HomeMy WebLinkAboutPermit File BLD-2020-0655 4410 San Juan Avenue (2)DocuSign Envelope ID B72D5C9D-SCE4-4060-AF26-52BDB2601EOD
."ni y o PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
'� Mailing Address: P.O. Box 547, Anacortes, WA 98221
Office Location: 904 61 Street, Anacortes WA 98821
. Phone: (360) 293-1901
FORM BP-1: RESIDENTIAL BuILDING PERMIT APPLICATION
1. PROPERTY INFORMATION
Project Address (Street, Suite #): Assessor Parcel Number:
4410 San Juan Ave, Anacortes WA 98221 P81763
Subdivision/Lot#: Zoning Designation: Lot area (size):
CLEARIDGE LT 106 Z 143( sq. ft
2. TYPE OF PROJECT
❑ New SFR ❑ New Accessory Dwelling Unit: ❑ Deck/porch (new/repair)
❑ New Duplex ❑ 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: Pv solar installation
Project Summary: Pv solar Installation / system size: 9.86 kw
PV MODULES: (29) Q. Cells Q.Peak DUO BLK-G6+ 340
/ INVERTER(S): (29) Enphase IQ7-60-2-Us
Project Valuation:
3. PROPERTY OWNER INFORMATION
Name: Michael Garrett Phone: (417) 414-0012
Address (Street, City, State, Zip): Email Address: mdg. garett@gmai 1 . com
4410 San Juan Ave, Anacortes WA 98221'
4. CONTRACTOR INFORMATION
Name:* Infinity Home Solutions Phone: (503) 896-4350
Contractor's Business Licenses
State License #:
City License #:
*All Contractors & Subcontractors must hove a valid City
Expiration Date:
Expiration Date:
of Anacortes business license prior to doing work in the
City.
Anthony.miller@Infinil:yd2d.com
Email Address:
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S. CONTACT PERSON
Select one person the city will contact for anything ❑ Applicant ❑ Property Owner ® Contractor
related to this project: ❑ Other flist below
Name: Z Phone: (503) 896-4350
Address (Street, City, State, Zi ): Email Address:
6405 E Mill Plain Blvd, Anthony.Miller@Infinityd2d.com
Vancouver WA 98661
Res. Building Permit Application Submittal Checklist
Updated October 10, 2019
Page 5of18
DocuSign Envelope ID: B72D5C90-5CE4-4060-AF26-52BDB2601EOD
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PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
Mailing Address: P.O. Box 547, Anacortes, WA 98221
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Office Location: 904 61h Street, Anacortes WA 98821
Phone: (360) 293-1901
fi. 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.
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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
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completing and I agree to provide the items needed for the City to calculate these securities and to
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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.
Ae�-_ Oq JW ZQ2o
Signature Date
Mai-���
Printed Name
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Res_ Building Permit Application Submittal Checklist
Updated October 10, 2019
Page 6 of 18