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HomeMy WebLinkAboutPermit File BLD-2020-0655 4410 San Juan Avenue (3)Docugign Envelope ID B72D5C9D-5CE4-4060-AF26-52BDB2601EOD Y O 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 FORM BP-Z: STRUCTURE AND SITE INFORMATION 1. PROPERTY WHERE WORK IS OCCURRING ADDRESS. 4410 San Juan Ave, Anacortes WA 98221 PARCEL P81763 NUMBER(S) 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 10 Floor: NA- 2nd Floor: NA 3'd Floor: Basement: Garage: Total deck: Total porch: Other: Other: Other: 3. QUESTIONS ABOUT THE PROPOSED STRUCTURE Is a fire sprinkler system being installed? ❑ YES Z NO Is a monitored fire alarm being installed? ❑ YES NO Are retaining wall(s) being built? ❑ YES © 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 ❑ YES ®NO to submit a right-of-way permit application. If you have already submitted a ROW permit, list the permit number here: B. Is the property located in a flood zone? ❑ YES © NO If yes, list the flood zone designation: C. Are there slopes in excess of 15% on or abutting the site? If yes, a ❑ YES a NO geotechnical report will likely need to be submitted. Res. Building Permit Application Submittal Checklist Updated October 10, 2019 Page 7 of 18 DocuSign Envelope ID; B72D5C9D-5CE4-4060-AF26-52BDB2601 EOD PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT ( G�fi Mailing Address: P.O. Box 547, Anacortes, WA 98221 Office Location: 904 61h Street, Anacortes WA 98821 �� M Phone: (360) 293-1901 D. Are there critical areas or buffers on or abutting (within 300-feet of) the ❑ YES Q 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 0 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 © 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. 0 _ O R l7_S Z ZO Signature Date i Printed Name Res. Building Permit Application Submittal Checklist Updated October 10, 2019 Page 8 of 18