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HomeMy WebLinkAboutPermit File 1109 Dakota Avenue O . Cityof Anacortes Invoice/Permit#: BLD-2016-1304 904 6th Street Applied date: 06/01/2016 P.O.Box 547 Issue date: 06/0112016 Anacortes, WA 98221-0547 Expire date: 05/27/2017 (360) 293-1901 Job Address: 1109 DAKOTA AVE Permit Type: Demolition Permit ANACORTES WA 98221-1344 Project: APN: P58284 Remarks: Remove old garage Owner: PAUL REISMAN Contractor: Address: 1109 DAKOTA AVE Address: ANACORTES WA 98221-1344 • Phone: (360) 708-8419 Phone: License#: General Information: Fees: Total Calculated: Adjustments: Deposits/Receipts: Total Due: 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 CONSTRUCTIRN OR THE PERFORMANCE OF CONSTRUCTION. SIGNATURE OF OWNER AUTHORIZED AGENT .ISSUED BY CITY OF ANACORTES DEMOLITION PERMIT APPLICATION Site Address:_ 1 0 C.: •\ ! -k#'w ZrE CJ Assessors Account No.: Date: Lot(s): Block: Addition; Owners Namer L-0-P-SPAPP Contractors Name: Address: \1oc D014cI-'Pc Address: State: WA Zip: 1 2J State: Zip: Phone: 0 " 3''- *[9 Contractors License: Phone: Have Utilities Been Disconnected? Description of proposed demolition. Wateept.: Yes No 4---'A1 OLD (ACE Electric: Yes No C„,1l51e: Yes No Yes No How Will Materials be disposed? BARRICADES TO BE PROVIDED FOR PUBLIC PROTECTION,AREA MUST BE ROPED OFF! Applicant -Agent's Signature ASBESTOS WARNING Breathing asbestos is hazardous to your health. Before starting a renovation or demolition project, survey for friable asbestos materials. Notify Northwest Air Pollution Authority prior to asbestos removal or containment 1600 S. 2'd Street,Mt.Vernon,WA 98273 (360) 428-1617. Fire Department Approval: 1 Date: S/3 f//6 y. Police Dept.Approval: Date: Public Works Department Approval: Date: 5/ // D Date: it9//f4- Comments: Anacortes Environmental, Safety and Health Services 8116ti Street Anacortes,Washington May 30, 2016 Paul Reismen 1109 Dakota Avenue Anacortes,WA 98221 RE: Asbestos survey of detached garage. Dear Mr. Reismen: This letter and the attached documentation will comprise the suspect Asbestos Containing Building Material (ACBM) survey performed on the detached garage unit located at the above referenced address on May 23, 2016. On May 23, 2016 Donald Swanby an EPA accredited building inspector (Cert# RHW-BI-14- 025) Expiration: September 10, 2016 conducted an inspection and sampling of the detached garage unit, located at 1109 Dakota Avenue Anacortes, WA 98221 for the specific purpose of identifying the presence or absence of suspect asbestos-containing building materials. The suspect materials sampled were delivered to "Seattle Asbestos Test" which is an NVLAP accredited laboratory by U.S. Mail for analysis by Polarized Light Microscopy(PLM). Samples collected and analyzed: Sample# G-1 Material: 3-Tab roofing. Green over red with Black, Gray and Pink sealant. No Asbestos Detected Location: North East corner area of roof at chimney vent. Sample# G-2 Material: 3-Tab roofing. Green over red with Black, Gray and Pink sealant. No Asbestos Detected Summary of Asbestos-Containing Materials No building materials identified contain asbestos materials. No other suspect materials were identified during the survey. d b�S� Anacortes Environmental, Safety and Health Services 811 6th Street Amcor/es, Washington Any building materials found to contain more than one percent asbestos are considered `Asbestos-containing materials' in accordance with Title 40 Code of Federal Regulations (40 CFR), Subpart lvl, Section 61 and typically must be removed from a structure prior to any demolition, renovation or remodeling that would disturb those materials. Laboratory reports and Inspector Accreditation attached. Please feel free to contact me if you have any questions or require additional services. Sincerely,1 h — bLi4 Donald Swanby EPA Accredited Building Inspector Cert# RHW-BI-14-025 Expires 9 10 2016 Attachments: Asbestos Laboratory Analysis Field Notes with Sample Locations Building Inspector Certificate 6{s Anacortes Environmental, Safety and Health Services 811 6th Street Anacortes, Gr'ashington Lyewo:we Leh.-eivy:1970;Scriber La:;e Fcr.1 S4im i113-LYnneteed,4't4 7.iPG[ Tel.•I 2c.5-,7,.F.d30,Fax 47.5.o7-.3>^E10.IdVLJ,¢La/5 Ccle;2L1D e 0 l4!ALYTICi.i..LA t'GraAT?QG`I'R PO'-`i pl.k9 Sy/faelhoti EPIJSoW -nii13 M .. Mr,pen Swaney nrecnk: Answries ESI-I i:ddrees: E El 60 St An3cor es,tAWH EI622 N/A ed.rh9r 2016110E8 l,_r cr[.-ne: 502112016 l:errpIcs Ha.tl: .2. Dale Anelvzrd: 0j26/2016 c,:rWw Anay_cd: 2 PnaiaG Lar: 'I109 Caketz Ave.Anacor0Ea �nzi:ed 4y.a. :wJ^-`Jr' � ' r-evIzs.ca tv :[yr<IF.:N..o721r=2.61.,*0 L010 i;Gan;Ssmple IC Lager C.anCiPkn '/, V EItsbesiu5 Ff6ers PI6n.f3:,ei CempDnawt< .1 I Nart.,,Je9In0 Fibcs Black asphaltic /*one l sphalt/Wilder, 1 material with green 27 'Giass/ibe s sand 4,,ter..E�[i Sand Blade asphaltic ,s;,rn® its ri trlbinder, 2 atatadal with red p Csi)uiose m it tied Sand 3 Black asphaltic •!o;i.o IAspha,rt/binder, g Cellulose fibrous material detocfied lBinderhliler _ _i 6iacJgray i;sia nsp haltibinder 5 Cellulose,Talc asphaltic material Lreteeeed i }Pink sortlelastic ,iQl:a 5 # Biiicsr,Filler2 Cellulose m5Parial jroetr cteo I Bleckl gray faiari.� 9 1 tialtibindar a lCellulose,Taff, asphaltic grata;,isl 1 I d e�ototi /�s p E (Black asphaltic • .i, Asptial`tibiridcr: I 'L material with green I d:4eciad' Salad 25 Glass fib-are 1 send 2 I G-2 Black asphaltic I L.k.EIE? Asphalt/binder. 0 material withrec I ,, ._c. i 3 Josesaid �_v Sand Slack asphaltic 1:51.2m J .sphaiirainder, w 1I 70 Cellulose anus criatrrfll 'doir::e:5i Binder/filler Pink soitrisiastic I tic�1-es. 5 Eind4r, ilcl' ? Celil iosxi i rnsEurlaf — cle'E..c4exl J_._.. -i T ' 1 - -- - , Anacortes Environmental, Safety and Health Services 811 e Street Anacortes,Washington . .--- . . - 1� J °!ly -- v1 ..1 'l5i4�vt Ito 1. „RI _._ 5 !� 6-1 _ . .� . +x - - �j6Vp_ _ )._.3.-r� . � , .C� �� to Gv r+.- e .1 jwy -- - ----------- .`-------- -.'g4t ie /_A T) 11" 0J1Ki dry. c1! . fdVI• �y d , . . .. , 1. , - it , -, .,A- .e ,-., 1 . , . , i 1 . , =MR 1 p Certificate 6.7 Completion r A I 1 1,, :vetch5II1Ce ,.,-.'I i - 1 i.11%in am I'el%A/Said:. 1,..1.041:rnilni Trannny,ti Con".tillii ig This is to certify that on • September 8-10, 2015 Donald S . Swanby Did attend and satisfactorily complete the training requirements in accordance with '-. • TSCA Title H (Section 206) and 40 CFR 763 & Missouri State RSMo 643.230 For designation as an - ... AITERA Building Inspector -a,_ J •i .• Certificate No. REN-B145-025 1 Expires September 10, 2016 , . . _. ,... ... - Presented By-4, Environmental/Safety agement t;_-. Michael J. Moore P Training& Co lting ..t 1 ...0 Training Director/Consultant .... 4, i.. .... ..., , 1 '-.• lk...- r a 4101t: 96902 E.Kaitlyn Rd. Kennewick,WA 99338 (509) 851-0771 m.j.moore@frontier.com - - _ -- ,.. . 1 --‘, ---- - e. - ,, 11; ;Igi- °-• . ._. - • - — . O . Cityof Anacortes Invoice/Permit#: BLD-2016-1304 904 6th Street Applied date: 06/01/2016 P.O.Box 547 Issue date: 06/0112016 Anacortes, WA 98221-0547 Expire date: 05/27/2017 (360) 293-1901 Job Address: 1109 DAKOTA AVE Permit Type: Demolition Permit ANACORTES WA 98221-1344 Project: APN: P58284 Remarks: Remove old garage Owner: PAUL REISMAN Contractor: Address: 1109 DAKOTA AVE Address: ANACORTES WA 98221-1344 • Phone: (360) 708-8419 Phone: License#: General Information: Fees: Total Calculated: Adjustments: Deposits/Receipts: Total Due: 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 CONSTRUCTIRN OR THE PERFORMANCE OF CONSTRUCTION. SIGNATURE OF OWNER AUTHORIZED AGENT .ISSUED BY CITY OF ANACORTES DEMOLITION PERMIT APPLICATION Site Address:_ 1 0 C.: •\ ! -k#'w ZrE CJ Assessors Account No.: Date: Lot(s): Block: Addition; Owners Namer L-0-P-SPAPP Contractors Name: Address: \1oc D014cI-'Pc Address: State: WA Zip: 1 2J State: Zip: Phone: 0 " 3''- *[9 Contractors License: Phone: Have Utilities Been Disconnected? Description of proposed demolition. Wateept.: Yes No 4---'A1 OLD (ACE Electric: Yes No C„,1l51e: Yes No Yes No How Will Materials be disposed? BARRICADES TO BE PROVIDED FOR PUBLIC PROTECTION,AREA MUST BE ROPED OFF! Applicant -Agent's Signature ASBESTOS WARNING Breathing asbestos is hazardous to your health. Before starting a renovation or demolition project, survey for friable asbestos materials. Notify Northwest Air Pollution Authority prior to asbestos removal or containment 1600 S. 2'd Street,Mt.Vernon,WA 98273 (360) 428-1617. Fire Department Approval: 1 Date: S/3 f//6 y. Police Dept.Approval: Date: Public Works Department Approval: Date: 5/ // D Date: it9//f4- Comments: Anacortes Environmental, Safety and Health Services 8116ti Street Anacortes,Washington May 30, 2016 Paul Reismen 1109 Dakota Avenue Anacortes,WA 98221 RE: Asbestos survey of detached garage. Dear Mr. Reismen: This letter and the attached documentation will comprise the suspect Asbestos Containing Building Material (ACBM) survey performed on the detached garage unit located at the above referenced address on May 23, 2016. On May 23, 2016 Donald Swanby an EPA accredited building inspector (Cert# RHW-BI-14- 025) Expiration: September 10, 2016 conducted an inspection and sampling of the detached garage unit, located at 1109 Dakota Avenue Anacortes, WA 98221 for the specific purpose of identifying the presence or absence of suspect asbestos-containing building materials. The suspect materials sampled were delivered to "Seattle Asbestos Test" which is an NVLAP accredited laboratory by U.S. Mail for analysis by Polarized Light Microscopy(PLM). Samples collected and analyzed: Sample# G-1 Material: 3-Tab roofing. Green over red with Black, Gray and Pink sealant. No Asbestos Detected Location: North East corner area of roof at chimney vent. Sample# G-2 Material: 3-Tab roofing. Green over red with Black, Gray and Pink sealant. No Asbestos Detected Summary of Asbestos-Containing Materials No building materials identified contain asbestos materials. No other suspect materials were identified during the survey. d b�S� Anacortes Environmental, Safety and Health Services 811 6th Street Amcor/es, Washington Any building materials found to contain more than one percent asbestos are considered `Asbestos-containing materials' in accordance with Title 40 Code of Federal Regulations (40 CFR), Subpart lvl, Section 61 and typically must be removed from a structure prior to any demolition, renovation or remodeling that would disturb those materials. Laboratory reports and Inspector Accreditation attached. Please feel free to contact me if you have any questions or require additional services. Sincerely,1 h — bLi4 Donald Swanby EPA Accredited Building Inspector Cert# RHW-BI-14-025 Expires 9 10 2016 Attachments: Asbestos Laboratory Analysis Field Notes with Sample Locations Building Inspector Certificate 6{s Anacortes Environmental, Safety and Health Services 811 6th Street Anacortes, Gr'ashington Lyewo:we Leh.-eivy:1970;Scriber La:;e Fcr.1 S4im i113-LYnneteed,4't4 7.iPG[ Tel.•I 2c.5-,7,.F.d30,Fax 47.5.o7-.3>^E10.IdVLJ,¢La/5 Ccle;2L1D e 0 l4!ALYTICi.i..LA t'GraAT?QG`I'R PO'-`i pl.k9 Sy/faelhoti EPIJSoW -nii13 M .. Mr,pen Swaney nrecnk: Answries ESI-I i:ddrees: E El 60 St An3cor es,tAWH EI622 N/A ed.rh9r 2016110E8 l,_r cr[.-ne: 502112016 l:errpIcs Ha.tl: .2. Dale Anelvzrd: 0j26/2016 c,:rWw Anay_cd: 2 PnaiaG Lar: 'I109 Caketz Ave.Anacor0Ea �nzi:ed 4y.a. :wJ^-`Jr' � ' r-evIzs.ca tv :[yr<IF.:N..o721r=2.61.,*0 L010 i;Gan;Ssmple IC Lager C.anCiPkn '/, V EItsbesiu5 Ff6ers PI6n.f3:,ei CempDnawt< .1 I Nart.,,Je9In0 Fibcs Black asphaltic /*one l sphalt/Wilder, 1 material with green 27 'Giass/ibe s sand 4,,ter..E�[i Sand Blade asphaltic ,s;,rn® its ri trlbinder, 2 atatadal with red p Csi)uiose m it tied Sand 3 Black asphaltic •!o;i.o IAspha,rt/binder, g Cellulose fibrous material detocfied lBinderhliler _ _i 6iacJgray i;sia nsp haltibinder 5 Cellulose,Talc asphaltic material Lreteeeed i }Pink sortlelastic ,iQl:a 5 # Biiicsr,Filler2 Cellulose m5Parial jroetr cteo I Bleckl gray faiari.� 9 1 tialtibindar a lCellulose,Taff, asphaltic grata;,isl 1 I d e�ototi /�s p E (Black asphaltic • .i, Asptial`tibiridcr: I 'L material with green I d:4eciad' Salad 25 Glass fib-are 1 send 2 I G-2 Black asphaltic I L.k.EIE? Asphalt/binder. 0 material withrec I ,, ._c. i 3 Josesaid �_v Sand Slack asphaltic 1:51.2m J .sphaiirainder, w 1I 70 Cellulose anus criatrrfll 'doir::e:5i Binder/filler Pink soitrisiastic I tic�1-es. 5 Eind4r, ilcl' ? Celil iosxi i rnsEurlaf — cle'E..c4exl J_._.. -i T ' 1 - -- - , Anacortes Environmental, Safety and Health Services 811 e Street Anacortes,Washington . .--- . . - 1� J °!ly -- v1 ..1 'l5i4�vt Ito 1. „RI _._ 5 !� 6-1 _ . .� . +x - - �j6Vp_ _ )._.3.-r� . � , .C� �� to Gv r+.- e .1 jwy -- - ----------- .`-------- -.'g4t ie /_A T) 11" 0J1Ki dry. c1! . fdVI• �y d , . . .. , 1. , - it , -, .,A- .e ,-., 1 . , . , i 1 . , =MR 1 p Certificate 6.7 Completion r A I 1 1,, :vetch5II1Ce ,.,-.'I i - 1 i.11%in am I'el%A/Said:. 1,..1.041:rnilni Trannny,ti Con".tillii ig This is to certify that on • September 8-10, 2015 Donald S . Swanby Did attend and satisfactorily complete the training requirements in accordance with '-. • TSCA Title H (Section 206) and 40 CFR 763 & Missouri State RSMo 643.230 For designation as an - ... AITERA Building Inspector -a,_ J •i .• Certificate No. REN-B145-025 1 Expires September 10, 2016 , . . _. ,... ... - Presented By-4, Environmental/Safety agement t;_-. Michael J. Moore P Training& Co lting ..t 1 ...0 Training Director/Consultant .... 4, i.. .... ..., , 1 '-.• lk...- r a 4101t: 96902 E.Kaitlyn Rd. Kennewick,WA 99338 (509) 851-0771 m.j.moore@frontier.com - - _ -- ,.. . 1 --‘, ---- - e. - ,, 11; ;Igi- °-• . ._. - • - — . Off:.: City of Anacortes Invoice/Permit#: BLD-2015-0046 904 6th Street Applied date: 02/03/2015 '` P.O.Box 547 Issue date: 02103/2015 Anacortes, WA 98221-0547 �,.,. Expire date: 08/01/2016 (360) 293-1901 tt .�5 .-.n. yJJ• Job Address: 1109 DAKOTA AVE Permit Type: Mechanical Permit ANACORTES WA 98221-1344 Project: APN: P58284 Remarks: Replace two electrical water heaters with one tankless on demand gas water heater. Owner: PAUL REISMAN Contractor: Address: 1109 DAKOTA AVE Address: ANACORTES WA 98221-1344 Phone: (360) 708-8419 Phone: License#: General Information: Fees: #of Gas Piping 1 Mechanical Permit Fees 38.90 #of Gas Water Heaters 1 Total Calculated: 38.90 Deposits/Receipts: 0.00 Total Due: 38.90 THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF i.. 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. , ZeZ°4--"6- /714 4/10 S6NATURE OF OWNER OR AUTHORIZED ISS ED BY • Y .. City of Anacortes Invoice/Permit#: BLD-2015-0047 904 6th Street Applied date: 02/03/2015 P.O.Box 547 02. Anacortes, WA 98221-0547 Issue date: 02/03/2015 ' ,' (360) 293-1901 Expire date: 08/01/2016 Job Address: 1109 DAKOTA AVE Permit Type: Plumbing Permit ANACORTES WA 98221-1344 Project: APN: P58284 Remarks: Plumbing permit for residential remodel. Owner: PAUL REISMAN Contractor: Address: 1109 DAKOTAAVE Address: ANACORTES WA 98221-1344 Phone: (360) 708-8419 Phone: License#: General Information: Fees: #of Clothes Washers 1 Plumbing Permit Fee 69.00 #of Dishwashers 1 Total Calculated: 69.00 #of Kitchen Sinks 1 #of Lavatories 1 Deposits/Receipts: 0.00 #of Showers 1 Total Due: 69.00 #of Water Closets 1 #of Water Piping 1 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 LOCA REGULATING CO STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. (7) r I, SIGNATURE OF OWNER R AUTHORIZED AGENT ISSUE 4114 VII • r \f'4° • ,-Cap A 191 Finance Department 015054-0001 Maryellen 02/03/2015 11 :55AM PERMITS AND INSPECTIONS PAUL REISMAN BLD-2015-0046 Mechanical Permit Replace two electrical water heaters with one tankless on demand gas water heater. issued 2015 Item: BLD-2015-0046 38.90 Payment Id: 46807 PAUL REISMAN BLD-2015-0047 Plumbing Permit Plumbing permit for residential remodel . issued 2015 Item: BLD-2015-0047 69.00 Payment Id: 46808 107.90 Subtotal 107.90 Total 107.90 03FINANCE CREDIT CARD 107.90 Visa ************240g Ref=6892309333 Auth=313065 Change due 0.00 Paid by: PAUL REISMAN II II II MI III I II I HMI liii Signature: Thank you for your payment COPY DUPLICATE RECEIPT 1.1, 0 th -- IA Ad ,,„„T, A PLUMBING PERMIT APPLICATION City of Anacortes Building Department P.O. Box 547 Anacortes,WA 98221 -Street Address: 904 6th Street Phone: (360)293-1901 Fax: (360)293-1938 SITE ADDRESS: F I Oq DA/40—ri! AIEri uE, 74,44c-c .,, CONTRACTOR rs Name i oi)STDCL A - Or4 —( - PROJECT DESCRIPTION Address(1OCI\ DiAeoTA I\d Erg MOVIAr6- % 'r C-14 'X'-c'.4, City/State/Zip4\rlA ( 5�- O�� 1 phone-360-7 au�25-1 II FAX Permit Fee 20.00 State License# CO CO'`232-C 98 Exp Fixture Type Fee Each No. Amount City of Anacortes Business License,Yes o No Toilet 7.00 PROP RTY OWNER Bathtub 7.00 1 Name ..- 1 -1 SM Shower 7.00 109 PA $\ NSA J E hi \.7-1/ i Address --- Dishwasher 7.00 City/State/Zip• iN y� , �tl2-- Hand Sink 7.00 / Phone 3 bO--i-O 0�i--g 4 $9 FAX Kitchen Sink 7.00 l ` �`� ���� _ ` "rf i + E-mail Address V1Ic,�t� t.�(1�i7�'�I age ��>(.�r� i Clothes Washer 7.00 �' 1 Electrical HINT 7.00 APPLICANT Grease Interceptor 7.00 3g Name , 1 .- REk Utility Sink 7.00 Address Urinal 7.00 Ii F City/State/Zip Backflow Preventor 7.00 t Phone FAX Drinking Fountain 7.00 P E-mail Address Slop Sink 7.00 f CONT Water Piping 7.00 ./ �L. kS Name � � Hose Bibb 7.00 I� Additional Fixtures 7.00 Address ®C' TOTAL FEES DUE 67:7-r0 , City/State/Zip Phone FAX III, 4 E-mail Address I HEREBY ACKNOWLEDGE I HAVE READ THIS PERMIT APPLICATION AND STATE THE INFORMATION IS CORRECT,AND AGREE TO I`, COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING ACTIVITIES COVERED BY THIS PERMIT APPLICATION. WITH THIS PERMIT ALL CONTRACTORS AND SUBCONTRACTORS SHLL HAVE A CURRENT WASHINGTON STATE CONTRACTORS LICENSE ANDARE W A R BUSINESS NGWITOUT LICEyr SE.PER STOP WORKLICENSE. ORDERS WILL BE ISSUED ON JOB SITES WHERE CONTRACTORS/SUBCONTRACTORS ; A LICANT'S SIGNA RE DATE Last updated Nov.9,2012 v. 4 &lw _ A �4coa�� , m)ITSE MECHANICAL PERMIT APPLICATION City of Anacortes Building Department P.O. Box 547 Anacortes, WA 98221 Street Address: 904 6th Street Phone: (360) 293-1901 Fax: (360) 293-1938 SITE ADDRESS: 1 r CC( P4 g..t-A 7 W a /eT S CONTRACTOR Namell I (,I4 •IST?iY Ti ILL- PROJECT DESCRIPTION (c D� N'-✓"`'') ❑ New Work Address �`� .-�-� � ^� y p�1 e. Ji �X.rA q f_2' ❑ Alteration Cit /State/Zi X`� Phonea5Vqov—g419 FAX Permit Fee 23.50 State License#033"'331 —I CI g Exp Type of Equip. Fee Each No. Amount City of Anacortes Business License:/Yes o No Air Cond.Unit 10.65 PROPERTY OWNER Refrigeration Unit 10.65 Name`��Ly- Re IS Forced Air System 14.80 Address 1\O(�q,�� �.1tr-t �• ,�rj� /�(t1 Floor Furnace 14.80 City/State/Zip Pfe\N 4''�- `X� I '?�( Wall Heater 14.80 Phone 60- 7p T$ 4 17 FAX Clothes Dryer 10.65 E-mail Address\NOOAS'4OCKCDUAs1 tUC ki 4°4. htiMCii L UM Ventilation Fan 7.25 APPLIT Range Hood 10.65 Name 1.- 1�-n-gib Gas Fireplace 10.65 • Address Gas Water Heater 10.65 / `0,4 r City/State/Zip Gas Piping 4.75 / ill 75- Phone FAX Other(Describe) E-mail Address CONTT Name 1 L— CtS TOTAL FEES DUE 33 2- - Address City/State/Zip �/,L Phone 36 0""^�0�/O"( )5 FAX E-mail Address I HEREBY ACKNOWLEDGE I HAVE READ THIS PERMIT APPLICATION AND STATE THE INFORMATION IS CORRECT,AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING ACTIVITIES COVERED BY THIS PERMIT APPLICATION. WITH THIS PERMIT ALL CONTRACTORS AND SUBCONTRACTORS SHLL HAVE A CURRENT WASHINGTON STATE CONTRACTORS LICENSE ANDpBUSINESS LICENSE.STOP WORK ORDERS WILL BE ISSUED ON JOB SITES WHERE CONTRACTORS/SUBCONTRACTORS ARENG WITHOUT P ER LICENSE. APPLICANT'S CANT'S SIGNATU DATE Last Updated Nov.9,2012 rtT~Y O Cityof AnacortesG _I Permit#: BLD-2013-0450 904 6th Street Issue date: 10/29/2013 P.O.Box 547 Expire date: 04/27/2015 11 0s Anacortes, WA 98221-0547 os et- r (360) 293-1901 og, : Job Address: 1109 DAKOTA AVE Permit Type: Mechanical Permit ANACORTES WA 98221-1344 Project: APN: P58284 Remarks: Install gas fireplace and piping. Owner: PAUL REISMAN Contractor: Address: 1109 DAKOTA AVE Address: ANACORTES VI 98221 { Phone: (360)708-8419 Phone: License#: General Information: Fees: #of Gas Fireplace 2 Mechanical Permit Fees 49.55 #of Gas Piping 1 Total Calculated: 49.55 Deposits/Receipts: 0.00 Total Due: 49.55 7.1 •. ro I.J C..1 f'� 1 m I 1t, I- (Z. C) I•� II CT. ..4) COco 0 "-I 4 •4) THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR I CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. a a 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 OF OWNER OR AUTHORIZED AGENT ISSUE BY 0934204-1 0002 12/09,2009 002 4 Permit Fees 008557 $39.90 %1 Y O fi City of Anacortes Permit#: BLD-2009-0478 904 6th Street Issue date: 12/07/2009 `* ' • P.O.Box 547 Expire date: 06/05/2011 '�'' CO ; Anacortes, WA 98221-0547 ".`��c k.,. (360) 293-1901 Job Address: 1109 DAKOTA AVE Permit Type: Mechanical Permit ANACORTES WA 98221 Project: APN: Remarks: Install gas fireplace and piping. Owner: JOHN MARTIN Contractor: HANDYS HEATING Address: 1109 DAKOTA AVE Address: 17737 STATE ROUTE 536 ANACORTES WA 98221-1344 MOUNT VERNON WA 98273-8754 Phone: (360)293-9214 Phone: (360)428-0969 License If: HANDYHI088JW General Information: Fees: #of Gas Fireplace 1 Mechanical Permit Fees 38.90 #of Gas Piping 1 Total Calculated: 38.90 Deposits/Receipts: 0.00 Total Due: 38.90 N co m i a) - +-, q- cv a; cv w a 4. to F- 4) C n.....y 1- tCD 0 ill 0 •Oi O �� fF ° N F- i-, m G O a)C)CC CaC) mCO01 01CC2 Wi - EOV3 GOJ S.-a) OW -Y 0_ LOOACC ID a) O LOO Hn ,9) -r \OF- CDi � 2., OCD CD CD CD CD OC CI.� A.' s- O 0 Y 0 -_-I I--r. t .w.-� O W\O CO -- mCJ •- U N 0 � 0 CO # F- CO a) e0 W,- NI--, •- 0 CA C C ^F- m L Yt -• O O CC .c .- CO CC (6 G CID c--.CO a I CDC) cr — m E +, cn CD — 0 O O .,- O d CO O) E E C= O N C3 -- -- C") :3 COW ` >.m LfA C .. F- C) `. 4-1 COC") y E 0 U fL Fi C L m e m o 6 o U N O F-- Z C N i E # �- �) 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 CiOnNNSTRUCTION. (�' ' SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSU D B r'Y.(! / l 11 G ?�l� U � T {' { APPLICATION FOR BUILDING PERMIT CITY OF ANACORTES Date. 97D T / Owner's Name F(/P///il iMentu Owner's Address ®w.EPS ,4t Phone No. Applicant's Name one f Ail-re rdi2'lik Applicant's Address ?O9 — cjwN .c,4 Phone No. 3-. /L Property Address _ //09 - _2b4..i4 Legal Description of Property (/0/4 7 e�/4r///4 8 JQ/ , /141, t,Y. ,tom/4 . j®•� xe / ' sail, Pa 41/ Sin, ill. Description of proposed improvement { 3/p'/ j /1u� l/1�Q917`• ttit? fit 4 h — _ m/ 2.4- Improved property to be used as follows rl44,440 NCO Value of proposed improvement $$ Z119 .� ¢� 0 0 PLOT PLAN Instructions: Draw a sketch of the property on the reverse side of this page or submit plot plan showing the following information: 1. Streets and alleys abutting property. 2. North point. 3. Size and shape of property. 4. Size of existing building or improvements. 5. Size of proposed buildings or improvements. 6. Distance of all structures from all property lines. oihtC ifif‘ Applicant's or agent's signature Sign only after reading attached building permit requirements.