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Home My WebLink About2032 W 4th St - Building N F mlm . � INREPORT [ u.-4 ..... ... ... .P a,, ,<a MOawaH,,i ... _..u_..., a,..............._.... .. „ _....._ A"DIRR S ": . . . a N..1I CH — . . . . . . . . . . . . . . . - 13 S :F:MCF,.w. . ..� FINAL 1 O I ff!''Y N'N s I,i�,11�11 c rOR WHE14 COR R ECT IONS .ARE COMPLI:iTED Wffi 1114 15 DAYS DO NOT REMOVE �q 0 l'['N' ()1 RI' kNGF,;1.1:5r PC:RNMij r 1'f'l,fCW1"f( "r f3aa'ilcflrs- Diw'isionl Elec�trlcdal fraslyectlons r 321 East F"iftla Street — P.O. F-ox 1 150 l Port Anueles Wrashingtora, 98362 Ph: (360) 417-4735 Fax: (360) 417-4711 gate .... � 'J '1 & 2 Single Family Dweliing � . Job Rerrte l la Be f Vr ed, cease Comp @ate Flec�tri�cal flan Rev eorr lnfarrnat�ion Sheet Building Square F ooa age esrri p klan of above Owner In io .. � Contra for Information MaOing Address _ M3rPm,g Address:7 �A-. � " .... City _State _2,p _.... ._. cfPy. I aw, SZip `r � 1 Phone: _ Fay. _ Phone - F °t7 - Licerrse Ex—p- Lrrensa Epp Item Unit Charge Qt 7ota1 Qt Nlualtu lied b, Mt Char e SerkelFeeder 200 Amp $120.00 Seruurae/Feeder 201-400 Amp $1466,00,E SerricelFeeder 401-600Amp $205,00 � $ _..-._ SerkelFe eder 601.1000 Arnp. $262.00 ServkceJFee3'er over 1000Amp $37300 Branch C rcO d F S errec. Feeder 5.,00, Branch ;Mc i W!0 Serr ce Feeder $ 5300 Each Addi! anal - �,,.,,� ✓� �,�",,, r Branch Clrcuet $ 5.00 S y Branch Orcu its 1-4 $ 75.00 Temmp Service(Feeder 201)Amp, $ 0100 Terrrp ServicerFeaedar201-400 Amp 5110.01) �— _......... r m�_.. Temp.Sereirre/Feeder 401-500 Amp. $149.00 Ternp. SevircerFeeder 60!-1000 Amp . $16800 _-- S _ Portal to Portal Hou dy $ 95.00 Signal CirculU Umutej Energy-1 &2 Famdl7 DvieUing $ 64 GO ...._._.._....._. Manufactured Home Connectiore $123 00 Rene,,vaNe Electrical Energy-5KVA System or Less $10200 5 Thermostat S 55.010 Note $5.00 for each ad6tionaV T-Stat NEW CONSTRUCTION ONLY: Firsa 1305 Square Ft. S 120 00 ,. 500 80 ta�r�dtPorCicn of � 4000, Each Ad�diteana0 Square Farah S�buil6n Pool er Hot d Garage $174.00 9 11000 5 ... Total Owner as defined by RCINA 9.28.281: (1) Owner^gill o�ccupy the structure for 1r,=ro years after this electrical permit Bs fnatized.(2)Owner is required to hire an electrical con`rarukar if abole said property is for sale, rent or lease. Permit expires after six months of last inspection. After reading the above statement, I hereby certify that I am the oarrner of the above named property or a hoensed electrical conlractear. I am making the electrical installation or alteration in compliance with the electrical laws, N E.C.,, KVi. Chapter 19 28,WAC Chapter 296-46E, The City of Port Angeles NlUn'icipal Code, and Utility Specifications and PANIC 14.05.059 regarding Electrical Permit Applicatlorros. Signature of orrrner„electrical contractor or electrical administrator: 0 Caar, 0 check Credit Card X r r2s Dated: dre , �� °-- _.,....___._ OV01 12 hq us. t. ELECTRICAL PERMIT CITY OF PORT ANGELES 360-417-4735 0 Application Number . . . 12-00001201 Date 9/13/12 Application pin number 436713 Property Address . . . 2032 W 4TH ST REPORT SALES TAX ASSESSOR PARCEL NUMBER: 06-30-00-9-4-0039-0000- on your excise tax form Application type description ELECTRICAL ONLY Subdivision Name to the City of Port Angeles Property Use . . . . . . . . (Location Code 0502) Property Zoning . . . . RS7 RESDNTL SINGLE FAMILY Application valuation . . . . 0 ----------------------------------------------------------------------------- Application desc Kitchen remodel 8 circuits ----------------------------------------------------I-------------------------- Owner Contractor -------------------------- ------------------------ LAURA K EYESTO NE JARMUTH ELECTRIC 2032 W 4TH ST' PO BOX 635 SEQUIM PORT ANGELES WA 983631604 SEQUIM WA 98382 � (360) 683-4104 ----------- - - - - ---------- ----- __------------- - - ------ -- Permit ELECTRICAL-ALTER RESIDENTIAL - - ----- --- VA Additional desc . - Permit Fee . . . 88.00 Plan Check Fee .00 Issue Date 9/13/12 Valuation . . . . 0 Expiration Date 3/12/13 Qty Unit Charge Per Extension 5.00 5.0000 ECH EL-BRANCH CIRCUIT W/FEEDER 25.00 1.00 63,0000 ECH EL-R- BRANCH CIR WO/ SER FEED 6'3.00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ----- --- --- Permit Fee Total 88,00 88,00 00 .00 Plan Check Total .00 .00 .00 Grand Total 88.00 88.00 .00 INSPECTION TYPE DATE RESULTS: INSPECTOR: DITCH SERVICE ROUGH-IN FINAL ZA_.A AR-592 COMMENTS: PERMIT WILL EXPIRE SIX(6)MONTHS FROM LAST INSPECTION Signature of mvner or Electrical Contractor G:\I-.'X('HANGE\BUI WING nLPfIN CITY OF PORT ANGELES Ec 0 DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION e� 321 EAST 5TH STREET, PORT ANGELES, WA 98362 f Application Number 12- 00000878 Date 7/12/12 Application pin number 025478 Property Address 2032 W 4TH ST ASSESSOR PARCEL NUMBER: 06- 30- 00 -9 -4 -0039 -0000- REPORT SALES TAX Application type description RE -ROOF on your state excise tax forum Subdivision Name Property Use to the City of Port Angeles Property Zoning' RS7 RESDNTL SINGLE FAMILY (Location Code 0502) Application valuation 5760 Application desc TEAR OFF REROOF HOUSE ONLY Owner Contractor BISHOP HAL F LARRY'S ROOFING 2032 W 4TH ST 352 AVIS ST. PORT ANGELES WA 983631604 PORT ANGELES WA 98362 (360) 452 -2215 Permit BUILDING PERMIT NO PR FEE Additional desc TEAR OFF REROOF HOUSE ONLY Permit Fee 151.75 Plan Check Fee .00 Issue Date 7/12/12 Valuation 5760 W V I Expiration Date 1/08/13 1(ti0�k -4. 1 Qty Unit Charge Per Extension 1 BASE FEE 95.75 4.00 14.0000 THOU BL- 2001 -25K (14 PER K) 56.00 Other Fees STATE SURCHARGE 4.50 Fee summary Charged Paid Credited Due Permit Fee Total 151.75 151.75 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 156.25 156.25 .00 .00 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after the work has commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and exa fined thi ap. 'cation and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be co •lie. with tether specified herein or not. The granting of a permit does not presume to give authority to vi to or cancel the prov' 'ons stat- or local law regulating construction or the performance of construction. �k 1-2 (Z 0 r ,z44 Date Print Name Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder) T:Forms /Building Division /Building Permit BUILDING PERMIT INSPECTION RECORD C� PLEASE PROVIDE A MINIMUM 24 -HOUR NOTICE FOR INSPECTIONS Building Inspections 417 4815 Electrical Inspections 417 4735 Public Works Utilities 417 4831 Backflow Prevention Inspections 417 4886 IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INCONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Inspection Type Date Accepted By Comments FOUNDATION: Footings Stemwall Foundation Drainage Downspouts Piers Post Holes (Pole Bldgs.) PLUMBING: Under Floor Slab Rough -In Water Line (Meter to Bldg) Gas Line Back Flow Water FINAL Date Accepted by AIR SEAL: Walls Ceiling FRAMING: Joists Girders Under Floor Shear Wall Hold Downs Walls Roof Ceiling Drywall (Interior Braced Panel Only) T -Bar INSULATION: Slab Wall Floor Ceiling MECHANICAL: Heat Pump Furnace FAU Ducts Rough -ln Gas Line Wood Stove Pellet Chimney Commercial Hood Ducts FINAL Date Accepted by MANUFACTURED HOMES: Footing Slab Blocking Hold Downs Skirting PLANNING DEPT. Separate Permit #s SEPA: Parking Lighting ESA: Landscaping SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE Inspection Type Date Accepted By am.. Electrical 417 -4735 Construction R.W. PW Engineering 417'4831 CYO Fire 417-4653 Planning 417 -4750 Q� Building 417 -4815 L 1 1 2- T•Pnrmc /Riiilrlinn rlivisinn /Ruilrlina Permit N H r CO W F Q Q a N N N in O 0 l0 N IX 1 0 W U H .0 H wZ F 40 0 0 cn x O Ox H U rn W a 0 H ei< C zi Fti q o a O !n H F ao cn F W W W N 0 L W E H rn W Z 2 i F.1 E o H W H O U Q N N 0 F 0 U W 0 C4) H LL H F W H 0) a 0 0 0 0 404 0HIX 0 W W a 7 0 0 q a W h F o 0 F at O H Ma C7 o F io 0, 0 C 41 N r F H s W ca U) nw zcn m o m L: x F <0 o 0 3o 0 N W Na S O P7 ti ,(77 222 V1 W 7-. O N r] O H O 0 W 0 0 �a a 0 400 w 0 w w O H W w 40 u 2 H a o m Q r-] 2 F a O W Q a W H U7 a r a F W U a X a m a U U 0 W Q W F pal THE OR 1 4 V LE Cll-Y For City Use 1 Permit 0 '31-2 o c r' o W A S H I N G T O N U.S. v� r r, o r n 1 Date Received: I I o 2 321 East 5t' Street 3-7;.) N Port Angeles, WA 98362 Date Approved: I ''z 7-1 N m P: 360- 417 -4817 F: 360- 417 -4711 c' hcatuzo @cityofpa.us Building Permit Application Project Address: -3Z 0 Main Contact: Phone gy m b C%LS Property Name tE E sL O Phone Owner Mailing Addr s f, Email City c r 1/ b O y .9 State, A Zip `CJ V v e l e Contractor Name aglf V J 3 Phone 4 4 Mailing Address Email City State Zip Y l ^4 Contractor License y Expiration: f r v Project Value: 7 6 0 Zoning: Tax Parcel ��U Lot Q( D OCR Type of Residential 1 Commercial Industrial Public Permit Demolition Fire Repair Reroof tear of /lay over) -t, For the following, fill out both pages of permit application: New Construction Remodel Addition Tenant Improvement Mechanical Plumbing Other Existing Fire Sprinkler System? Maximum height of structure Proposed Bedrooms Proposed Bathrooms Yes No Project k q Qemo De scription kotte, cv O�- 1 I Z, laire k) n j noilc I have read and completed the application and know it to be true and correct. I am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required, and to obtain permits prior to working on projects. I understand the plan review fee is not refundable after review has occurred. I understand that I will forfeit 20% of the review fee if I cancel or 'thdraw the application before plan review has occurred. I understand that if the permit is not issue withi 0 days of receipt, the application will be considered abando d, and the fees forfeit. Date Print Name Signature —1 f2— to m Residential Structures Area Description (SQ FT) Existing Proposed Minimum For Office Use value Basement First Floor Second Floor Covered Deck /Porch /Entry Deck Garage Carport Other (describe) Area Totals Commercial Structures Area Description (SQ FT) Existing Proposed Minimum For Office Use value Structure (s) Addition Tenant Improvement Other (describe) Area Totals Lot /Site Coverage Calculations Footprint (SQ FT) of all Structures: Lot Size: Lot Coverage SQ FT Site coverage (all impervious Site Coverage structures) Mechanical Fixtures Indicate how many of each type of fixture to be installed or relocated as part of this project. Air Handler Size: Haz /Non -Haz Piping of Outlets: Appliance Vent Heater (Suspended, Floor, Recessed wall) Boiler /Compressor Size: Heating /Cooling appliance repair /alteration Evaporative Cooler (attached, not Pellet Stove /Wood- burning /Gas portable) Fireplace /Gas Stove /Gas Cook Stove /Misc. Fuel Gas Piping of Outlets: Ventilation Fan, single duct Furnace /Heat Pump/ Size: Ventilation System Forced Air Unit Plumbing Fixtures Indicate how many of each type of fixture to be installed or relocated Plumbing Traps Fuel gas piping of Outlets: Water Heater Medical gas piping of Outlets: Water Line Vent piping Sewer Line Industrial waste pretreatment interceptor Other (describe): G et; 1 )0,4) 41- 7- I -zto( i ..1..-,0:-.0.41b,, P:' .'-'.'f..4-:.: 1 jj" _,.,_g :1 .1, ,c1 ..,,I. it S l'S -7:3° ,t,,,:...A.7,44..a:t.,:-,,,.; L1,1 eA: _i__ .3.':. 7 i :;:...._,..7; Q9' O r i fit .10,F 101 or._ 1 acr 1 1 1 4 .4,0:2e.„::_z6i7f,,,,.7-:::_.:.:.,,,..7: 7- 7 1 Ili i i.' --;E:-411, i' .,.....:::7N,. F_Re,.____ ,..4 1 1 1 I, ..*..i...:.i. f _____________________3:123 7 it 4 _1_ 7:7_7_7 4- I :r. l, Y_ a F e L R J F 0 G f "7"47"....,,:,,,:7," ors t.- 4, �m r r.' O N y, s 6 a j '4n d t J s ti 0 is I y x S w r x x N e t LL r 1 ...„.„2, 1 E\ 1 0-,.. (--...4-,,,„, N :t r y a r, p.........J. y t, r Application Number 05 00000944 Application pin number 825008 Property Address 2032 W 4TH ST ASSESSOR PARCEL NUMBER 06 30 00 9 4 0039 0000 Tenant nbr name QWEST Application type description PUBLIC WORKS UTILITES Subdivision Name Property Use Property Zoning RS7 RESDNTL SINGLE FAMILY Application valuation 0 Owner Contractor BISHOP HAL F 2032 W 4TH ST PORT ANGELES T \Policies \1102.15R [1/05] WA 983631604 CITY OF PORT ANGELES PUBLIC WORKS UTILITIES DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 OWNER Fee summary Charged Paid Credited Due Date 10/04/05 Other struct info TOTAL LOT COVERAGE 1 00 NUMBER OF STORIES 1 00 LOT SIZE 1 00 TOTAL LOT COVERAGE 1 00 NUMBER OF UNITS 1 00 Permit RIGHT OF WAY Additional desc UNDERGROUND PHONE SERVICE Permit pin number 61622 Permit Fee 00 Plan Check Fee 00 Issue Date 10/04/05 Valuation 0 Expiration Date 4/02/06 Permit Fee Total 00 00 00 00 Plan Check Total 00 00 00 00 Grand Total 00 00 00 00 Separate Permits are required for electrical work, SEPA, Shoreline ESA, utilities private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days if construction or work is suspended or abandoned for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last inspection 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 state or local law regulating construction or the performance of construction Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date PW UTILITIES (Engineering Division) WATERLINE METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE SITE EROSION CONTROL PARKING SIDEWALK CURB GUTTER DRIVEWAY APPROACH BACK -FLOW DEVICE RESIDENTIAL CONSTRUCTION R.W PW/ ENGINEERING 417 -4807 FIRE 417 -4653 PLANNING DEPT 417 -4750 I BUILDING 417 -4815 T \Policies \1102.15R [1/05] PERMIT INSPECTION RECORD CALL 417 -4807 FOR UTILITY INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE ACCEPTED COMMENTS YES I NO FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL DATE ACCEPTED YES I NO CONSTRUCTION R.W PW ENGINEERING I FIRE DEPT I PLANNING DEPT BUILDING I I I I I I I I I I I ~....'. VI CONT~c;TOR OWNER VARIOUS Port Angeles, W A 99360 206/000-0000 PROJECT INFO ,.,Project Value: $150.00 Project Type: BACKFlOW VALVE Occupancy Type: RESIDENTIAL OcCupancy Group: Construction Type: Zoning Use: RS7 BUILDING PERMIT 'OWNER/APPLICANT HAL BISHOP 2032 W 4TH Port Angeles, WA 98363 206/000-0000 T: ClTYOE PORT ANGEI1ES PUBLIC WOJ.U(S - BUlLDING DMSION 321 EAST 5TH STREET, PORT ANGELES; W A 98362 ';;j,:"" , ',5,." S: ISSUED:' 8/17/2001 12882 "'PROPERTY LOCATION 2032 4TH ST W lot: 13 Block: IZI long leg~1 Subdivision:,. EDGECLlFF Parcel No: ARCHITECT N/A , 98360-0000 360/000-0000 SFD Units: SFD SO FT: o o Commercial: Industrial: Garage:' o o o i I N........1: 0... ~I 1'" ~I ~ ~ MF[) Units: 'MFDSQ FT: "0 () PROJECT NOTES INSTALLATION OF 5 BACKFlOW DEVICES FOR LAWN SPRINKLER SYSTEM FEES ASSESSMENT Building Permit: Plan Check: State Surcharge: House Moving: Manufactured Home: Sign: Plumbing: Mechanical: Radon: $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.00 $0.00 $0.00 Misc Fee 1: , Misc Fee 2: Misc Fee 3: $0.00 $0.00 $0.00. TOTAL FEE: AMOUNT PAID: BALANCE DUE: $25.00 $25.00 $0.00 . Separate P~rmlts are required for electrical WOrk, SEPA,Shoreline, ESA, utilities, private and public ImProvements. Thl.s ~tmlt~s null and void If work or con.structionautho~ed Is flot commen~,~in 180 days, If construction or worj( i.". SUfJ~l1~pJ:'.,f;)andoned for a period of 180 days after the work as commenced, or if required Inspections have not been requested within 1~0 dBYlfrom theiast Inspection. I hereby certify that I have read and examined this applicatlonand know the sallle to be true and,Correct.,~lpl'9visi~nsof laws and ordinances governing this type ofYiork.wiil be complied with whether specified herein or not. The granting ofa.peimltdoes not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the perfonnance of construction. Date ~6.i?~ Slgn"'~ of Owner (If own r is builder) ... '- - ,. ?/~.)' 1< '. ale Signature of Contractor or Authorized Ag~nt Bun.DING PERMIT INSPECTION RECORD ;~:~~-~~'" CALL 417-4815 FOR BUlLDINQINSPECTIONS. PLEASE PROVIDEAMINIMUM 24 HOUR NOTICE. IT IS UNLAWFULt'f1t(;OVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. KEEP PERWT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE 'DATE -, ~ ACCEPTED .I YES I NO COMMENTS --,;- FOUNDATION: FOOTINGS WALLS FOUNDATION DRAINAGE , , ELECTRICAL ROUGH-IN PLUMBING UNDER FLOOR / SLAB (LIGHT DEPT) SEPARATE P~: # ") - I " . ROUGH-IN WATERLINE GAS LINE .' , , . AIR SEAL BACK FLOW /WATER " , WALLS CEILING FRAMING JOISTS / GIRDERS SHEAR WALL WALLS I ROOF / CEILING DRYWALL T-BAR INSULATION SLAB WALL / FLOOR / CEILING MECHANICAL HEAT PUMP WooDSTOVE / PELLET/CHIMNEY /INSERT " , I . , . ", . I I HooDlDUCTS PW UTILITIES / SITE WORK (Eilgineering Division) SEPARATE PERMIT #'5: . ' WATERLINE / METER , SEWER CONNECTION SANITARY STORM PLANNING DEPT. SEPARATE PERMIT #'5 c' " RESIDENTIAL SEPA: ESA: SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE ',. DATE YES NO,' COMMJ!:RCIAL , ,. PARKlNGlLIGHTING LANDSCAPING , . '" ", 417-4735 ,', . c'' , 411-4801 1,,- _) J":" RF. . rcIlJ /J'1 I AI' 411-4653 I " 411.-4150 417-4815 " i '~i', ",', " '" " 1M~:i'.'" '~ ' '" , , ,ACCErrED ,,' ", YES.! " NO ; ',,1 ,1' ELECTRICAL- UGHTDEPT. :r"c:' ..,', ' CONSTRUCTION R;W./ PWI ENGIl'IEERlNG: ' ,.' FIRE PLANNING DEPT. " c' ELECTRICAL ,LIGHT DEPT " " CONsTRUCTION - R; W. ,pw / ENGINEERING, FIRE DEPT. PLANNING DEPT. BUlWINCFlL . .: ' , , BUILDING ,) F ",("" ,"'" , ;~ C:\APPL WPD ~ ~ORT """ .......O~~ (; r-G!iii~ "-~ ~ -' ~1CwP'. CITY OF PORT ANGELES PUBLIC WORKS - UTILITIES DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 [)S-41cj Application Number Application pin number Property Address . ASSESSOR PARCEL NUMBER: Tenant nbr, name Application type description Subdivision Name Property Use Property Zoning . . . Application valuation 05-00000944 Date 10/04/05 825008 2032 W 4TH ST 06-30-00-9-4-0039-0000- QWEST PUBLIC WORKS UTILITES j16 J03Z WI RS7 RESDNTL SINGLE FAMILY o Owner Contractor ~esr BISHOP HAL F 2032 W 4TH ST PORT ANGELES OWNER WA 983631604 Other struct info . TOTAL \ LOT COVERAGE NUMBER OF STORIES LOT SIZE TOTAL LOT COVERAGE NUMBER OF UNITS 1. 00 1. 00 1. 00 1. 00 1. 00 Permit RIGHT OF WAY Additional desc UNDERGROUND PHONE SERVICE Permit pin number 61622 Permi t Fee .00 Plan Check Fee .00 Issue Date 10/04/05 Valuation 0 Expiration Date 4/02/06 Fee surrunary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total .00 .00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total .00 .00 .00 .00 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from Ihe last inspection. 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 state or local law regulating construction or the performance of construction. Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date T:\Policics\1 102.15R [1/05]