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HomeMy WebLinkAboutPermit File BLD-2021-0806 1117 14th Street City of Anacortes invoice/Permit #: BLD-2021-0806 904 6th Street Applied date: 09/28/2021 P.a.Box 547 Issue date: 09/28/2021 t. ;= Anacortes, WA 98221-0547 Expire date: 09/2312022 'r`: (360) 293-1901 Job Address: 1117 14TH ST Permit Type: Residential Demolition Permit ANACORTES WA 98221-2127 Project: APN: P55239 Remarks: Strip interior of house down to the studs for a full renovation/remodel. Contact person is Nina Lebaron nina©islandarchitecture.net: 3603787647 Owner: ANDY KURNIAWAN Contractor: Address: 22308 BRIER RD Address: BRIER WA 98036 Phone: (206) 354-1980 - Phone: License #: General Information: Fees: Dwelling Units 1 State Building Code Fee Resi 6.50 Demolition permit 60.00 Total Calculated: 66.50 Deposits/Receipts: 0.00 Total Due: 66.50 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 within 180 days 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 examined this application and know the same to be true and correct. SIGNATURE OF OWNER OR AUTHORIZED AGENT I UED B PLANNING,COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT .111111111111rMailing Address: P.O. Box 547,Anacortes, WA 98221 Office Location: 904 6th Street, Anacortes WA 98821 kr1:1111JVP; Phone: (360)293-1901 r.- DECONSTRUCTION/DEMOLITION PERMIT APPLICATION 1. PROPERTY INFORMATION Project Address(Street,Suite#): Assessor Parcel Number: 7 / 1 5r PcsL5q 2. TYPE OF STRUCTURE 1 Single Family ❑ Multifamily,#of Dwelling Units ❑ Commercial/Industrial ❑ Duplex ❑ Other Use Type: ❑ Underground Fuel Tank 3. STRUCTURE INFORMATION FOR BUILDINGS: Description of Work: 57701136 / Z/C9 L(r� Size of structure: le 0 sq.ft. . Meent IzeNDVMIO Method of Disposal: Dal 40 orginal construction of structure: Historic Resources Information: Is the structure listed on the City of Anacortes Local, if identified prior to demolition,are you willing State,or National register of historic places? to salvage from the structure historically ❑ YES* r4 NO significant architectural features? Designation: *If yes,SERA review is required prior to issuing a demolition permit ❑ YES ❑ NO • N ote:Check with the City of Anacortes Museum and/or the WA State Dept. / f�epri//�-! j Q /70f✓1 of Archaeological and Historic Preservation's W ISSARI)system to answer f/! GGQ///���fff�►►f ' // this question. Y v! VA 1rlta . �p �1 Utility&services disconnection/interruption information Identify which City services you would like to disconnect/stop: —Water ❑ Disconnect ❑ Retain Storm ❑ Disconnect ❑ Retain Sewer ❑ Disconnect ❑ Retain Garbage ❑ Discontinue ❑ Retain _ J For private utilities(gas,electricity,cable, etc.),you will need to contact the applicable companies if their services are to be interrupted or disconnected. FOR UNDERGROUND STORAGE TANKS: Decommissioning type: E3 Abandonment in place (Fire o Approvals required) ❑ Removal Date of pump&rinse: Disposal Location: Type of inert fill: Approximate age of tank: ICC Certification#: Deconstruction/Demolition Permit Application Submittal Cheddist Updated February 24,2021 Page 3 of 4 PLANNING,COMMUNITY,&ECONOMIC DEVELOPMENT DEPARTMENT 9/4* Mailing Address: P.O. Box 547,Anacortes, WA 98221 1, Office Location:904 6th Street, Anacortes WA 98821 \'�.! Phone: (360)293-1901 4. PROPERTY OWNER INFORMATION Name: Phone: M 9( V (A/AtJ - $5 f - � Address(Street,City,State,Zip): Email Address: Z30t:, eviZrAYL w: � Q"3 _ g4 r-iaq• 5. CONTRACTOR INFORMATION Name:' Phone: Contractor's Business licenses State license#: City of Anacortes •lip Contractors&Subcontractors must have a valid City Endorsement? of Anacortes business U ense prior to dour work in the Expiration Date: ❑ YES Crty ❑ NO Address(Street,City,State,Zip): Email Address: 6. FINANCING INFORMATION {Required if project valuation exceeds$5,000,per RCN 1927.095) tender administering the construction financing or firm issuance a payment bond(if any)on behalf of the prime contractor for the protection of the owner,if the bond is for an amount not less than 50%of the total amount of the construction project(if owner is self-financing,please indicate). Completion of this information may be deferred until permit issuance. Name: Phone: Address(Street,City,State,Zip): 7. CONTACT PERSON Select one person the city will contact for anything ❑ Property owner ❑ contractor related to 4///{4 this project: Other(fiistbelow) , c7ZCtt'1?2C1 Name: Phone: - - / "r1 Address(Street, 1,State,Zip : q0 Z�' Email Address: 1' it f�1./ /P 9 / lr19 V/S t`G,f't ,4(C 4+'+ec fi A pre , rl Q 8. SIGNATURE 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 dedare 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 knowledg7and belief. -/27/ZJ Si ature Date Deconstruction/Demolition Permit Application Submittal Checklist Updated February 24,2021 Page 4 of 4 PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT ( *I* RESIDENTIAL BUILDING PERMIT APPLICATION Mailing Address:P.O. Box 547, Anacortes, WA 98221 OC Office Location: 904 6t Street, Anacortes WA 98821 Phone: (360) 293-1901 PLEASE REFER TO THE RFSIDENI7AL BUILDING PERMIT CHECKLIST BELOW FOR SUBMITTAL REQUIRMIENTS PROJECT ADDRESS(Street,Site It): PARCEL(S) i I/7 14 r.i S[Rz T f SS �'�- Subdivision/Lot#: PROJECT VALUATION: $ APPLICANT` � : e r�Arzokl\-- ,, P��: 3&0, �7 76 -7 Address(Sued,Cam,Stale,�): Email Address: MO 5' 1� irj rArt /4ico,/ s �If3 24 , A tkq-P 1s 1 dodo"-di;4-r-c,-4, p' .� f-- PROTRTY° le- ,) i .frvAm. P� :��, .3C 4`0 I q1(q o Address(Stied,City State Zip): WA- Email Address: CONTACT 2O 1 PD f op- `' b 3 ' Phone:`7. ky�v►t w4V)(9c7I a�l, .5M r Address(Street,City,Sow,Zip): Email Address: LENDING AGENCY: Phone: Address(Street,City,State,Zip): Email Address: CONTRACTOR:* Phone: Address(Street City.State.Zip): Email Address: *AB Carters&Subcontractors mot have a wild City of Prof # Exp.Date: A� todung lank im the City. C Go 7 72_ the city Fina nce aaae D� at(36B)Z99-I9i6R Basr�ss l ontact _ icense Exp. : PROPOSED WORK: ll-/)L'l LO I titZF4•t O!L n E • �11-tr aOr i .Z I floqt. PION(1 A-14-L[3n► i t S- - fczoA.. A-D GLD% f 7omoist— r�//t/r-0 Ki aJ� viAeA / "goo r/t-414! act-- c.m 4- U�C.K-, t 5 r Basement SQ': Finished Basement: ❑ Unfinished Basement 1'Floor SAT: Garage/Carport SQ': 2'Floor SQ': Deck/Covered Porch/Patio SQ': j 2 i• /el 2 s 3 zA Fire Sprinkler: El Yes IX No Lot Area SQ.: Z7LP k 40 PG �` I declare under penally of perjury that the information I have provided on this form/application is true,correct and complete,and that I am the property owner or duly authorized agent of the property owner to submit a permit application to the City of Anacortes_ Print Name: AI WA- L b1'r/`ter`F Owner CI Agent (specific'): /' w- i I if Signature: /, - �� Date: I a 1/ 2 I Page 1 of 5 I\11'ERV101 S St RFA( F: \ RI. 1: Existing Impervious SQ': New Impervious SQ': Total Disturbed Land/Soil SQ': Total Proposed: Cut Fill: New hard surfaces(pervious&impervious) Land converted from native vegetation to lawn or landscaping SQ- Land converted from native vegetation to pasture SQ- \lE('H.A\RI \L.: Equipment Type: Appliance/Equipment Information(new and relocated): Total#: Furnace: Gas#: i Elec#: BTU: Other it: Wall Heater: Gas#: Elec#: Other: It Location(s): - Gas Water Heater: #: i Location(s): _ Heat Pump: Elec#: Other it: Air Conditioning: Elec#: Other it: Radiant/Hvdronic Heating: Gas#: Elec#: Other: #: Location(s): Exhaust Fans: Bath it: "72 Laundry II: t Other Range Hood: #: Location(s): -I T(e . 1- Fireplace: Gas#: Elec#: Other.#: Location(s): Clothes Dryer&Duct: Gas#: Elcc#: Other: #: Location(s): i Stove/Range/Oven: Gas#: Elec#: Other:#: Location(s): Gas Piping/Outlet(s): #: Location(s): Boiler Gas#: Elec#: BTUs. Location(s): Other: #: Location(s): TOTAL MECHANICAL OUTLETS PL_i'\lBI\G FIXTURES: Fixture Type(new and relocated): Total#: Fixture Type(new and relocated): Total#: / Water Closet(Toilet): '3 Refrigerator water supply (for water/ice dispenser): Kitchen Sink: I Pressure Reduction Valve/Pressure Regulator: Utility Sink: . I Water Service Line: Tub: , Water Piping: Hand Sink: 2 Clothes Washer 1 Shower 7 kj Electric Water Heater. Tank-less? Yes ❑ Nov Dishwasher ( Backflow Prevention Device: l Hose Bib: r Other: i TOTAL PLUMBING FIXTURES: I r. Page 2 of 5