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Home My WebLink About1717 W 6th St - Building Bun.DING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUlLDING.INSPECflONS. CALL 417-4735 FOR ELECTRICAL INSPEctIONS. , ' , -. . . . PLEASE PROVIDE A MINIMUM 24. HOURNOTICE. IT IS UNLAWFUL TO eOVERiINSULATE OR CONCEAL ANYWORKBEFORB INSPECTED ANDACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. . ' KEEP PERMIT CARn AND APPROVED PLANS:ATJOBsIre . INSPEcnON TYPE DATE I ACCEPTED .' ,'.,i'," COMMENTS . \ .,i ........ . '." . YES NO . ; .'. ..... . FOUNDATioN:' i. ." / " FOOTINGS '. .... '>(';. WALLS. FOUNDATION DRAINAGEIDOWN SPOUTS . ELECTRICAL SEPARATE PERMIT: #I , (LIGIIT DEPT) .'. ROUGH-IN '" . . I . I '. PLU!\fBING ..' t . . .. UNDER1'LQOR/SLAB .... , . . '.' ROUGH-IN . .... WATER LiNE (METER TO BLOG) . . GAS LINE . I .. BAcK FLOW / WATER .... '. . '. .,. AIR SEAL ,.i '. . .. I , WALLS '.'; ...... .... ii.'.,i ..... CEILING .' "..' .' I .... . I '. I '. '. .. FRAMlNq, . ". '. ....;.!.;/ J01STSIG1RD~ . . Ifi SHEAR,WAWHOLD DOWNS ..' ......'....\"!;.\... W ALLSlRboFI CEILING' I. -;'?";" ..".'. I.;','.. .' ... DRYW,qL(INTERlOR BRACED PANEL ONLY) . . .. ", I'. T"B!.IL..... '. ..... I......... " . .' INSULATION' ..... -. I .. .'r Ii SLAB . > WALL lFLooRl CEILING I I I .' ' , MECHANICAL ..' , HEAT PUMP .' . I, GAS~ ...... WOOD STOVE I PELLETl CIDMNEY .' -- i. HOOD 1 DUCTS. .' .. '.' . . PWUTILItIES 1 SITE WORK SEPARATE PERMITI/'s: . .., (Engineering Division) . ." , WA TE~INE I. METER . ...>..,.... SEWER CONNECTION ." ". '. '. SANITARY . . ) STORM ."'.' .. ',. }, PLANNING DEPT. SEPARATEPERMITII's SEPA: PARKlNGlLlGlITlNG ". . ESA: '. - LANDSCAPING . . .. .' , " . Sliq!iELINE:.. . '. ." ,. . . .... .' FINAl.. INSPECTiONS REQUIRED PRIOR TO OCCl!PAN€Yty~(,; '.... ". .,.; . ..' . li;' RESIDENTIAL , ". ~ATE' YES NO . iCOMMERCIAL DATE ACCEPTElJ . ..' I L .'. " " '" .,.' YES NO " . , .. / ,'. ELECTRICAL -.LlGHT DEPT: 417-4735 ELECTRiCAL . ,., LlGIITDEPT -,- . '. ~NSTRUCTlON R. W./ PW/ CONSTRUCTlON"R.W. GINEERlNG , 417-4807 PW / ENGINEERING ,. FIRE '. 417-4653 FIRE DEry:" .,' . ... ., . ." Pl.ANNING DEPT. PLANNING D~. ... 417-4750 . ~ 417-4815 [Z);., l~-o j...J oTT . .. . Ii BUILDING BUILDING , , .i..:..o:_::_:..:~_____----'---___,,-""""--__c,~,'_ ", ".,.:'/,.....,' '~i ,F; ...; ,....-,;.',~ :;"';' BUILDING PERMIT - APPLICATION FOR OFFICIAL USE ONLY: Date Rec.: 12-J 1-03 Fill out COMPLETELY and in INK. Your application and site plan MUST BE COMPLETE to be accepted for review. If you have any questions, call (360) 417-4815 Permit #: Date Approved: Date Issued: Applicant or Agent: Owner:ShCU1 (\0 0 ~ An..~112- Address: 17 17 W p..::f ~ 'Vr Architect/Engineer: Contractor Phone: YotLlL- Phone:501 .- b;;- 9 City: P u-tr ~~ILS Zip: -r;r'fl 7'13~~ Phone: State License #: Exp: Phone: Address: City: Zip: PROJECT ADDRESS: /7 / 7 w~ fLJ -zA.. ZONING: LEGAL. DESCRIPTION: Lot: It? c /?- Block: / ~;2 Subdivision: CLALLAM COUNTY PARCEL NUMBER: 0 -6 ...3 Do () 0 / ~ & 7 0 Credit Card Holder Name: Billing Address: Credit CardType VISA MC # TYPE OF WORK: o Residential 0 New Constr. 0 Re-roof o Multi-family 0 Addition 0 Move o Commercial 0 Remodel ji!I: Demolition o Repair 0 Sign BRIEF DESCRIPTION OF THE PROJECT: City: Exp. Date: o Stove o Garage o Deck o Other '7~ s.-. L (, SIZEN ALUATION: SF.@$ /SF.=$ SF.@$ /SF.=$ SF. @ $ /SF. = $ ...:::2-OV, 0 (:) TOTAL VALUATION $ ~+ ~kec! COMMERCIAL/RESIDENTIAL: Occupancy Group: Occupant Load: Construction Type: No. of Stories: Lot Size: Existing Sq. Ft. & Proposed Sq. Ft. Existing lot coverage _ % & Proposed lot coverage _% = Total lot coverage APPROVALS: PLAN : BLDG: DPWU: FIRE: OTHER:_ PLANNING USE ONLY: ESA/Wetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other: BUILDING PERMIT APPLICATION SUBMITTAL: The Building Division can provide you with information on the application and plan submittal requirements if you have questions. VALUATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applicant. This figure will be reviewed and may be revised by the Building Division to comply with current fee schedules. Contact the Permit Coordinator at 417 -4815 for assistance. PLAN CHECK FEE: IF a plan check fee is due it must be submitted at the time the building permit application and construction plans are submitted. All other permit fees are due at the time of permit issuance. EXPIRATION OF PLAN REVIEW: Ifno permit is issued within 180 days of the date of application, the application will expire. The Building Official can extend the time for action by the applicant up to 180 days upon written request by the applicant (see Section 107.4 of the Uniform Building Code, current edition). No application can be extended more than once. I hereby certify that I have read and examined this application and know the same to be true and correct. I am authorized to apply for this permit and understand that ff is my responstbiiffy to detennine what pennffs are reqUi~ that 1 must obtain such jnn1. p~ to ':. T:\FORMS\APPS\BuiJdingpermit.wpd Apphcant: ~ Date: / I( I (. it-- PREPARED 5/12/04, 13:07:07 CITY OF PORT ANGELES INSPECTION TICKET INSPECTOR ROGER VESS PAGE DATE 6 5/12/04 ADDRESS CONTRACTOR OWNER PARCEL . . APPL NUMBER: 1717 W 6TH ST SUBDIV: PHONE PHONE : (509) 679-5141 YORK, ANGIE/SHANNON 06-30-00-0-1-4270-0000- 03-00001176 DEMOLITION PERMIT: DEMO 00 DEMOLITION REQUESTED INSP TYP/SQ COMPLETED RESULT DESCRIPTION RESULTS/COMMENTS BL99 01 5/12/04 R~ ~ ~~~;~G4;;~~~77 ---------~----~--~---------- COMMENTS AND NOTES -------------------------------------- . o<'ORT~ l~~ ,. "'--~ ~ ~WiP CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, W A 98362 Application Number pin number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Use Property zoning . . . Application valuation 05-00000189 Date .284806 1717 W 6TH ST 06-30-00-0-1-4270-0000- DEMOLITION 3/17/05 RS7 RESDNTL SINGLE FAMILY o Owner Contractor YORK, ANGIE/SHANNON 1717 W 6TH ST PORT ANGELES ( 50) 679-5141 Structure Information Construction Type . . . . occupancy Type . . . . . OWNER WA 983631719 REMOVE/DEMO 18' X 20' GARAGE TYPE V NON-RATED GARAGES, CARPORTS, SHEDS Permit Additional desc Permit Fee Issue Date Expiration Date DEMOLITION REMOVE 18' 47.00 3/17/05 9/13/05 X 20' GARAGE Plan Check Fee Valuation .00 o -J -J BASE FEE Extension 47.00 Qty Unit Charge Per Other Fees STATE SURCHARGE 4.50 ~ Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 47.00 47.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 51.50 51.50 .00 .00 tJ' + :> 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. ,.r, " J L_..J I V Signature of Contractor or Authorized Agent FILe ~te \ \ '\ " Date Signature of Owner (if owner is builder) T:\Policies\1102_15 building permit inspection record05.wpd [1/4/2005] BUILDING PERMIT INSPECTION RECORD 0 S - / g I CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS. CALL 417-4807 FOR PUBLIC WORKS UTILITIES PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL 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 I YES NO FOUNDATION: FOOTINGS WALLS FOUNDATION DRAINAGE / DOWN SPOUTS PIERS POST HOLES (POLE BLDGS.) PLUMBING UNDER FLOOR 1 SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW 1 WATER AIR SEAL WALLS CEILING I I FRAMING JOISTS 1 GIRDERS SHEAR WALL/HOLD DOWNS WALLS 1 ROOF 1 CEILING DRYW ALL (INTERJOR BRACED PANEL ONLY) T-BAR INSULA T10N SLAB WALL 1 FLOOR 1 CEILING I I MECHANICAL HEAT PUMP 1 FURNACE 1 DUCTS GAS LINE WOOD STOVE 1 PELLET 1 CHIMNEY COMMERCIAL HOOD 1 DUCTS MANUFACTURED HOMES FOOTING 1 SLAB BLOCKJNG & HOLD DOWNS SKJRTING PLANNING DEPT. SEPARATE PERMIT #'s SEPA: PARKING/LIGHTING ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRJCAL - LIGHT DEPT. 417-4735 ELECTRJCAL LIGHT DEPT CONSTRUCTION R.W. 1 PWI CONSTRUCTION - R.W. ENGINEERJNG 417-4807 PW 1 ENGINEERJNG FIRE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 "5 /7-0<, ~LC-- BUILDING T:\Policies\1102_15 building permit inspection record05.wpd [1/4/2005] Mar 17 05 09:27a . 2005/MAR/17/THU OS:38 AM ClTY OF PA BLOC DEPT .-AI No. jtiU 41'1 \ HI p.1 r. UU,: I,' 'f'Ol\ omcw..USl ONLY: II 8' . 'BUILDING peRMIT~:~"PR-t&AffON. ...._~_. ~'~;'s'.-'-r,.'-":>5 ! . " . PonniU': c~- t'd' . " ~ .d:..-.l--""-l--lUI-MtJCWl'BE-' ,.~",,,,...."~_"~~""""ll"o"~'-' ..... ~.- ... , ~ . . . r _ " .-. ''1'1l1''tlQt"COM7rsnJ.n'~'IQt'i~~~J'I-~''''--~ ~... ..... O"U!A~IVYDG: i' COMl~lt'I':E to 'be' accepted for re.sew. 'If yo~ l1a... lIDY questiOD5, esll Dl.le ~~ i PDMITS (360)..1'....815 FAX(360)417....711 I ... /. Appli-''''A8='' $hM n.., J._';'. A "J ,e. . Y..; ~ I<:.....!'hono; .::..~o. ::: !-Ii. I ~ otL~. Owner:S h eJ"l. r" ().) r--. ~ /~"(\. .t:....~ ~- '1' l? ..0c- phone: ~ ~ " D - <tn l4>- 100 Address; ql! 0 lollS lOw .~ -r J City: P D"- f- Or c...J-.. ,^r ,,\ Zip: q y .3 ~ Ce- Pbone: ' 'N _.Ar.ehit~tI.Eu~; . ,.eonn-actor.-. -".... . ...... - ." .~. ._. --- .".._-u. ...State.LiceDSC.#:...-............... - ...,&xp:- .--'- -." ...-.llhone:. ..~. . .... ....... .- .... , .., ~:i.J."- ..~,..('.....';-:' . _ Address: ,?'':' t' -.~ Clty~ .., Zlp. FllOJECf ADDJlESS: ~ Cr" ~ W...., i '~.~ S' +- LD -t /7 61 iHtoNrNG: LEGAL DESCRIPI1ON: Lot: I I Block: I '-I- ~ Su'odiviaion: ~J ;;A- 7 S- CLALLAMCOUN1YPARCELNtJMBER: 0 (., :..3 co 0 0 / -, , 000 0 . . '* Credit Card Bolder Name: BiWlllI'A'ddre,s:" q//- ..0j",:\1 c'..v .. ~+ Credit C..... Type ~C # 'lYPE OF 'WOJUC: :J Rl:sidcaba1 C New CoDStt. 0 RD-roof D Stow: SF. @ $ f:>>f. - S l:J M1Ilti--fIlml1y 0 Additioo C Move 0 Gang.= SF. @ S /SF. ... S ' D CoDJlDlll(cial C Remodel ~ Demolition. C Dect. SF. @ S /SF. - S ..- .-. -- .........' O''R.epair'-- - .a'-51ga-' - -.. ..ooQ-<>thcr..-. ....- -- .--...:r-0T2\h'V:AJ:;UA=aeN- -... '$_." ..... ."..........---. n.. .- "..".... llRIEF DESClW'TION OF TBE PROJECT: -~~ ~ t:; ~~. r 1 ~ ~ 9. ~ f\'Ov~ ~ ?Dn...~ oi2-t!.~/~ .c..1~9 COMMl'JlClAlJlt!'.SmaNTIAL: oceujlaney Grouy: 0cGupuar: LoIAJ: ~tiOD Typo: No. of StoIie$: _ Lot S1z.c~ ~ Sq_ Fl. 4lt Pl:OpOlloc1 Sq. Pt. - TOT AI.. Sq. rt. Torallot COYIDgD % _----__0 .. :.Citr:~P ". - J -,.- ".hC'-;"'~ J..." .~rl . .. f.)? ";:.t;. C:. -:., .. . Exp. Date: ~ 1...~ SI2J:IV ALlJAno.N: -.- . 'I' ':,' AJ-mOVALS: PLAN: BLDG: . DPWU: li1RE: OTHER:_ PLANNING USE ONLY: ESAlWetlmd(s); C YCIi C No SEPA OliUlistrequRd? C Yes C No Odw: V ALUA 110JlJ OF CONSTIlUC110N: III all CIiIlS, S \laJuati.DJl unollDt must be entered by the appliCallt. This figun: will 'be nM8Wl!ld d may b~1msed. by !be BWldint DiviAOJI.. to comply with altRDt file IclxdWcs. CDIl1:!lct the PamitCo~t.Dr at 417-42115 for assi~tancc. PLAN CHECK Fa: IF a plaA cJIcek f~e is due it1D1St be submitmd al the time the buiJcJius pemllit appli"tion a:ad conscruitiOll plans are iubmla.ed. All o~ fs:cs are due at cbc time ofpmDit is~. . . OOIRA~O REVIEW: HnD pca:oI.tis iaMld \lnmmlSO days of1llt date ofapp~t:lo:lo the applkat1o.'WW ~ Tho BuiJdlDe Omci.a1 caD ~ the timr; for amOll by 1he app1.lc:am UJI to 180 days 'Upon wnu= ~q~1t by tbf: s.pplieaut (sa: 5miou R1 05.3.2 cf the lJrtemuioJW BuildiDg/.Residal.tisl Colier 2003). No lpplication can be CJaaldcd amc thaD OIlCC. I hereby r;erlify th~f I hBve reed and f1X,.rnin~ thi$ appJicafjon ."d lenD" the same to be true and correr!!. l.em authorized to apply for 1M; penmt and UJldarsfsnd list H. Is my IW$poII$ibility fo a~ wtIllC petf7Ib iW raquIred ,not the CH~, '''C1.Jh8t'1JPtl!st Obtain .well permits pnqr t6 wW-. '!':\R.v~tJ)G..rorms.brtlCllul'ell'\200&-8Ui}I1Jqpcmlit.~ ApplicaD.t: c:: ;??.-r- Date: 0 7 ~ S ~ VIS"'. lfl:l./ 7'1/1 ,,-/3{ fJ7/) .e~r'/'()5 03/?>"-/o"b? - rt&)( ~\-L .J.- 610 - t..( rJ - 471l -JJk U;~. :'i VORT ~ $4.0~~~ rea "-~ ~ "lti~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number pin number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Use Property Zoning , . . Application valuation 04-00000418 Date .355884 1717 W 6TH ST 06-30-00-0-1-4270-0000- RES REMODEL 6/03/04 RS7 RESDNTL SINGLE FAMILY 1225 Owner Contractor YORK, ANGIE/SHANNON 1717 W 6TH ST PORT ANGELES WA 983631719 ( 50) 679-5141 OWNER Permit BUILDING PERMIT -RESIDENTIAL Additional desc REPAIR EXISTING GARAGE Permit Fee 71.40 Plan Check Fee .00 Issue Date 6/03/04 Valuation 1225 Expiration Date 11/30/04 Qty Unit Charge Per Extension BASE FEE 47,00 8.00 3.0500 HND BL-501-2K (3.05 PER C) 24.40 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit F'ee Total 71.40 71.40 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4,50 4.50 .00 .00 Grand Total 75.90 75.90 ,00 ,00 ~ \L J.J ~ ?0J V ,>It,e. .' Jv \,. 0 D. 0 \, r-J..... k?J' . U \,)0' ~ ",..rl ~ ~..- {)7 /\b .....;j Other Fees STATE SURCHARGE 4,50 -- ....:j n "'7 / E ~ ~. 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. 11 -.. Signature of Owner (if owner is builder) Date T:\PLANNING\FORMS\1102.15 [11/14/2003] BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIqE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCA nON. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE. INSPECTION TYPE DATE ACCEPTED COMMENTS YES I NO FOUNDATION: FOOTINGS WALLS FOUNDATION DRAINAGE/DOWN SPOUTS ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # ROUGH-IN PLUMBING UNDER FLOOR 1 SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW 1 WATER AIR SEAL WALLS CEILING FRAMING JOISTS 1 GIRDERS SHEAR WALL/HOLD DOWNS WALLS 1 ROOF 1 CEILING DR YW ALL (INTERJOR BRACED PANEL ONL Y) T-BAR INSULATION SLAB WALL 1 FLOOR 1 CEILING I MECHANICAL HEAT PUMP GAS LINE WOOD STOVE 1 PELLET 1 CHIMNEY HOOD 1 DUCTS PW UTILITIES 1 SITE WORK (Engineering Division) SEPARATE PERMIT #'s: WATERLINE 1 METER SEWER CONNECTION SANITARY STORM PLANNING DEPT. SEPARATE PERMIT #'s SEPA: P ARKING/LIGHTlNG ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRJCAL - LIGHT DEPT. 417-4735 ELECTRJCAL LIGHT DEPT CONSTRUCTION R.W. 1 PWI \ JJ: ~fONSTRUCTION - R.W. ENGINEERJNG 417-4807 PW 1 ENGINEERJNG FIRE 417-4653 t\ 112e. JOT- FIRE DEPT. PLANNING DEPT. 417-4750 ~'I pl\r~( ~I PLANNING DEPT. BUILDING 417-4815 3--/6-0S- leV BUILDING T:\PLANNING\FORMS\1102.15 [11/1412003] BUILDING PERMIT - APPLICATION FOR OFFICIAL USE ONLY: Date Rec.: z::; - I'; - 0,-\ PC1111it # 01./- 9 /8 Date Approved: Date Issued: Fill out COMPLETELY and in INK. Your application and site plan MUST BE COMPLETE to be accepted for review. If you have any questions, call PERMITS (360) 417-4815 FAX(360)417-4711 Applicant or Agent: ~hl't~~,1't\. ..s'f.l.A.IJ,UWl Address: u.J / AA.J61~ L{o.-/c &+"'-. ~~J1'f- Phone: (~o) 9.!:Jr- 3~ 7- (3t'Lo) ijj-J- - 35- '1 t Zip: cP"d' 362 ~ Phone: A x.N1.~ t'/t~JI of Cfcrl<- Phone: Owner: 17-/1 City: p<<--.}- IJA.I)~j,..<: Architect/Engineer: AJDvt..f( Contractor OWAQ/' State License #: Exp: Phone: Address: City: Zip: PROJECT ADDRESS: '1-/1 UJ. &l+l.. S k.p+ FA I ZONING: k51 Rs:,. ~ I 1-1ltJ1, LEGAL DESCRIPTION: Lot: I~t Lt. Block: I '-1'2.... Subdivision: I ?A CLALLAM COUNTY PARCEL NUMBER: 0& - 30 .- nb - D - , - 42- f() - OOOeJ Credit Card Holder Name: Billing Address: Credit CardType VISA TYPE OF WORK: o Residential 0 New Constr. 0 Re-roof 0 Stove o Multi-family 0 Addition 0 Move Ii( Garage o Commercial 0 Remodel 0 Demolition 0 Deck iJi" Repair 0 Sign 0 Other BRIEF DESCRIPTION OF THE PROJECT: Rep.,.e. r-><,s.~.~ f' " I, '" S",~p..i-t.'A) .4-lrI 8,"7 (;.,f.lRA..:;..; L\'"w)'- +6 COMMERCIAL/RESIDENTIAL: Occupancy Group: No. of Stories: -L Lot Size: -~)( ''Ie Existing Sq. Ft. 317- Total lot coverage /, OSlo % City: MC # Exp. Date: SIZEN ALVA TION: SF. @ $ /SF. = $ SF. @ $ /SF. = $ SF. @ $ /SF. = $ TOTAL VALUATION $ rtz...S'.- ~I{ ~'1 (J,,.ifl<""~J t:U9/{ ShHk ~) "PeA..- p~ ~ J<.1"'~5 Occupant Load: Construction Type: ..v~c! & Proposed Sq. Ft. 3.:r-'Z = TOTAL Sq. Ft. 31z. APPROVALS: PLAN: BLDG: DPWU: FIRE: OTHER: PLANNING USE ONLY: ESA/Wetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other: BUILDING PERMIT APPLICATION SUBMITTAL: The Building Division can provide you with information on the application and plan submittal requirements if you have questions. VALUATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applicant. This figure will be reviewed and may be revised by the Building Division to comply with cunent fee schedules. Contact the Permit Coordinator at 417 -4815 for assistance. PLAN CHECK FEE: IF a plan check fee is due it must be submitted at the time the building permit application and construction plans are submitted. All other penllit fees are due at the time of permit issuance. EXPIRATION OF PL'AN REVIEW: Ifno permit is issued within 180 days of the date of application, the application will expire. The Building Official can extend the time for action by the applicant up to 180 days upon written request by the applicant (see Section 107.4 of the Uniform Building Code, cunent edition). No application can be extended more than once. I hereby certify that I have read and examined this application and know the same 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 ,not the City's, and that I must obtain such permits prior to work. nFORMSIAPPSIB,i1d;ogp'mi<.wpd APpli,"nt~L -7""- Dot" ~ /7 Z6cf 84] &/ . 20 Feet Vertical Datum = NA VD 88 Horizontal Datum == NAD 83/91 N Area Map This map is not intended to be used as a legal description. This map/drawing is produced by the City of Port Angeles for its own use and purposes. Any other llse of this map/drawing shalf not be the responsibility ~rthe City. CLALLAM COUNTY OFFICE OF COUNTY ASSESSOR CLALLAM COUNTY COURTHOUSE 223 EAST FOURTH STREET, SUITE 2 PORT ANGELES, WASHINGTON 98362-3015 FAX (360) 417-2299 PHONE (360) 417-2204 E-mail: lowings-rosenburgh@co.c1allam.wa.us LINDA OWINGS-ROSENBURGH, ASSESSOR FOR CITY USE ONLY PARCEL #S REQUEST TO CONSOLIDATE/SEGREGATE THIS REQUEST IS TO CONSOLIDATE 0 SEGREGATE if' () ~,3 0 00 - (\ I -+ ~ 7 () LAND ONLY 0 LAND & BUILDINGS ~ LAND ONLY 0 LAND ONLY 0 LAND ONLY 0 LAND ONLY 0 LAND & BUILDINGS 0 LAND & BUILDINGS 0 LAND & BUILDINGS 0 LAND & BUILDINGS 0 REQUESTED BY SJlc,nno.,J '11 ()IL:~ ~L<~L / / /=1 VI ~~EI, ;_ '-( QR_~ ,/,/ .(/' ~~ /r" ./ (To be signed by all owners) PHONE NO, 5 (., () Lj 5'? 3 s "1 7' DATE /2 ~ LbCJ y' Please have this acknowledged by the appropriate department before returning to theAssessor's Office for processing ........................................................ H f)lcJ ~-~~ Nee,c)S\~r - ?-ev V\I' I r ;-0 or N2 uJ tfe;qs 0 ...... .. I ***DISCLAIMER *** Any changes made by the Assessor's Office are for 1 _ F, rst I to request the Assessor's Office to segregate/consolidate these parcels mayor may not affect present or future ability to build or subdivide the subject land. Please contact the City of Sequim Planning Dept, the City of Port Angeles Planning Department or the City of Forks Planning Department (depending where your property is located)regarding the future consequence of segregating/consolidating these parcels. CITY PLANNING D~. ~ SIGNED BY '.. , DATE 5J:/otr CITY CODE (If applica Ie) PROCESSED BY DATE RECEIVED IN OFFICE DATE J:\Users\lowings\ASSESSOR FORMS - MADE BY OUR OFFICE\REQUEST TO SEG OR CONSOLICATE_CITY.doc Shannon and Angie York 1717 W. 6th Street P~rt Angeles, Washington 98363 City of Port Angeles 3fl E. 5th Street P<frt Angeles, Washington 98362 [R1 [E~m [E ~ MAY 2 1 2004 I CITY OF PORT ANGELES I .E! p! ...~~!S'::o ~ rn!! ~i!y"~_~~elop.~:_nt May 21,2004 To Whom It May Concern: As per-the-request of t:heCity of Port~. p~ and-COUUllWU!,y Oevelopment Department and BradC~we are submitting this letter concerning the segregation of our property known as parcel # 063000014270 Lot 16&17, block l42TPA. Wejhe,owners.ofabove f':Irr.p.1" agree.nauo. selLeither pr~ untila..bu4ding permit has been submitted for the plot onwhiclrtheJ~ara,ge'is locatedorthe-~is-~ from the lot in order to make the lot confonning. .~ Sincerely: ~~ / ~ L (c::l---- Angie York SbannonYork '" '\J "". ~ t ('. ~ ~ N- ["/ MEMO DEPARTMENT OF ECONOMIC & COMMUNITY DEVELOPMENT Brad Collins Manager 417-4751 Sue Roberds Assistant Planner 417-4750 Scott Johns Associate Plallller 417-4752 Roger Vess Permit Technician 417-4712 Jim Lierly Building Inspector 417-4816 FORTANGELES WAS H I N G TON, U. S, A, DATE: February 14,2005 TO: Shannon and Angie York FROM: Sue Roberds, Assistant Planner RE: 1717 W, 6th Street Director Collins asked me to provide you with information that we have in the building permit files relative to the development of Lot 17, Block 142 TP A. I have enclosed the agreement that you signed in May, 2004, that enabled you to segregate your property in the manner that you planned at that time. Upon reading the statement, you will note that you agreed that neither lot would be sold without the nonconforming lot being made conforming by either relocation of the garage to Lot 16, the construction of a residence on Lot 17, or demolition of the garage, I know this information is not what you were hoping to hear, but it is nevertheless what is in the files and what we have to work with, Please let us know if you have further questions. Enclosure - .j - --.) < 6' -t ;- 4---- 4' I :0 13' Distance From Bounderys . I~ ~ 107' ':\ Site View r I 2 " I I 38' ' r:;' l f'~ Y . I .j , Db t..., \.--- 1-:' ~~ -t { e~ e. t- 50' 140' Ii:>... Shannon and Angie York 1717 West 6th Street Port Angeles, Washington 98363 May 12, 2004 Existing Garage Wall Repair A Garage located at the above address is in need of repair due to age and rot. The top half of the structure is sound, however, the lower wall studs and sheeting are in need of repair. There is an existing perimeter foundation to begin the repair from. The following are a list of items in need of repair along with the proposed repair solutions: 1. Pressure Treated 2"x4" mud sills should replace the existing rotted 2"x4" mudsill that touches the cement foundation. These should be fastened to the floor with bolts and washers and nuts. 2. All existing 2x4 wall studs on 2' centers need to be replaced with 2x4 studs of equal length and placed on 16" centers. These should be nailed to the mudslide and a new double top plate should be installed on the East and West walls to replace boards that appear in poor condition due to age. 3. Existing sheeting of lx6 shiplap siding needs to be removed and replaced with rated LP SmartPanel siding 8"OC and nailed at 6" intelVals on the edges and 12" in the centers with galvanized nails. 4. Front of garage needs to be filled in with studs and sheathing to eliminate the 18' free span and an 8'xT standard garage door installed. The existing header is a double 2"x6" on the gable end of the building. 5. A man door should be placed at the rear of the structure to replace the old door that is rotted and in 3 separate pieces. This door will have a double 2"x6" header and a Kwickset Locking handle. 6. Trim should be placed around all openings and comers for aesthetics. 7. Z-Flashing should be placed on edges of panels if more than one panel is needed vertically 8. Top portion of building on gable ends are not changing structurally. Veneer needs to be replaced and overlapped over new siding to form a weather tight seal. Expenses: Lumber Siding Cement Nails and Mise 60 20 6 yards 2x4 4x8 sheet 180.00 550.00 395.00 100.00 1225.00 C'7\~ FILE 2ncj ~:~e~o:L~;~t:on, fJ!.!.~:itJ:S 'cero!J , 0, r. "d, ilit3'-IC~tTg . carried on th,s:ecnde'~' ..\,~,'~'.',' ,I C:-I,'lpr~-_irl:'''l f)rrl _ , _ _ ,\ '11,:.;/ in _ '~;'-':~ ",~_' _, _lo,lnr.:r:ces of tllfS JUrisdiction ~;)~~~g Corle.) /J / . ---LBy _~ Ft:,"'j')'b'j} Dale ;it 1717 W. 6th Street Existing Garage Repair ,1 8'-10" /r 9'-9" 1, 8CO" x 7'-0" OHD I I I I I I I I I I___________J I b -' c C\I I Cement Slab I I\) c .- f 9'-8" td J 8'-11" 1 J J '[ii (i CITY OF PORT ANGELES PUBLIC WORKS - ELECTRICAL DIVISION 121 EAST 5TH STREET. PORT ANGELES. WA 98.162 Application Number pin number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Use Property Zoning . . . Application valuation 04-00001207 Date .995092 1717 W 6TH ST 06-30-00-0-1-4270-0000- ELECTRICAL ONLY 1/04/05 RS7 RESDNTL SINGLE FAMILY o Owner Contractor YORK, ANGIE/SHANNON 1717 W 6TH ST PORT ANGELES WA 983631719 ( 50) 679-5141 OWNER Permit Additional desc Permit Fee Issue Date Expiration Date ELECTRICAL NEW ~ESIDENTIAL 200 A SERVICE 78.70 Plan Check Fee 1/04/05 Valuation 7/03/05 .00 o Qty 1. 00 Unit Charge Per 78.7000 ECH EL-RM-0-200 1ST SRV FEEDER Extension 78.70 ............. "'-J Fee summary Charged Paid Credi t-ed Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 78.70 78.70 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 78.70 78.70 .00 .00 --- ............\ (" ( (\', \-~ . -(-, (P. .'1 COMMENTS! ACTION NEEDED ELECTRICAL PERMIT INSPECf,lON RECORD CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULA TE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE ACCEPTED COMMENTS YES I NO UnCl1. IHlIlr.-H-IN I LJV,hK ;S~K V lC~ I 7#' (-::' ...~_.. Arf.J 1-<'1'" A I I . IA. ,'~/ I /ttfU 1 -...... GENERAL COMMENTS: PW-II02.1S (4196] " ",":-'" rf pORT ~ 'Ii'~~"" Uha" "'--~ ~ ~W? CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number Pin number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Use Property Zoning . . . Application valuation 04-00001185 Date .754665 1717 W 6TH ST 06-30-00-0-1-4270-0000- PLUMBING REPAIR 12/20/04 RS7 RESDNTL SINGLE FAMILY 1500 Owner Contractor YORK, ANGIE/SHANNON 1717 W 6TH ST PORT ANGELES WA 983631719 ( 50) 679-5141 OWNER Permit Additional desc Permit Fee Issue Date Expiration Date PLUMBING PERMIT ADD BATHROOM 68.00 12/20/04 6/19/05 Plan Check Fee Valuation ,00 o Qty Unit Charge Per Extension 47,00 21,00 BASE FEE 3.00 7,0000 ECH PL- EA,FIXTURE ON ONE TRAP Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 68.00 68.00 .00 .00 Plan Check Total .00 ,00 .00 .00 Grand Total 68.00 68.00 .00 .00 -:J \J -...:J ..... ~" ~ ~ r ~' ~ ....::; 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. _~!- C; ~ Signature of Contrattor or Authorized Agent IZ/~~i Date Signature of Owner (if owner is builder) \ \ \.\ Date T:\PLANNING\FORMS\1102.15 [11/14/2003] BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL 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 FOUNDATION: FOOTINGS WALLS FOUNDATION DRAINAGEIDOWN SPOUTS ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # ROUGH-IN I I PLUMBING UNDER FLOOR 1 SLAB ROUGH-IN J_lq-n'" j L WATER LINE (METER TO BLDG) GAS LINE BACK FLOW 1 WATER AIR SEAL WALLS CEILING I FRAMING JOISTS 1 GIRDERS SHEAR W ALL/HOLD DOWNS WALLS 1 ROOF 1 CEILING DRYWALL (INTERJOR BRACED PANEL ONLY) T-BAR INSULATION SLAB I WALL 1 FLOOR 1 CEILING I I MECHANICAL HEAT PUMP GAS LINE WOOD STOVE 1 PELLET 1 CHIMNEY HOOD 1 DUCTS PW UTILITIES I SITE WORK (Engineering Division) SEPARATE PERMIT #'s: WATERLINE 1 METER SEWER CONNECTION SANITARY STORM PLANNING DEPT. SEPARATE PERMIT #'s SEPA: P ARKING/LIGHTING ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRJCAL - LIGHT DEPT. 417-4735 ELECTRJCAL LIGHT DEPT CONSTRUCTION R.W. 1 PWI CONSTRUCTION - R. W. ENGINEERJNG 417-4807 PW 1 ENGINEERING FIRE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 ; _ 1.-1, - O~.... J.1.J BUILDING T:\PLANNING\FORMS\1102.15 [11/14/2003] BUILDING PERMIT - APPLICATION FOR OFFICIAL US1 ON) Y: Date Rec.: 12. '2.0 e.1 Pelmit#: oLI - 1I6s' Fill out COMPLETELY and in INK. Your application and site plan MUST B COMPLETE to be accepted for review. If you have any questions, call PERMITS (360) 417-4815 FAX(360)417-4711 Date Approved: Date Issued: Applicant or Agent: SJlAN~ ; 4j;~ Owner: ~,q U~ ~'4A~/~ Cfork Address: I ~ It 0.) < (OU-. /f/k. Phone: 3~() t.f 71 olJ 85 Phone: ~ if 11 (')yr~3 aA- Zip: 9' g.3c{, S City: ~I ,-4~PJz<,,, Architect/Engineer: Contractor Phone: State License #: Exp: Phone: Address: City: Zip: PROJECT ADDRESS: 1:11--:f W. ~ st. ZONING: LEGAL DESCRIPTION: Lot: ;}" Block: J 4 L Subdivision: fA T6w.... s.k CLALLAM COUNTY PARCEL NUMBER: 0(03 ab(l - 014 7 1-b t Zab"f A v' I L q J ZQ6 ) Credit Card Holder Name: Billing Address: Credit Card Type VISA TYPE OF WORK: lX'Residential 0 New Constr. 0 Re-roof o Multi-family 0 Addition 0 Move o Commercial ~ Remodel 0 Demolition o Repair 0 Sign BRIEF DESCRIPTION OF THE PROJECT: .1'+R,.H'j..~l. C ~A"<('$_ COMMERCIAL/RESIDENTIAL: Occupancy Group: City: MC # Exp. Date: o Stove o Garage o Deck o Other A.-V NELJ SIZENALUATION: SF. @ $ ISF. = $ SF. @ $ ISF. = $ SF. @ $ ISF, = $ TOTAL VALUATION $ .$ JSlJO- 64""'''--1''".___ ,.... (. IA~ :Sr~<t. /N6 , Occupant Load: Construction Type: & Proposed Sq. Ft. fcAo = TOTAL Sq. Ft. /OY" No. of Stories: ---1- Lot Size: $o;t..f\.Io Existing Sq. Ft. itOtlb Total lot coverage Jr." % APPROVALS: PLAN: BLDG: DPWV: FIRE: OTHER:_ PLANNING USE ONLY: ESAlW etland( s): 0 Yes 0 No SEP A Checklist required? 0 Yes 0 No Other: BUILDING PERMIT APPLICATION SUBMITTAL: The Building Division can provide you with information on the application and plan submittal requirements if you have questions. VALVA TION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applicant. This figure will be reviewed and may be revised by the Building Division to comply with current fee schedules. Contact the Permit Coordinator at 417 -4815 for assistance. PLAN CHECK FEE: IF a plan check fee is due it must be submitted at the time the building permit application and construction plans are submitted. All other permit fees are due at the time of permit issuance. EXPIRATION OF PLAN REVIEW: Ifno permit is issued within 180 days of the date of application, the application will expire. The Building Official can extend the time for action by the applicant up to 180 days upon written request by the applicant (see Section RI05.3.2 of the International BuildinglResidential Code, 2003). No application can be extended more than once. I hereby certify that I have read and examined this application and know the same 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 ,not the City's, and that I must obtain such permits prior to work. HRVESS\BLDG-fo=-bm,b",,,~OO3-B"i1di"gpomi'.wpd Appl;,<mt, d' - ~ D,te, I zL../o( '0 '0 I:""' I:""' 10 N 10 o 0 f-' f-' tf-'f-' ............ NNf-' 0010 ...... ...... ...... 00 1.111.111.11 \ iJ;t>!:.< '01:""' . 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Application valuation 5/28/04 RS7 RESDNTL SINGLE FAMILY 1200 Owner Contractor YORK, ANGIE/SHANNON 1717 W 6TH ST PORT ANGELES WA 983631719 ( 50) 679-5141 OWNER Permit Additional desc permi t Fee Issue Date Expiration Date BUILDING PERMIT TEAR OFF, FELT, 68.35 5/28/04 11/24/04 - NO PR FEE COMP Plan Check Valuation Fee .00 1200 Qty Unit Charge Per Extension 47.00 21. 35 BASE FEE 7.00 3.0500 HND BL-501-2K (3.05 PER C) Other Fees STATE SURCHARGE 4.50 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 68.35 68.35 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.50 4.50 .00 ,00 Grand Total 72,85 72.85 .00 ,00 --:l -.J c G" "':i S 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 autho~ty to violate or cancel the P:ZOViSi ~Of Y state or local law regulating construction or the performance of construction. /..---;/' y""'" .-'"} -.:/ ,,/ l/ ~ ) 2 P c. _J t:;-- v'l "'" \ ~ignature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Da~, ". T:\PLANNING\FORMS\1102.15 [11/14/2003] BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL 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 FOUNDATION: FOOTINGS WALLS FOUNDA TlON DRAINAGE/DOWN SPOUTS ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # ROUGH-IN I PLUMBING UNDER FLOOR 1 SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW 1 WATER AIR SEAL WALLS CEILING I FRAMING JOISTS 1 GIRDERS SHEAR WALL/HOLD DOWNS WALLS 1 ROOF 1 CEILING DRYW ALL (INTERJOR BRACED PANEL ONLY) T-BAR INSULATION SLAB WALL 1 FLOOR 1 CEILING MECHANICAL HEAT PUMP GAS LINE WOOD STOVE 1 PELLET 1 CHIMNEY HOOD 1 DUCTS PW UTILITIES 1 SITE WORK (Engineering Division) SEPARATE PERMIT #'s: WATERLINE 1 METER SEWER CONNECTION SANITARY STORM PLANNING DEPT. SEPARATE PERMIT #'s SEPA: PARKING/LIGHTlNG ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRJCAL - LIGHT DEPT. 417-4735 ELECTRJCAL LIGHT DEPT CONSTRUCTION R.W. 1 PWI CONSTRUCTION - R.W. ENGINEERJNG 417-4807 PW 1 ENGINEERJNG FIRE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 I i 11 -/6 -r) i.f .Ll BUILDING T:\PLANNING\FORMS\1102.15 [11/14/2003] , , , , , , , :i ' '" , , >-' , a-, , '- k: :-f! ' t-< , t-< , , , , , , , , , , , o o 3: 3: "' Z >-3 Cl) ~ tI Z o >-3 "' Cl) tJ:l t-< '" '" >-3 "', ~ ~ Cl) H o >-l o >-' ~~ GlH Ht-< "'t:J H 'Z Gl ~ O:uo 0",'" 3:0 'd0::0 t-<",O ",Cl) >-3 >-3 III "'"'e:: tlt:J.... 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Installation descripti.on Job wired by o Electrical Contractor jli{ Owner License number 200 A.MP A l+Jtr"-.\ 0,... ' v-..t f... Electrical contractor name 1+1'1- W. u.~ Purchaser's mailing address p.",~ (J.~o 1."-. City ~. it)" ~ ~ "3iP"? State ZIP Cr\Ov"1L (->tI.-N 6- ( TO Telephone number 3W-'t1-I-O<j'll3 M Premises owner's name ~Ql-\ANw-OD L. Ynt'k.. Address of inspection lQ~ FAX number rl\.JT<" I fl r;: itl\- Citr s), It 131#5 o Cash 0 Check # I hereby certify that I am the owner of the above named property or a licensed electrical contractor (or the finn's authorized agent) and am making the electrical installation or alteration in compliance with the electrical law, Chapter 19.28 RCW. o Credit Card Card # Visa Mastercard Discover ---------------- Signature of owner, electrical contractor or electrical administrator x.---.LS L --Z Expiration Date of card - Approved By ./ tJ.!'V THERMOSTAT "- Date Approved By .I / DITCH Dale Approved By-../ SERVICE '( , CEILING Insulation Only )-7-0<; Date *-9) Approved WALLS insulation Only Approved By FEEDER Date Approved By Dale Cover Cover Dale Approved By Dale / \. Dale Approved By "- Service Information Electrical Load Additions and or subtractions llll NO LOAD CHANGES o Baseboard KW o Furnace ~ KW o Heat Pump ~ Ton _ LAR o Fan-Wall KW Inspection Area, Building or Equipment Inspected Action Taken Electrical pate / Inspector ,-qUi /o/f oL- ~ S' ot-f2.- flllC< ":.-r., \?M~<- 'i i ,~.-.., ~ fP'\b+~ u/ A II - - . , I /J M.k4 ., T/l-rVJ \He:... !\?.cJd+(I~ , /.1",_ '" , . ~. Overhead Service o Temp Service o Underground Service Voltage Phase0103 Service Size: __ Feeder Size: /1/1/( ) ,.. /~/J/_J I.