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Permit File 5409 Doon Way
X City of Anacortes Permit#: BLD-2014-0131 904 6th Street Issue date: 04/03/2014 . � P.O.Box 547 Expire date: 09/30/2015 ''" , Anacortes, WA 98221 0547 - " (360) 293-1901 ,,O.klhillifarrq Job Address: 5409 DOON WAY Permit Type: Single Family Alteration/Repair Permit ANACORTES WA98221-2915 Project: APN: P59612 Remarks: Garage remodel. Owner: BIL&KIM MONTEFORTE Contractor: NEW CREATIONS BUILDING CO. LLC Address: 5409 DOON WAY Address: 3408 F AVE ANACORTES WA 98221-2915 ANACORTES WA 98221-4707 Phone: Phone: (360)540-2216 License#: NEWCRCB945O5 General Information: Fees: Building Valuation 3000 Building Permit Fee 83.25 Plan Review Fee 54.11 State Building Code Fee 4.50 Total Calculated: 141.86 Deposits/Receipts: 0.00 Total Due: 141.86 0 . -„ P ,2, -0 x - .y, ...r•P r C, C .1 _ s ,� {µ, — • • ,... ,:c:• P kTT c' Sv .t-r-! X, s t t-+• {=• r" CI . .-h• ,.r, ,-•.• t--, -rt —t• y r- m , THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAVS'P"OR• [F CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMalOrht t HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL Pf2O41.tNt OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR:INOT,rF GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHERr6TAT •O 2 LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. I_ 44. CA wy r• P .• .... ti.• - Wy 0 . r•.., _r. SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSUED BY ,r: r. Ajar r4r Cole i y.. SINGLE FAMILY RESIDENTIAL PERIMtT:_.��:: { .;. 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: 5 j if-2 q P, ©It 1'0 CONTRACTOR -, Appplicant PROJECT DESCRIPTION Name Pe Lo �ce�tC e1 t it .4.3 ax.et. Pcycyx v--eivv( 0064- Address 3 ®g F VC_ r_ I G6t City/State/Zip v'���rr 1 �p 5'ZZ Phone 3b0 1{0 -0-4kX ---.. State License# Exp PARCEL NUMBER City of Anacortes Business License:o Yes ❑No PROPERTY OWNER ❑A pplicant LEGAL DESCRIPTION P Name f[It 1 y,,�erkiN Iter( k— Address Cif® 17 GSA+� City/State/Zip 164cke 11°51 We" FX221 PROJECT VALUATION Phone FAX f ®q. Number of Dwelling Units E-Mail Address Number of Stories Building Area: 0 Architect 0 Designer.: ngmeer❑ Applicant 1st Floor s.f. 2❑d Floor s.f. Name 11 1 c.L&ej, \s-vti in --t 3rd Floor s.f. Basement s.£ Address Garage s.f. Carport s.f. City/State/Zip Deck s.f. Lot Area s.f. Phone FAX E-mail Address CONTACT D Applicant LENDER LENDER INFORMATION MUST BE PROVIDED FOR PROJECTS OVER$5,000 Name IN VALUATION PER RCW. Address Name City/State/Zip Address Phone FAX City/State/Zip E-mail Address Phone No. CONTINUED ON THE BACK Residential Mechanical Fixtures Fuel Type ❑ Natural Gas ❑ Electric ❑ Wood 0 Propane Gas ❑ Other Type of Equipment Number of Type of Equipment Number of Fixtures Fixtures Furnace<=100K BTU Clothes Dryer Boilers/AC/Heat Pump Gas Water Heater Gas Outlets Gas Fireplace Ventilation Fans Fireplace Insert Stove,Appliance Other Units Range Hood Residential Plumbing Fixtures Type of Fixture Number of Type of Fixture Number of Fixtures Fixtures Toilet Clothes Washer Bathtub Electric Water Heater Shower Utility Sink Dishwasher Hose Bibb Hand Sink Water Piping Kitchen Sink w/Disposal Additional Fixtures I HEREBY ACKNOWLEDGE IF HAVE READ THIS PERMIT APPLICANT AND STATE THE INFORMATION IS CORRECT,AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATINGACITIVIES COVERED BY TIES PERMIT APPLICATION.WITH THIS PERMIT ALL CONTRACTORS AND SUBCONTRACTORS SHALL HAVE A CURRENT WASHINGTON STATE CONTRACTORS LICENSE AND A CITY BUSINESS LICENSE.STOP WORK ORDERS WILL BE ISSUED ON JOB SITES WHERE CONTRACTORS/SUBCONTRACTORS ARE WORKING WITHOUT PROPER LICENSE. APPLICANT'S SIGNATURE DATE Last Updated Nov.9,2012 _ F.-I-L.- 1---- HI H---- '---H--- ----4.--- L---- ---01- ------- -I - - ,-- - _ , ' ' 11 ■ I pl ) i num II_ W MmEIIM w.1 1E1M11aOEm I II I1 N* b , I7 1I1 •I MEE I IIMIIMM = EN 1 i II. IME 1111111NEIENIENEMMINIE INEMEMIME MIME 111111MMIENNOMMEINIEMEMMININ NIIMINIMMENIMI IIMIEEMEENIMMEEMEMEMMENIMENEINIMIENIMMEMME MINIMMENEEMENEEMINIMMEMEMINEMOINIMMEMMIN 111111111.111111MMOINTALIONMENIMMIMEMSEMENIMIIMEMEMEN IMIEMINIMMIMEMINIMMIEMIIMIENEMMINNIONININIMMINI MIIMIIIIIIIMIIIIIMIMIIMIIININIEEIMMIEIIMIMIMIEIIIIIMEMMII IMEMBEEMERMIENEINIEMIEMEMINEMMIIIIMEMENIEMEMII EMU 111111MINEEMENIEM 101111111111111111111111111111MINIEMINIMI IMINEMENEMINISMOMMEMEIMINIENNIMAIMMINEMMEMEIMMI 1110V INIONEENSIMENEMEMINIMMENNEENIENNIMINIIIMEM IIIIMMUMFAMISMEMENIMINENIONEMINIMEMENEENII -- EU II is ABEITMIROMMINIZAMI ITIMINIMENEMEIMIMEIMEIN 11111 immommommaisimmumnimmommommommummammism ; w 0 NE= aimommemmunum , 11 mil iii MEM MEM JIMEMEEMEMMEMMINIMMEMMMERMW II < mu MIIIIMNINIMMIIIIIMNIIIIIINIIIIIIIIIIIIIIMIIIIMIIIIIIIINIIIIIIIIIIIII \ \ ENE mmummommummommommummommommommaimmom 11111111111•1111111111111111111111111111111111310111111MMISMIER1EMIEMEI 111111111111111111111111111111111111111111111111EMMENNEIMMENEMINONIMMI 1111.1111111111111111111111111111110111111111111111111111111MINIMINMEINIMININI STRUCTURAL CALCULATIONS FOR COLUMN REMOVAL MONTEFORTE RESIDENCE 5409 Doon Way Anacortes, WA 2012 IBC November 18, 2013 2013-1091 �y Pi Prepared By: Michael L. Schemmer, P.E. 5, x '> 1 17„ 2032 N Avenue, Unit A r.; fJ" Anacortes, WA 98221 `` js3 ''_°'.r (360) 941-1607 00. a�,\ mIspe.structures@yahoo.com k' MICHAEL L. SCHEIVIMER, P.E. --- ,i,r, (0-W „Ivy . 7:--------- ; ; 1/ ephrT1444 1 C,"r Tei*, (-0 gwret4.- -V-rittsr— '-•D 4_ ee.-04.01.z.... N i )k 4 1 I TIT ,s; r% stjt w : I--dc----- 4. ,--- •61-31. ' sict5T °Ft‘.1- lb 150, e., 474-1, 1-1,*-404 5,0."41 P ‘ . 130 -F,,,,, -ayz.): is v 3/z, z-' tizz _a 4 1,0 .' 4 P‘lb 0.... t co a 5125' 14e 4:12/44.LAati tie aNtv 4,7 13gAM tatA--( 015i 4-xt, eryao 1-- 3rz----("--e-ip-,I, 1 (2.-.. , ' E„..c..cesi 464052,c --'g.'- ''T40-1" 444, rto- '45'114- VL Michael L.Schemmer,P.E. 2032 N Avenue,Unit A Armen-rte.%WA 9/1221 (360)941-1607 mispe.structutes@yahoo.corn Michael L.Schemmer,P.E. Project Title: 2032 N Avenue,Unit A Engineer: Project ID: Anacortes,WA 98221 Project Descr: (360)941-1607 • mispe.structures@yahoo.com Punted:18 NOV 2013,9:43AM Wood Beam File=c:\Users\Michael\DOCUME-1\ENERCA-1\20C311-1.EC6 ENERCALC,INC.1983-2013,Build:6.13 8,31,Ver:6.13 8 31 Lic:#:"KW=06010145 . ,^ ;� f; _ `: lcensee: ic ae :i Gherrimer, Description: B1 CODE REFERENCES Calculations per NDS 2005, IBC 2006, CBC 2007,ASCE 7-05 Load Combination Set:ASCE 7-05 Material Properties Analysis Method: Allowable Stress Design Fb-Tension 3100 psi E:Modulus of Elasticity Load Combination ASCE 7-05 Fb-Compr 3100 psi Ebend-xx 2000 ksi Fc-Pdi 3000 psi Eminbend-xx 2000 ksi Wood Species :Boise Cascade Fc-Perp 750 psi Wood Grade :Versa Lam 3100 Fv 285 psi Ft 2100 psi Density 32.21 pcf Beam Bracing : Completely Unbraced D(1.128) S(1.881) 5.25x14 Span = 19.50 ft Applied Loads Service loads entered.Load Factors will be applied for calculations. Beam self weight calculated and added to loads Point Load: D=1.128, S=1.881 kna,8.670 ft,(P1) DESIGN SUMMARY —,-- Desi.n OK [Maximum Bending Stress Ratio = 0.347:1 Maximum Shear Stress Ratio = 0.130 : 1 Section used for this span 5.25x14 Section used for this span 5.25x14 fb:Actual = 1,066.65psi fv:Actual 36.99 psi FB:Allowable = 3,072.43 psi Fv:Allowable 285.00 psi Load Combination +D+S+H Load Combination +D+S+H Location of maximum on span = 8.682ft Location of maximum on span = 0.000 ft Span#where maximum occurs = Span#1 Span#where maximum occurs = Span#1 Maximum Deflection Max Downward L+Lr+S Deflection 0.207 in Ratio= 1130 Max Upward L+Lr+S Deflection 0.000 in Ratio= 0<360 Max Downward Total Deflection 0.353 in Ratio= 662 Max Upward Total Deflection 0.000 in Ratio= 0<240 Overall Maximum Deflections-Unfactored Loads Load Combination Span Max.°°Den Location in Span Load Combination Max."+"Defl Location in Span D+S 1 0.3534 9.465 0.0000 0.000 _Vertical Reactions-Unfactored Support notation:Far left is#1 Values in KIPS Load Combination Support 1 Support 2 Overall MAXimum 1.831 1.498 D Only 0.787 0.662 S Only 1.045 0.836 D+S 1.831 1.498 packers360-Yahoo Mail Page I * Home Mad News Sports Finance Weather Games Groups Answers Screen Flickr Mobile More , Y"J-pac Search Mail Search Web J 0 i e 11—N h <4 ♦ ® Delete n Moves, Q Spam ® More X Ls- lnbox Drafts Sent Jon Moehl e Today at 2:43 PM Spam(9) To Me Trash(1) > Folders ) Recent Jon Moehl _ New Creations Building Co. 360-540-2216 Attarhmentc Vipw all Downlnarl all v Nor moon • P https://us-mg6.mail.yahoo.com/neo/launch?reason=ignore&rs=1 4/2/2014 3:08:07 PM 0 ;i6703-: 0007 06/17r2008 001 9 Permit Fees 008019 33255.48 G1`t Obi City of Anacortes Permit#: BLD-2008-0299 q 904 6th Street Issue date: P.O.Box 547 5 ,"" r Expire date: 06/17/2009 =,'0' t/) Anacortes, WA 98221-0547 WA -, Cott Job Address: 5409 DOON WAY Permit Type: Single Family Alteration/Repair Permit ANACORTES WA 98221-2915 Project: APN: P59612 Remarks: Remodel bath and laundry Owner: KIMBERLY ADAMS Contractor: Address: 602 POSSESSION VIEW LN Address: MUKILTEO WA 98275-2246 Phone: Phone: License#: General Information: Fees: #of Clothes Washers ,- 1 Plumbing Permit Fee 55.00 #of Lavatories .- 3 Plan Review Fee 91.33 #of Clothes Dryers 1 State Building Code Fee 4.50 ' #of Showers 1 Mechanical Permit Fees 34.15 Building Valuation 20000 Building Permit Fee 140.50 Total Calculated: 325.48 Deposits/Receipts: 0.00 Total Due: 325.48 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. SIGNATURE Of,OWNER OR AUTHORIZED AGENT I SUED Y 0 LCViMAI IL AYE ,, VA-a 1-1- b - . ---. t lin e s t cnn s a op (oy; vvtcAA- / 11-6" / / 31-0" 5'-6" // 3L0" / 5r4„ / Orr x 3 0rr 0cuks:e.e -bow \ ii _ 31-0„ x6, 8„ Citiouiel-r 'VAC<,L'y / 5r0„ S _ A , tA a M F Lacv,.i(,- j - 5, ( - � Z pow`, ffl -' IV Fr- J r- \ k \ cn \ \ 3-2„ a? w arr r CIoS-O ti O sa - 3' „x6, o LN 'l 11 �0r,x6, 8, \ • \ A2'-2"/ 7'gar 1'- „ 5, 2„ / / 11'6" CITY OF AWCORIES ERMI 1 CENTER APPROVED PLANS ,rw.a .MIT P k,y . -ram e -w... _. i ao •ROVED BY- JQc�C�vu-� 3JECTTO FYELE INSPECTION. OVERSIGH t VIOLATION OF CODE IR NOT INCL.UDE.P ,SAD 9 Dao>- , nigezenied D / re pose d / 11 '-6" / / 2_9" / 5'-9" / 3'-0" 71 5'-2" '' / 3'-7" x 3'-0" -0„ x 6` N Wash&Y tic'le' ,i Sk© r \ r `? V / 5'-0„ Lob Q / QO 9 ctA h� , G-rhe, js ` St' 7 /4- N.)lV/ X \ / (L,9) , atto 1 Cita 3'- ' x 6'-Alm 3 -0 x 6 -8 A " \ 9'-4 2'-2"/ 5'-4" / / 16'--10" C l'l"Y OP AffACORTES FERMI G%JEKK l :APPROVED ------ rt..- T TO vial) INSPECTION. OvERSIGH , AG{ NOFCODEiSNOTINCLUDED 5-5/?) 9 0 d ri . Allicte tr e-ct hial7ar "a �zx cial Building Permit Application Building Department ' o /0 P.O. Box 547 Anacortes, WA 98221 Phone No.: 360-293-1901 FAX: 360.293.1938 SITE ADDRESS: CVO .Doan r4.1n-y, /the?en-led, 9,e / CONTRACTOR 0 Applicant PROJECT DESCRIPTION ,Q2iC14,1Ec muie9Ky � / j Name GENL/uii ecru-mnfl,/[I 6 /�ennic)047 /Glrjf� e 1 aA �aFiat e v AKA: R11MC H aat ctoucrtt-rlct t Oa) ?C /— i s ke c.ii or- Address er 0/0 8-0 Av't Aft- ,O tie o% ,r� cu, -c.t4(e sin Zs City/State/Zip 4 ayy /fe WA , r/8d7(� Relocc�Fc- efach-, c ca v p( C • Phoney�S 239-�151FAX WCu4e4 'n�U- ( ve.I.J) Re 1 et c: is %t r�c%-, snik. State License#4 l t-4E.HC''ll 475SExp 11'0"09 PARCEL NUMBER y City of Anacortes License P5C//y/a_ . PROPERTY OWNER X Applicant LEGAL DESCRIPTION SKy/:ire a/ 7, r..C4e7 3a Name ie/ri✓/erG T /flt✓tz4-71S Address 401 "%secs:on I/'e.-J 'tint- City/state/Zip//',t/.;Hee. u//1I, pd'o2 73 PROJECT VALUATION Phonegar-3:3tO-S"y&7 FAX rale,0©0 E-Mail Address Min/a4danIc CoyrteaJt. Number of Stories / nea- Building Area: 0 Architect 0 Designer 0 Engineer 0 Applicant l'Floor AC 06 s.f. 2nd Floor s.f. Name 3'd Floor s.f. Basement s.f. Address Lot Area s.f. Construction Type rendke City/State/Zip Use Zone Phone FAX Impervious Area E-mail Address Other(Describe) TENANT 0 Applicant LENDER LENDER INFORMATION MUST BE PROVIDED FOR PROJECTS OVER$5,000 - Name IN VALUATION PER RCW. Address Name City/State/Zip Address _,. i . Phone FAX City/State/Zip - .. , 0 `' i TA E-mail Address Phone No. - n .. CONTINUED ON THE BACK W V e_..y ...._ CAD —c7? Residential Building Permit Application `LL Building Department beau P.O. Box 547 Anacortes, WA 98221 Phone No.: 360-293-1901 FAX: 360.293.1938 SITE ADDRESS: C(NTittird dit tm71-41044`' :.} Name Address City/State/Zip Phone FAX State License# Exp PAMCEQ NUMI3Ek City of Anacortes License tf OI?ETtT ';OWN1;R_ CIApplcau4',,::: E.0.4DE5CRIP.xTO1V 1 Name Address City/State/Zip PROJECT VALUATION Phone FAX Number of Dwelling Units E-Mail Address Number of Stories Building Area: A`rc'Ygte it3 De§ighec []%Flpg neetZfl Ap liCaii2 I"Floor s.f. 2"d Floor s.f. Name 3`d Floor s.f. Basement s.f. Address Garage s.f. Carport s.f. City/State/Zip Deck s.f. Lot Area s.f. Phone FAX E-mail Address LENDER INFORMATION MUST BE PROVIDED FOR PROJECTS OVER$5,000 Name IN VALUATION PER RCW. Address Name City/State/Zip Address Phone FAX City/State/Zip P E-mail Address Phone No. CONTINUED ON THE BACK Residential Mechanical Fixtures Fuel Type ❑ Natural Gas ❑ Electric ❑ Wood 0 Propane Gas ❑ Other Type of Equipment Number of Type of Equipment Number of Fixtures Fixtures Furnace<=100K BTU Clothes Dryer Boilers/AC/Heat Pump Gas Water Heater Gas Outlets Gas Fireplace Ventilation Fans Fireplace Insert Stove,Appliance Other Units Range Hood Residential Plumbing Fixtures Type of Fixture Number of Type of Fixture Number of Fixtures Fixtures Toilet Clothes Washer Bathtub Electric Water Heater Shower ( Utility Sink Dishwasher Hose Bibb Hand Sink 3 Water Piping Kitchen Sink w/Disposal Additional Fixtures I HEREBY ACKNOWLEDGE IF HAVE READ THIS PERMIT APPLICANT AND STATE THE INFORMATION IS CORRECT,AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING ACITIVIES COVERED BY THIS PERMIT APPLICATION. WITH THIS PERMIT ALL CONTRACTORS AND SUBCONTRACTORS SHALL HAVE A CURRENT WASHINGTON STATE CONTRACTORS LICENSE AND A CITY BUSINESS LICENSE. STOP WORK ORDERS WILL BE ISSUED ON JOB SITES WHERE CONTRACTORS/SUBCONTRACTORS ARE WORKING WITHOUT PROPER LICENSE. APPLICANT'S SIGNATURE DATE ggNIDILLILLUiLLJT L� !j 91 is i-@ 0 E1 2CO3 p;i� V ) Commercial COMMERCIAL FIRE PROTECTION, lIkir 'Ill '' I1 Fire Protection 17199 BENNETT ROAD, MOUNT VERNON, WA 98273 a d INC. (360) 848-9093 FAX (360) 848-1072 - - CONTRACTOR'S LICENSE NO. COMMEFP132MM WET SYSTEM I CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR ABOVEGROUND PIPING il PROJECT NAME ISLAND INTERANL MEDICINE JOB NO. C2009137 PROJECT ADDRESS 910 32ND STREET ANACORTES, WA 98221 SYSTEM NO. 1 SERVES ENTIRE BUILDING Upon completion of work,inspection and tests shall be made by the contractor's representatives and witnessed by an AHJ and/or owner's PROCEDURE representative. All defects shall be corrected and systems left in service before contractor's personnel finally leaves the job. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities,owners and contractor. It is understood that owner's representative's signature in no way prejudices any claim against contractor for faulty material,poor workmanship,or failure to comply with approving authority's requirements or local ordinances. AUTHORITY HAVING ANACORTES FIRE DEPARTMENT JURISDICTION 1016 13s'Anacortes,WA 98221 ' PERMIT NO. BLD 2010-0018 PLANS Installation conforms to accepted plans ®YES 0 NO Equipment used is approved RYES ❑NO If no,explain PIPE AND PIPE CONFORMS TO NFPA 13 - 2007 STANDARD ®YES 0 NO FITTINGS FITTINGS CONFORM TO NFPA 13 - 2007 STANDARD ® YES ❑ NO Do you certify as the sprinkler contractor that welding procedures used comply with the minimum 9 YES ❑NO requirements of AWS B2.1,ASME Section IX Welding and Brazing Qualifications,or other applicable qualification standard as requited by the AHJ? ' WELDED PIPING Do you certify that all welding was performed by welders or welding operators qualified in accordance the ®YES ❑NO ' rri minimum requirements of AWS 82.1;ASME Section IX Welding and Brazing Qualifications,or other ' ® YES 0 NO > applicable qualification standard as required by the AHJ? Is- Do you certify that welding was conducted in compliance with a documented quality control procedure to I: YES 0 NO ensure that(1)all discs are retrieved;(2)that openings in piping are smooth,that slag and other welding residue are removed;(3) the internal diameters of piping are not penetrated;(4)completed welds are free from cracks,incomplete fusion,surface porosity greater than 1/16 inch in diameter,undercut deeper than 25%of the wail thickness or 1132 inch;and(5)completed circumferential butt weld reinforcement does not exceed 3/32 inch? HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi for two hours or 50 psi above static pressure in excess of 150 psi for two hours. All aboveground piping leakage shall be stopped HYDROSTATIC TEST ALL PIPING HYDROSTATICALLY TESTED AT 200 PSI FOR ' 2 HOURS? ElYES ElNO IF NO,STATE REASON WITNESSED BY FOR ORTE FIRE,AEPARTMENT �/J/� f/f, y///7 SIGNATURE ' TITLE ?ten,. AA. $ 4"a_Zc..'(DATE 4'f�—./0 I Underground mains and lead-in connect' s to system risers flushed before connection made to sprinkler piping. FLUSHING VERIFIED BY COPY OF UNDERGROUND PIPING TEST CERTIFICATE? ® YES 0 NO VERIFICATION FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING'? ® YES ❑ NO OTHER—EXPLAIN ADDITIVE AND DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS,SODIUM CORROSIVE SILICATE OR DERIVATIVES OF SODIUM SILICATE,BRINE,OR OTHER CORROSIVE CHEMICALS WERE NOT USED CHEMICAL FOR TESTING SYSTEM OR STOPPING.LEAKS? ® YES 0 NO VERIFICATION BLANK TEST GASKETS Number Used 0 Locations Number Removed 0 MANUFACTURER SIN TYPE MODEL YR OF K- TEMP. QUANTITY NUMBER - MFG. FACTOR RATING °F TYCO TY3131 SSU TYFRB 2009 5.6 200 36 TYCO TY3231 RECD SSP TYFRB 2009 5.6 155 29 SPRINKLERS I', ; . ,, ' TOTAL 65 ALARM DEVICE ALARM DEVICE MAX.TO OPERATE THRU TEST PIPE ' TYPE MAKE MODEL MIN SEC. WATERFLOW SWITCH POTTER ELECTRIC VSR 5 EQUIPMENT EQUIPMENT OPERATES PROPERLY ® YES ❑ NO OPERATION IF NO, EXPLAIN HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROL VALVES AND ID YES ❑ NO CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? 11 IF NO, II EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES? I 1 SYSTEM COMPONENTS INSTRUCTIONS ® YES ❑ NO I 2. CARE AND MAINTENANCE INSTRUCTIONS ® YES ❑ NO 3. NFPA 25 ® YES ❑ NO HYDRAULIC DATA NAME PLATE PROVIDED ® YES ❑ NO II NAMEPLATE IF NO, EXPLAIN CUT OUT(DISC) DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUT OUTS(DISCS)ARE ® YES ❑ NO RETRIEVED? CERTIFICATION IF NO,EXPLAIN PRESSURE LOCATION MAKE& STATIC PRESSURE RESIDUAL PRESSURE FLOW RATE REDUCING &FLOOR MODEL SETTING INLET(PSI) OUTLET(PSI) INLET(PSI) OUTLET(PSI) (GPM) VALVE INSTALLED _ ❑YES ®NO --- ------- -- - - --- - -- - . ' PRESSURE REDUCING LOCATION& STATIC PRESSURE RESIDUAL PRESSURE FLOW RATE VALVE INSTALLED FLOOR MAKE&MODEL SETTING INLET(PSI) OUTLET(PSI) INLET(PSI) OUTLET(PSI) FLOW(GPM) ❑YES ® NO IF POWDER DRIVEN STUDS ARE USED IN CONCRETE,HAS REPRESENTATIVE SAMPLE TESTING BEEN D YES ❑ NO POWDER DRIVEN SATISFACTORILY COMPLETED? STUD INSTALLED IF NO, ❑YES ®NO EXPLAIN IN-SERVICE DATE DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN• el / `5 / 20/0 MAIN DRAIN READING GAUGE LOCATED NEAR WATER SUPPLY TEST PIPE RESIDUAL PRESSURE WITH VALVES IN TEST PIPE TEST STATIC PRESSURE: / „0 / PSI OPEN WIDE _r PSI FOR A ANACORTES FIFIE DEPARTMENT FINAL ACCEPTANCE SIGNATURE al.D .) TITLE \ i ' ' DATE 1)/Z7/110 FOR PROPERTY OWNER OR THEIR AUTHORIZED AGENT TEST WITNESSED SIGNATURE TITLE DATE _ BY FOR COI MERCIA FR VeTECTION, INC.i / L / 'I SIGNATUR- A o -!IA 'A ' TILE FOREMAN ' DATE?//"!/ZOI0 - } I CERTIFY THAT T INFORMA 10 EIN IS TR AND THAT 1 THIS SPRINKLERS STEM WAS INS • LED IN ACCORDANCE 1 .WITH RCE 18-160 AND THE RULES ADOPTED BY THE 1 WASHINGTON ADMINISTRATIVE CODE AS ADMINISTERED BYTHE STATE FIRE MARSHALL. j CERTIFICATION Richard J. Sigmen . Il PRINTED NAME OF CERTIFICATE OF COMPETENCY HOLDER fetiti- A CERT GISTRATION NO. 391-07Yl1'' j`L n CV I S NATURE O ER IC E / E Y HOLDER .r 1 ' DATE ���s ! O p�~— I 3!i 0733204-1 0002 11/26/2007 002 4 Permit Fees 007712 $137.33 1 0 ., City of Anacortes Permit#: BLD-2007-0820 904 6th Street P.O.Box 547 Issue date: 11/28/2007 $'' •_ CO; Anacortes, WA 98221-0547 Expire date: 11/27/2008 �� w... (360) 293-1901 Job Address: 5409 DOON WAY Permit Type: Single Family Alteration/Repair Permit ANACORTES WA 98221-2915 Project: APN: P59612 Remarks: Replace float on dock, pilings, ramp and landing to remain as they are. Owner: KIMBERLY ADAMS Contractor: CARLSM CONSTRUCTION Address: 602 POSSESSION VIEW LN Address: PO BOX 943 MUKILTEO WA 98275-2246 LA CONNER WA 98257-0943 Phone: (425)330-5467 Phone: (360)466-4550 License#: General Information: Fees: Building Valuation 10000 Plan Review Fee 52.33 Building Permit Fee 80.50 State Building Code Fee 4.50 Total Calculated: 137.33 Deposits/Receipts: 0.00 Total Due: 137.33 THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. • 1 M ry)M2 he-L!? cd0 n SIGNATURE OF OWNER OR AUTHORIZED AGENT ISS D BY — S1°7 at o Residential Building Permit Application Building Department ',ecw� P.O. Box 547 Anacortes, WA 98221 Phone No.: 360-293-1901 FAX: 360.293.1938 SITE ADDRESS: s-ve)9 000/t) t oxiv, /42aeaY fes CONTRACTOR ❑Applicant ,PROJECT DESCRIPTION Named //✓YJ (167€57✓LIG vY-) Apet, -G-F 1/U ion Ga Atide/. Address P(]' k5 Ox 9Y3 7 /1/4 s //t�Z�l%L� l�/CGE� City/State/Zip/�aCOY/ne,r- uii/4, '9�'as /e Gt�i),Cp k /c:Jzati /4 LI Phone. O-yle!`i • at S-6PAX `` ./e State License# Exp .i PARCEL NUMBER City of Anacortes License PROPERTY� OWNER� ♦Applicant LEGAL DESCRIPTION Name Jt i/1 /��f'WC-%/,�$ // Address kOZ /-(75SCISi n-i t/ICLEl/_azit t✓ City/state/Zip s/at /IC0 Ea ✓f10173— PROJECT VALUATION u /c7/ 00 0 Phone/cif 33O S'(o 7 FAX li /Cade,`NSzvia, NumberofDwellingUnits E-Mail Address Number of Stories me/sea/9e . /2 e Building Area: 0 Architect 0 Designer 0 Engineer 0 Applicant 1st Floor s.f 2"d Floor s.f Name 3`d Floor s.f. Basement s.f. Address Garage s.f. Carport s.f. City/State/Zip Deck s.f. Lot Area s.f. Phone FAX E-mail Address CONTACT 'Applicant LENDER CC � / LENDER INFORMATION MUST BE PROVIDED FOR PROJECTS OVER$5,000 Name aYU/A���c as 6t6y1x- IN VALUATION PER RCW. Address Name City/State/Zip Address Phone FAX City/State/Zip E-mail Address Phone No. CONTINUED ON THE BACK an 3/1 '3 Residential Mechanical Fixtures Fuel Type ❑ Natural Gas 0 Electric 0 Wood 0 Propane Gas 0 Other Type of Equipment Number of Type of Equipment Number of Fixtures Fixtures Furnace<=100K BTU Clothes Dryer Boilers/AC/Heat Pump Gas Water Heater Gas Outlets Gas Fireplace Ventilation Fans Fireplace Insert Stove,Appliance Other Units Range Hood Residential Plumbing Fixtures Type of Fixture Number of Type of Fixture Number of Fixtures Fixtures Toilet Clothes Washer Bathtub Electric Water Heater Shower Utility Sink Dishwasher Hose Bibb Hand Sink Water Piping Kitchen Sink w/Disposal Additional Fixtures I HEREBY ACKNOWLEDGE IF HAVE READ THIS PERMIT APPLICANT AND STATE THE INFORMATION IS CORRECT,AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING ACITIVIES COVERED BY THIS PERMIT APPLICATION. WITH THIS PERMIT ALL CONTRACTORS AND SUBCONTRACTORS SHALL HAVE A CURRENT WASHINGTON STATE CONTRACTORS LICENSE AND A CITY BUSINESS LICENSE. STOP WORK ORDERS WILL BE ISSUED ON JOB SITES WHERE CONTRACTORS/SUBCONTRACTORS ARE WORKING WITHOUT PROPER LICENSE. APPLICANT'S SIGNATURE DATE Last Updated 11-29-05 CITY OF ANACORTI ra- r°`F t Y SJ O **-1 Hit LAND USE City of Anacortes 2 Second Floor EXEMPTION FROM SHORELINE MANAGEMENT ACT - St 0726004 1 09/17/2007 BR2 T4 PERMIT REQUIREMENT Mon Sep17,2007 02:SSPM Trans#2-2 Name: ADAMS KIMBERLY : M ,WA 98221 TO: Kimberly Adams 2 Addr$200.005409 DOOM 8000WAY PermitANACORTES Fees 602 Possession View Lane * Customer #: 007712 * Permit #: Mukilteo, WA 98275 PLN-2007-0041 1 ITEM(S): TOTAL: $200.00 Check PAID $200.00 The proposal by Kimberly Adams to undertake the following dev Working together to serve you better. The existing 42' x 8' float will be replaced with a 42' pilings, ramp, and landing will remain. Upon the following property: Generally, 5409 boon Way, Section 28, Township 35 North, Range 1 East, Anacortes, Skagit County, Washington Within (name of water area) Flounder Bay and and/or its associated wetlands is exempt from the requirement of a substantial development permit because the development constitutes: Normal maintenance or repair of existing structures or developments, including damage by accident, fire or elements WAC 173.27.O4O(2)(b) Description of any other work planned in the future which is related to this project. N/A Corps Public Notice Number: NWS-2007-1683-NO CONSISTENT INCONSISTENT (Check one) V Policies of the Shoreline Management Act. The guidelines of the Department of Ecology where no Master Program has been finally approved by the Department. The master program Date Ian S. Munce, Shorelines Administrator cc: Department of Ecology; Department of Fish and Wildlife; Building; Engineering Building Department M e mo To: Kathy Janke, Land Use Permit Manager From: Don Measamer, D Date: October 2,2007 Re: Float Replaced—5409 Doon Way The development review group discussed the proposed shoreline permit exemption for float replacement at the September 25th meeting, and finding a complete application recommend moving forward with the request per WAG 173-27-040(27)(b)as normal maintenance/repair: - 1 September 12, 2007 Please find my application attached for a permit to replace the float at our private dock in the Skyline Marina in Anacortes. I have included the completed JARPA form, a list of property owners within approximately 200 feet of the project, and a copy of the approval from the Army Corps of Engineers to perform the project as maintenance. The letter from the Corps has all the drawings pertaining to the project attached as they were submitted to the Corps. All other dock components will remain as they exist. (Pilings, Ramp and landing) The square footage of the float will be decreased by approximately 84 square feet. It will be constructed and installed commercially by Carlson Construction in Laconner. It will be constructed from lumber and supported by poly floats consistent with current standards. If you need further information, please don't hesitate to contact me. Kimberly Adams 425-330-5467 kadamsewa@netscape.net - AGENCY USE ONLY JARPA FORM LAST UPDATED:March 19,2007 Agency Reference 4: Date Received' Circulated by. (local gout or agency) Project Tracking Number (ctl Washington State JOINT AQUATIC RESOURCES PERMIT APPLICATION (JARPA) Form (40 Step 1: Get Ready Step 2:Complete Form Step 3: Check Work Step 4:Copy and Send In Go to w4414.epermittumg.org Use black ink. Use intemet"Help" Use final review See JARPA Contacts at for correct form and Check correct buttons to answer checklist at y4wir epennntm.!ore for instructions. permit boxes. questions completely. mw\y.epennnt Inv org. correct mailing addresses. 3 Fish Habitat Enhancement Projects per RCW 77 55.181 You must submit copy of completed JARPA form and Fish Habitat Enhancement JARPA Addition to your Local Government Planning Dept and WA Dept of Fish and Wildlife (WDFW)Area Habitat Biologist on same day. Note for Local Governments: You must submit comments to WDFW within 15 working days. Based on instructions at www epermittinq orq, I am sending copies of this application to the following: (ctmpa all that apply) X,]Local Government for Shoreline: nSubstantlal Development nConditional Use FI/anance Exemption ❑Revision nFloodplain Management OCritical Areas Ordinance Nashington Department of Fish and Wildlife for Hydraulic Protect Approval (Submit 2 copies to WDFW Region) ❑Washington Department of Ecology for 401 Water Quality Certification (to Regional Office-Federal Permit Unit) ❑Washington Department of Natural Resources for Aquatic Resources Use Authorization Notification )Corps of Engineers for: (Section 404 permit nSectlon 10 permit Approved 8/28/07 ❑Coast Guard for: (General Bridge Act Permit nPrivate Aids to Navigation (for non-bridge projects) ❑For Department of Transportation projects only: This project will be designed to meet conditions of the most current Ecology/Department of Transportation Water Quality Implementing Agreement PROJECT TITLE: Adams Float Replacement PROJECT DESCRIPTION: Replace the float portion of our dock SECTION A - Use for all permits covered by this application. Be sure to ALSO complete Section C (Signature Block) for all permit applications. tk.�$ 1.APPLICANT: Kimberly Adams MAILING ADDRESS � /j 602 Possession View Lane l 11 yy (A.�(2.�J*jj A c Q 215 WORK PHONE E-MAIL ADDRESS HOME PHONE FAX# NA kadamsewaAnetscape net 425-330-5467 NA ,fan agent is acting for the applicant during the permit process, complete #2. Be sure agent signs Section C (Signature Block)for all permit applications !! _kw0 2.AUTHORIZED AGENT: NA MAILING ADDRESS WORK PHONE E-MAIL ADDRESS HOME PHONE FAX# 3. Relationship of applicant to property: frl OWNER ❑ PURCHASER ❑ LESSEE 0 4. Name,address and phone number of property owner(s)if other than applicant: William Monteforte,same address&phone it !! Russ&Margaret Jacobson, 13309 SE 46'h Street, Bellevue,WA, 98006, 425-746-9697 Era 5. Location(street address, including city, county and zip code,where proposed activity exists or will occur) 5409 Doon Way,Anacortes,WA, 98221 BIM Local govemment with jurisdiction (city or county) City of Anacortes Waterbody you are working in Flounder Bay MO Tributary of t WRIA# 41 Is this waterbody on the 303(d) List ❑ YES ® NO If YES,what parameter(s)? En Shoreline designation MEI Zoning designation ' ,ction Section Township Range Government Lot 28 35 01 DNR stream type if known Tax Parcel Number P59612 boo. Latitude and Longitude: 48"29"42 40"/ 122'40'49 35" Office of Regulatory Assistance,JARPA JARPA FORM LAST UPDATED: March 19,2007 For help call 800-917-0043 or visit www epermithnq orci 1 CM 6. Describe(a)the current use of the property, (b) structures existing on the property, and (c)existing environmental conditions. li Have you completed any portion of the proposed activity on this property? 0 YES ® NO For any portion of the proposed activity already completed on this property, indicate month and year of completion. The float is shared between a vacant lot and a single family residence. It is used for private boat moorage. Era Is the property agricultural land? ❑ YES to NO MA Are you a USDA program participant? ❑ YES ® NO 7a Describe the proposed work that needs aquatic permits: Complete plans and specifications should be provided for all work waterward of the ordinary high water mark or line, including types of equipment to be used. If applying for a shoreline permit, describe all work within and beyond 200 feet of the ordinary high water mark. If you have provided attached materials to describe your project,you still must summarize the proposed work here. Attach a separate sheet if additional space is needed. - The existing float constructed of Styrofoam and plywood has deteriorated to the point that it needs replacement. It is a 42' x 8' float. We will replace it with a 42' x 8' float that tapers to 4' at the westerly end. Existing pilings, ramp and landing will remain as they are. II PREPARATION OF DRAWINGS: See sample drawings and guidance for completing the drawings ONE SET OF ORIGINAL OR GOOD QUALITY REPRODUCIBLE DRAWINGS MUST BE ATTACHED. NOTE: Applicants are encouraged to submit photographs of the project site,but these DO NOT substitute for drawings THE CORPS OF ENGINEERS AND COAST GUARD REQUIRE DRAWINGS ON 8.112 X 11 INCH SHEETS. LARGER DRAWINGS MAYBE REQUIRED BY OTHER AGENCIES. � ` 7b. Describe the purpose of the proposed work and why you want or need to perform it at the site. Please explain any specific needs !, that have influenced the design. , The existing float is rotting and will not be serviceable soon. Tapering the new float will allow easier access to the moorage and reduce the size of the float by 84 square feet. 1 17:17c. Describe the potential impacts to characteristic uses of the water body These uses may include fish and aquatic life,water quality,water supply, recreation and aesthetics. Identify proposed actions to avoid, minimize, and mitigate detrimental impacts and provide proper protection of fish and aquatic life. Identify which guidance documents you have used. Attach a separate sheet if additional space is needed. The characteristic uses of the water body will not be impacted. The new float covers less square footage and the deteriorating wood and Styrofoam will be removed from the water. (Old float= 336 sq ft. New float = 252 sq ft.) 7d. For in-water construction work,will your project be in compliance with the State of Washington water quality standards for turbidity (WAC 173-201A-410)? ® YES ❑ NO 8. Will the project be constructed in stages? ❑ YES in NO Proposed starting date: Winter,2007 (As soon as permitting is completed) Estimated duration of activity: 1 day 9. Check if any temporary or permanent structures will be placed:A Permanent float will be place ON the water. ❑ Waterward of the ordinary high water mark or line for fresh or tidal waters AND/OR ❑ Waterward of the mean higher high water for tidal waters? t`ti'• 10. Will fill material (rock,fill, bulkhead,or other material)be placed: NO O Waterward of the ordinary high water mark or line for fresh waters? If YES,VOLUME (cubic yards) /AREA (acres) ❑ Waterward of the mean higher high water for tidal waters? If YES,VOLUME (cubic yards) /AREA (acres) Office of Regulatory Assistance,JARPA JARPA FORM LAST UPDATED:March 19,2007 For help call 800-917-0043 or visit www_epermittinq orq 2 ce• 11. Will material be placed in wetlands? ❑ YES On NO If YES: MIR A. Impacted area in acres: B.Has a delineation been completed? If YES,please submit with application. ❑ YES ❑ NO MI C. Has a wetland report been prepared? If YES, please submit with application ❑ YES ❑ NO hPl D.Type and composition of fill material (e.g., sand,etc.) E.elflE. Material source: lP F.List all soil series(type of soil) located at the project site, and indicate if they are on the county's list of hydric soils Soils information can be obtained from the natural Resources Conservation Service (NRCS). '^ G.WILL PROPOSED ACTIVITY CAUSE FLOODING OR DRAINING OF WETLANDS? ❑ YES ❑ NO If YES, IMPACTED AREA IS ACRES OF DRAINED WETLANDS. NOTE:If your project will impact greater than 1/10 of an acre of wetland,submit a mitigation plan to the Corps and Ecology for approval along with the JARPA form. NOTE:A 401 water quality certification may be required from Ecology in addition to an approved mitigation plan if your project wetland impacts are greater than 1110 acre in size Please submit the JARPA form and mitigation plan to Ecology for 401 certification review. 141P 12. Stormwater Compliance: This project is (or will be) designed to meet ecology's most current stormwater manual,or an Ecology approved local stormwater manual. ❑ YES ® NO, the project will not affect stormwater. If YES—Which manual will your project be designed to meet? ` If NO—For Clean Water Act Section 401 and 404 permits only—Please submit to Ecology for approval, along with this JARPA application,documentation that demonstrates the stormwater runoff from your project or activity will comply with the water quality standards,WAC 173-201(A) IIPIR 13. Will excavation or dredging be required in water or wetlands? ❑ YES jI NO If YES: A. Volume: (cubic yards) /area (acre) B. Composition of material to be removed: C. Disposal site for excavated material: D. Method of dredging: 14. Has the State Environmental Policy Act(SEPA) been completed ❑ YES ('R-J NO NA per Army Corps of Engineers approval letter SEPA Lead Agency: SEPA Decision: DNS, MDNS, EIS,Adoption, Exemption Decision Date (end of comment period) SUBMIT A COPY OF YOUR SEPA DECISION LETTER TO WDFW AS REQUIRED FOR A COMPLETE APPLICATION ein 15. List other Applications, approvals or certifications from other federal, state or local agencies for any structures, construction discharges or other activities described in the application(i e. preliminary plat approval, health district approval, building permit, SEPA review,federal energy regulatory commission license(FERC), Forest practices application, etc) Also, indicate whether work has been completed and indicate all existing work on drawings. NOTE: For use with Corps Nationwide Permits, identify whether your project has or will need an NPDES permit for discharging wastewater and/or stormwater. TYPE OF APPROVAL ISSUING AGENCY IDENTIFICATION NO DATE OF DATE COMPLETED' APPLICATION APPROVED NWP Authorization Corps of Engineers NWS-2007-1683-NO 8/21/07 8/28/07 Yes Local Government/Shoreline Exemption City of Anacortes 9/12/07 No HPA Wa Fish&Wildlife 9/12/07 No 16. Has any agency denied approval for the activity you're applying for or for any activity directly related to the activity described herein? ❑ YES ® NO If YES,explain: SECTION B- Use for Shoreline and Corps of Engineers permits only: *2 17a. Total cost of project. This means the fair market value of the project, including materials, labor,machine rentals, etc. Office of Regulatory Assistance,JARPA JARPA FORM LAST UPDATED:March 19,2007 For help call 800-917-0043 or visit www epermitting orq 3 10,000.00 ` 17b. If a project or any portion of a project receives funding from a federal agency,that agency is responsible for ESA consultation. Please indicate if you will receive federal funds and what federal agency is providing those funds. FEDERAL FUNDING 0 YES ® NO If YES,please list the federal agency. 118. Local government with jurisdiction: City of Anacortes illa 19. Provide names,addresses and telephone numbers of adjoining property owners, lessees, etc. Please note: Shoreline Management Compliance may require additional notice— consult your local government. NAME ADDRESS PHONE NUMBER Please see attached list SECTION C - This section MUST be completed for any permit covered by this application I 20. Application is hereby made for a permit or permits to authorize the activities described herein. I certify that I am familiar with the information contained in this application,and that to the best of my knowledge and belief, such information is true, complete, and accurate. I further certify that I possess the authority to undertake the proposed activities. I hereby grant to the agencies to which this application is made, the right to enter the above-described location to inspect the proposed,in-progress or completed work. I agree to start work ONLY after all necessary permits have been received. DATE 9/12/07 SIGNATURE 0 PLICANT I ' DATE 1 SIGNATURE OF AUTHORIZED AGENT I HEREBY DESIGNATE NA TO ACT AS MY AGENT IN MATTERS RELATED TO THIS APPLICATION FOR PERMIT(S). I UNDERSTAND THAT IF A FEDERAL PERMIT IS ISSUED, I MUST SIGN THE PERMIT. SIGNATURE OF APPLICANT DATE ISIGNATURE OF LANDOWNER (EXCEPT PUBLIC ENTITY LANDOWNERS, E.G. DNR) THIS APPLICATION MUST BE SIGNED BY THE APPLICANT AND THE AGENT, IF AN AUTHORIZED AGENT IS DESIGNATED. 18 U.S.0 §1001 provides that: Whoever, in any manner within the jurisdiction of any department or agency of the United States knowingly falsifies, conceals,or covers up by any trick,scheme,or device a material fact or makes any false,fictitious, or fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false, fictitious,or fraudulent statement or ' entry,shall be fined not more than$10,000 or imprisoned not more than 5 years or both. COMPLETED BY LOCAL OFFICIAL A. Nature of the existing shoreline. (Describe type of shoreline, such as marine, stream, lake, lagoon, marsh, bog, swamp,flood plain,floodway,delta;type of beach,such as accretion, erosion, high bank,low bank,or dike; material such as sand,gravel, mud,clay, rock,riprap;and extent and type of bulkheading,if any) B. In the event that any of the proposed buildings or structures will exceed a height of thirty-five feet above the average grade level, indicate the approximate location of and number of residential units,existing and potential,that will have an obstructed view: C. If the application involves a conditional use or variance,set forth in full that portion of the master program which provides that the proposed use may be a conditional use,or, in the case of a variance,from which the variance is being sought: These Agencies are Equal Opportunity and Affirmative Action employers For special accommodation needs, please contact the appropriate agency in the instructions UPDATED: March 19 2007 For helpcall 800-917-0043 or visit www.epermdtmq orq 4 Office of Requlatory Assistance,JARPA JARPA FORM LAST �� OF DEPARTMENT OF THE ARMY (d SEATTLE DISTRICT,CORPS OF ENGINEERS jP ). P.O.BOX 3755 SEATTLE,WASHINGTON 98124-3755 REPLY TO ATTENTION OF Regulatory Branch AUG 2 8 2007 Ms. Kimberly Adams 602 Possession View Lane Mukilteo, Washington 98275 Reference: NWS-2007-1683-NO Adams, Kimberly Dear Ms. Adams: Our regulatory program utilizes a series of nationwide permits (NWPs) to authorize specific categories of work that have minimal impact on the aquatic environment when conducted in accordance with the permit conditions (Federal Register, January 15, 2002, Vol. 67, No. 10). Based on the information you provided to us,NWP 3, Maintenance, authorizes your proposal to replace an existing structure (float) in waters of the United States, as depicted on the enclosed drawings dated August 24, 2007. The proposed project would occur in Flounder Bay at Anacortes, Skagit County, Washington. In order for this NWP authorization to be valid, you must ensure that the work is performed in accordance with the enclosed Nationwide Permit 3, Terms and Conditions and the following special condition that the District Engineer has added to ensure that this project would have no more than a minimal adverse impact on the aquatic environment: a. No residue from construction activity shall be allowed to enter waters of the U.S. The permittee must install and maintain debris and spill collection measures until all project operations are complete. The authorized work complies with the Washington State Department of Ecology's (Ecology) Coastal Zone Management Act requirements for this NWP. No further coordination with Ecology is required for these requirements. We have reviewed your project pursuant to the requirements of the Endangered Species Act and the Magnuson-Stevens Fishery Conservation and Management Act in regards to Essential Fish Habitat (EFH). We have determined that this project complies with the requirements of NWP National General Condition 17 and will not adversely affect EFH. -2- Our verification of this NWP authorization is valid for 2 years from the date of this letter unless the NWP is modified, reissued, or revoked prior to that date. If the authorized work has not been completed by that date, please contact us to discuss the status of your authorization. Failure to comply with all terms and conditions of this NWP verification invalidates this authorization and could result in a violation of Section 404 of the Clean Water Act and/or Section 10 of the 1899 Rivers and Harbors Act. Also, you must obtain all State and local permits that apply to this project. Upon completing the authorized work, you must fill out and return the enclosed Certificate of Compliance with Department of the Army Permit form to the address indicated on the form. Your signature on this form is our assurance that the completed work and any required mitigation was conducted in accordance with the terms and conditions of this NWP, including any special conditions required by the District Engineer. Completing and returning the compliance certification form is a requirement of every NWP authorization (see NWP National General Condition 14). Thank you for your cooperation during the permit process. Your efforts help us protect our nation's aquatic resources, including wetlands. Please remember to fill out and return the compliance certification form as soon as you complete the authorized work. We are interested in your thoughts and opinions concerning your experience with the U.S. Army Corps of Engineers, Seattle District's Regulatory Program. Please complete a Customer Service Survey form. The form is available on our website at: http://per2.nwp.usace.army.mil/survey.html. At your request, we will mail you a paper copy that you may complete and return to us by mail or fax. If you have any questions about this letter or our regulatory program, please contact me at telephone (206) 764-6985 or email Randel.J.Peny a,usace.anmv.mil. Sincerely, Randel P rry, Project Manager Application Review Section Enclosures KimberleyAdams "�g�� E ir;,, , �� -: a - ; Q.t s f�y' - �i. �s4 �. � xl � '�¢ i�uS�Ri3' � '" e ,n ti.F. X y tart S�. '' Float Replacement Project'„ A:s �' � f4 � -* , - d , 4O F ; ., . .L .:- - , "°1. �pp���?./ i 4 "f fit `' C r .'� '' 1 r 1- ' -- '" e;, ic L : 48° 29' 42.40" � ��5 , . a63 k, Long: 122° 40' 49.35" fn tfi)a u .' 3 III --) 4-32P ) , 44. jj ceir 't'+2 ar w Aso �' '<sE My / . _ ,Ty`/r' i 7' 411-4:kri•;4,7,:•vrrSil ... •'-' "rt• ' 1 '.11s. ::::1-S't 31; r ••rt :`;41 1 o CF'/ x 1} xv v 4, ,. r 1 ' 4� i z s ` Fgo Island 41 yr{ u : kItift. . •. 11`1bP'4 4 .. l is / t x 4illw.,,-..,;'.hey ,, 3 i•, /f/ l�"N'.or`'i1 '"1 IX •;;x9 4..i ,'��E`,¢q x 1$ F ..ra,x , '' ,waiya lslan trAl - _ - .. Healfier Der 7 . -,, 1 • ^Lti Ilir .., ..., FLOuNbER OA`( _, w Proposed: Replace float Reference: NWS-2007-1683-NO Purpose: private moorage App.By:Adams,Kimberly In: Flounder Bay At: Anacortes,Skagit Co.,WA Sheet_1_of_4_ Date_Aug. 24,2007 Skagit County iMap V1 C in, iL y 4l/f P 67/V�ci- �7e-l1'' 1 # / A IBA 1U / /) `n �y� )) r • 7/3/0776 30 PM FLU/f �i��1���/1 e V1 IColx Skagit County GIS Map • �.y,,I: '. `",r"• , r'' County Boundary f'.—" j-U ...Oa' Railroads i -4Roads SfBtlB ROsds \ Local Roads t L.) CliyL6nlCa x• 11111 I ^t; 1\ / F1y1 1 Parcels I n,�r° k� Rivers and Streams ~ 1p�^ .,_.1 ... w 'FI— '-wJ /� r�_� I JifitlOna �, IN 11 0/ �yyY�i�',4 Vqd i 'M!.P 3_ 1 W.I &'4ary J�it l {.iiii„,—.---5,=-,-,_-_--. .I t `...�. 1 �' "Y. I tt t J " • ( �`,-I ' dog- �,' rp-� +s (" 1 kalASSLUSIS '''Oa ,--11---__ .373--(177---. -:1,?: ;11:\,..-:-: / i�T~ . IN, /014 ry FfotxadrlEay N�W. , ,. / /., 3,- II, t lt: " `�_` \` ti1l ' ham` / 1. eT _ r'. / - ter' � ___ r+ - .. / 1 .*:. I --_v 0�178ft / 7 I tI Skagit County iMap Map Scale: Proposed: Replace float SKAGIT COUNTY does not atlasReference: NWS-2007-1683-NO 1 inch = 286 Feet and makes no warranty with resp Purpose: private moorage Data contained in this map is limi App.By:Adams,Kimberly (1 inch = 0.1 Miles) In: Flounder Bay At: Anacortes,Skagit Co.,WA Sheet a_ of_4_ Date Aug 24,2007 Imo//www skagitcounty net/GIS/Applications/iMop/Asp/iMai - - Page I of I i 1 \ / \ - ir .., / 1 ��' r ,j lei f // n�a R � tJ 4 gd ) f' / 7L Get 1\ ts' 2 N✓ tRP - \ t bLAUD - _f GIST � 1 e float bras e ' t 9'3Li `{tr) 3 �j1. 36- `,-~�"" yro4p$ed. ep l 200att683 �f* 4 ' CceA�b� eof 7.35 t Ltaca �-sICOP'� Rowse ell -07 te 6-AI aee k 41 D E � � ynrP°Se'pAdams i{nID ,Y./k' j� MP*6;oder gay tt Co„W A .24 2ool- , ^ - --- 1At FAnac,O t S. kag pia \ tSheet, uv aC `o 7- go so tiVA*4 ItE46111 1 `;; e 2. g pc,0•1‘) -&_._ . ,, -- ,ei--•°•° :az. / l / Eft 511NLt - 14 • EXIST/N(>- E xsTtNit PIL/% -tip ' ,, WA. 4. 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'O\iCC— Proposed: Replace float Reference:NWS-2007-1683-NO Purpose:private moorage App.By: Adams,Kimberly In: Flounder Bay At: Anacortes,Skagit Co., WAr; Sheet 14_of_4_ Date Aup""24,2007_ 0705704-1 0002 02/26/2007 002 8 ( t(1-- Permit: Fees 007414 $103.00 GS x O _ City of Anacortes Permit#: BLD-2007-0141 904 6th Street Issue date: 02/26/2007 ., ,�. e P.O.Box 547 '' �T 'C/1;' Anacortes, WA 98221-0547 Expire date: 02/26/2008 Job Address: 5409 DOON WAY Permit Type: Reroof Single Family Residence ANACORTES WA 98221-2915 Project: APN: P59612 Remarks: Remove existing roofing, apply composition roofing over 15#felt over solid sheathing Owner: WILLIAM MONTEFORTE Contractor: MOUNT BAKER ROOFING Address: 5409 DOON WAY Address: 3950 HOME RD ANACORTES WA 98221-2915 BELLINGHAM WA 98226-9147 Phone: (425)261-2000 Phone: (360)733-0190 License#: MTBAKRI055ML General Information: Fees: Occupancy Group it-1 Building Permit Fee 98.50 Building Valuation 12850 State Building Code Fee 4.50 Total Calculated: 103.00 Deposits/Receipts: 0.00 Total Due: 103.00 I 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 COtSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION SIGNATURE OF OWNER OR AUTF{p'R?I�{5`AGENT ISSUED BY////// c, " O (fag of cAnarortes 7 7..1.-., iiir:3 asliington /C WO BUILDING DEPARTMENT CERTIFICATE OF OCCUPANCY # } 3 This is to certify that the (Descriptipri of Building ar4tructure): SiA/6/ ,r-t', 7-k/Gy 5r/)pN7e„" st • Located At: 5'10 9 ..,loit/ Co 4 y ' /�/STREET& NUM�ER Owner:`�EI7FR IC N1/47ROIS7 Fierce OarAje,e , Constructed By: Gca/HiSi - OWNER OR CONTRACTOR Bldg. Permit # 6 ao13 Date Of Issue: (MAflt Occ. Group: /0-1 /i// Use Zone: let Has Been Inspected And Occupancy Is Hereby Authorized, This .6 Day Of i.�C7 2 19 . NTH �a— A THO RING OFFICIAL SEE REVERSE NM FOR SPECIAL REQUIREIVEN7S. ir. C (� CITY OF ANACORTES BLDG. Li PLUMBING YE. MECHANICAL 41 - PERMIT I,42 6223 Tekpbone 293-1901 �j Anecortes,WA Date "/ 19 PERMISSION IS HEREBY GRANTED TO: OWNER fie)riZ''c :`IA1tQ✓ii f.'tti/,-ft i..,- riti Cc-AA-a ' STREET ADDRESS ..3 Ff✓y ,..1100Af 14 ..//,,,.- Logeti here works to be done CONTRACTOR/ 6 .�..4,4.e. TO ERECT 9 INSTALL ❑ OR REPAIR/0 IN-THEFOLLOWING MANNER: SJ/Aft ff e PSs Kc=S,LJc , '(CZ 'fir it 0 . ;7 .©Arts -' ff Ur" PERMIT EXPIRES ONE YEAR FROM DATE ISSUED PLANS FOR CONSTRUCTION WERE NOT ❑ SUBMITTED WERE A WORK TO BE DONE BY OWNER.K CONTRACTOR r RECEIPT OF FEES IS ACKNOWLEDGED AS FOLLOWS: TYPE APO WORK VALUE PERMIT FEES State Building Code Surcharge '5—' State Energy Study Surcharge /j Oa Building . /otI,G(I c1d 3 t{1 o ' Plumbing and W.S. 31✓CJ r Mechanical . 33 Cc) Plan Check Feed j''v0 . 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