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HomeMy WebLinkAboutPermit File 3019 Oakes Avenue Site Address: 30lq Caves Q.UC Lot: Block: Addition: Permit No. Date Description of Permit rvlgot9Fl -004g S/? mlerA ?armf'( _3ld g -ooci q R/Q8/91v RJ4 Perm,`E 8 753 545/q' 6:2/ fly/f Bldg Pot-mitt 5g58 /1/6 f87 $lcl permle R/ 'P�orm/I a pp/i`CaJ ib-n /c/ do -,ti, & ecod Lint o‘rePerm,z5 533 '? / 1-9 ° , - :;f'; CITY OF ANACORTES a 9c ', `,, DEMOLITION PERMIT APPLICATION , i Site Address: So)q ©ctkv.s 4ue n u e.. Assessors Account No.: Date: o Lot(s): Block: Addition: Owners Name:LA-co yy C.Torl S Contractors Name: G(Rc,te e Eii„,rron In... *t. Address: IRo2Co 5ar3 ea L._ it Address:'etel&P iZssS•-ll ge-- Pik, Ilea State:J uc j j L t JA Zip: `t''#r(4.9 State: (4,44 Zip: q g 21 r Phone: (to ) ?lS -- ill !p Contractors License: Crial Cy6s(oW 7 Phone: Have Utilitiesr Been Notified? Description of proposed demolition. How will materials be Lt✓.tr V4ea 4 extGsc}i*-4 or ti disposed? ' :Water Dept.: Yes 44Rn'Ab" (ih -p Ic-e so sat, Electric: Yes tIll Cable: Yes +.F ko-Nst, As 4m 0, I -6n k L.tgoiA Ct:S� Gas: Yes CI ifaII ect 0v--4 a{" Ev'wc( ?e, kan 5uc.5 7 BARRICADES TO BE PROVIDED FOR PUBLIC PROTECTION,AREA MUST BE ROPED OFF! Applicant's or Agent's Signature 1 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 °d Street,Mt Vernon,WA 98273 (360) 428-1617. Fire Department Appro : �— a Date `�— /��7 Police Dept.Approval: Date: Public Works Department Approval��� ----C_'�_ Date: )/—12-0 t i Comments: tY\ — "' ` , sti j6, 6,6 .• trt environmental services. Inc. cop kwiverribe- zoo4 Mr. Leroy Gates -1K)26 303 Avenue NE Duvall WA 983 t 9 RE: Decommissioning of Residential Heating Oil Tank at 3019 Oakes AvenuR, Anacortes, Washington Dear Mr. Gates. This Eater duo:intents work performed by Glacier Environmental Services. Inc (Glacier ,vitn regard to closure of a 300 gallon (approximate) heating oil tank at he above re7erenced residential properly The tank was located nelow the concrete back porch and waif way of Vie home, A site plan snowing 'me locabon of the abandoned tank is attached A photographic record of the abandonment ts also inciuded, On November t 0, 2004, in accordance 0. t Uniform Eire Code, Glacier performed an in- place closure of tne subject UST ;underground storage tank). A section of tne concrete walkway above the tank was removed the top of tne UST was uneartfied. cut open and afi residual fuel otl removed The tank was hen triple rinsed with soap and water. pumped dry, and filled with clean builders sand. The removed section of walkway was replaced. All residua, fuel oil and wash solution was dsposed of in accordance with state and federal regutahons, The lank was noted to be, in very good condition with no holes or interior corroston. No ViSU310• odorous nciication of environmental impairment was found A copy of the Anacorte,s Fire Department Permit is enclosed for your records, If you have any questions regarding the performance of this work please do not hesitate to cal' Steve Miles or David deSousa at (425l 355-2826 Respectfully Submitted. Glacier Environmental Services, Inc. • Steve Mites President riann.F.1.5) C.C. City. c;-ix Anacones ) NOV 1 5 28114 P 71 547 ' Ann WA. 98221 ' . • irriar7...,0 ..............."a-4"-a 44 IF, Ruse: Road, Suite A. Mekilteo, WA 98275 Phone, (425) 355-2826 Fax (425) 290 918G _ -------- Y City of Anacortes Permit#: BLO-2004-0185 904 6th Street Issue date: 11/10/2004 ",•1•14116eas••• P.O.Box 547 Expire date: 01/09/2005 CO LAnactortes. 'NA 98221-0547 • (360) 293-1901 Job Address: 3019 CAKES AvE Permit Type: Demolition Permit ANACORTES 98221 Protect: APN: P58404 Remarks: Decommission ltrel Oil Tank Owner: GATES REVOCABLE LIVING TRUST Contractor: GLACIER ENVIRONMENTAL Address: 3019 CAKES AVE Address: ANACORTES 9822' Phone: Phone: (425) 355-2826 License #: General Information: Fees: Total Calculated: Adjustments Deposits/Receipts Total Due TruS PERMIT BECOMES NULL AR: VOID :F WORK OF CONS1RUCt;:thr AUTHORIZED IS NOT COMMENCED MTHIN 180 GAYS CF: :F CONS-RUCTION OR WORK S .81•,PENDED OR ASAN)ONEC: nOR A .".F.RIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED ' HEREBY CERTIFY THAT HAVE READ AND EXAM.NED THE A2,'LICA-ION AND KNOW THE SAME TO BE TRUE AND CORREC1 A__ PriOv:SIONS OF LAWS AND ORDIrANCES GOVERNING THS TYPE OF WORK WIL. BE COMPLIED WITH WHETHER SPECIFIED HEHEN Nt:',T,THE GRANTING OF A BERM T DOES NC! PRESUME T GIVE AjlHORITt" TO VIOLATE OR CANCEL THE PROvISIONS O. ANY 0-1-ER LOCAL'LAW CCNSTRUCION C.1.PTHEREREDIRmANCE OF CONSTRUCTION SIGNATURA CF OWNER DR Ft:THCRCED AGEr:' :sSUto I1eaiiii (til .1 a7 ik A iv.int o nntent Lcrcn {fates Resid;:ne 3019 Oakes Avcnuv Anacortes. WA 9S;21 A lie` , • 14 i J x j , r f, i f • • • (ilcicier l ti irott:nem ai _rt ices. Inc:. 4- 441e, Russel, Road, `nth, A Mukilteo. WA V82.5 .425) 15:_7R2t, ?4r51 ?of'_71$;, A\ ,.....-+` -._,{ Tilt`, PERMIT Ft) PT I IMTI ,1/47 El) .1s RE,yutR EIS fvs I ¢'itti .,t.,...colt . ` SPECIAL PI IHPUSIs PER M IT NI :if_<.i in f,tm r' with thi: i :iiiht}rm Fiie Cosh:, track: .i,..L- „tiotl 'I.i()1 , and the provisions tit rh: )'t!:. PItveilt i'n€i ( )ls liti,u i( is Ali qui by t tt,' (lint' ,tt Ahacorrc's, \X/;ts)iiii .; -on. this permit- is hereby <' tauter{ !t,r , DECOMMISSION UST FILL IN PLACE I)m-d t'ial, } fly 019 iThlotrn Avenue ,.:,,ta Glacier Environmental Services ; „- _a Steve Miles 425-:355 72826 .. , I : . 206-71,8-9316 1:,,,.:,,:., shy _ 4.4,16 . Russell Road,_ Faii Sc A .. . . ._ .. ;. ,,, Leroy Gates Muki 'too, WA 98275 { ' ::it+.,:'.;:tittiriit, ti, : I ) Locate 2) Expose Tank 3 ) Inert Tank +3 ) Meter for tEL 5 } Fill 6) Contact Fire Marshal Dan Harjtt 7) Photo site, post r"•moval and tile with But (cling Department 1 Ir. ;", i I. 'i , . :,,.... . . .. 'i„ [.i. ri,iiiit ..4t, :,. :: ..lilt«,.+! ..iti tit:, . . ...;,t3,a+i ., .. .,lu,`<'%.. }: 1\ .% lAk { ` ii I. .:• € ,;., 11 / 10/200I ;.:, ,t,,,., Wu,or 1If1612004 0; S`r Y t7`. City of Anacortes permit#: BLD-2004-0185 •5 904 6th Street Issue date: 11/10/2004 P.O.Box 547 ~ Expire date: 01/09/2005 'C Anacortes, WA 98221-0547 r* _ (360) 293-1901 Job Address: 3019 OAKES AVE Permit Type: Demolition Permit ANACORTES WA 98221 Project: APN: P58404 Remarks: Decommission fuel Oil Tank Owner: GATES REVOCABLE LIVING TRUST Contractor: GLACIER ENVIRONMENTAL Address: 3019 OAKES AVE Address: ANACORTES WA 98221 Phone: Phone: (425)355-2826 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 S ATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. I SIG T RE OF OWNER 0 AUTHORIZED AG NT ISSUED BY ( J CITY OF ANAGORTES DEMOLITION ' RIV ITAP PLI+ ATIOl' Site Address: 0 ' Date: l l I I /LA Assessors Account No.: 12 s g 4 Oki Lot(s): Block: Addition: Owners Name: U,Th` (SCi,`yr __ Contractors Name: t. t*UZo11h¢� Address: �bl°I C2 Glatt✓ Address: 41..ic( csC P i Kid State: wet r Zip: 61 S 7 Z-( State: (..,0 A . Zip: el F3-tic Phone: Contractors License: (oL-frc(Cr; 1 O&C7 Phone: u to -.''v 5 -Zgj Z(® Have Utilities Been Notified? Describe Work & Tools To Be Used. How Will Materials Be Disposed? Water Dept.: Yes No `TAN, Electric: Yes No (¢r-, ;% a . Cable: Yes No - Gas: Yes No Phone: Yes No BARRICADES TO BE P OVIDED FOR PUBLIC PROTECTION,AREA MUST BE ROPED OFFttttttttttttt SEE ��SECTION 4409 B.C.^ ,, (Applicant's or 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. 201 Pioneer Bldg., Mt. Vernon,WA 98273. (360)428-1617 Fire Department Approval: Date:_ (Fire Chief or Fire Marshal) Police Dept. Notification: Date:_ Public Works Dept: Date: (Speed Garrett) Comments: THIS PERMIT TO BE DISPLAYED AS REQUIRED p'l ..0s, PERMIT No. sue .. :, ANACORTES FIRE DEPARTMENT tErlitiV_ Its 1891 diet t�$ SPECIAL PURPOSE PERMIT In accordance with the Uniform Fire Code, Article 4, Section 4.101, and the provisions of the Fire Prevention Ordinance adopted by the City of Anacortes, Washington, this permit is hereby granted 3 1 for DECOMMISSION UST FILL IN PLACE LOCATION CONDUCTED BY Address 3019 Oakes Avenue Company Name Glacier Environmental Services Telephone Steve Miles 425-355-2826 Telephone 206-718-9316 Business Address 4416 Russell Road, Suite A Owner Leroy Gates Mukilteo, WA 98275 O. CONDITIONS/RFSTRICTIONS 1) Locate 2) Expose Tank 3) Inert Tank 4) Meter for LEL 5) Fill 6) Contact Fire Marshal, Dan Harju 7) Photo site, post removal and file with Building Department This permit is issued on the condition of compliance with all Fire Codes and Ordinances as adopted and any conditions listed above. � _Signature of Requesto cd 2 V \ Signature of Fire Office(\ W Li. Issue Date 11/10/2004 Expiration Date 11/16/2004 MSN'Maps'& Directions- Map Print Page 1 oI 1 o n featuring Microsoft" rust. Maps & Directions 1/4- Mappoint- Technotogy j 3019 Oakes Ave Anacortes,WA 98221 -- �L Indian M a6ddR'. Guentes Island. ,Wi age _<:MapP,t)Int a - - S-shore`5 G"eii Pads!/a v i - - T _ _ y - a 5 f i 1 S - - 'S y i i3`'L > a `t +�. vO 4' -ts45 Mi -S -�'� F` 2'a` M' r^-tea- - i (i R R--ni st g r V--4- a r,= Ze i 3019,Oakes Ave, ' �9th St rr . -yam _ $ e s u w y. ,, wix Anacortes, WA 98221L�e�� o, s�r$ f A 't ` - t z ��(. _i t:3th 5tR - _ _ r ?` -. ' .. 15th"St 19th.R tsth--, & g i71h St' nth R (y a - late st- 11 . 2IXhR S AO+ 2?st st - - a 2 R " n�, Yi�__ gt Fidalgo 23rd 5F_22nd R. _,¢ - a 6� Island ._ 24th st R 24th ---th d - ' ,' - � d - 26th-St ._ vs. - R t --_ Suraet-Ave .8 291 r St- = 29th St'- . a l nth St--":,., $ a — g130th St-- no� alst,St 'o� ' 32nd St . _ " - W.r_ -- - -33rd St eii- - ¢ g� 34t1 R % . o - -- 96th R 37th 2- qzoonuiagsertcory®zoos °' - a 38th St3 " C C Q ct Your right to use ma s and routes generated on the MSN service is subiect at all times to the MSN Terms of Use. Data credits,ajp_yright,and disclaimer. LoL i. t, a 0-0(u,,,7,,i, ' c ; - NcN V http://mappoint.msn.coin/(kwcn2ye0m1s3s555dgkcrn45)/PrintMap.aspx?MPMtd=M&L=U... 11/9/2004 ':*'irid Ptift5k, AVr.f.,;,,, ,gtlfHitrin,55-4,,V-&-WI;i-4a INTERNATIONAL FIRE CODE INSTITUTE 48I6 --:) DAVID M. DESOUSA GLACIER ENV SVC ... . ., 12521 EVERGREEN DR STE A . - ..--, MUKILTEO, WA 98275 e._-- t '. ! ±r- r--F_ SSN: - ASI ID: 32-US-32000426 . , . ., Vicf-,:- ----,- — ----",I a EXAMINATION: DECOMMISSIONING EXAM DATE: 02/10/01 : •1 '-'!.:i': liri711t ".: rp ---' EXAMINATION RESULT: PASS 'alcylvs.-i Congratulations! You have passed the IFCI voluntary 6 certificatipa, - .„ ,. ., .:$examination listed aloovn. This achievement attests to your knowlepge - of national UST regulations and industry standards in effect on this .; A .,,,? date. j Your IFCI certificate and wallet card will be,mailed to you py IFCI -,.* - 1 S''' fltr.- Within six weeks . This certificate is not a licenne to praqtice. :YOU. .., ..„,.. ,.:-) Ir5-33,;: should contact the local regulatory agency to verify local/state .-, requirements to practice In some cases, this letter may be requested, !...?/, 1 ,,! : by state licensing agencies as evidence that, you successfully completed ieq. . 15'' --Th this examination. ..„ :;_- This IFCI certification is valid for a period of two years. Should you ' .1. - retest.wish to renew this IFCI certificate, you will be requiredto tykr;, - Please notify IFCI of any changes in your nddress. Thank you for yourl, participation in the IFCI Voluntary Certification Program. IFCI Certification Section 5360 Workman Mill Road ' 'Whittier, CA 90601-2298 '4.,::-.- (800) 423-6587 ;' ! .': .'..5 DIAGNOSTIC REPORT ID: 32-US-32000426 DECOMMISSIONING 02/10/01 PASSING YOUR ..:-..,,,,--,: EXAMINATION SCORE SCORE RESULT 4.i. ..DECOMMISSIONING 75 PASSED PASS . .. . _ - .--. CONTENT AREA LOW HIGH'' RECORDS/RELEASES e i g:K:3::3:::::::*:::::::::::::::: ..mx.:„.x.x.x.x.x,x0x,..4:x1/4:::::::„.. x::::::..0„."DECOMISSOIRONING xox•x::::::::::::::::::::::::::::::::::::::miagomx.:m.:4.:44::::::::::::::::::::::::::::::::.x.x.g.x.:44:0:::a,:4,...„.,0ZZvex.xix.m.M.::::::=040=0:=0*:.:,:onwozweeeenee---.QmY. HEALTH/SAFETY 4.m:omox'mwoheeee.yevaxom*mmovemxymy.......y...4x .! . . .. ., .:..il --7..,..., cl;:•:,4e A .,, , • .. . : - - - . flciwo.,Wwlfor4fgflIA4P2-54..sngeest-e4W -71-A4 =4"R'::=14%*;Al kiv'fi?:ttitaPagatte-ati.V.c.taz,VIS*--traknamel:-.4<ft,..rim., -,4f.ise,(fez---e.,..,ffs,,,,,---,a,,,,,,,,-: ,.- , Heating Oil Tank Abandonment Leroy Gates Residence 3019 Oakes Avenue Anacortes, WA 98221 Alley 35o qA 4. �SJT/l GarcAge, Q 4 _ (Gbanab,-c x p ,K 30%9 actl<eo AIt_ 4 tx x x -f� I i enL q Ape Sala- I'�=?a' A 0a I<es Ve . /,a,( -N Glacier Environmental Services,Inc. `I' 4416 Russell Road, Suite A Mukilteo, WA 98275 (425) 355-2826 (425) 290-9186 FAX BUILDING PERMIT CITY OF ANACORTES PERMIT NO. : BLD94-0388 P.O. BOX 547 APPLIED: 09/26/94 ANACORTES, WA 98221 ISSUED: 09/29/94 (206) 293-1901 EXPIRES: 09/29/95 SITE ADDRESS: 3019 OAKES AVE ASSESSOR' S PARCEL NO. : 3809-502-007-0005 PROJECT DESCRIPTION: Add entry door. OWNER — CONTRACTOR - — LENDER - DELVIN GATES JORGENSEN CONSTRUCTION 3019 OAKES 13702 SR 9 SE ANACORTES WA 98221 SNOHOMISH WA 98290 293-6283 481-1776 JORGEC197L9 TYPE OF WORK *ADD AREA (sf) VALU. . . $: 5000 TYPE OF USE 'SF LOT • 0 REQUIRED SETBACKS---- CENSUS CATEGORY •434 1ST FLR • 0 FRONT • 0 ft ZONING 2ND FLR • 0 SIDE • 0 ft :RL BASEMENT • 0 REAR • 0 ft OCCUPANCY GROUP GAR/CARPORT. . . : 0 REQUIRED PARKING-- :R3 : 2 :2 :2 .• OTHER • 0 TOTAL • 0 TYPE OF CONSTRUCTION HANDICAPPED: 0 : 5N :? : ? : ? NUMBER OF UNITS • 0 COMPACT • 0 OCCUPANT LOAD STORIES • 0 IMPRV SURF. : 0 sf .• 0: 0: 0: 0: BUILDING HEIGHT. : 0 ft — FEES — NOTES Code Amount---- By- Date---- Receipt PRMT $ 50.50 DM 09/29/94 3041 STBC $ 4.50 DM 09/29/94 3041 TOTAL $ 55.00 I hereby acknowledge that I have read this permit and state that the above information is correct, and agree to comply with all ordinances and laws regulating activities covered by this permit./,,,,,,,/ Issued by Applicant or Owner' s Signature 24 Hour Notice Required For All Inspections bld_prmt, Rev: 06/11/92 MECHANICAL PERMIT CITY OF ANACORTES PERMIT NO. : MEC98-0048 P.O. BOX 547 APPLIED: 08/26/98 ANACORTES, WA 98221 ISSUED: 08/26/98 (206) 293-1901 EXPIRES : 08/26/99 SITE ADDRESS : 3019 OAKES AVE ASSESSOR' S PARCEL NO. : 3809-502-007-0005 PROJECT DESCRIPTION: Gas furnace, water heater and piping — OWNER — CONTRACTOR DELVIN GATES RAMPART MECHANICAL CORP. 3019 OAKES AVENUE 716 S. MARCH POINT ROAD ANACORTES WA 98221 ANACORTES WA 98221 293-6283 293-3339 ANACOR*066BS TYPE OF WORK. . . :ADD BOILERS/COMPRESSORS- DOMES . INCIN • 0 TYPE OF USE •RES 0-3 HP • 0 COMML. INCIN • 0 3-15 HP • 0 RELOC/REPAIR. . . : 0 FUEL TYPES 15-30 HP • 0 CLOTHES DRYERS . : 0 : /GAS/ / / : 30-50 HP • 0 GAS WTR HEATERS : 1 FURN < 100K BTU: 1 50+ HP • 0 STOVE, APPLI . . . : 0 FURN >=100K BTU: 0 AIR HANDLING UNITS-- FIRE LOG/LITE. . : 1 FURN - FLOOR. . . : 0 <= 10000 cfm. : 0 WOODSTOVES • 0 UNIT HEATERS . . . : 0 > 10000 cfm. : 0 OTHER UNITS • 0 VENT FANS • 0 EVAP COOLERS . . . : 0 GAS OUTLETS • 1 VENT SYSTEMS . . . : 0 HOODS • 0 VENT W/O APPLI . : 0 — FEES — NOTES Code Amount---- By- Date---- Receipt PRMT $ 67 . 95 MD 08/26/98 8908 TOTAL $ 67 . 95 I hereby acknowledge that I have read this permit and state that the above information is correct, and agree to comply with all ordinances and Laws regulating activities covered by this permit. Issued by Applicant or Owner' s Signature 24 Hour Notice Required For All Inspections mec_prmt, Rev: 06/11/92 BUILDING PERMIT CITY OF ANACORTES PERMIT NO. : BLD96-0097 P.O. BOX 547 APPLIED: 03/28/96 ANACORTES, WA 98221 ISSUED: 03/28/96 (206) 293-1901 EXPIRES: 03/28/97 SITE ADDRESS: 3019 OAKES AVE ASSESSOR'S PARCEL NO. : 3809-502-007-0005 PROJECT DESCRIPTION: Replace existing deck at southwest corner of dwelling — OWNER — CONTRACTOR — LENDER DELVIN GATES 3019 OAKES ANACORTES WA 98221 293-6283 TYPE OF WORK •ADD AREA (sf) VALU. . . $: 800 TYPE OF USE *SF LOT • 0 REQUIRED SETBACKS---- CENSUS CATEGORY •434 1ST FLR • 0 FRONT 0 ft ZONING 2ND FLR • 0 SIDE • 0 ft :R2 BASEMENT • 0 REAR • O ft OCCUPANCY GROUP GAR/CARPORT. . . : 0 REQUIRED PARKING-- :R3 :? :7 :7 OTHER 0 TOTAL • 0 TYPE OF CONSTRUCTION HANDICAPPED: 0 :5N :? :? :? NUMBER OF UNITS • 0 COMPACT • 0 OCCUPANT LOAD STORIES • 0 IMPRV SURF. : 0 sf 0: 0: 0: 0: BUILDING HEIGHT. : 0 ft — FEES — NOTES Code Amount---- By- Date---- Receipt PRMT $ 14.50 MD 03/26/96 5185 STBC $ 4.50 MD 03/28/96 5185 TOTAL $ 19.00 I hereby acknowledge that I have read this permit and state that the above information is correct, and agree to comply with all ordinances and laws regulating activities covered by this permit. two ilAhAty4A7-7-67---) Rued by A 1icant or Owner' s Signature 24 Hour Notice Required For All Inspections bldyrmt, Rev: 06/11/92 C . , Ill FOR INSPECTIONS CALL: CITY OF ANACORTES PERMIT Ne $753 • 293-1901 BUILDING PERMIT 24 lira. Notice Requested Site Addrese3019 Oakes Avenue NAME(OR NAME OF BUSINESS) aces ()Glynn Gates PLUMBING MAILING ADDRESS 3010 Oakes Avenue No. TYPE OF FIXTURE OR ITEM FEE CITY ' TELEPHONE NUMBER Water Closet $ Anacor te:. WA 98221 293-6 a 63 Bathtub NAME Lavatory Shower ADDRESS Kitchen Sink Dishwasher CITY TELEPHONE NUMBER Laundry Tray Clothes Washer NAME Water Heater m Urinal ADDRESS Drinking Fountain Floor Sink or Drain CITY TELEPHONE NUMBER Slop Sink cz U Water Piping STATE LICENSE NUMBER CITY LICENSE NUMBER f:Residential 0 Non-Residential PERMIT $ ❑ New 0 Add 0 Alter 0 Repair TOTAL-F-EE $ l Building 0 Plumbing 0 Mechanical MECHANIC Ace. ❑ Sign 0 Demolition 0 Other ❑ GAS 0 OIL 0 ELECT. ❑ OTHER Legal Description of Property or lhx Account Number Na TYPE OF EQUIPMENT FEE Lot Block of Air Cond. Unit $ Refrigeration Unit— HP Boiler— HP Forced Air System— BTU/KW Describe Work Floor Furnace New Dec- Wall Heater Unit Heater Clothes Dryer Occupancy Use Ventilation Fan D<Single Family Residence 0 Multi-Family Residence Range Hood ❑Office 0 Retail ❑Storage 0 Church Air Handling Unit— CFM ❑ Restaurant 0 Other Pre-manufactured Stove or Fireplace NOTICE Gas Piping This permit is issued by the Building Official and,under the provisions of the Uniform Building Code,shall expire by limitedoh and become null and void if the building or work authorized by such permit is not cons- . PERMIT $ menced within 180 days from the date of permit issuance,or if the building TOTAL, FEE S or work authorized by such permit is suspended or abandoned at any time after the work is commenced for a period of 180 days. TOTAL FEES VALUATION FEE By affixing my signature, I hereby certify that I am the owner of the I ,000.00 18.00 property for which this permit is issued or am an authorized represen- Building $ fative of the owner. Plan Check D'4� All provisions of laws and ordinances Plumbing becomplied with whether specifiedherein or not, this type of work will Mechanical or including routine calls for inspections. Sign x. - Demolition ! ,�,e (4 l r< (IJ '...f��-� ' ���J i- l Energy Surcharge Signature d Owner or Aphorized 4 . 50 • Agent (Date) State Surcharge - Street Setback Side Yard Setback Rear Yard Setback Other 22. 50 TOTAL $ Use Zone Occuncy croup Typed coax. Conditions: tw Lot Area Vacant Site Duelling Units ❑Yes ❑No Fire Sprinkles.Required Na of Stories Bedrooms Occupant Load ❑Ya ❑No Size of Bldg. Pane Checked By: WHEN SIGNED AND DATEDBELOW,TM IS YOUR PERM PeWdm is hereby lives to do the ahbvedeei$ed wady wording to the acidities*dCOFWitte,subject to ordinanea the CITY ANACORTES. rampant*with the 05/15/91 Permit Issued By 'j A \fy ft I.9 "t`(i i( Building Official (Dab) Edwin Frank: tlrh PERMIT VE sin ), CITY OF-ANACORTES BLDG. WI_ PLUMBING ❑ MECHANICAL ❑ PERMIT 6212 Telephone 293-1901 ( �/ Anacortes,WA Date 6 I 190 p PERMISSION IS HEREBY GRANTED TO: OWNER i i•'-c V --:A/ LaddSTR ,t ADDS ESS Li L. /9 c2A/t'i-5 f tocza Location where wont ,/]to be done CONTRACTOR %Y. LA) . (.RJ t 1 pJO E{i r a,Dye. 7> TO ERECT ❑ INSTALL W OR REPAIR ❑ IN THE FOLL�rOWING MANNER; , r+' ` c i ck .. PERMIT EXPIRES ONE YEAR FROM DATE ISSUED PLANS FOR CONSTRUCTION WERE NOTUBMITTED WERE ❑ WORK TO BE DONE BY OWNER ❑ CONTRACTORa' RECEIPT OF FEES IS ACKNOWLEDGED AS FOLLOWS: TYPE APPROXIMATE VALUE PERMIT FEES OFWORK State.Building Code Surcharge 0 5(1 State Energy Study Surcharge • Building L'io(j UU 4/0 CO Plumbing and W.S. Mechanical Plan Check Fee TOTAL o7C9� Li )w �t Cam/, .r^� LEGAL DESCRIPTION �LJS 'S. c,� �C/ Lf� ic- ,7 o 2` A/cR7Ha tW Mc16Cc Acid CITY INSPECTOR , CITY OF ANACORTES BLDG. ❑ PLUMBING ❑ MECHANICAL 0 • PERMIT 1;' sin , Telephone293-5173 //,,YY ff ANACORTES, WASH. _ DATE .4:2,-`+r-- 1: Ec 18_.. PERMISSION IS HEREBY GRANTED TO: i OWNER 5 STREET s,< yr j( ' ADDRESS ` '-'t / ' <✓a41Gfc) ii A; LOCATION WHERE WORK IS TO BE DONE CONTRACTOR t= Pic i-- TO ERECT Fe INSTALL 0 OR REPAIR ❑ • IN THE FOLLOWING MANNER: /,c_. tf I:-ec -4 dw; C. i .'LI6 - a✓,.,,,-.1E r:.4 : .R.P7;.: .:'�'-/,‘tP...�m^Cei..- M C PERMIT EXPIRES ONE YEAR FROM DATE ISSUED 1 PLANS FOR CONSTRUCTION WERE WER NOTE ❑SUBMITTED WORK TO BE DONE BY OWNER 0 CONTRACTOR 4. rt' RECEIPT OF FEES IS ACKNOWLEDGED AS FOLLOWS: I TYPE' APPR OFI MAT WORK ALOE PERMIT FEES h ISSUING r� i BUILDING ill -e__ /L^ea/ 00 /5 CA! I GAS PIPING PLUMBING AND W.S. 1 SEWER CONNECTION INSP. ? MECHANICAL 3 r PLAN CHECK FEE - I MISC. I TOTAL / t yr 0C'e . / )l `"' 1 LFGAbrDESCRIPTION,l'%`> a4 ; ,t c-U ] t /' cQ,; 1 ,1/l: r1ffl "' da;} CA,t+L. ADPA , J. ' CITY INSPECTOR i APPLICATION FOR BUILDING PERMIT CITY OF ANACORTES Date `D— Z 7 -2 -- Owner's Name -)14 � Q — Owner's Address 3o J C1---c-a eA -C�'LICZ . Phone No. Applicant's Name q-414.4 p Applicant's Addres / Li [ q--/Qom/ S ✓ Phone No. Property Address 3 p/ q----emakz_ekALD Legal Description of Property Description of proposed improvement t,_,e-teQ , t, � Improved property to be used as follows l� P .iXA.M Value of proposed improvement $ t L0, © p V m-- �V1 /4, ,st PLOT PLAN Instructions: Draw a sketch of the property on the reverse side of this page or submit plot plan showing the following information: - I. Streets and alleys abutting property. • j 2. North point. 3. Size and shape of property. 4. Size of existing building or improvements. 5. Size of proposed buildings or improvements. 5. Distance of all structures from all property lines. -214/7 /4 Ap ice 's or agent's signature S,gn-only after reading attached building permit requirements. For Inspections Call CITY OF ANACORTES P. O. Box 547 293-19U1 BUILDING DEPARTMENT 904-6th Street 24 Hrs. Notice Requested PERMIT APPLICATION Anacortes, WA 98221 c � Je (or Nacre' /of Business) APPLICANT C)Lers THIS FORM wrnm4 HEAVY LINE FDA"WRFC , .M..-Lvi./ Scare .5 C'FICH THIS PFIdOT WILL BE APPLICABLE. - Failing teas g3o'l o kr�.Z PLUMING City i Telephone Hunter No. Tye of Fixture or Item FEE p &,(„ 7 — b�C Niter Closet (lbiiet) $ Nate G✓ / Bathtub Lavatory (Wash Basin) Address Shower Kitchen Sink c Disp. City Telephone Number Dishiasher Laundry Tray Name Clothes Washer 1JAI, (0- WwC J ?Po-Vac/5 Water Heater Addrel , urine. V _a 7/�G 2— D inking Fountain City !! Telephone Number Floor - Sink or Drain We1v A Tci-✓G- ?etc/ (9O"/— !DepJ Slop Sink State License Bunter 0 27"1a 4/ Y�r�' '`,/ Water Piping & Treat; Equip. p� _Resideride-1 > Dampish PantingWaste Interceptor . Ftvirg Mechanical Vacuum Breakers ton-Onmercial_ Spa/Pool Add Lawy sprinkler System New Sign Repair PEiM/T $ Legal Descriptionof Property (Show Belw or Attach 2Rxs Copies)) TOPAZ FEE $ Lot C./ ///6 Block 5-0"— of ill l 4 Ji c (� '4 MECHANICAL NAT. GAS OIL L% ELEC. ib. Type of Equipment FEE Air Cond. Units - H.P. Ea. $ Refrigeration Units - N.E. ea. Boilers - H.P. Ea. Neatyre,of Work f k - -.-_} (h Cas Fire A.C. its - Tonnage Ea. I, . ,..,`,:, :., f'�•�`Via?:F y Ford Aix Systems - B.T.U. M Ea. Gravity Systems - B.T.U. M Ea. Fall Heaters - B.T.O. M Proposed Use / Unit Heaters - B.T.O. M c. /FL'- T Evaporative Coolers ' ?MICE Clothes Dryers This permit bemres null and void if work or construction authorized is Ventilation Fan not camenced within 180 days, or if construction or work is suspended 1 or abandoned for a period of 180 days at any timeafter work is com- > Hood - Coml. mewed. I hereby certify that I have read and examined this applica- Air Handling Unit C.F.M. tiao and know the same to be true and Correct. All provisions of laws and ordinances governing this type of work will he Complied with Incinerator whether specified herein or rot, the granting of a permit does rot pre Gas Piping sure to give authority to violate or cancel the provisions of any other state or local law regulating Contortion or the performance of Con- Tanks stnrtion. Rom Heaters - W,md Stoves Signature of Owner or Authorize) Agent (Date) NGIE: MOOT LIMIT QE YEAR (accept DQ9LITICtS AND MYJING PERMITS - which shall be Completed in sixty days.) PEm4T $ TOPAZ FEE $ Side Yard Setback Street Serhark Rear Yard Setback APPHDXLMATE 7'+T Lt. Ft. PE VALUE PERMIT FEES Use Tare tot Area Vacant Site Issuing Yes Fb Building if W-d (w P Type of Cont. Occupancy Group No. of Dwelling Units 0SW Gas Piping Size of Bldg. Sq.Ft. Carport ----- Max. occ. load Plating i W.S. ,� • ,\13rd _ Sewer Qom. Insp. N hd Garage Fire Sprinklers Reg'd. Mechanical • 0 1st Yes No Basement Fire Place/Insert Wood stove Plan Check Fee u) Dad — . I ( pY —barked By: StateIIrsgy t i Code Srrcl arge e1 S° �T TOTAL 4(3 A7> 1 1 • REGISTERED AS PROVIDED BY LAW AS A: COMET CONT GE NERAI- EXPIRATION DATE REGISTRATION NUMBER 01 JORGEC' 197L.9 q�/29/31 EFFECTIVE DRTE . JORGENSEN. CONSTRUCTION 13702 SR 9 SE !dA 99290 SNOHO SIGN E OF LABOR AND INDUSTRIES . ! I ED BY DEP _- _ _. ___ _- ADDRESS (Th19 OLl CJ LEGAL DESCRIPTION ASSESSORS ACCOUNT NO. - cta --ot ?-C;CX zi PERMIT NO. DATE DESCRIPTION DATE FINALED * fl qay u, -ers'`-K ;, i99 —a3 72S " .rcoc • •