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HomeMy WebLinkAboutPermit File 4603 Anaco Beach Road 1 4 City of Anacortes Invoice/Permit#: BLD-2017-0396 904 6th Street "'"' P.O.Box 547 Applied date: 07/3112017 Issue date: 08/02/2017 Anacortes, WA 98221-0547 Expire date: 07/28/2018 „4 (360) 293-1901 Job Address: 4603 ANACO BEACH RD Permit Type: Demolition Permit ANACORTES WA 98221-8708 Project: APN: P61819 Remarks: Demo a single family residence to be replaced in the future by a new one Owner: NELSON STEVEN F Contractor: LAUTS INC Address: 4603 ANACO BEACH RD Address: 13084 BALL RD ANACORTES WA 98221-8708 MOUNT VERNON WA 98273-8201 Phone: Phone: (360)757-4000 License#: LAUTSI*93105 General Information: Fees: Dwelling Units 1 Total Calculated: Adjustments: Deposits/Receipts: Total Due: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PR VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUC ION OR THE PERFORMANCE OF CONSTRUCTION. j SIG AT R OF OWN AU HORIZED AGENT ISSUED BY I I �`+� PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT /!� � DEMOLITION PERMIT APPLICATION �h�A� Mailing Address:P.O. Box 547,Anacortes, WA 98221 ,9r Office Location: 904 6th Street, Anacortes WA 98821 Phone: (360) 293-1901, Fax: (360) 293-1938 PLEASE REFER TO THE DEMOLITION PERMIT CHECKLIST FOR SUBMITTAL REQUIREMENTS BUILDING DEMOLITION [ UNDERGROUND TANK REMOVAL/DECOMMISSIONING ❑ PROJECT APDRESS(Street,Suite#): Parcel(s)#: 411D3 .0Y4 AU) A/Z-4 /ZeaJ P 6/ i / Subdivision/Lot#: 404G41 l3g/ic1 #7 1 APPLICANT: 1 Phone: Fax: ikVe. /uo150.1 5120-- 3- 7,9 3 ci Address(Street, City,State,Lip): E-Mail Address: ,z 1( 0 reelort. 14-v t, .5.ie v-e',Get ski fat5 epalloek.6_0,4. PROPERTY OWNER: Phone: Fax: j"feve._ )ebd.1 / 7 r� t)dw4 3IaO— �' 333-739 Address(Street, City State,Zip): E-Mail Address: CONTACT PERSON: Phone: Fax: steVe— /4).e15,0. ) I Address(Street,City,State,Zip): E-Mail Address: CONTRACTOR:* Phone: Fax: tte,c /ler & IL h 7---J. ba--7-7>"--Li 0 oo Address(Street;City,State,Zip): E-Mail Address Contractor's License# Exp.Date: *All Contractors&subcontractors must have a valid City of T'TI?Ea- ®3UL3 Anacortes business license prior to doing work in the City. Business License#: Exp.Date: Contact the City's Finance Department at(360)299-1968. PROPOSED WORK: p c yki 0 c7-[- <i'.-.el le 4,4 .-r►1. Ic/ (-e 5;G riCC. UTILITY DISCONNECTION: Water Department Yes E No 0 Electricity Yes Er"No ❑ Gas Yes E'er No 0 Cable TV Yes Er- No 0 I declare under penalty of perjury that the information I have provided on this form/application is true,correct,and complete, and that I am the property owner or duly authorized agent of the property owner to submit a permit application to the City of Anacortes. Print Name: 1/e.- -1 6 n Owner L 'Agent 0 (specify): Signature: t ,., Date: ,- C-- 2131 Page 1 of 3 PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT Art. DEMOLITION PERMIT CHECKLIST Mailing Address:P.O. Box 547, Anacortes, WA 98221 Tivi Office Location: 904 6th Street,Anacortes WA 98821 ....,- -y Phone: (360) 293-1901, Fax: (360) 293-1938 / BUILDING DEMOLITION: RESIDENTIAL Er COMMERCIAL ❑ TYPE OF STRUCTURE TO BE DEMOLISHED: tot r£j i z7cc �METHOD OF DISPOSAL: [ left L l 1 FLOOR AREA OF STRUCTURE TO BE DEMOLISHED: tO D S,t- HAVE YOU NOTIFIED THE NORTHWEST CLEAN AIR AGENCY(NWCAA)10 WORKING DAYS OR MORE BEFORE BEGINNING DEMOLITION-(360)428-1617 Yes [i]— No ❑ CRITICAL AREAS ON PROPERTY? Yes 0 No UV UNDERGROUND TANK REMOVAL/DECOMMISSIONING: METHOD OF TANK ABANDONMENT: Removal 0 Number of Gallons: Fill in Place 0 Fill Material: (Fill in place only permitted if you can't remove the tank and if approved first by the Fire Marshal) PERMIT TYPE: n > do d ?r,' Q CD SUBMITTAL REQUIREMENTS: 2 5 1 g. a z n The number indicates the number of ° 2 ° C `A w q F. 7� ,, copies for submittal(if applicable). o a w oAll P m 1. Demolition Permit Application 1 1 1 Site Plan 1 1 1 Pedestrian Safety Plan l Asbestos Survey—Prepared by a Washington State Certified Asbestos 1 1 Abatement Contractor Provide Proof of NWCAA Demolition Permit Approval' l I 1. Contact the Northwest Clean Air Agency(NWCAA)at(360)428-1617 or online at http://nwcleanairwa.gov for a demolition permit and a list of WA State Certified Asbestos Abatement Contractors if needed. Page 2 of 3 FOR OFFICE USE ONLY: FIRE DEPT.APPROVAL: I DALE,: 7 � ? r // POLICE DEPT.APPROVAL: /0/G�l DATE: PUBLIC WORKS DEPT.APPROVAL: C IP DATE:1/7/// 7 MUSEUM APPROVAL: 40. DATE: C7/ /p 7 BUILDING DEPT.APPROVAL:_[C% /t-�,r1 DATE: 7 k Page 3 of 3 . . . . . • . . . ; • - • . . . • •• . . . . . -ri,2 c.4_2 - '77,/.. / 'Xt 'dc/i...-./. °A-D 00 g —-4/7.7./ 'X‘•:-/-cieJ /6b' - —• ' 1- _ =-- = ====- , / A1- -c/- - "N It \ - •- .5:7A•7li•---v•y•••-,•y-_--y--7-7,g--a-Z-..4•—/••••X-x-_•-g••-. ---- . . . 1 • '1 '1 - i I • - I I t. • ! I I. 11. ,,.' 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Anacortes, WA 98221 (360) 333-7839 Dear Mr.Nelson: This letter and the attached documentation will comprise the Asbestos Inspection Report for a single family residential building located at 4603 Anaco Beach Road in Anacortes, WA. This is a single story home built in 1952. On March 10, 2017 I personally conducted an inspection of the above mentioned property for the specific purpose of identifying the presence or absence of asbestos- containing building materials. In addition to conducting a visual assessment to identify any suspect materials, any materials viewed that have historically been found to contain more than one percent asbestos were sampled and those samples were delivered to an accredited laboratory by U.S. Mail for analysis by Polarized Light Microscopy(PLM). Samples collected included the following: Sample# Material Location Asbestos % SN-001a Wallboard Through-out 2% SN-001b Wallboard Through-out NT SN-002a 9"Floor Tile Bath& Closet ND SN-002b 9"Floor Tile Bath& Closet ND SN-003a Roofing' Exterior ND SN-003b Roofing' Exterior ND SN-004a Roofing2 Exterior ND SN-004b Roofing2 Exterior ND SN-005a Skim Coat on Ceiling Ceilings ND SN-005b Skim Coat on Ceiling Ceilings ND Summary of Asbestos-Containing Materials (more than 1%): Only those materials shown in bold text contain more than 1%Asbestos. ' Old roofing 2 New roofing 3 See Point Count results...this material is denied as `asbestos-containing material'. ND indicates `Non-Detect'. NT indicates 'Not Tested' Conclusion: While the Wallboard (textured paint layer) initially tested positive at 2%,Point Counting revealed objective findings of 0.25% and 0.0%. Point Count results always prevail,if different from the initial PLM results. No materials were found to contain more than one percent asbestos. Any building materials found to contain more than one percent asbestos are considered `Asbestos-containing materials' in accordance with Title 40 Code of Federal Regulations (40 CFR), Subpart M, Section 61.141 and typically must be removed from a structure prior to any demolition, renovation or remodeling that would disturb those materials. Laboratory reports and Inspector Accreditation attached. It is understood that the purpose of this inspection was to identify asbestos-containing materials, if any,prior to planned demolition of this single family residence. This will conclude the Asbestos Inspection Report for the single family residence located at 4603 Anaco Beach Road in Anacortes, WA. Sincerely, Robert H. Welch, AHERA Building Inspector 4017 Ridge Way Mt.Vernon,WA 98273 (360)333-7500 rhwelch05(a,gmail.com SEATTLE ASBESTOS T . T Seattle Laboratory:4800 9th Ave.NE,Suite 300,Seattle,WA 98105,Tel:206.533.11111,Fax:208.833.4747,N1rtAP Lab Code:201057-o ANALYTICAL LABORATORY REPORT PLM by Method EPA/600/R-93/116 Attn.; Mr. Robert Welch Client: R. H.Welch,Inc. Address; 40.17 Ridge Way, Mt.Vernon,WA 98273 Job#: Steve Nelson Batcht3: 201710238 Date Received: 3113/2017 Samples Rec'd: 1() Date Analyzed: 3/1412t117 Samples Analyzed: 9 Project Loc.: 4603 Anaco Beach Rd. Anacortes,WA 98221 Analyzed by:wC sic an,g Reviewed by: Steve(Fanyao)Zhang,President Lab ID Client Sample)b Layer Description Ye Asbestos Fibers Non-fibrous Components ` % Non-asbestos Fibers Trace white 1 powdery material 2 Chrysotile Binder/filler, Paint 3 Cellulose 1 SN-00l a _ with paint 2 White chalky None Binder/filler, Cellulose material with paper detected Gypsum/binder 2 SN-001 b Sample not analyzed Beige rubbery None Rubber/binder 2 Cellulose material detected None 3 SN-002a 2 Clear mastic detected !Mastic/binder 3 Cellulose 3 Trace brown wood None Wood aggregates 4 Cellulose block detected Beige rubbery None Rubber/binder 2 Cellulose material detected None „� 4 SN-002b 2 Clear mastic detected Mastic/binder 2 Cellulose 3 Trace brown wood None Wood aggregates 3 Cellulose block detected 4 Silver paint None Paint, Filler 4 Cellulose detected . 2 Black asphaltic None Asphalt/binder 3 Cellulose material detected 5 SN-003a Black asphaltic None Asphalt/binder, 3 material with 26 Cellulose detectedBinder/filler fibrous material _ 4 Black asphaltic None Asphalt/binder 5 Cellulose material detected fi Silver paint None Paint, Filler 3 Cellulose detected 2 Black asphaltic None Asphalt/birnder 4 Cellulose material detected 6 SN-003b Black asphaltic 3 material with Dane Asphalt/binder, 26 Cellulose fibrous material detected Finder/filler J T Black asphaltic None 4 Asphalt/binder 3 Cellulose material detected 1Black asphaltic None Asphalt/binder, 23 Glass fibers material with sand detected Sand 1 7 SN-004a Black asphaltic None Asphalt/binder, 2 material with detected Binder/filler 24 Cellulose V fibrous material 1 Black asphaltic None Asphalt/binder, 21 Glass fibers material with sand detected Sand 8 SN-004b Black asphaltic None Asphalt/binder, 2 material with detected Binder/filler F 26 Cellulose fibrous material 1 SEAT T LE ASBESTOS TEST Seattle Laboratory:4500 9th Ave.NE.Suite 300,Seattle,WA 98105,Tel:206.633.1111,Fax:208,833.4747,NVLAP Lab Code:201057-0 ANALYTICAL LABORATORY REPORT PLM by Method EPA/600/R-93/116 Atte.: Mr. Robert Welch client: R. H.Welch, inc. Address: 4017 Ridge Way, Mt. Vernon,WA 98273 Job#: Steve Nelson Batchtr: 201710238 Date Received: 3/13/2017 Samples Rec'd: 10 Date Analyzed: 3/14/2017 Samples Analyzed: 9 Protect Loc.: 4603 Anaco Beach Rd.- Anacortes,WA 98221 Analyzed by: Cassi uang Reviewed by: Steve(Fanyao)Znang,President Lab lD Client Sample ID Layer Description ele Asbestos Fibers Non-fibrous Components a Non-asbestos Fibers Trace white None 1 powdery material detected Filler, Binder, Paint 3 Cellulose 9 SN-005a with paint Trace light None 2 green powdery detected Filler, Binder, Paint 2 Cellulose material with paint Trace white None 1 powdery material detected Filler, Binder, Paint 4 Cellulose 10 SN-005b with paint Trace light green None 2 powdery material detected Filler, Binder, Paint 3 Cellulose with paint 2 SEATTLE ASBESTOS TEST NVLAP Accreditation Lab Codes,200768 and 200876 19701 Scriber Lake Road.Suite 103,Lynnwood,WA 98036,Tel:425.673.9850, Fax:425.673.9810 12727 Northup Way, Suite 1, Bellevue,WA 98005,Tel:425.861.1111, Fax:425,861.1118 Webs[te:www.seattleasbestostest.corn, Email:adrnin@seattleasbestostest.corn PLM by Point Count (400 points) Client Job#: Steve Nelson Attention: Mr. Robert Welch Laboratory Batch#: 201710275 Client: R. H.Welch, Inc. Date Received: 3/14/2017 Address: 4017 Ridge Way, Mt. Vernon, WA 98273 Samples Received: 2 Date Analyzed: 3/15/2017 Project: 4603 Anaco Beach Rd. -Anacortes,WA 98221 Sample Requested for Paint Count SNM001a Previous Analytical Informaijon Previously Analyzed by: Cassie Huang Previous Batch#: 2017/0238 Previous Lab ID: 1 Previous Description: Trace white powdery material with paint Layer to be Point Counted: 1 Asbestos Type Found: Chrysotile Asbestos Percentage Found: 2 Point Count Analytical Procedures New Lab ID: 1 Asbestos Points Non-Asbestos Points Total Points Counted Slide 1 + 50 50 Slide 2 ! 50 50 Slide 3 1 49 50 It ! ! 50 t ! 50! 50Total 1 399 400 Point Count Summary Results Type of Asbestos: Chrysotile Percentage of Asbestos: 0.25% Analyzed By: Cassie Huang Reviewed by: Steve Zhang, President I SEATTLE ASBESTOS TEST NVLAP Accreditation Lab Codes;200768 and 200876 19701 Scriber Lake Road, Suite 103, Lynnwood,WA 98036,Te1:425.673.9850, Fax:425.673.9810 12727 Northup Way,Suite 1, Bellevue,WA 98005, Te1:425.861.1111, Fax:425.861,1118 Website:www,seaftteasbestostest,com, Email:admin@seattleasbestostest.comn PLM by Point Count (400 points) Client Job#: Steve Nelson Attention: Mr. Robert Welch Laboratory Batch*: 201710275 Client: R. H.Welch, inc. Date Received: 3/14/2017 Address: 4017 Ridge Way, Mt.Vernon, WA 98273 Samples Received: 2 Date Analyzed: 3/15/2017 Project: 4603 Anaco Beach Rd. -Anacortes,WA 98221 Sample l quested for Point Count SN-001 b Previous Analytical Information Previously Analyzed by: Cassie Huang Previous Batch #: 20 1710238 Previous Lab ID: 2 Previous Description: No asbestos detected in this sample Layer to be Point Counted: Asbestos Type Found: Asbestos Percentage Found: 0 Point Count Analytical Procedures New Lab ID: 2 Asbestos Points Non-Asbestos Points Total Points Counted Slide 1 0 50 50 Slide 2 0 50 50 -` Slide 3 0 50 50 Slide 4 0 50 50 Slide 5 0 50 50 Slide 6 0 50 50 Slide 7 0 50 50 Slide 8 0 50 50 Total 0 400 400 Point Count Summary Results Type of Asbestos: Percentage of Asbestos: 0% Analyzed By: Ca ie Huang Reviewed by: Steve Zhang, President 2 01123S • R. H. Welch Asbestos Inspection Data Sheet Client: S1 1 Phone: _232 Address: k, -A-vlatz,v4 ± LOA cj Inspector: A LA.3e,i Date: .3-/0-f Cert. Expiration Date: Building Address: L(603 vctgNACL jiL-ADA21213.- Res: tv"-Com: Pub: Ind: Other: DemoTL7 Renov: Remod: Other: Year Const: 1(45-1,,--- Prey. Insp.: _ Material Category F/ Cond. Location Quantity Sample ACM Description TSI-SM-M NF CA.4.11 boar dAJL F Fy TK4u.tsw- Oto‘ a.:120Lb_ 4 5 Pk " " C.-tinst SP1-0021 Fai ,/;•"" A.04-11Ati N rnak_A ttr- S/Y- OCibt -06qh SkI C:0-0.1 M IYF _IDLierd e:11vta, Sti-0 os tfv, cled!t tei* I. ‘.,t I _Sr-Oa h Legend: FT: Floor Tile ACT: Popcorn' CAB: Cement Board CT: Ceiling Tile AC: Air Cell Boiler Ins. PI: Pipe Ins. FP: Fire Proofing FM: Floor Mastic R: Roofing VS: Vinyl Sheeting JC: Joint Compound G: Gasket WIR: Wallboard M: Mortar WE: Wallboard P: Piaster SC: Soft Concrete CAP: Cement Pipe WP: Window Putty FB: Fire Brick DW: Duct Wrap CM: Carpet Mastic CBM: Cove Mastic 4017 Ridge Way Mt Vernon,WA 98273 (360)333-7500 rwelehAfidalgo.net y Vae/i 01,1 6akitt—LIAJZ-64 rail) 2/[31 r z.I 1,te„) ,LA h 77 I 3 t* / 1� 7ty , :1k. ""`.ter go- Wit 1'),S 11 :t} ri Tiit. i{ir1 1 Y , r ki Yet:. • "r r.,•,• • i 5 ,i• ) • ..'ir.tb 3 Irli 4.4.• I4. Ate • 1 1 t r q ,. 1� 11 it i� r�l^'' ';" ' -' • J• f' r,.. r ol, 1 iY J" L� J r t' i t "I IY rll Y' ( Ira M1 9 17,Ptl/t\/'i{r / 1( ' r ,h e 1 . . - 1 n.. ..r... . " \ „'t • :., . fi . ,�. . 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Lt: 'Y.l . .Stl. _.�� 'ry .t 1 . y,•',t:j13���1p t S. :6st:,;'� YL(t :�1kr '. 1 'i. •�{l. i p1. lII �t � ,.•r q i .,. C � , l'Pf i..: ( K. ry�7„ li- I a� �.. ' � :rl' ; v `�1.,is, �i ti};�r/1' p .. � . y i 1 1, ( t , 11 ;' .1 , I� y,Qll-•�ri rY, 11. fa' i�a..�.,:o:Nri )(.: • • Y !.: '•• . Y9� {• ,?(�l` f •'wx II, J • ,.4r �.i- f i ' r� , l , Y•fI rrl ' .} ' [i I t - 1.- ffft -G ' r1�'/'���t•.. `�.. f } ir. .ji.' .`:j �, :.S�r � d 5.`tN l`�'4 .� J{a1 i`(vr ��: t, r. �r Yy 7 �1,. 119(:"4"." t r: 1••"rr 3 { }"Y�'f� f ` !b�f.. . b,!,1 p. 1 ..•IA ' I�,C.y` " l I%i1 �y'9 �II' , .ti, •:''''''. C:' Its , ipt • ] ttsnr ((,,1%. >, pp ' . • rN`• 1' 'Wv! I r ;{( . i,' ) 1.p,,,'{ T'i)-' "I.f{I) ' J 1 i.1 , ,l .. r '' 1} • r y } v R �;.r 1: 1 •': 9.r. n.' � ' ,1;1) ' , ti ,. f,1;•; •1)r,.', t I stir r I}, 'r,iG '' J 'U ` •i'•"?: iSi1j� "�Y i4)' 7) t:'y'l • ti r i !' t �' • },'�,, V�. iU t' k' =7. ' `, � di : V r 1 4vi 1 �.. /.fit 1 C . rrt •y )rye, G�, 'M it i r .Y.y i, �r., i+ .�j" 1 ,f t,` ..: r, I <S • a 1 Ir ," • r r ,- vd1 .w7 4i la ,�, c .�La,,l_ r � £i .t1t `Y{ , 5 t J k tXil!� ,::s ' 1' t' e? aJ.i'fl .'ka"1q1i / r ' . `. �,,yY ,S afljf ,'(;'G,r ( �t t .. " .4�1 (tmYi. =.`�;'/• .`!>/'�,.+117i: } t• 19y1 .141 ( V1A i! I. et vnlni ,Ii d - , ,..1 ,f r . TY ,'. . Nelson, Steve F SOPUS-DMW/424 From: Steve Nelson <Steve.Cassius@outlook.com> Sent: Saturday, July 29, 2017 4:57 PM To: Nelson, Steve F SOPUS-DMW/424 Subject: Fwd: NWCAA Notification of Demolition Sent from my iPhone Begin forwarded message: From: noreply@formstack.com Date: May 19, 2017 at 4:30:23 PM PDT To: steve.cassius@outlook.com Subject: NWCAA Notification of Demolition Reply-To: noreply@formstack.com I Formstack Formstack Submission for form NWCAA Notification of Demolition Submitted at 05/19/17 4:30 PM NWCAA case no. (Take this number to the permitting authority as proof 17-217 of compliance with NWCAA demolition regulations.): Date and time: May 19, 2017 08:45 AM Payment information: $52 05416D Estimated demolition date: Jun 15, 2017 Site address: 4603 Anaco Beach Road Anacortes, WA 98221 Facility description or building name: Single Family Resident County of site address: Skagit Permitting authority: City Will a licensed contractor perform the demolition for you?: Yes Demolition contractor: Lautenbach State license number: TTRECI*030L3 City: Mount Vernon ZIP: 98273 Contact person (if different than contractor listed above): 1 Phone number: (360) 757-4000 Property owner: Steve Nelson Property owner email: steve.cassius@outlook.com Property owner address: 2211 Oregon Ave Anacortes, WA 98221 Contact person: Steve Nelson Phone number: (360) 333-7839 Is asbestos present?: No Has an asbestos survey been conducted?: Yes Comment: AHERA asbestos inspector name: Robert H. Welch AHERA asbestos inspector certification number: RHW-BIR-16-090 Please attach your asbestos survey or summary page: View File Asbestos removal contractor name: Building services/permitting contact: Name of person completing this form: Steve Nelson Email: steve.cassius@outlook.com Phone number: (360) 333-7839 Is this an emergency -(exempt from waiting period, additional fee No applies): Briefly explain why this is an emergency:: 2017 FEES: Fees, check all that apply:: $52 Demolition only fee- no asbestos present Total due: 52 I CERTIFY THAT THE INFORMATION CONTAINED IN THIS I agree NOTIFICATION AND ANY SUPPLEMENTAL INFORMATION PROVIDED IS, TO THE BEST OF MY KNOWLEDGE, ACCURATE AND COMPLETE.: Terms I Privacy Copyright©2017 Formstack, LLC.All rights reserved. This is a customer service email. Formstack, LLC 8604 Allisonville Rd. Suite 300 Indianapolis, IN 46250 2 ENGINEERING Job '4I * �AD 0 STEVEN LANGE, P.M. Title P.O.BOX 547 .-' ANACORTES,WA 98221 Calculated by STEVEN LANGE DATE r " ` w40 Cell:(360)661 3468 �01% E-mail:stevel@cityofanacortes.org Checked by DATE FAX(360)293-1938 44 ff Sheet 1 of l SCALE .r17- r--r-7/>-- C: CY1 o 4 -I 1 =I . smyr V3soicie. gzz..0 NieT>t 0 "act 1-1 CzxykrtieTev, . a}a i • 4` • ANACORTES PUBLIC WORKS DEPARTMENT a Y Steven Lange, Project Manager - P.O.BOX 547,ANACORTES,WA 98221 PI-1(360)293-1920 '`rr W E-MAIL:stevei@cityofanacortes.org FAX(360)293-1938 'le o % Memo Date: December 19, 2016 To: Kevin Cricchio, Senior Planning Associate From: Steven Lange Subject: Proposed New Residential Home at 4603 Anaco Beach Road(P61819) cc: Eric Shjarback, Fred Buckenmeyer, Don Measamer, Paul Ingals The Engineering Department has reviewed the submitted documents for a proposed 2- lot Boundary Line Adjustment. Below are the following comments and or recommendations. It is understood that these comments and recommendations are based on the submitted 11x17 sketch as shown as an attachment. Zoning: • This property is located within the R2 Zone. Subdivision Type: • Existing Parcel of record. Critical Areas: A Contact the Planning Department regarding Critical Areas requirements. Permits: • Right-of-Way Permit for work being performed Inside and Outside the Traveled Way. Contact Jim Baldwin, Public Works Inspector, at 360.661.3547. , • Contact the City of Anacortes Planning Department for additional permitting requirements such as SEPA, Grade and Fill permits, Conditional Use, Building, etc. City of Anacortes Development Standards: • The 2011 Development Standards can be found on-line at +,vww,cityofanacortes,org. If the Engineer of Record needs any COA Standard Details in AutoCAD format, they can email me at stevel(acityofanacortes-erg and request a CD. This CD will be mailed to a provided address. iA_•• • Water • Wastewater • Streets • Storm Drainage ® Engineering D Solid Wastes • Transportation•Equipment • Capital Projects • Development Services 9 V S• Sewer: • For additional Sewer information and design criteria, see the 2011 EDS Standards, Chapter 5— Sanitary Sewer. • Sewer exists to the existing home. • Is there an easement in place for the sanitary sewer force main to Anaco Beach Road? Storm: • For additional Storm information and design criteria, see the 2011 EDS Standards, Chapter 4— Storm Drainage. • This project is currently under the 2005 Department of Ecology Manual. As of January 1, 2017, the project will be under the 2012\14 Department of Ecology Manual. Traffic: • Pedestrian facilities are required based on the attached drawing. • Provide a Traffic Control Plan (Current MUTCD Manual) prior to any construction taking place for acceptance by the City of Anacortes City Engineer. n Street Lighting is not required for this proposal. Street: (Anaco Beach Road) • For additional Street information and design criteria, see the 2011 EDS Standards, Chapter 3—Street. • Per AMC 15.20.030-All improvements required shall be extended as necessary to provide a smooth transition with existing improvements both laterally across the street and longitudinally up and down the street for drainage, vehicular and pedestrian traffic. ■ Per AMC 16.32, the Residential Access Right-of-Way Width is 50-feet. This project is not required to dedicate any additional Right-of-Way. • Per the Anacortes Municipal Code, Chapter 15.20.040—Public Streets, Alleys and Storm Sewer System improvements, sidewalk, curb and gutter improvements will be required along the frontage of Anaco Beach Road. • Street Trees: Contact Jonn Lunsford @ 360.299.1953, Parks Department for a list of City approved Street Trees. See EDS Standards, Chapter 3— Streets, Section STR-18.2 regarding Street Trees and Root Barrier requirements. Garbage: a Sanitation and recycle pick up will be at curb side. Water: For additional Water information and design criteria, see the 2011 EDS Standards, Chapter 6-,Water. • Water exists to the existing home. joyik ® Water • Wastewater • Streets • Storm Drainage • Engineering • So Waste lid• Transportation®Equipment • Capital Projects • Development Services Fire Coverage: • The project does not have fire coverage. • Contact Jack Kennedy, Assistant Fire Chief © 360.293.1925 for fire coverage requirements. Utility Companies: • See Anacortes Municipal Code, Section 16.20.080— Utilities for required Franchised Utilities as well as City of Anacortes Utilities. ▪ All franchised utilities shall be underground. Fees: ▪ See the Planning and Building Department for fees related to building permits. • Per AMC 15.24.010 this project is subject to Engineering Fees for Plan Review and Construction Inspection. Other: • For Landscaping and Landscape requirements, see Planning Department. ▪ Mail Boxes (See Chapter 3--Streets, Section STR-19): For Mailbox Locations, coordinate location, type and size with the Anacortes Post Master. The access and areas around the mailboxes need to meet ADA requirements. • Encroachments (See Chapter 3 —Streets, Section STR-18.3): Prior to any placement of any barricades, material, earth, gravel, rock, debris or any other material or thing over, under or upon the Public Right-of-Way or easement, an Encroachment Agreement shall be obtain from the City of Anacortes. See the Anacortes Municipal Code, Section 12.30 for additional information regarding the Encroachment Agreement and processes. Contact Russ Pittis at 360.661.3460 regarding questions or to obtain an agreement. • For addressing information, contact Rob Hoxie (GIS Coordinator) at 360.293.1920, extension 233. • Improvements shall be designed by a Professional Engineer, licensed in the State of Washington. • Improvements are subject to a 2-year Maintenance Bond in the amount of 10% of the actual construction costs. • Contractor shall be licensed by the State of Washington and hold a City of Anacortes Business License. Thanks, Steven Lange ert.. e • Water • Wastewater • Streets • Storm Drainage • Engineering • Solid Waste ` • Transportation•Equipment • Capital Projects • Development Services itAwP. tY 1 - /f/ 3 vr� • a° /1/1 . f r ti�at ti' 80 tzaw c ac� car 14 if // 1 / /r, i // 1 // - *`-_`\sf , 75 4; 1- 'g"u a /.`r /j// // ' / / 4`617 //J /i` f,�� - Ls { ; <� /J J/ / // / / \\ f r/ / I .. ~ % / / ,/:" 4609 :, ` .J /" . 40\ .. 14(1 I / / f• /,/ „lc ,C� f,/ r,} ' �/// cr�''7/y,n r.• ",r / Syr• !�JJ}�/C�,- y C // //i/ • ,.�,/f "-�.-��-,-.a / ,- --\ ,<„ moo- �7, G3' /''. (// , , 4607'.‘ ''''. ... \ 77::'-:::;1;ei cl' s I---/// / //pump f •;. , / 1 .9- ;;;;;;,+.'.. /e/ / at�/ / /////^. / N., ..... / // „:.... J IS4 ! • f r • /J , / /, / :./ / p/ / / /4603 '• ' � / /, ' J / , ♦ f / J • J / / / / U R VEY , ? / / // %, / / / / /'• ' J / AEN, /O1510290 '3 ; ' ' ,' / i. ; , ,o'// // J/ / / . ,�,/ / / V f �� r / / / J%,7T J /I •••4,,,:.,. •_,...,A4-,7.-/ ?.' / /I / /7 / fr ;:// \-:-..T:. • ,/ / , / / / ' .` / / r r Ff }/ . / / // // /i''.y !' / ,7 / / r/ #//F \/ r ,/ f� /4. // /J /( , 1/ , / \I 11-1.I.4 tlf>47 64_ 4lo6.2) A- L c 21.E , . . ._ ... . . . 1 ".- I ENGINEERING Job '4I * �AD 0 STEVEN LANGE, P.M. Title P.O.BOX 547 .-' ANACORTES,WA 98221 Calculated by STEVEN LANGE DATE r " ` w40 Cell:(360)661 3468 �01% E-mail:stevel@cityofanacortes.org Checked by DATE FAX(360)293-1938 44 ff Sheet 1 of l SCALE .r17- r--r-7/>-- C: CY1 o 4 -I 1 =I . smyr V3soicie. gzz..0 NieT>t 0 "act 1-1 CzxykrtieTev, . a}a i • 4` • ANACORTES PUBLIC WORKS DEPARTMENT a Y Steven Lange, Project Manager - P.O.BOX 547,ANACORTES,WA 98221 PI-1(360)293-1920 '`rr W E-MAIL:stevei@cityofanacortes.org FAX(360)293-1938 'le o % Memo Date: December 19, 2016 To: Kevin Cricchio, Senior Planning Associate From: Steven Lange Subject: Proposed New Residential Home at 4603 Anaco Beach Road(P61819) cc: Eric Shjarback, Fred Buckenmeyer, Don Measamer, Paul Ingals The Engineering Department has reviewed the submitted documents for a proposed 2- lot Boundary Line Adjustment. Below are the following comments and or recommendations. It is understood that these comments and recommendations are based on the submitted 11x17 sketch as shown as an attachment. Zoning: • This property is located within the R2 Zone. Subdivision Type: • Existing Parcel of record. Critical Areas: A Contact the Planning Department regarding Critical Areas requirements. Permits: • Right-of-Way Permit for work being performed Inside and Outside the Traveled Way. Contact Jim Baldwin, Public Works Inspector, at 360.661.3547. , • Contact the City of Anacortes Planning Department for additional permitting requirements such as SEPA, Grade and Fill permits, Conditional Use, Building, etc. City of Anacortes Development Standards: • The 2011 Development Standards can be found on-line at +,vww,cityofanacortes,org. If the Engineer of Record needs any COA Standard Details in AutoCAD format, they can email me at stevel(acityofanacortes-erg and request a CD. This CD will be mailed to a provided address. iA_•• • Water • Wastewater • Streets • Storm Drainage ® Engineering D Solid Wastes • Transportation•Equipment • Capital Projects • Development Services 9 V S• Sewer: • For additional Sewer information and design criteria, see the 2011 EDS Standards, Chapter 5— Sanitary Sewer. • Sewer exists to the existing home. • Is there an easement in place for the sanitary sewer force main to Anaco Beach Road? Storm: • For additional Storm information and design criteria, see the 2011 EDS Standards, Chapter 4— Storm Drainage. • This project is currently under the 2005 Department of Ecology Manual. As of January 1, 2017, the project will be under the 2012\14 Department of Ecology Manual. Traffic: • Pedestrian facilities are required based on the attached drawing. • Provide a Traffic Control Plan (Current MUTCD Manual) prior to any construction taking place for acceptance by the City of Anacortes City Engineer. n Street Lighting is not required for this proposal. Street: (Anaco Beach Road) • For additional Street information and design criteria, see the 2011 EDS Standards, Chapter 3—Street. • Per AMC 15.20.030-All improvements required shall be extended as necessary to provide a smooth transition with existing improvements both laterally across the street and longitudinally up and down the street for drainage, vehicular and pedestrian traffic. ■ Per AMC 16.32, the Residential Access Right-of-Way Width is 50-feet. This project is not required to dedicate any additional Right-of-Way. • Per the Anacortes Municipal Code, Chapter 15.20.040—Public Streets, Alleys and Storm Sewer System improvements, sidewalk, curb and gutter improvements will be required along the frontage of Anaco Beach Road. • Street Trees: Contact Jonn Lunsford @ 360.299.1953, Parks Department for a list of City approved Street Trees. See EDS Standards, Chapter 3— Streets, Section STR-18.2 regarding Street Trees and Root Barrier requirements. Garbage: a Sanitation and recycle pick up will be at curb side. Water: For additional Water information and design criteria, see the 2011 EDS Standards, Chapter 6-,Water. • Water exists to the existing home. joyik ® Water • Wastewater • Streets • Storm Drainage • Engineering • So Waste lid• Transportation®Equipment • Capital Projects • Development Services Fire Coverage: • The project does not have fire coverage. • Contact Jack Kennedy, Assistant Fire Chief © 360.293.1925 for fire coverage requirements. Utility Companies: • See Anacortes Municipal Code, Section 16.20.080— Utilities for required Franchised Utilities as well as City of Anacortes Utilities. ▪ All franchised utilities shall be underground. Fees: ▪ See the Planning and Building Department for fees related to building permits. • Per AMC 15.24.010 this project is subject to Engineering Fees for Plan Review and Construction Inspection. Other: • For Landscaping and Landscape requirements, see Planning Department. ▪ Mail Boxes (See Chapter 3--Streets, Section STR-19): For Mailbox Locations, coordinate location, type and size with the Anacortes Post Master. The access and areas around the mailboxes need to meet ADA requirements. • Encroachments (See Chapter 3 —Streets, Section STR-18.3): Prior to any placement of any barricades, material, earth, gravel, rock, debris or any other material or thing over, under or upon the Public Right-of-Way or easement, an Encroachment Agreement shall be obtain from the City of Anacortes. See the Anacortes Municipal Code, Section 12.30 for additional information regarding the Encroachment Agreement and processes. Contact Russ Pittis at 360.661.3460 regarding questions or to obtain an agreement. • For addressing information, contact Rob Hoxie (GIS Coordinator) at 360.293.1920, extension 233. • Improvements shall be designed by a Professional Engineer, licensed in the State of Washington. • Improvements are subject to a 2-year Maintenance Bond in the amount of 10% of the actual construction costs. • Contractor shall be licensed by the State of Washington and hold a City of Anacortes Business License. Thanks, Steven Lange ert.. e • Water • Wastewater • Streets • Storm Drainage • Engineering • Solid Waste ` • Transportation•Equipment • Capital Projects • Development Services itAwP. tY 1 - /f/ 3 vr� • a° /1/1 . f r ti�at ti' 80 tzaw c ac� car 14 if // 1 / /r, i // 1 // - *`-_`\sf , 75 4; 1- 'g"u a /.`r /j// // ' / / 4`617 //J /i` f,�� - Ls { ; <� /J J/ / // / / \\ f r/ / I .. ~ % / / ,/:" 4609 :, ` .J /" . 40\ .. 14(1 I / / f• /,/ „lc ,C� f,/ r,} ' �/// cr�''7/y,n r.• ",r / Syr• !�JJ}�/C�,- y C // //i/ • ,.�,/f "-�.-��-,-.a / ,- --\ ,<„ moo- �7, G3' /''. (// , , 4607'.‘ ''''. ... \ 77::'-:::;1;ei cl' s I---/// / //pump f •;. , / 1 .9- ;;;;;;,+.'.. /e/ / at�/ / /////^. / N., ..... / // „:.... J IS4 ! • f r • /J , / /, / :./ / p/ / / /4603 '• ' � / /, ' J / , ♦ f / J • J / / / / U R VEY , ? / / // %, / / / / /'• ' J / AEN, /O1510290 '3 ; ' ' ,' / i. ; , ,o'// // J/ / / . ,�,/ / / V f �� r / / / J%,7T J /I •••4,,,:.,. •_,...,A4-,7.-/ ?.' / /I / /7 / fr ;:// \-:-..T:. • ,/ / , / / / ' .` / / r r Ff }/ . / / // // /i''.y !' / ,7 / / r/ #//F \/ r ,/ f� /4. // /J /( , 1/ , / \I 11-1.I.4 tlf>47 64_ 4lo6.2) A- L c 21.E , . . ._ ... . . . 1 ".- I ®�-l6 0 I RAJA c � �il� St c sewenz - ie� I 1� a � 1 = ly' II 0 --- - — S a SANK-I :ill r ts Ve, j s°y'° ', I t — - 4 - � =fit . { ',I — co li Ilir- - P°g ii II, \ 46) d :f - „I I' N \9-V. 0 a CO 3e �� -- , 0622904-1 0002 10/1 /2006 002 4 AT Y Fermi t UU 5;c O Cityof AnacortesGPermit#: BLD-2006-0728 904 6th Street Issue date: 10/16/2006 toile.,+ P.O.Box 547 Anacortes, WA 98221-0547'C/1<' Expire date: 10/16/2007 ficW` (360) 293-1901 Job Address: 4603 ANACO BEACH RD Permit Type: Mechanical Permit ANACORTES WA 98221-8708 Project: APN: P61819 Remarks: Install gas fireplace and piping. Owner: NELSON STEVEN F Contractor: Address: 4603 ANACO BEACH RD Address: ANACORTES WA 98221-8708 Phone: Phone: License#: General Information: Fees: #of Gas Fireplace 1 Mechanical Permit Fees 38.90 #of Gas Piping 1 Total Calculated: 38.90 Deposits/Receipts: 0.00 Total Due: 38.90 • THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSvTTR/UUCCTIION. ,p SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSUED BY � ��e/// �G n . 11 PLUMBING AND MECIIANICALPERMIT APPLICATION FOR''TBE GI:TY:O ANACORTES I: Site Address q(003 Alas Parcel No.: PG 14lq Lot(',) Block. Addition 37SA-ono-007 -O2o$ Contact Person be,/ : Lo✓-c-r Phone• aC,o-3310 --g-C32...- Owner - Contractor ICI; Name -..S�a-ve, Weise Name. C(t}arf4-$1-'GJ< .Sy,- Ssl -f- Lilo9 v1Z- Mailing Address L/603 Arno co &ad\ re!�1 fitnn. Mailing Address. o L./Err hi✓/10,J (His 4.444417, .State L _ Zip. cn2-24__— City:f'wvh V.Letivae'___- State Ida-_ _ Zip 97Z73 Il I Phone Nu 3(,o-d3=41o7-3 Phone No 3(.90 — 333fo— S3 1-9 PLUMBING MECHANICAL - i No.: Type of Fixture No.: Type of Fixture ,? Water Closet 15 GPF Air Cond Unit HP Bathtub Refrigeration Unit HP Shod Cr 2 5 GPM Boiler BTU/HP I Dishwasher 2 5 GPM Forced Air System BTU Lavatory 2 5 GPM Floor Furnace Kitchen Sink 2 5 GPM Wall Heater i lothes Washer Clothes Dryer Urinal I 0 GPM Ventilation Fan Drinking Fountain Range Hood Floor S'^I'or Drain Pre-Mani Stove or Fireplace t I Water Piping / Gas Fireplace /0 4 C-- Hose Bibs Gas Water Heater Back Flow Prevention Device / Gas Piping y 7C I Other(Describe) - Other (Describe) _ d 3.So 3 7.so THIIS API'I RATION Is REC'IVFD BY THE BUILDING DEPARTMENT UNDER THE PROVISIONS OF THE UNIFORM PLUMBING AND MECHANICAL CODES AND SHALL EXPIRE BA I IN11 r Al CN AND BECOME NOLL AND VOID IF PERMIT IS NOT OBTAINED WITHIN 180 DAYS OF THIS APPLICATION. BY AFFIXING MY SIGNATURE I HEREBY CERTIFY THAT 1 n V Tiu LI C V OWNER OF TILE PROPERTY FOR WHICH THIS APPLICATION IS ISSUED OR AN AUTHORIIZED AGENT OF THE OWNER. ALL PROVISIONS OF LAWS AND (IR DIN ANr E CAA/EKING t THIS TYPE OF WORK WILL BE COMPLETED WITH,WHETHER SPECIFIED HEREIN OR NOT,INCLUDING CALLS FOR INSPECTION ' SGNATURE N/44e;L7 K/ DATE 4Z, o(A a 0522004-1 0001 08/08/2005 002 4 8,1 O ' , Ci of Anacortes Permit Fees 006586 $38.90 A tY Permit#: BLD-2005-0596 904 6th Street Issue date: 08/08/2005 x 547 Expire date: 08/08/2006 ' vfi, ; Anacor Anacortes, WA 98221-0547 'ItlC - _ (360) 293-1901 Job Address: 4603 ANACO BEACH RD Permit Type: Mechanical Permit ANACORTES WA 98221-8708 Project: APN: P61819 Remarks: Install gas fireplace and piping. Owner: NELSON STEVEN F Contractor: CRAFT STOVES INSTALLATIONS, IN Address: 4603 ANACO BEACH RD Address: 900 W DIVISION ST ANACORTES WA 98221-8708 MOUNT VERNON WA 98273-3226 Phone: Phone: (360)336-2532 License#: CRAFTSI97OBT General Information: Fees: - #of Gas Fireplace 1 Mechanical Permit Fees 38.90 #of Gas Piping 1 Total Calculated: 38.90 Deposits/Receipts: 0.00 Total Due: • 38.90 • THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW R ULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.r . , _ fdt- ^ NATURE OF NER OR AUTHORIZED AGENT ISSUED BY 4 - 0 A BUILDING PERMIT CITY OF ANACORTES PERMIT NO. : BLD93-0147 P.O. BOX 547 APPLIED: 04/27/93 ANACORTES, WA 98221 ISSUED: 04/27/93 (206) 293-1901 EXPIRES: 04/27/94 1 SITE ADDRESS: 4603 ANACO BEACH RD ASSESSOR'S PARCEL NO. : 3858-000-006-0001 PROJECT DESCRIPTION: Addition to house and new roof OWNER — CONTRACTOR - LENDER LARRY KATSEL TALBERT CONSTRUCTION 4603 ANACO BEACH ROAD 1604 15TH STREET ANACORTES WA 9822 ANACORTES WA 98221 I 293- 293-6787 TALBEC146PH TYPE OF WORK •ADD AREA (sf) VALU. . . $: 70000 TYPE OF USE •SF LOT • 0 REQUIRED SETBACKS---- CENSUS CATEGORY •434 1ST FLR • 0 FRONT 0 ft ZONING 2ND FLR • 0 SIDE • 0 ft :RL BASEMENT • 0 REAR • 0 ft OCCUPANCY GROUP GAR/CARPORT. . . : 0 REQUIRED PARKING-- :R3 :? : ? :? OTHER 0 TOTAL • 0 TYPE OF CONSTRUCTION HANDICAPPED: 0 : 5N :? : ? :? NUMBER OF UNITS • 0 COMPACT • 0 OCCUPANT LOAD STORIES • 0 IMPRV SURF. : 0 sf . 0: 0: 0: 0: BUILDING HEIGHT. : 0 ft — FEES — NOTES Code Amount---- By- Date---- Receipt PRMT $ 343. 00 MD 04/27/93 1117 STBC $ 4.50 MD 04/27/93 1117 TOTAL $ 347.50 I hereby acknowledge that I have read this permit and state that the above information is correct, and agree to comply with aLL ordinances and laws regulating activities covered by this permit. t- Issued by Appli t or Owner's Signature 24 Hour Notice Required For All Inspections bld_prmt, Rev: 06/11/92 PLUMBING PERMIT CITY OF ANACORTES PERMIT NO. : PLM93-0049 P.O. BOX 547 APPLIED: 04/27/93 ANACORTES, WA 98221 ISSUED: 04/27/93 (206) 293-1901 EXPIRES: 04/27/94 SITE ADDRESS: 4603 ANACO BEACH RD ASSESSOR'S PARCEL NO. : 3858-000-006-0001 PROJECT DESCRIPTION: Addition to house and new roof — OWNER — CONTRACTOR LARRY KATSEL 4603 ANACO BEACH ROAD ANACORTES WA 9822 293- TYPE OF WORK •ADD KIT SINKS W/DISP: 0 WTR PIPING/TREAT: 0 TYPE OF USE •RES WASHING MACHINES: 0 HOSE BIBBS • 0 ELEC WTR HEATERS: 0 GREASE TRAPS • 0 WATER CLOSETS. . . : 1 LAUNDRY TRAYS. . . : 0 ADD'L FIXTURES. . : 0 BATH TUBS • 0 URINALS • 0 SHOWERS • 1 WASTE INTERCEPT. : 0 DISHWASHERS • 0 DRINKING FOUNT. . : 0 LAVATORIES • 2 FLOOR DRAINS • 0 • — FEES — NOTES Code Amount---- By- Date---- Receipt PRMT $ 48. 00 MD 04/27/93 1117 TOTAL $ 48.00 I hereby acknowledge that I have read this permit and state the above information is correct, and agree to comply with all ordinances and laws regulating activities covered by this permit. Issued by Applicant or Owner' s Signature 24 Hour Notice Required For All Inspections plm_prmt, Rev: 06/11/92 We 2. -76 oil 7 1‘ \p:— TAN"- 2t"..3! je V- r,- 0 Y - Ey��' 1:APC C., rl-, \,/ ! po az CAO ) • 11 tip • • \ y a,iracc 3eacZ._ 1