HomeMy WebLinkAboutPermit File BLD-2022-0512 1608 Georgia PlaceNor—,
PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
Mailing Address: P.O. Box 547, Anacortes, WA 98221
Office Location: 904 61h Street, Anacortes WA 98821
Phone: (360) 293-1901
RESIDENTIAL BUILDING PERMIT APPLICATION
THIS APPLICATION PACKET IS USED FOR THE FOLLOWING PROJECT TYPES:
Single -Family Residences (SFR), Duplexes, Additions & Remodels, Accessory Structures (i.e. garages,
carports), Accessory Dwelling Units, Manufactured Homes, Residential Decks & Retaining Walls, and
Docks & Pilings.
FORM BP-1: RESIDENTIAL BUILDING PERMIT APPLICATION
PROPERTY INFORMATION
PROJECT ADDRESS (STREET, SUITE #)
ASSESSOR PARCEL NUMBER
1608 Georgia Place
P99826
SUBDIVISION/LOT#
ZONING
LOT AREA (SIZE) 16552.80
SQ. FT.
TYPE OF PROJECT
NEW
ADDITION
X
REPAIR
REMODEL CHANGE OF USE
IX4SFR Duplex ❑ Deck / Porch
Accessory Dwelling Unit: ❑Detached ❑ Attached ❑ Retaining Wall
❑ Manufactured Home ❑ Accessory Structure
❑ Shoreline Structure (dock, pilings, floats etc.) * ❑ Other:
*If application is for a shoreline structure, please complete the Shoreline Structure Checklist.
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? I YES ✓ NO
f YES, provide the permit/application number:
PROJECT SUMMARY:
PROJECT VALUATION
Replace 46 feet of wall bottom plate on wall separating living space from conditioned crawl space. Temporarily support loads
(Cost of Materials & Labor)
using beams and jacks, replace water damaged bottom plate with new pressure treated material and install isolating
membrane between concrete and new plate.
$ 3,910
PROPERTY OWNER INFORMATION
NAME
PHONE
Gail Grotte
360-299-3309
ADDRESS (STREET, CITY, STATE, ZIP)
EMAILADDRESS
1608 Georgia Place
ggrotte@outlook.com
CONTRACTOR INFORMATION
NAME*
PHONE
Efekt Services
360-913-2116
CONTRACTOR'S BUSINESS LICENSES
STATE LICENSE #
EXPIRATION
*All Contractors & Subcontractors must have a valid City
EFEKTSL803PF
10/06/2022
of Anacortes business license prior to doing work in the
UBI #
EXPIRATION
City.
604-642-963
08/31 /2022
ADDRESS (STREET, CITY, STATE, ZIP)
EMAILADDRESS
PO BOX 527 Sedro Woolley, WA 98284
Timber@efektservices.com
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Res. Building Permit Application Submittal Checklist
Updated April 20, 2021
CONTACT PERSON - Select one person the city will contact for anything related to this project:
❑APPLICANT ❑PROPERTY OWNER ❑■ CONTRACTOR ❑OTHER (LIST BELOW)
NAME
PHONE
Timothy Malsch
360-913-2116
ADDRESS (STREET, CITY, STATE, ZIP)
EMAILADDRESS
PO BOX 527 Sedro Woolley, WA 98284
Timber@efektservices.com
LENDER INFORMATION
RCW 19.27.095 requires the City to obtain information with regard to lenders. If there are no lender
involved with your project, write "no lenders" on the Name Line below.
NAME
PHONE
No Lender
ADDRESS (STREET, CITY, STATE, ZIP)
EMAILADDRESS
ACKNOWLEDGEMENTS & SIGNATURE
Read and initial each of the following statements prior to signing this application:
1 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 1 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.
1 understand and acknowledge that Special Inspections could be required as part of my project, and
if needed 1 will be required to pay for the cost of these inspections.
1 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
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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 1 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.
06/27/2022
SIGNATURC DATE
Timothy Malsch
PRINTED NAME
Res. Building Permit Application Submittal Checklist
Updated December 2021
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