HomeMy WebLinkAboutPermit File BLD-2021-0523 3916 W6th Street • 0 _ Cityof Anacortes
Invoice/Permit #: BLD-2021-0523
904 6th Street
Applied date: 06/25/2021
P.O.Box 547 Issue date: 06/25/2021
WA 98221-0547: Anacortes, Expire date: 12/22/2022
(360) 293-1901
Job Address: 3916 W 6TH ST Permit Type: Single Family Alteration/Repair Permit
ANACORTES WA 98221-1294 Project:
APN: P107093
Remarks: REPLACE SIDING ON HOME WITH HARDIE BOARD. Owner: 360-855-5660
Owner: DAVIS CHARLES J Contractor: WASHINGTON ENERGY SERVICES
Address: 3916 W 6TH ST Address: 3909 196TH ST SW
ANACORTES WA 98221-1294 LYNNWOOD WA 98036-5732
Phone: Phone: (206) 378-6648
License #:
General Information: Fees:
Flood plain development N Building Permit Fee 603.85
Building Valuation 45100 Plan Review Fee 392.50
State Building Code Fee Resi 6.50
Total Calculated: 1 ,002.85
Deposits/Receipts: 0.00
Total Due: 1 ,002.85
The issuance or granting of this permit shall not be construed to be a permit for, or approval of, any violation of this Code or any other ordinance or order of
the City, of any state or federal law, or of any order, proclamation, guidance advice or decision of the Governor of this State. To the extent the issuance or
granting of this permit is interpreted to allow construction activity during any period of time when such construction is prohibited or restricted by any state or
federal law, or order, proclamation, guidance advice or decision of the Governor of this State, this permit shall not authorize such work and shall not be
valid. The building official is authorized to prevent occupancy or use of a structure where in violation of this Code, any other City ordinances of this
jurisdiction or any other ordinance or executive order of the City, or of any state or federal law, or of any order, proclamation, guidance advice or decision of
the Governor. The building official is authorized to suspend or revoke this permit if it is determined to be issued in error or on the basis of incorrect,
inaccurate or incomplete information, or in violation of any City ordinance, regulation or order, state or federal law, or any order, proclamation, guidance or
decision of the Governor. This permit becomes null and void if work or construction authorized is not commenced with'. :: o: s or if construction work is
suspended or abandoned for a period of 180 days at any time after work is commenced. I have read and exami' --: this applica on and know the same to
be true and correct.
SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSUED 41"--
Y o PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
`+ ,'‘ Mailing Address: P.O. Box 547, Anacortes, WA 98221
Office Location:904 6th Street, Anacortes WA 98821
9'L `''' Phone: (360)293-1901
FORM BP-1: RESIDENTIAL BUILDING PERMIT APPLICATION
1. PROPERTY INFORMATION
Project Address(Street,Suite#): Assessor Parcel Number:
Subdivision/Lot#: Zoning Designation: Lot area (size):
sq.ft.
2. TYPE OF PROJECT
❑ New SFR ❑ New Accessory Dwelling Unit: ❑ Deck/porch (new/repair)
❑ New Duplex E Attached to Primary Unit ❑ Interior remodel
❑ Detached from Primary Unit
❑ New Addition to SFR ❑ Garage, carport or accessory building ❑ Fence or retaining wall
or duplex (new/repair)
❑ Other:
Project Summary:
Project Valuation: $
3. PROPERTY OWNER INFORMATION
Name: Phone:
Address(Street,City,State,Zip): Email Address:
4. CONTRACTOR INFORMATION
Name:* Phone:
Contractor's Business Licenses State License#: City License#:
*All Contractors&Subcontractors must have a valid City
of Anacortes business license prior to doing work in the Expiration Date: Expiration Date:
City.
Address(Street,City,State,Zip): Email Address:
5. CONTACT PERSON
Select one person the city will contact for anything
❑ Applicant ❑ Property Owner ❑ Contractor
related to this project: ❑ Other(list below)
Name: Phone:
Address(Street,City,State,Zip): Email Address:
Res.Building Permit Application Submittal Checklist
Updated October 10,2019
Page 5 of 18
Y .. PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
Mailing Address: P.O. Box 547, Anacortes, WA 98221
Office Location:904 6th Street, Anacortes WA 98821
7/1,. 4' Phone: (360)293-1901
6. LENDER INFORMATION
RCW 19.27.095 requires the City to obtain information with regard to lenders. If there are no lenders involved with your project,
write"no lenders"on the Name Line below.
Name: Phone:
Address(Street,City,State,Zip): Email Address:
7. ACKNOWLEDGEMENTS & SIGNATURE
Read and initial each of the following statements prior to signing this application:
I understand that when a building permit application is taken in over the counter it does not mean
the application has been deemed technically complete and sufficient for staff review.
I understand that if I submit incomplete, inaccurate, and/or erroneous information it will take the
City longer to process my permits.
I understand and acknowledge that I could be responsible for providing as-built drawings (on paper
or electronically) as part of the project's certificate of occupancy process.
I understand and acknowledge that Special Inspections could be required as part of my project, and
if needed I will be required to pay for the cost of these inspections.
I understand and acknowledge that financial securities could be required as part of the work I am
completing and I agree to provide the items needed for the City to calculate these securities and to
provide the securities themselves.
I understand that if permits are reviewed concurrently such as design review,site plan,traffic
concurrency,etc., any required revisions to one permit may affect the entire plan set and could
add costs and time to the project.
I hereby declare that I am either the owner of the property listed on this application or the owner of
this property has authorized me to be their representative to act for them. I also declare under
penalty of perjury under the laws of the State of Washington that all of the statements and answers
contained herein,and the information submitted with this application form is in all respects,true,
correct, and complete to the best of knowledge and belief.
r
Signature Date
Printed Name
Res.Building Permit Application Submittal Checklist
Updated October 10,2019
Page 6 of 18