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HomeMy WebLinkAboutPermit File 5501 Doon Way r x 920904-I 0€001 0� 28P-0. rIC > 102 Engineering and Development Se ice c8'tY 9k PO Box 547,Anacortes,WA 98 mi.t Fees 0U 070 1 A 04, TN: 360.293.1920 FAX 360.293.1938 ik `. , EMAIL: engineering@cityofanacortes.org a v -4 4 'C' RIGHT-OF-WAY PERMIT APPLICATION "�C08,� '4•P•vd•P Applicant shall submit application 5 days prior to start of work and application shall include: EVSJ) Payment of assessed fee tii(2) Drawing illustrating proposed work and its location. See checklist on Page 2 of 2. ❑ (3) iability insurance CG 2026 or similar. City named as additional insured. Minimum$1,000,000 each occurrence,$2,000,000 general aggregate and $2,000,000 products-completed operations aggregate limit. rl: (4) Proof of both state and city business licenses ❑ (5) Performance Bond—Construction cost x 150% before work begins n (6) Encroachment Agreement Required To be completed by City: ❑ Yes No Site Address: f� City Approved Exemption ❑ Yes No �j ce/ �� 1/ EDEN ASSIGNED PERMIT NUMBER: ii Parcel No. t®"3 - "'""1 - 0 0 S Owner Information (Required) Contractor Information (Required) Name 4€0,.....----rxie Name <D z Y kI`_m Address Address 4--: .*6/ -1 d'#11 *.121 ,1 /040;/Y-#7nrie.--4,eGe--, %� City /'� / 94- - City /4_ }-'4 /gat,2/i Phone G-f i s/ Y Phone f, C'9,4. Email {� - r�Email ''y•L` /, Address j%6 S'e...-Zt - AA) ,dress .���� f4'�,fjr/�� 7. Work Includes (check a that apply ,, .arm ❑ Curb Cut ❑ Water ❑ Sewer ❑ Storm ❑ Street Cut ❑ Sidewalk El Phone ❑ Other Describe Work to be Performed: (Notification of Utility Companies is Required) -f--;11,-.--1651--:'"/, __ ,., _ -7:4-e-rA-le "tG.Ce)e --,f--e-t.,f,e---e-4A'er(e" 1?-- 64.--e-A.,--,"Z--3, ,,,te 1 pp ova ature Date (2 By si ature 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 'ssuance of this Permit,e cept for injuries and damages caused by the sole negligence of the City. (/P / 437. Applicant Signature Date I Final Inspection Approval Signature Date { NON-REFUNDABLE PERMIT FEE: (To Be Completed by City) ❑ Curb Cut $50.00 ❑ Street Cut $50.00 ❑ In ide Travel Way $50.00 Outside Travel Way $20.00 ❑ Sewer Inspection Fee $50.00 ❑ Sewer Re-Inspection Fee $25.00 TOTAL FEE ASSESSMENT $ `,.0 0 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. w • 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 http://mutcd/fhwa.dot.gov). 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. 1< Page 2 of 2 6 0 Glassett Residence 5501 Doon Way Skyline Anacortes 0 A Exposed Aggregate 6 x 2" approach R-q • ed by city 5/8's Broom Finish II Modified Compacted 6' Radius Gravel Parking Area f 1 J t � t' N\i- --.:1 `1 ‘‘,. A w-4 V f (t'� I ______0_, -___-,-- -'.- , attlz- -,,,C .. ,. 1 r, C .. _ .. , ! / \pti C- f - , r- 0Y Y `w.p~ / - % r -- 04,6 r �..._� ---1-- \I \ ' \ , r 1 `. (; Iat- Sdc S ! 3 REYNOLDS 4, 4 ALUMINUM ,; Supply Company 1 . PERFORMANCE AS PROMISED. PERIOD. ALUMINUM • STAINLESS STEEL • NICKEL • COPPER PRODUCTS `JOOti'1 �, \ w •-,1,,, (--• 1 55 — in 6 , I .x ts sv le i -_ 1) • s = 31 © r - REYNOLDS ALUMINUM SUPPLY COMPANY 2306 B St. N.W., (Auburn) Seattle, WA 96001 (253)238.1100•FAX:(253)288-3933 Spokane(509)448-3836 Vancouver(800)589.5181 Visit our website: www.rmc.com/rasco 0427404-1 0002 09/30/2004 002 4 'SrPerruit Fees 005995 $8r680.60 Gi`� Q ._ City of Anacortes Permit#: BLD-2004-9941 904 6th Street Issue date: 09/3012004 .,,,s���� P.O.Box 547 °. ""i ;CO i Anacortes,WA 98221-0547 Expire date: 09/30/2005 �'Ai�i!'ec' - (360)293-1901 Job Address: 5501 DOON WAY Permit Type: Single Family Residence Permit ANACORTES WA 98221 Project: APN: P59610 Remarks: New single family residence. Owner: ROD GLASSETT Contractor: Address: 14820 GOEBEL HILL RD Address: GRANITE FALLS WA 98252 Phone: (425)760-4967 Phone: License#: General Information: Fees: Lot Area 7700 Plan Review Fee 366.70 1st Floor Square Footage 2100 Mechanical Permit Fees 107.40 Garage Square Footage 800 Plumbing Permit Fee 111.00 Building Valuation 213200 State Building Code Fee 4.50 # Forced Air Furnace <=1,000 1 Sewer Inspection Fee 50.00 #of Bathtubs 1 Storm Drain GFC-Residential 1,126.00 #of Clothes Dryers 1 Sewer GFC-Residential 4,682.00 #of Clothes Washers 1 Park Impact Fee 615.00 #of Dishwashers 1 Traffic impact Fee 900.00 if of Gas Fireplace 1 Building Permit Fee 718.00 #of Gas Piping 1 Plan Review Deposit 100.00 if of Gas Water Heaters 1 Total Calculated: 8.780.60 #of Water Piping 1 Deposits/Receipts: 100.00 #of Hose Bibbs 3 #of Kitchen Sinks 1 Total Due: 8,680.60 #of Lavatories 2 #of Range Hoods 1 #of Showers 1 #of Ventilation Fans 3 #of Water Closets 2 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. SIGNATUR OF OWNER OR AUTHORIZED AGENT ISSUED BY City of Attacartes Buiiltlikiw"ehnit Appiicatlon Site Address: 550 I Do 0 Vl Parcel No.: Lot: Block: Div: Addition: -'_ 04oNER_ _:.. : : s` 1 E. l LEN➢ER ... s _- CON1'KAMIOIt, € Name Name Name Rac4ITru�� Cltzsse4 + Rod �[assei E Mailing Address Mailing Address Mailing Address at-lta-o Gotha Ni1I -1 Q . iyta-o Cae&et Nit! Rd . City: State: Zip: City: State: Zip: City: State: Zip: Ora RI I-e. PaCLk 5, (.W4}gg'z c 537"€n.i-f e F2CGs ldldt 'i cb s-a Lips-- 7(J� _ l 7 Contractor Lie.No.:RO b NEJ G 2 fllMO y25-760 - Phone No.: Phone No.: - Phone No.:t{Q(07 Exp Date: Cl/Qs Contact Person: Rock C-s � L (a.BSei- Phone No.: t{0-c'760- ` Re7 (Check One) Single Family: /Multi-Family: Apartment: Condominimum:_Senior Housing: Retail: Office: E. Restaurant: Manufacturing: Storage: Bank: Assembly: Accessory: Automotive Repair: Other(Specify) DESCRIPTION OF WORK: r i c gC.u,'a(4tJ-I c-Y . ...:. t- . . 9ENE.RAL;IN1?0,41va IOI - , Street Setback: .5 ft, 2nd Floor: sf. (Circle Y or N) 1s`Side Setback: /t ft. 3`d Floor: sf. Shoreline/Wetlands N 2"Side Setback: _ES.' ft. Basement: sf. Water on/Adj. To Property 3J N Rear Setbackft. Occ.Group: Soils Report Y N Use Zone: 2 Carport Area: sf. Sensitive Area Y N Type of Construction: Garage Area sf. Latecomers Agreement Y N Lot Area:7 /"J` sf No. of Stories: / O,aOO Fire Hydrant(250 Feet) 47 N No.of Dwellings: ( Building Height: /y f[ Valiance N Lot Coverage:a,Q DO 1-3 spit. D�Deck Area: sf. Covenant Y N 1et Floor,2/Oro I sf.f95 00 Flood Zone 1 I i rC t i P Project Valuation(Labor and Material Cost): ? . 1 AUG Y gngl� Ii L!11' (ra ! r THIS APPLICATION IS RECEIVED BY THE BUILDING OFFICIAL UNDER THE PROVISIONS OF THE UNIFORM BUILDING Cf]WND SHALL REB EXPIRE BY LIMI ON IN AND BECOME NULL AND VOID IF PERMIT IS NOT OBTAINED WITH 181)DAYS OF THIS APPLICATION. BY AFFIXIN& S1 A FIIA.E K T I AM THE LEGAL OWNER OF THE PROPERTY FOR WHICH THIS APPLICATION IS ISSUED OR AN AUTHORIZED AGENT OF THE OWNER=-Atfs'ROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT,INCLUDING CALLS FOR INSPECTIONS. SIGNATURE: `' ~ -" \ C DATE; 8-.2 L/-0 cl y `0 v OF CITY OF ANACORTES WASHINGTON aycoati` BUILDING DEPARTMENT CERTIFICATE OF OCCUPANCY This is to certify that the(Description of Building or Structure): i Single Family Residence Located At: 5501 Doon Way STREET♦NUMBER Owner. Rod Caseate n Constructed By: Owner OWNER OR CONTRACTOR Bldg.Permit#: BLD-2004-9941 c, Date Issued: September 30, 2004 s' Occ.Group: R3 'Use Zone: R2 Has Been Insp ected And Occupancy 1s Hereby Authorized. H This -13th Day.of July 20,05 �S.E.REVEL SIDE FOR ltPEc1AL REauREMENI6. I Final Inspection.Checklist I Site Address: 59 o / Doon @r�7 Permit No.: O i ?rill Date Issued:°/ -3 c=- t' Zoning: $ Occ. Group: ki' Constr. Type: Owners Name: rbei `tee ,F Owners Mailing Address: 5 Sot .0o0 j) Ire c.7 _State: Zip: Variances: No Yes Safety Glass: No Yes i/ Sewer Fee Paid: No Yes ad-Rails. No --Yes Sewer Inspected: No Yes -thrwfdltails: No Yes WSEC Compliance: No - Yes r Traps: No Yes ei' Attic Access: No Yes / -Wood Stove:---- No------~Yes--- Smoke Detectors: No Yes 1% Water Pressure: No Yes l---- T&P Drains: No Yes 7 House Numbers: No Yes Insulation Cert.: No Yes IV Site Drainage: No Yes _ Curb Cut: No Yes V Crawlspace Insul: No Yes i! Bedroom Windows: No Yes G-------/ Water Heater Strp: No Yes I Vapor Barrier: No Yes D.W. Air Gap: No Yes // Water Meter Box: No Yes Auto Garage Door: No Yes -woto--- Yes--- - Outside Caulking: No Yes / Garage/House Door: No Yes t/ Inspected By: it., 7 Crawl Space Access: No Yes 1 Date: 9/3 / / 6 9�+'h ti l+7 l i 2/ o 5 - - Exh. Duct/Dryer Vent Dampers: No Yes I 0. (' = ,_, ��` .—•••c +"`:✓a e`?k Z_/:IA s ` S``.��+'...a. .i"`,_/•,_/.. �AQ*,-J4✓-4,-.a� <C=- `'. ��;" @-' e�'a`es✓` ..a. • ..a ✓.✓ ✓.� Cs '� v �?... ✓..-5a,'�.✓ ✓ tom, ., I(4 CLIMATE PRO® FIBER GLASS BLOWING WOOL .. " ' Your home has been professionally insulated to provide It a guaranteed thermal resistance. ' I\ n 0 a` HoAx�otvt Rx'sNnnse ` Z� ��- ADDREss cC,fl\ .'r)rtc, '44I RECORD OF INSTALLATION G� ( 1 BLOWING WOOL BATTS AND ROLLS :.I Iii NEW CONSTRUCTION IF RETROFIT: f R-VALUEARM THICKNESS INSULATED •k ❑ RETROFIT DEPTH OF PREVIOUS ` �.a) INSULATION CEILINGS % :�y^� SQ.FT. a�/y. iiilile NUMBER OF BAGS USED INCHES �y`QQ� \O IN. 1�I �pV (.' Q`' "� \� IN. SQ.FL I I AREA INSULATED ESTIMATED R-VALUE OF \ PREVIOUS INSULATION WALLS \ ' IN. \ SQ.FT. A.9 SO-'. THICKNESS OF INSULATION TIPE(S)OF PREVIOUS N. SQ,FT. D3. a INCHES INSULATION INATTIC �^. d 1. III Q• R-VALUC OF INSULATION IN, SQ.FT, Os It; 1 CLIMATE PRO,BAG WEIGHT 27 LB NOMINAL 4y0 � R VALJE , MINIMUM 0S P IMU GE MINIMUM WEIGHT -- r1 THICKNESS RA PER I -To obtain au Installed The number of bags I�,I -insulation - -- institution per1004sq. of thubaggltfotild- 'Thevei 1 Py reststanre ' '4Jroubl not rnsul-gf o ( (R)o =tie-less than: al ,shottdtl swea -_m not surer not hI kon should , t� I .� be.�ers4h47& a _- r aR9fiiike . not b less jha+ .5, :t1 - 19 8 50 an ;.110 156 sq ft 01731bs'_ 1' �°� , 81 sq fc 0 296II 4 22 ,,: 975Tn 12.8 . 78sy ft. 08461bs IIP I 30 ' 12,'5In • t .:1 76 '' x - "` sq r slap 0A75 lb s �I 'I p 8I3 l S.50 tin 5 sq tt 0 03 lbs :• � ` 0 17.501n 2 8 rki� - 39sq ft. ' s .I. fi0�'701.jbg,: 50 19.50in 29t8�s u< , 34sc( 1't z r+ 0804dbs i i , 28 sq ft,:..," 0 9817bs ? 46 INSULATION CONTRACTOR SIGNATURE / DATE \—A\ t. r [.�, COMPAN ADDRESS\ Al \ti /"fie�_ SN� \4 x HONE �, 9 I HOME BUILDER SIGNATURE DATE K J COMPANY ADDRESS PHONE ,P i�a1 Jul y v Johns Manville IO BIC-250 loroa Y 02002 Johns Manville ya F��.�..>vl'yS'-v'�:.Sic S.v •iic 9 � �sva 9d'9 ...v ,'�+.c 9i+•'--v,c• ,v a•' 9 CA th'. ttei '/...✓2a. _ J`4.?'4 sy` J.`�'�✓'ttel a..✓".heel %nai ch</.-'ekta e%sS",./.�r�`A-iC.��.G��=/'.4 ��'-�ky�a'ak`G`'a"� ette—S." * Johns Manville,PO Box 5108,Denver,CO 80217-510B,wwwlm corn For more information, call 1-800-654-3103 FROM :hIORTLJEST DATUM & DESIGN FRX NO. :360-404-2021 Sep. 29 2004 01:23PM P2 . FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 30E17-0077 NATIONAL FLOOD RNSURANCEPROGRAM Expires December 31, 2005 ELEVATION CERTIFICATE Important Road the IrmNmdions on pa9ts 1-1. SECTION A•PROPERTY DWNERINFORMATION Fry lee Gunplay Um: ' BUILDING OWNER'S NAME Porky.Number Rodney asset BUILDING STREET ADDRESS(Including Apt Unit,Suite,and/or Bit,No.)OR P.O.ROUTE AND BOX NO. carnpa,ny NAIL Number 5501 noon Way .., .: CITY M STATE ZIP CODE An acodes WA 93221 PROPERTY DESCRIPTION(Lot end Bkelt Numbers,Tax Penal Rimini',Legal Desd4tion,etc) P59610/Tax Id:3823-000-0300003 BUILDING USE(e.g.,Residential,Narrestdentel,AddNar,Acceesory,a. Use a Oorrrrroras arc IFne?ery) Resid ntial LATITUDE/LONGITUDE DE/ ONGITUDE(OPTIONAL) HORIZONTAL DATU1t SOURCE; MPS(Type):,_ _ (We-##'-alit or SAWN) ❑NAD 1927 ❑NAD 1883 0 USGS Quad Map 0 Other. SECTION B-FLOOD INSURANCE RATE MAP Fweg INFORMATION B1.NFPCOI.UM'ITY NAME&CCONLINr1YNUMBER BE000atYWit I STA-1E slaglCootyN Irosp d) Ski WA B&MAPAND PANEL BW.ERN PATO. M.BASE FLOOD ELEVADON(S) NUMBER 06.SUFFD( BB.FRANCO(MTh t3TEC NEREYEED DATE BB.RI.0OD2J (S) (ions AO,ussdgArdNod99) 53 0151 Tr726 c .Nn3,1E115 Jan3,1916 ' Al in 1310.Ito to sadcedthe B®Flood Elevation(BEE)dala cr brelood depll aimed ln B9. ❑FI4 Profile PI FIRM ❑annaityDeidlried ❑ 811.Irecate the Dewar'dathim dfurtheBFEIlIN:®MVD1931 o MVO THIS &For(D®(be): B12.Is the Mang toted Ina Costal Barrier Rentals Sysfan(CURS)a(woraaa113PDdetiad/laal00 1 CI Yes =! No Daslgle x080 SECTION C-BUIIAING ELEVATION IiFORMATION(8URW!REQUIRED) CI.ailing elevatiorsere based on:®CmmVucoal DiSigs' (]Butts)thaw Conshuobre C7 Rristed Catdndion A raw Elevation Certfi ateMAl be required whenmabidm dtobrlrlat)soarckaa. CZ Building dam Number (Select Me balding dam most skniarb the tate frrwNchtNscall ale s Wig completed-see pis 6 end 7. It no*gram aocuralely represents te bulldog,provk(aa sketch orplai aph) C3.Semites—ZresA1-A10,AE,AH,A(MhBEE),VE,V1 V30,V(itBFE),ARARIA,AWAEAR*A1a,AWAH,AWAO Couplets Items C3.414 helm=dog to the hiking diagram splefedIn Nan CL Slaters elm coed lited llen"stirawn(tom Me deMn used for the BFEin SectionB,convert lhe Wan to that used for es BEE Showliddn(ds ernersaddabanmaasim calcuktion. Use the space orte Salim Dcr Sedan G,as appropriate,toOxitertis&hm=scrim rA RJ t\ Datum N3V1:129 (brnerslaJCdnments See Salim D Elevation Memos mark used _Dosstheelesabonrafisnmrt used �kda8et7 1 OYee ®No bdla CIa)Topdnloor(lndudngt ltOrerdoaae) S..61t(m) 1 ❑b)Topof rest Hgherfloor 8_.91L(m) E' C'41 ❑c)BotlandloweifWhd shudualnarrba(Varmati) WA.tt(m) � „a2seta ,Z. 0 d)Anatel garage(t pofslab) 7.eft(m a ) g Pt i Z ❑e)Lomat elevation d machinery and/or egdprrem 'gr . Q seMdrg the bulking(Describe in a Caaredsarea) 8.9ft(m) !.❑f)Lomat Ascent(finished)(Se(LAG) 7.4 Um) r r CI g)H ON&asfrent(fintated)grade(HAG) 7. 48(m) 'Nl 1IJl 110 Ci h)No.d pgmerentdpenings(iwd tents)%Min 1 IL above acbaatgrado 12 O I)Toll area dal,rammed openings Good vent)In Oh 1536 sq.h(seam) SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTRICATION This certification Is to be signed and sealed by a land surveys,engineer,or snarled adrrodmd by law to Wily elevation Information. 1 mRy that the Information In Sedloms A,B,end C on this wr8tale moments my best efforts to Ma/prel the data available. I understand that any false statement may be punishable by fine oimprisonment rmda118 U.S.Code,Sacton 1001. CERTIFIER'S NAME UCENSENUMBER DOUGLAS E.SCHWIND 28023 TITLE COMPANY MIME PRESIDENT,PE,RS FCRlltWESTDATUM&DESIGN ADDRESS CM STATE ZIP CODE 160 CASCADE PLACE i1102 ////! BUF>LINi1ON WA 88233 SIGNATURE .4� t DATE TELEPHONE --- 1... 360-401-2020 FROM :RtORTLEST DATUM & DESIGN FAX NO. :360-404-2021 Sep. 29 2004 01:23PM P3 IMPORTANT: In there sa p ces,copyihoconcagondinginfnnnabon from Speller'A. ForthIcrameC.riNIVUM- BUILDING STREET ADDRESS ondtBngnpt,UM,Snis,ardarBrdg.NalCR P.O.ROUTE AND ROM. PdkyNumha. 5501 Dan WaY CITY STATE ZIP CODE Canper&MC Muter Anemrms WA 90221 SECTION P-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy bdh sides ef this Bevelbn Certificate for(1)mmmur tydfdal,(2)irmanceeoaYoonpay,aid(3)beltingost. COMMENTS City ofAnemdesMonument-4"oar( temonumentv4lhlackIn®30DftsatdNeWors9ondDoor(Waym Dover Drive 1931Adl©ev=B.84 ❑Check hete)f altadtmenfs SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT RECTURFf1)FOR ZONE AO AND ZONE A(WITHOUT SEE) For Zone AC/and Zone A(WthoutBEE),complete ItemsEl through E4, Hawke Carob btiasdediQueas staccato information for eLOMAorLOMRf, Section C must be competed. El.BuileRnB Diagram Minter_(Sele4Nabulkingdagrernmodar wBrebrldngforNi#rAs b Pang completed—seepages 6ard7. arouratay represents I e building,provide a skrtrlr orptct grapbd E2.TN tap of Be bottom Boer(Inducing basement aeKimae)Mho Puking s _11.(m4_hdam)paWorao Q bob"(draic one)Iho highest alacantgrade,(Ike natural grads,If available). E3.ForBuildingDlagnans134withapentrtgs(seepage7),BerxalNghalkranorak/elstor(meveBmb) bulking is _R(m)_1n.(an) n'a the N9hestadjacent grade. Complete Bare C3.h and C3i on hart dlr. E4,The top ofbeplatamof machinery andlorutdpment snoring la belting ia 14(m) n(cm)papnvea [lDew mica an )IheIllgheeta3%adg (Us natural grade,V available), ES.FaZareAOonly: If no!tad depth number Is wadable,ishe top cite bibs Aoor(total ten madam airyteaamruiyeflaodp{eknmanegemadadrn? ❑Yes p No 0 Unknown The local dicta(must orgy NbYyanoabitrSecBanG, SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The properly armor oronc Wsaulfcdoalmore:snlathe%toco pleteSerfianA,e,C(flcoe;C4hadC3iariy).ardEiXZaeA(NitlalaFEMllissund rm xl(y- t ued FIFE)or Zona AO must sign tere The statements/nSednAAC,ant Ewe toad brf,e)5mtdnyloaajrkys PROPERTY OWNERS OR OWNERS AUTHORTZED REPRESENTATIVES NAME F DOUGLAS E.SCNWINND-NORTHWEST DATUM&DESIGN ADDRESS ZIP CODE 160 CASCADE RAC #102 CITY WA STATE SIGNATURE J/ yam //sir(veZ ���J 2F/ p COMMENTS l( "y?, 3 e,1 j ❑Cheddars E atlachmaMa ,t, '`50.�' SECTION G-COMMUNITY INFORMATION(OPTIONAL) The local to edairris4rr the aenuiisfirxb4in marojameniudrucecan complete Sodom A,B,C(or E),and G delis FleANCe Cethfitale. tee Item(s) )stew. GI.p In other doamenleB n has he neignedaMentrasdbyatrensedmaveyer,eglrear,OrarcJitectwhok ManoAredby or (Indrete tee source ard dcia alto ebvalon Main IeCants*we MeA) G2.[A mu E abukrgloosiadin7meA(alai FEAhissredaoartun adBM)orZoneAO. G3.0 losing axis dea fry(annuity flaofcfa)management Fumes G&PERMITNR1 DATE PERMIT ISSUED m DATE CERTIFICATE OrCOMPOSNCEotC PNCYISSUED G7.This emit has teen Issued for:❑NewConstruc.tion ❑Sitarist Inpoeneri 08.Elevalonofas-bullt loses(floor(irdudmgbacierenl)of Ito hrldrjb tl(m) Marc Ga.BEE a(In Zone AO)depth d Reeding stele building site ls: t(m) um: LOCAL OFFICIAL'S NAME ITU COMMUNITY NAME —'—" TiOPE SIGNATURE DATE COMMENTS ""— ----\ I ---D 00� / ' V --.... 0/4 ),„ SET 5/8" REBAR/CAP/ ° 0 R,1326"75" i h G ,y 0 FND 3/4" PIPE W sv 7 l / 6\ �Fq� �F 00 co / / laivl �NF FND 3/4" PIPE /// 0.3 W OF TRUE CORNER "q" / / / .� / / / a / // 6, CATCH BASIN / L0 / 10 / JO � / / FND 3/4" PIPE � r/ / O / \ / / �\ / hti FND 5/8" REBAR T, \�/ ,�g°�' z \ �/ �2 <�\ - 40 \ 0 " FND 3/4" PIPE aoa 4 i* 4). ekQ4 o. Q cv Q \` h R ►ot 0 rk� f -+ ' a , cil GRAPHIC SCALE 20 0 10 20 40 BD ( IN FEET ) 1 inch = 20 ft. DATE* DRAWINGN D ,y _ SHEET DESCRIPTION: 0. NORTHWEST tea, SCALE. I" _ 20' 01051.dwg DATUM & DESIGN, Inc. Elk" DRAWN BY: pm LOT 30 - SKYLINE NO 7 JOB NO CIVIL ENGINEERING AND SURVEYING SOLUTIONS �� 01051 160 CASCADE PLACE, SURE 101 • gThtst, F' CHECKED BY: des for BU6LINCtON,WASHINGTON 98233 ��?? ROD GLASSETT SHEET NO. PH (360)404-2010 FAX: (360) 404-2021 DOUGlAS S Ne1N1N0 P.e.,S.1.S. i of 1 DATE: July, 2001 n rn N eA 0 10 Vc #' 0 t a O C �5 N -9 0 ,L P O % W Iti 27 AR . ., t r.,/ 31's. • ✓h �8, s j <I- AfS?if kkii, . / II :;ø!E I I 4 ova / , ...,,,,.. 1 ��O ti 6 f „vit. ^ , 4/40 itt if 4\b il.......„,...! „7 v S ti 1 L c� 4 m p 000 Z O r> k3 4/4y h Hil ' 1+ I. SCALE 1`=ZJ FT Country loads ;HEFT Site Plan — Rod Glassett 1 OF I �c�,�E DESIGh� �rd�wna eY Country Roads -2/9/02 6.52 f'NGLASS-site.dwg , Comono Island, WA 98282 (360) 629-6068