HomeMy WebLinkAboutPermit File BLD-2021-0813 2206 20th Place (5)�"v Y .0 PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
Mailing Address: P.O. Box 547, Anacortes, WA 98221
Office Location: 904 6tn Street, Anacortes WA 98821
Phone: (360) 293-1901
Residential Building Permit Application
Submittal Packet
New Single Family Residences (SFR) Duplexes Additions and Remodels (SFR & Duplex)
Accessory Dwelling Units Manufactured Homes Residential decks and retaining walls
fit' : '-1: RESIDENTIAL BuILDING PERMIT APPLICATION
1. PROPERTY INFORMATION
Project Address (Street, Suite ft
Assessor Parcel Number:
�2010 -2DO pla(;e V-5
?5�24�M2 -2 i - 020- OAR
Subdivision/Lot #:
Zoning Designation:
Lot area (size):
M Al- 004
sq. ft.
2. TYPE OF PROJECT
❑ New SFR ❑ New Accessory Dwelling Unit: 4V Deck orch new epair
❑ New Duplex ❑ Attached to Primary Unit X Interior remodel
n Detached from Primary Unit
El New Addition to SFR El Garage, carport or accessory building ❑ Retaining wall
or duplex (new/repair)
❑ Other:
Project Summary: V r-oA- p�c.* P,Aamot w�( vd ee" (i- vim{- w ij tP
?% (aLlL y (/1(1 V�Pst�t t�VvUf 11.E �1C'.f i�a� J�'�/
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W / . d0 V' ' Ky i kG + 1 "A tnQ o % "� (r1. Ina 5 K..C-� . N Y � Y '' � ,F�'4n/4 V 6 + k
Project Valuation: S �� i�D0 vuh 't\ 5v�� b �"� c-�` 1�'
3. PROPERTY OWNER INFORMATION
Name: (A
prn - TIA,5fee
Ph ne:
Address (Street, City, State, Zip):
2 0b 'Xt t IA9 U+6 WAg92
Email Address:
anY\e ve-i et
4. CONTRACTOR INFORMATION
Name: *%r1 \IvheeAe Phon'(2-V
- 0 2- 90
Contractor's Business Licenses
*All
Sta a License #:
'TC L
City License #:
Contractors & Subcontractors must have a valid City
Expiration Date.
Expiration Date:
of Anacortesbusiness license prior to doing work in the
city. 5. Cc' R'4fu ' Ii on
Address (Street, City, State, Zip):
Email Address:
b1sl tibf6w�-�al' 'NaCe-
A r,cz,ad4o, VQA qi 2 (
Page 1 of 19
Res. Building Permit Application Submittal Checklist
Updated April 20, 2021
1l x 0 PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
Mailing Address: P.O. Box 547, Anacortes, WA 98221
Office Location: 904 6th Street, Anacortes WA 98821
` " Phone: (360) 293-1901
5. CONTACT PERSON
Select one person the city will contact for anything ❑ Applicant ❑ Property Owner 0 Contractor
related to this project:
Name:C 'v1i'hedf,r
Phone:(. )5q j — �2`O
Address (Street, City, State, Zip):
irzZ i � ► a � � L i+ r (� (GEC �'
`Email Address:
ehtmj,� iI+ccii4w6n %, ff4`Ce,6.co(yt
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: N® tfnA-err
Phone:
Address (Street, City, State, Zip):
Email Address:
7. ACKNOWLEDGEMENTS & SIGNATURE
Read and initial each of the following statements prior to signing this application:
w
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
G�
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.
Res. Building Permit Application Submittal Checklist
Updated April 20, 2021
Page 2 of 19
Y
PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
Mailing Address: P.O. Box 547, Anacortes, WA 98221
Office location: 904 611 Street, Anacortes WA 98821
Phone: (360) 293-1901
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.
Signature D f�� 5 �e/ la _ � � f Date
Printed Name
Res. Building Permit Application Submittal Checklist
Updated April 20, 2021
Page 3 of 19
PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
Mailing Address: P.O. Box 547, Anacortes, WA 98221
Office Location: 904 6th Street, Anacortes WA 98821
Phone: (360) 293-1901
SUBMITTAL CHECKLIST
Residential Building Permit
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Submittal Requirement Checklist
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See pages 2-3 of this handout for information about each
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a[ , submittal item listed below.
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Residential Building Permit Application Form
X
X
X
X
X
(FORM BP-1 —attached)
Structure & Site Information Form
(FORM BP-2—attached)
X
X
X
X
X
Mechanical & Plumbing Fixtures Form
X
X
X
(FORM BP-3—attached)
Architectural Plans
X
X
X
X
X
(requirements listed on FORM BP-4 - attached)
Stormwater Management Minimum Requirements
Determination
X
X
X
X
(FORM BP-5, attached)
Stormwater Site Plan
X
X
X
X
Site Plan & Landscape Plans
X
X
X
X
X
(requirements listed on Form BP-6)
Structural Plans & Calculations
X
X
X
X
X
Energy Code Plans & Forms
X
X
Manufacturer's Specifications/Cut Sheets
X
Copy of recorded survey
X
X
X
X
Technical Reports
X
X
X
X
Other Required Permits
X
X
X
X
X
ADU Affidavit of Owner Occupancy (signed)
X
Submittal Information
Fees
Send applications in PDF format with a file and message
Once we receive your application, we will
size no greater than 30 MB. Please review our Electronic
contact you about payment of the
Submittal Guidelines for more information. An email
required deposit, if any.
with a link to a file share site (Dropbox, Google Drive,
OneDrive, etc.) is acceptable.
Permit fees are paid prior to building
permit issuance.
Email: buildingpermit@cityofanacortes.ora
Incomplete applications will not be processed.
Res. Building Permit Application Submittal Checklist
Updated April 20, 2021
Page 4 of 19
v PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
- Mailing Address: P.O. Box 547, Anacortes, WA 98221
Office Location: 904 V Street, Anacortes WA 98821
,�: `� Phone: (360) 293-1901
g. e-STRUCTURE ANDINFORMATION
1. PROPERTY WHERE WORK IS OCCURRING
ADDRESS:
2_to 20t- 'Pt"e(e A-riA," S+5 q �2�2_1
PARCEL
V%2(0q% 2`7 7Z -2l _02() __ 0Qq
2. DETAILED PROPOSED STRUCTURE INFORMATION
Complete the following information as it relates to your project. Mark items that are not applicable with
Structure height:
AREA
SQUARE FOOTAGE
OCCUPANCY GROUP
CONSTRUCTION TYPE
OCCUPANT LOAD
1st Floor:
2nd Floor:
31d Floor:
Basement:
Garage:
Total deck:
Total porch:
Other:
Other:
Other:
3. QUESTIONS
ABOUT THE PROPOSED STRUCTURE
Is a fire sprinkler system being installed?
❑ YES NO
Is a monitored fire alarm being installed?
❑ YES NO
Are retaining wall(s) being built?
❑ YES C NO
Are structural plans required?
❑ YES NO
4. PROJECT SITE INFORMATION
A. Is work within the City's right-of-way proposed? If yes, you will be required
to submit a right-of-way permit application.
If you have already submitted a ROW permit, list the permit number here:
❑ YES CYNO
B. Is the property located in a flood zone?
If yes, list the flood zone designation:
❑ YES aNO
C. Are there slopes in excess of 15% on or abutting the site? If yes, a
geotechnical report will likely need to be submitted.
❑ YES NO
Res. Building Permit Application Submittal Checklist
Updated April 20, 2021
Page 8 of 19
y PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
Mailing Address: P.O. Box 547, Anacortes, WA 98221
Office Location: 904 6rh Street, Anacortes WA 98821
Phone: (360) 293-1901
D. Are there critical areas or buffers on or abutting (within 300-feet of) the
❑ YES C�r NO
project site? If yes, a critical areas report will likely need to be submitted.
E. Is the lot less than 5,000 sq. ft. in area?
❑ YES NO
If yes, your site and building will need to comply with the standards in AMC
19.43.010.C.
F. Is your project involving an accessory dwelling unit?
❑ YES] NO
If yes, your site and building will need to comply with the standards in AMC
19.47.
G. Will more than 2-acres be cleared and/or more than 5,000 board feet
❑ YES 19 NO
(about 1 log truck load) of timber be harvested? If so you may need to
obtain a forest practices permit from DNR.
H. Is this project subject to the SEPA process? If yes, you will be required to
❑ YES NO
submit a SEPA checklist.
If you have already completed the SEPA process, list the permit number
here:
5. REQUIRED 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 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.
4�"-
"e �)
Signature Da e
Printed Name
Res. Building Permit Application Submittal Checklist
Updated April 20, 2021
Page 9 of 19
x PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
Mailing Address: P.O. Box 547, Anacortes, WA 98221
Office Location: 904 61,1 Street, Anacortes WA 98821
7......_
Phone: (360) 293-1901
MECHANICAL
Equipment Type:
Appliance/Equipment Information (new and relocated):
Total #:
Furnace:
Gas #:
Elec #: BTU: Other #:
Wall Heater:
Gas #:
Elec A Other: A Location(s):
Gas Water lankkto
#:
Location(s): oeke
Heat Pump:
Elec A
Other A Capacity:
Air Conditioning:
Elec A
Other #: Capacity:
Radiant /Hydronic
Gas A
Elec #: Other: #: Location(s):
Exhaust Fans:
Bath #:
Laundry#: Other:
Range Hood:
A i
Location(s): V. %fie r\
Fireplace:
Gas A
Elec A Other: #: Location(s):
Clothes Dryer & Duct:
Gas A
( Elec A Other: #: Locati n : ' Y
Stove/Range/Oven:
Gas A
( Elec A 2 Other: A Locate K( (v
-3
Gas Piping/ Outlet(s):
A 2
Location(s): L n & t -,
2-
Boiler
Gas A
Elec #: BTUs: Location(s):
Other:
A
Location(s):
TOTAL MECHANICAL OUTLETS:
PLUMBING
Fixture Type (new and
relocated):
Total #:
Fixture Type (new and relocated):
Total #:
Water Closet (Toilet):
Refrigerator water supply (for water/ice
)
Kitchen Sink:
(
Pressure Reduction Valve/Pressure Regulator:
Utility Sink:
Water Service Line:
Tub:
Water Piping:
Hand Sink:
Clothes Washer:
Shower:
(
Electric Water Heater: Tank -less? Yes ❑
Dishwasher:
j
Backflow Prevention Assembly:
Hose Bib:
Other:
TOTAL PLUMBING FIXTURES:
Res. Building Permit Application Submittal Checklist
Updated April 20, 2021
Page 10 of 19