HomeMy WebLinkAboutPermit File BLD-2020-0703 1217 12th Street Y
Cott' �� u Ani aco es Invoice/Permit #: BLD-2020-070�3
904 6th Street
t Applied date: 11/10/2020
'4"..001611 P.O.Box 547
Anacortes, WA 98221 -0547
' �-
�puUe date: l cic�512021
," (360) 293-1901 ��
Job Address: 1217 12TH ST Permit Type: Residential Demolition Permit
ANACORTES WA 98221-2105 Project:
APN: P55435
Remarks: DEMOLISH A GARAGE THAT IS ON 2 PARCELS. THE OTHER PARCEL IS1209 M AVE. BOTH OWNERS AGREE TO
THE DEMO.
Owner: ANACORTES CHRISTIAN CHURCH Contractor: OWNER
Address: 1211 M AVE Address:
ANACORTES WA 98221-2149
Phone: (360) 293-3729 Phone:
License #:
General Information: Fees:
State Building Code Fee Resi 6.50
Demolition permit 60.00
Total Calculated: 66.50
Deposits/Receipts: 0.00
Total Due: 66.50
t I I (a
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The issuance or granting of this permit shall not be construed to be a permit for, or approval of, any violation of this Code or any other ordinance or order of
the City, of any state or federal law, or of any order, proclamation, guidance advice or decision of the Governor of this State. To the extent the issuance or
granting of this permit is interpreted to allow construction activity during any period of time when such construction is prohibited or restricted by any state or
federal law, or order, proclamation, guidance advice or decision of the Governor of this State, this permit shall not authorize such work and shall not be
valid. The building official is authorized to prevent occupancy or use of a structure where in violation of this Code, any other City ordinances of this
jurisdiction or any other ordinance or executive order of the City, or of any state or federal law, or of any order, proclamation, guidance advice or decision of
the Governor. The building official is authorized to suspend or revoke this permit if it is determined to be issued in error or on the basis of incorrect,
inaccurate or incomplete information, or in violation of any City ordinance, regulation or order, state or federal law, or any order, proclamation, guidance or
decision of the Governor. This permit becomes null and void if work or construction authorized is not commenced within 180 days or if construction work is
suspended or abandoned for a period of 180 days at any time after work is commenced. I have read and examined this application and know the same to
be true and correct.
SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSUED BYJ �
Transaction 24 (Batch 20394)
Batch 20394
Amount 67 50
Department Finance Department
Created by Ken Knapp
Created 11/10/2020
Workstation
Comment
Payments Tenders
Tender 264991
Amount $6750 Card Type Visa
Type 03Finance Credit Card Name Ronald A Pinson
Paid by Ronald A Pinson Number 3598
Deposit reference Ken 11/10 Expiration date 02/2021
Deposit account Main Checking Banner Fee $1 00
Created 11/10/2020 Authorization 710141
Created by Ken Knapp Reference ID 42344101270
Settlement ID Status
Card presence Not present
0\1 PLANNING,COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
Mailing Address:P.O. Box 547,Anacortes, WA 98221
Office Location:904 6th Street,Anacortes WA 98821
-<,c o
iv Phone:(360)293-1901
Nt
DECONSTRUCTION/DEMOLITION PERMIT APPLICATION
1. PROPERTY INFORMATION
Project Address(Street,Suite#): A Assessor Parcel Number:
;207 Ave shnreci GC�/w7t P 6�172Js p J J l3(f--.
2. TYPE OF STRUCTURE
Single Family 0 Multifamily,#of Dwelling Units ❑ Commercial/Industrial
0 Du lex
C�ri+c) C.
Other Use Type: 0 Underground Fuel Tank
p
3. STRUCTURE INFORMATION
FOR BUILDINGS:
Description of Work: Size of structure: L{O 0 sq.ft.
Doin j G cv-a_Fc
Method of Disposal: Date of original construction of structure:
?() d Pvrlvif ? yo'I G 2 SO f
Historic Resources Information:
Is the structure listed on the City of Anacortes Local, If identified prior to demolition, are you willing
State,or National register of historic places? to salvage from the structure historically
❑ YES* V NO I significant architectural features?
Designation:
*If yes,SEPA review is required prior to issuing a demolition permit. YES ❑ NO
Note:Check with the City of Anacortes Museum and/or the WA State Dept. I
of Archaeological and Historic Preservation's WISSARD system to answer
this question.
Utility&services disconnection/interruption information /`/U 5'€n ui c
Identify which City services you would like to disconnect/stop:
Water 0 Disconnect 0 Retain ; Storm 0 Disconnect ❑ Retain
Sewer 0 Disconnect 0 Retain I Garbage 0 Discontinue 0 Retain
For private utilities(gas, electricity,cable,etc.),you will need to contact the applicable companies if their
services are to be interrupted or disconnected.
FOR UNDERGROUND STORAGE TANKS: -e--
Decommissioning type:
❑ Abandonment in place (Fire Dept.Approval required) ❑ Removal
Date of pump&rinse: Disposal Location:
Type of inert fill:
Approximate age of tank: ICC Certification#:
Deconstruction/Demolition Permit Application Submittal Checklist
Updated October 9,2019
Page 3 of 4
�1S y o� PLANNING,COMMUNITY,&ECONOMIC DEVELOPMENT DEPARTMENT
Mailing Address: P.O. Box 547,Anacortes, WA 98221
Office Location:904 6th Street,Anacortes WA 98821
` 4. `� Phone: (360)293-1901
4. PROPERTY OWNER INFORMATION
Name:tlji cs6/ 4 c i C.ri17i CA ,c A, Phone:
p44,-, lea 104/-04 '3(.20 7 3 17"d �l
Address(Street,City,State,Zip): Email Address:
/2 / I /1VC C 1y OFFicc e c,o ( 1u cA,.�h
5. CONTRACTOR INFORMATION N, 01c/cyl —/-& f r/0 Coi1t-/cL
Name:* Phone:
Contractor's Business Licenses State License#: City of Anacortes
*All Contractors&Subcontractors must have a valid City Endorsement?
of Anacortes business license prior to doing work in the Expiration Date: ❑ YES
City. ❑ NO
Address(Street,City,State,Zip): Email Address:
6. FINANCING INFORMATION (Required if project valuation exceeds$5,000,perRCW 19.27.095)
Lender administering the construction financing or firm issuance a payment bond(if any)on behalf of the prime
contractor for the protection of the owner,if the bond is for an amount not less than 50%of the total amount of
the construction project(if owner is self-financing,please indicate). C1
*Completion of this information may be deferred until permit issuance.
Name: -.— Phone: —
Address(Street,City,State,Zip):
7. CONTACT PERSON
Select one person the city will contact for anything ❑ property Owner ❑ Contractor
related to this project:
Other(list below)
Name: C-C/ G C9 Cr' Phone: y60._ ),T___q 7 7/
Address(Street,City,State,Zip): t Email Address:
Lo/S- C r e cj cj e- ca/mil Cd1f - 14C
8. SIGNATURE
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 complete to the best of
knowledge and belief.
C„� _ 7 -, a Zd
Signature Date
Deconstruction/Demolition Permit Application Submittal Checklist
Updated October 9,2019
Page 4 of 4
City of Anacortes Building Department
Demolition of a garage
This / these properties share in a garage that has a common center wall. Both parties want it
taken down and replaced with a shed.
I have written permission from both parties to demo the building.
Patrick Robertson of 1902 M Ave and Anacortes Christian Church of 1211 M Ave.
There are no utilities in the building and the entire structure is constructed of wood including
the cedar shingled roof.
I have applied with Wash. State Clean Air agency and got approval.
Thank you
Ed Gegen
360-728-9731
1014 CE1 Pr/A
III NOV 06 2020
ANAcdR s
P~
Confirmation of Payment
ACI Payments,Inc.-Customer Service<customerservice@officialpayments.com> 9:19 AM 1
To Edward Gegen
Reply Forward Delete
; ,,'ACI Payments, Inc.
I
Dear ACI Payments, Inc. Customer:
Thank you for selecting ACI Payments, Inc. for electronic payment f Asbestos Notification or
Demolition. Your payment \ f
of$56.00 w to Northwest Clean Air Agency, WA on 11-05-2020. Your confirmation
number is 091902.
To check the status of your payment,
visit the ACI Payments, Inc. web site at
https://www.officialpayments.com/pc_paym.jsp. Please be prepared to provide
your e-mail address egegen@comcast.net and one of the following two
items:
-Your confirmation number, 091902
OR
-The last four digits of the card you used for payment, 1222
To become a registered user of
ACI Payments, Inc., enabling you to access your complete tax and
fee payment history, visit our Web site at
https://www.officialpayments.com/pc_sign.jsp.
Again, thank you for
using ACI Payments, Inc. We hope you enjoy the convenience, cash
management, and payment card benefits earned from your
payment.
Customer Service
4
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