— OWNER — CONTRACTOR
KALE KOLBE BEL-AIRE HEATING & AIR COND
820 34TH STREET 2172 DIVISION STREET
ANACORTES WA 98221 BELLINGHAM WA 98226
293-3801 428-2726
BELAIHA163LJ
TYPE OF WORK. . . :ADD BOILERS/COMPRESSORS— DOMES . INCIN • 0
TYPE OF USE •RES 0-3 HP • 0 COMML. INCIN • 0
3-15 HP • 0 RELOC/REPAIR. . . : 0
FUEL TYPES 15-30 HP • 0 CLOTHES DRYERS . : 0
: /GAS/ / / : 30-50 HP • 0 GAS WTR HEATERS : 0
FURN < 100K BTU: 1 50+ HP • 0 STOVE, APPLI . . . : 0
FURN >=100K BTU: 0 AIR HANDLING UNITS-- FIRE LOG/LITE. . : 0
FURN — FLOOR. . . : 0 <= 10000 cfm. : 0 WOODSTOVES • 0
UNIT HEATERS . . . : 0 > 10000 cfm. : 0 OTHER UNITS • 0
VENT FANS • 0 EVAP COOLERS . . . : 0 GAS OUTLETS • 1
VENT SYSTEMS . . . : 0 HOODS • 0
VENT W/O APPLI . : 0
— FEES — NOTES
Code Amount---- By- Date---- Receipt
PRMT $ 43 . 05 MD 10/05/98 9083
TOTAL $ 43 . 05
I hereby acknowledge that I have read this permit and state that the above information is correct, and agree to comply with all
ordinances and laws regulating activities covered by this permit.
CY
Issued by Applicant or Ow er' s Signature
24 Hour Notice Required For All Inspections
mec_prmt, Rev: 06/11/92
ip
9 oa - CITY OF ANACORTES
BLDG. X PLUMBING-0 MECHANICAL
PERMIT, N 77
Telephone 293-1901 )
-Anacortes,WA Date ! 6 Ot/'i` 19_
_ PERMISSION IS HEREBY, !�l GRANTED TO:/ - -
OWNER f`°'b- � 4 • kit; .
J
STREET
ADDRESS eA3-2, .) � ' •
Location where work is to be done
CONTRACTOR t7✓i:: _yr '
TO ERECT , J INSTALL ❑ OR REPAIR ❑
IN THE FOLLOWIW MANNER: r3/ n _ / l/ • -P -'
/2-/ye+, eight `lf e. 4",K,�' �"• -�
PERMIT EXPIRES ONE YEAR FROM DATE ISSUED - j
PLANS FOR CONSTRUCTION WERE NOT L SUBMITTED
WERE ❑
WORK TO BE DONE BY OWNER Ai CONTRACTOR ❑
RECEIPT OF FEES IS ACKNOWLEDGED AS FOLLOWS:
TYPE APPROXIMATE VALUE PERMIT FEES
OF WORK
State Building Code Surcharge ^t5 U
State Energy Study Surcharge -
Building d.Jo/',K 4/co "--jam ,5f..a "P
Plumbing and W.S.
Mechanical
Plan Check Fee
•
TOTAL ,a 9j sty
LEGAL DESCRIPTION
�=r � CI Y IN�OR
ADDRESS cat70 �
LEGAL DESCRIPTION
ASSESSORS ACCOUNT NO.
PERMIT NO. DATE DESCRIPTION DATE FINALED
•
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