HomeMy WebLinkAboutPermit File BLD-2023-0162 2313 R Avenue (3) City of Anacortes Invoice/Permit#: BLD-2023-0162
904 6th Street
Applied date: 03/20/2023
P.O.Box 547
Issue date: 04/12/2023
Anacortes, WA 98221-0547
Expire date: 10/08/2024
Mp 'e �..,'a (360) 293-1901
Job Address: 2313 R AVE Permit Type: Grading Permit
ANACORTES WA 98221 Project:
APN:
Remarks: Remove asphalt parking lot at Skate Park.
Owner: PARKS DEPT CITY OF ANACORTES Contractor: OWNER
Address: PO BOX 547 Address:
ANACORTES WA 98221-0547
Phone: 293-1918 Phone:
License#:
General Information: Fees:
CUBIC_YARDS 75 Grading Plan Review Fee 23.50
Grade and Fill 37.00
Total Calculated: 60.50
Deposits/Receipts: 0.00
Total Due: 60.50
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 a this application and know the same to
be true and correct.
SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSU
VV x o PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
Mailing Address: P.O. Box 547, Anacortes, WA 98221
Office Location: 904 6th Street, Anacortes WA 98821
%7�� Phone: (360)299-1984
o w�
CLEARING & GRADING PERMIT APPLICATION
21
Clearing & Grading Permit o
Submittal Requirement Checklist
v — �
a See pages 2-3 of this handout for information about each submittal item listed below. See
Qu AMC Ch. 19.78 Clearing and Grading for review and approval criteria. p
v Clearing&Grading Permit Application Form
(FORM CG-1—attached)
Agent Authorization Form, if applicable
Critical Area Identification Form, if applicable
❑ Site Information
(FORM CG-2—attached)
❑ Stormwater Management Minimum Requirements Determination (FORM CG-3,attached)
Stormwater Drainage Report
Stormwater Site Plan
❑ Clearing & Grading Plans (requirements listed on Form CG-4,attached)
Environmental Review(SEPA) checklist, if appliable
Subdivision Guarantee
Technical Reports
Other Required Permits
Copy of recorded survey
Required Number of Copies and Plan Size Application Fee
2 paper copies of each item above
Plans must be minimum 11" x 17",to scale, and legible See the Land Use Permit Fee
Schedule
1 reduced size copy(maximum size 11"X 17") of plans
Digital copy of the application and all submitted materials (flash
drive or to Aced@citvofanacortes.org.)
Clearing&Grading Permit Application
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REQUIRED SUBMITTAL INFORMATION
Additional details on certain submittal items are provided below to ensure Applicants are fully aware
what City staff will be looking for when an application is submitted to the City.
• FORM CG-1: CLEARING & GRADING PERMIT APPLICATION FORM. Provides key information
about your project, including project details, property owner, contractor, and contact information.
• AGENT AUTHORIZATION FORM. Provide this completed form to authorize someone other
than the property owner to apply for permits.
• CRITICAL AREAS IDENTIFICATION FORM. Use this from to determine and/or identify if
critical areas or critical area buffers are located on or within 300 ft. of the development
area. If critical areas are determined to be present, a Critical Area Permit may be required.
• FORM CG-2: SITE INFORMATION FORM. Provides key information and asks questions about
site characteristics that are used to determine whether your project requires any other information
or additional permit applications to be submitted.
• FORM CG-3: STORMWATER MANAGEMENT MINIMUM REQUIREMENTS
DETERMINATION FORM. Most development within the City of Anacortes that involves
disruption of soils, or construction of buildings, streets, parking lots, etc. requires a Stormwater
review. Stormwater review requirements are based on either the amount of soil to be disturbed
(grading, vegetation removal), or the amount of hard surface that is created or replaced on a site
(building footprint, concrete, asphalt or gravel parking, sidewalk, etc.). Form CG-3 assists you in
determining the level of stormwater review (applicable Minimum Requirements) required for your
project.
• STORMWATER SITE PLAN. The Stormwater Site Plan is the comprehensive report containing all
of the technical information and analysis necessary for regulatory agencies to evaluate your
project for compliance with stormwater requirements. The level of stormwater review and
contents of the Stormwater Site Plan will vary with the type and size of the project, and individual
site characteristics.
• STORMWATER DRAINAGE REPORT. Use Form CG-3 to determine the level of stormwater
review and then complete the applicable Stormwater Minimum Requirements Form on the Public
Works- Engineering Department Forms website and provide required submittal items/plans.
• FORM CG-4: CLEARING & GRADING PLANS. Form CG-4 contains a list of all the items required
to be shown clearing and grading plans.
• SEPA CHECKLIST: Unless a project is categorically exempt, an environmental checklist is required
to be completed and submitted.
• SUBDIVISION GUARANTEE: A document prepared by a title insurance company documenting
the ownership and title of all interested parties in the development and that lists all encumbrances.
The certificate or report must be dated within 30 days prior to the submittal of a permit to the City.
Copies of all the encumbrances listed within the certificate or report must be provided.
• RECORDED PROPERTY BOUNDARY SURVEY: A recorded survey is required to define the limits
of the property subject to the application. All property corners must be staked/marked and visible.
Clearing&Grading Permit Application
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OTHER SUBMITTALS DETERMINED ON A CASE-BY-CASE BASIS
Following is a list of technical reports that will be required to be submitted to the City when certain
circumstances exist on or near a site an Applicant is planning on making improvements to. The general
triggers for each of the listed technical reports I provided below:
A. CRITICAL AREAS REPORTS: In general, Critical Area reports are required when wetlands
and/or streams are located on or near a site. Critical area mitigation plans may also be required,
depending on the project proposal. See Anacortes Municipal Code Ch. 19.70 for additional
information.
B. GEOTECHNICAL REPORT: In general, Geotechnical Reports are required when work is
proposed on or near slopes in excess of 15%and/or known landslide hazard areas. See
Anacortes Municipal Code Ch. 17.70 for additional information.
C. STORMWATER DRAINAGE REPORT: In general, Stormwater Drainage Reports are required
when an applicant is proposing to add or replace more than 2,000 square feet of impervious
surfaces. See Anacortes Municipal Code Ch. 19.76 for additional information.
OTHER PERMITS DETERMINED ON A CASE-BY-CASE BASIS
Following is a list of other permits that could be required in certain circumstances. The general triggers
for each of the listed permits is provided below.
A. RIGHT-OF-WAY PERMIT: A right-of-way permit is required anytime the public right-of-way is
disturbed or obstructed in any way by private development or the general public.
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FORM CG-1: CLEARING & GRADING PERMIT APPLICATION
1. PROPERTY INFORMATION
Project Address(Street,Suite#): Assessor Parcel Number:
2313 R Ave P77984
Subdivision/Lot#: Zoning Designation: Lot area (size):
Industrial 5,715 sq.ft.
2. PROJECT DESCRIPTION
Project Summary:
As part of the Ben Root Skate Park remodel project, City staff will be removing the
existing parking lot prior to the contractor accessing the site.
Total area of land disturbance: 5,715 sq.ft.
Grading quantities:
Imported material/fill 0 cubic yards Source:
Excavated material/cut 75 cubic yards Disposal site:Lakeside Industries
Total: 75 cubic yards
3. PROPERTY OWNER INFORMATION
Name: City Of Anacortes Phone: 360/293-1918
Address(Street,City,State,Zip): Email Address:
PO Box 547, Anacortes bobv@cityofanacortes.org
4. CONTRACTOR INFORMATION
Name:*Same as Owner Phone:
Contractor's Business Licenses State License#: UBI License#:
*All Contractors&Subcontractors must have a valid City
of Anacortes business license prior to doing work in the Expiration Date: Expiration Date:
City.
Address(Street,City,State,Zip): Email Address:
S. CONTACT PERSON
Select one person the city will contact for anything NX Applicant ❑X Property Owner ❑Contractor
related to this project: Other(list below)
Name: Phone:
Bob Vaux 360/588-8233
Address(Street,City,State,Zip): Email Address:
PO Box 547. Anacortes bobv@cityofanacortes.org
Clearing&Grading Permit Application
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7. ACKNOWLEDGEMENTS & SIGNATURE
Read and initial each of the following statements prior to signing this application:
RW I understand that when a clearing and grading permit application is taken in over the counter it
V does not mean the application has been deemed technically complete and sufficient for staff
review.
RWV I understand that if I submit incomplete, inaccurate, and/or erroneous information it will take the
City longer to process my permits.
RWV I understand and acknowledge that I could be responsible for providing as-built drawings (on paper
or electronically) as part of the project's final approval process.
RWV 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.
RW I understand and acknowledge that financial securities could be required as part of the work I am
V completing and I agree to provide the items needed for the City to calculate these securities and to
provide the securities themselves.
RW I understand that if permits are reviewed concurrently such as SEPA, critical areas, or shoreline
V permits, 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.
Feb 22, '23
Signature Date
Robert W. Vaux
Printed Name
Clearing&Grading Permit Application
Updated November 2021 Page 6 of 14
FORM CG-2: SITE INFORMATION
1. PROPERTY WHERE WORK IS OCCURRING
ADDRESS: 231 3 'R' Ave
PARCEL P77984
NUMBER(S)
2. PROJECT SITE INFORMATION
A. Is work within the City's right-of-way proposed? If yes, you will be required OYES ONO
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 within 200' of a shoreline (marine waters or a lake)? DYES ONO
C. Are there critical areas (wetlands, streams, fish &wildlife conservation DYES ONO
areas, geologically hazardous areas) or buffers on or abutting (within 300-
feet of)the project site? If yes, a critical areas report will likely need to be
submitted.
D. Is this project subject to the SEPA process? If yes,you will be required to OYES ONO
submit a SEPA checklist.
If you have already completed the SEPA process, list the permit number SPR-2023-0001
here: 202300766
3. 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.
Feb 22, '23
Signature Date
Robert W. Vaux
Printed Name
Clearing&Grading Permit Application
Updated November 2021 Page 7 of 14
FORM CG-3: STORMWATER MANAGEMENT MINIMUM
REQUIREMENTS DETERMINATION
1. PROPERTY WHERE WORK IS OCCURRING
ADDRESS: 231 3 'R' Ave
PARCEL NUMBER(S) P77984
2. GENERAL INFORMATION
Most development within the City of Anacortes that involves disruption of soils,or construction of buildings,
streets, parking lots,etc. requires a Stormwater review. Stormwater review requirements are based on either
the amount of soil to be disturbed (grading,vegetation removal),or the amount of hard surface that is created
or replaced on a site(building footprint,concrete, asphalt or gravel parking,sidewalk,etc.)
This form is largely targeted for small projects and single family residences. For larger projects and more
information please refer to the Anacortes Municipal Code(Chapter 19.76 Stormwater Management)and the
latest Washington State Department of Ecology Stormwater Management Manual for Western Washington
(Ecology Manual).
3. LAND DISTURBANCE AND HARD SURFACE AREA CALCULATION
Please calculate your project's area of land disturbing activity and hard surface amount;guidance is provided on
the next page of this document. Use your project's total hard surface calculation to follow the flow chart(s) in this
packet and determine the level of stormwater management required for you project.
When determining your permit level or if stormwater thresholds are met or exceeded the entire project must be
considered. A project is that portion of a property, properties,or right of way subject to land disturbing activities,
new hard surfaces and replaced hard surfaces. The hard surface on your property will determine the storm water
utility fees and the stormwater general facility charge. All new or replaced hard surfaces should be accounted for.
Below are excerpts from the Anacortes Municipal Code and Ecology Manual that may assist you in preparing this
information.
"Hard surface area"means an impervious surface, a permeable pavement, or a vegetated roof.
"Impervious surface"means a non-vegetated surface area which either prevents or retards the entry of water into
the soil mantle as under natural conditions prior to development. A non-vegetated surface area which causes
water to run off the surface in greater quantities or at an increased rate of flow from the flow present under
natural conditions prior to development.
"Replaced impervious surface"means,for structures, the removal and replacement of impervious surfaces down to
the foundation. For other impervious surfaces, the removal down to bare soil or base course and replacement.
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LAND DISTURBANCE
Description Total
(SF)
5,715
Total Area of Land disturbing activity
Total area converted from vegetation to 0
lawn or landscaped areas
HARD SURFACE AREA CALCULATION
Existing Removed Proposed Proposed
Description (SF) (SF) Replaced New
(SF) (SF)
Non Pollution Generating Hard 0 0 0 0
Surface Area
(Sidewalks, paths, patios,etc.)
Pollution Generating Hard Surface
5,715 5,715 0 0
Area
(Driveways, parking areas, etc.)
Total Hard Surface 57715
Site Size 5,715
Existing impervious surface 100
/o
coverage
(sq.ft. hard surface/site size)
Use the information in the above table to navigate the flow chart(s) on the next page and
determine the applicable stormwater management minimum requirements for your
project. Then complete the applicable Stormwater Minimum Requirements Form on the
Public Works - Engineering Department Forms website and provide required submittal
items/plans.
Check applicable box Minimum Requirements Determination
❑ Minimum Requirements #1-9.
❑ Minimum Requirements #1-5.
❑ Minimum Requirement#2.
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FLOW CHART DETERMINING REQUIREMENTS FOR NEW DEVELOPMENT
Start Here
Does the site have 35% Yes See Redevelopment Minimum
or more of existing No Requirements and Flow Chart
impervious coverage? (Figure 1-2.4.2).
No
Does the project convert%4
IF acres or more of vegetation to
Does the project result in lawn or landscaped areas, or
5,000 square feet, or No convert 2.5 acres or more of
greater,of new plus native vegetation to pasture?
replaced hard surface
area?
No
Yes
Yes Does the project result in 2,000
IF square feet, or greater, of new plus
All Minimum Requirements replaced hard surface area?
apply to the new and replaced
hard surfaces and converted Yes NO
vegetation areas.
IF
Does the project have land
Minimum Requirements#1 disturbing activities of 7,000
through#5 apply to the new Yes square feet or greater?
and replaced hard surfaces
and the land disturbed. iNa
Minimum Requirement#2
applies.
Figure 1-2.4.1
Flow Chart for Determining Requirements for
New Development
DEPARTMENT OF Revised June2015
ECOLOGY Please see http:11Www.ecy.wa.gov/copyright.html for copyright notice including permissions,
State of Washington limitation of liability,and disclaimer.
Clearing&Grading Permit Application
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FLOW CHART DETERMINING REQUIREMENTS FOR REDEVELOPMENT
Does the project result in 2,000 square feet, or more, of new plus replaced hard surface area?
OR
Does the land disturbing activity total 7,000 square feet or greater?
Yes �No
Minimum Requirements#1 through#5
apply to the new and replaced hard Minimum Requirement#2 applies.
surfaces and the land disturbed.
Next Question
Does the project add 5,000 square feet or more of new hard surfaces?
OR
Convert 3/4 acres or more of vegetation to lawn or landscaped areas?
OR
Convert 2.5 acres or more of native vegetation to pasture?
Yes No
All Minimum Requirements apply Next Question Is this a road
to the new hard surfaces and the related project? No
converted vegetation areas.
Yes
Does the project add 5,000 square feet or more of new hard surfaces?
Yes No
Is the total of new plus replaced hard surfaces
Do the new hard 5,000 square feet or more,
surfaces add 50% or No No additional No AND
more to the existing requirements. does the value of the proposed improvements
hard surfaces within -including interior improvements-exceed
the project limits? 50%of the assessed value (or replacement
value)of the existing site improvements?
Yes All Minimum Requirements apply to the new and replaced
hard surfaces and converted vegetation areas. Yes
Figure 1-2.4.2
Flow Chart for Determining Requirements for
Redevelopment
DEPARTMENT OF Revised June2015
ECOLOGY Please see http:11Www.ecy.wa.gov/copyright.html for copyright notice including permissions,
State of Washington limitation of liability,and disclaimer.
Clearing&Grading Permit Application
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FORM CG-4: CLEARING & GRADING PLAN REQUIREMENTS
1. GENERAL INFORMATION
This form is intended to assist applicants in creating complete, code compliant clearing and grading plans.
To the right of the Requirements column is space for you to list the sheet number of the plan set where
the listed information is shown.
• Minimum Plan Size: 11" x 17" and drawn in an engineering scale.
2. INFORMATION REQUIRED ON ALL SITE PLANS
✓or N/A PAGE#ON
PLANS
Cover sheet must contain all of the following:
• Vicinity Map
• Name of the project
• Name, address, and telephone number of owner and agent(s)
• Name,address,and telephone number of Applicant(if different from
the owner)
• Zoning designation of the site
• Area, in square feet and acreage, of the project site
• Percent impervious surfaces
Scale and North Arrow
Property features
Location, identification, and dimensions of all property lines and easements.
II easements shown on the title report, Record of Survey, or plat must be
dimensioned and shown.
Location and dimensions of existing critical areas (wetlands, streams, steep
slopes) and their associated buffers.
Location of Ordinary High Water Mark and shoreline jurisdiction limits (if
adjacent to a shoreline).
Identify any erosion or landslide hazard areas as well as any potential
unstable slopes greater than 15%. (Percentage%slope=Rise(drop in height)
divided by Run (distance) multiplied by 100).
Show the location, type and size of existing significant trees and native
vegetation.
• Significant tree means deciduous and evergreen trees greater than 6" in
diameter at 5' above grade.
• Native vegetation means vegetation composed of plant species,other than
noxious weeds, that are indigenous to the coastal region of the Pacific
Northwest and which reasonable could have been expected to occur on the
site. Examples include trees such as Douglas fir,Western Hemlock,Western
Red Cedar, Alter, Big-Leaf Maple, and Vine Maple; shrubs such as willow,
elderberry, salmonberry, and salal; and herbaceous plants such as sword
fern,foam flower,and fireweed.
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Clearing & Grading Details
Show appropriate elements of the Construction SWPPP, including:
a. Areas of vegetation to be preserved; clearing limits
b. Drainage ditches and swales (existing/proposed)
c. Construction access
d. Temporary and permanent stormwater retention or detention
facilities; sediment and erosion controls; slope protection, etc.
e. Infiltration systems (existing/proposed)
See the Stormwater Management Requirements handout for other
requirements.
Indicate proposed area(s) of disturbance.
Show location of clearing limits and clearing limits fencing
Show existing and proposed contours and site elevations(i.e.finished grades)
at 5-foot minimum increments. The horizontal and vertical control datum
must be clearly shown.
Show corner elevations (existing and proposed) of the site and lot.
Use contour lines or arrows to show direction and percent (%) slope(s).
Extend contours onto adjacent properties and show proposed transitions.
Include a Cross Section Plan (show dimensions of original and proposed
grading) at key locations across the site.
Structures
Location, identification, dimensions and size of all existing and proposed
buildings and other structures.
Location of structures on adjacent properties within 20'of the site boundary.
Location of existing and proposed retaining walls, rockeries, and fences.
Location, identification, and dimensions of all setbacks.
Utilities & Easements
Location and dimensions of existing and proposed stormwater, sanitary
sewer, potable water, and fiber lines/facilities. All wells and septic systems
located on or near the project site must also be identified.
Landscaping
Show the location and design of vegetation areas to be preserved and
planted,and a plant list to include the location,number,size and type of plant
material by botanical and common name.
Location of irrigation system if a permanent or temporary system is
,proposed.
Show the location of existing trees to be retained in conformance with AMC
16.50, and tree protection measures to be implemented, when applicable.
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Provide a maintenance plan for any infiltration-based stormwater best
management practices (BMPs) built as part of the landscaping design,
including the specifications and maintenance procedures of any soil
amendments.
Show new trees to be planted and tree unit credit calculations, in
conformance with AMC 16.50 Tree preservation, when applicable
Clearing&Grading Permit Application
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