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HomeMy WebLinkAbout17601 59th Ave Ne_BLD6161_2025 Permit Packet Coversheet Community and Economic Development City of Arlington • 18204 59th Avenue NE • Arlington, WA 98223 • Phone (360) 403-3551 Page 1 of 1 Permit Number: Permit Type: Address/Parcel: Completed (Month/Year): Land Use ˆ Notice of Decision ˆ Staff Report ˆ Application ˆ Narrative ˆ Legal Description ˆ Vicinity Map ˆ Site Plan ˆ Landscape Plan ˆ Complete Streets Checklist ˆ Traffic Impact Analysis ˆ Snohomish County Traffic Mitigation Offer ˆ WSDOT Traffic Offer Form ˆ Tree Survey ˆ Stormwater Drainage Report ˆ Geotech Report ˆ Critical Area Evaluation Form ˆ SEPA Checklist ˆ Public Notice Material ˆ Noticing and Related Documents ˆ Water / Sewer Availability Certificate ˆ Unanticipated Discovery Plan Form ˆ Aerial Photo of Site ˆ Proposed Building Materials ˆ Lighting Plans and Lighting Cut Sheets ˆ Color Elevations ˆ Design Matrix ˆ Plat Map ˆ Title Report ˆ Lot Closures ˆ Preliminary Civil Plans ˆ Archaeological Survey o Confidential Documents. Contact the City to obtain. ˆ Topography (Existing Conditions) ˆ CC&R’s ˆ Deeds / Easements / Conveyances /Dedications ˆ Developer’s Agreement ˆ Recorded Copies ˆ Bonding or Assignment of Funds o Confidential Documents. Contact the City to obtain. ˆ Letters and Project Documents ˆ Other: Civil ˆ Issued Permit ˆ Application ˆ Other Applications ˆ Construction Calculation Worksheet ˆ Approved Plans ˆ Review Comment Form ˆ Letters and Project Documents ˆ Other Agency Permits ˆ Reports: o Drainage Report Pg: o Stormwater Pg: o Geotech Pg: o All Other Reports ˆ SEPA and Noticing Materials ˆ Inspections ˆ As-Builts ˆ Other: Building ˆ Issued Permit ˆ Application ˆ Additional Applications ˆ Approved Plans ˆ Site Plan ˆ Letters and Project Documents ˆ Calculations ˆ Project Specification Manuals ˆ Reports ˆ Certificate of Occupancy ˆ Inspections ˆ Other: BLD6161 Operating 17601 59th Ave Ne March 2025 ✔ ✔ ✔ OPERATING PERMIT APPLICATION Community & Economic Development City of Arlington • 18204 59th Ave NE • Arlington, WA 98223 • Phone (360) 403-3551 REV032021 Page 1 of 3 Part I Part II Type of Operating Permit An Operating Permit is required to conduct any activity or to use any class of building listed below. Please indicate the type(s) of Operating Permit(s) requested by checking each applicable box. (If you require assistance, or would like more information, contact the City of Arlington Building Department at 360-403-3551.) Manufacturing, storing or handling hazardous materials in quantities exceeding those listed in the Fire Code (see Appendix A.) Identify the materials and quantities and describe the manner in which the materials will be manufactured, stored or handled (attach additional sheets if necessary): _______________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ Conducting a hazardous process or activity, including, but not limited to, any commercial or industrial operation which produces combustible dust as a byproduct, fruit and crop ripening, waste handling, spray operations, and high-piled storage (see Appendix B.) Describe the process(es) or activity(ies) to be conducted (attach additional sheets if necessary): _____________________________________________________________________________ __________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________ Property Address for which Operating Permit is requested: Parcel ID No.: Current Occupancy Project Description: Applicant Name: Home No.: Email Address: Cell No.: Mailing Address: City: State: Zip: Contact Person: Phone No.: REV032021 Page 2 of 3 Use of pyrotechnic devices in assembly occupancies (see Appendix C.) Describe the devices to be used and type of event (attach additional sheets if necessary): ____________________________________________________________________ __________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________ Aboveground Storage Tank (AST) (see Appendix D) Removal Decommissioning Temporary tank closure Changes in service Permanent tank closure Brief description: ____________________________________________________________________________________________ _________________________________________________________________________________________________________________________ Underground Storage Tank (UST) (see Appendix D) Removal Decommissioning Temporary tank closure Changes in service Permanent tank closure Brief description: ___________________________________________________________________________________________ _________________________________________________________________________________________________________________________ Temporary Membrane Structures, including tents and canopies (see Appendix E.) Brief description of structure and use: _______________________________________________________________________________________________________________ ___________________________________________________________________________________ Special Event Operating Permit - An Operating Permit is required for any special event that takes place within an occupied building, or an outdoor mass gathering, which is outside the scope of the permitted use (see Appendix F.) Brief description of type of gathering proposed: _______________________________________________________________ __________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________ Mobile Vendor - (see Appendix G.) Brief description of vehicle and use: ____________________________________ ___________________________________________________________________________________ Part III Premises/Building Information 1. Date of last inspection of Premises: ______________________ 2. Has a Certificate of Occupancy been issued for the premises? Yes No Type: Permanent Temporary Date of Issuance: _____________________________________________________ REV032021 Page 3 of 3 3. Are there currently any open Building Permits associated with the premises? Yes No If yes, please describe (attach additional sheets if necessary): _______________________________________________ _____________________________________________________________________________________________________________________ ________________________________________________________________________________ 4. Additional Comments: ____________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ SIGNATURE OF APPLICANT I herby certify that the foregoing information (and all information in attached sheets, if any) is true and complete. __________________________________________________________________________________________________________________________ Signature of Applicant or Authorized Representatives Signature Date __________________________________________________________________________________________________________________________ Name and Title (if applicable) of person signing Application (Please print) Part IV To be completed by the City of Arlington Building Department Inspection Required: Yes No Inspections Performed: Yes No Date of Inspection: Tests or Reports required verifying compliance? Yes No If YES, have Tests or Reports been received? Yes No OPERATING PERMIT APPROVED Operating Permit Issued by: Date Operating Permit Issued: Date Operating Permit Expires: Type/Description of Operating Permit: Conditions of Operating Permit (list conditions here AND in the space provided in the Operating Permit: Additional Comments: (Attach additional pages if needed)      "#  $%&&'()*+,-./+%-01 4#  56-,-78/,&-.69:$%2;;<< =&)>8?-*68)59B @C D+*+99E(F A 4 " G+*-7+%*+/0,+*H 4 I'' J 3 K*L*+/0,+*M/6-N.LO0-7 PQ R  /S.)*+?++9-?,8T,N8>+/9-*)T+.N9-?++9-?N*-L.09,+8TU 3V  4 OV X   PB <  4 "[ V \ A ; \<<V; J]< = I B V< &^_<`4; 7+*+/8)_)a>8/LL*+// _+T)>%+/0*8N98-6 a6+*)7+ a6+*,-6+   Ide5+098-6-a6/,8N= )6T+If.)*9+*5_&g_h5i_5$% &i I IFh( 5 j 5 5%5&$h_&$_g%5& F9&6/N+098-6:N+ %+/0*8N98-6 50,+L.>+L%)9+ &-7N>+9+L%)9+ 6/N+09-*       !"!# " $%#"  !#&  '#(&)! 12345 /!.)  !"!# /)$#". ) ".) B .-#CD++++++++ $!/./E(!FG334@HI@J.K454@L!(./$OOPQRSOQTOROPRSUVWXYZ