HomeMy WebLinkAbout1936 W 5th St - BuildingPREPARED 8/05/08 10 06 55 INSPECTION TICKET PAGE 5
CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 8/05/08
ADDRESS 1936 W 5TH ST SUBDIV
TENANT NBR ROBERT CATES
CONTRACTOR PHONE
OWNER ROBERT J CATES PHONE (360) 452 -4926
PARCEL 06 30 00 9 0 0230 0000
APPL NUMBER 08 00000813 RE ROOF
PERMIT BNOP 00 BUILDING PERMIT NO PR FEE
REQUESTED INSP DESCRIPTION
TYP /SQ COMPLETED RESULT RESULTS /COMMENTS
BL99 01 8/05/08
r r
L77
BLDG FINAL
August 5 2008 9 53 47 AM 1pangrle
ROBERT 452 4926
BLDG FINAL RE ROOF DETACHED GARAGE
THE PERMIT IS POSTED ON THE GARAGE
ENTER FROM THE ALLEY SIDE
COMMENTS AND NOTES
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER
Tenant nbr name
Application type description
Subdivision Name
Property Use
Property Zoning
Application valuation
Application desc
TEAR OFF RE ROOF GARAGE
Owner Contractor
ROBERT J CATES
PO BOX 2198
PORT ANGELES
(360) 452 4926
WA 98362
T.FormslBuilding Dvision/Building Permii (10/01l07).wpd
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET PORT ANGELES, WA 98362
08 00000813
201747
1936 W 5TH ST
06 30 00 9 0 0230 0000
ROBERT CATES
RE ROOF
RS7 RESDNTL SINGLE FAMILY
2000
OWNER
Date 7/09/08
Permit BUILDING PERMIT NO PR FEE
Additional desc TEAR OFF RE ROOF GARAGE
Permit pin number 129742
Permit Fee 95 75 Plan Check Fee 00
Issue Date 7/09/08 Valuation 2000
Expiration Date 1/05/09
Qty Unit Charge Per Extension
BASE FEE 50 00
15 00 3 0500 HND BL -501 2K (3 05 PER C) 45 75
Other Fees STATE SURCHARGE 4 50
Fee summary Charged Paid Credited Due
Permit Fee Total 95 75 95 75 00 00
Plan Check Total 00 00 00 00
Other Fee Total 4 50 4 50 00 00
Grand Total 100 25 100 25 00 00
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Separate Permits are required forelectrical 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 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 lam regulating co stru or the performance of
construction.
y- R,czr—/
Date U Print Name Signature of Contractor or Authorized Agep(
Signature of Owner (if owner is builder)
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 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
FOUNDATION-
FOOTINGS
SHEAR WALLS WALLS
FOUNDATION DRAINAGE DOWN SPOUTS
PIERS
POST HOLES (POLE BLDGS.)
PLUMBING
UNDER FLOOR SLAB
ROUGH -IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS ROOF CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T -BAR
INSULATION
SLAB
WALL FLOOR CEILING
MECHANICAL
HEAT PUMP /FURNACE /DUCTS
GAS LINE
WOOD STOVE PELLET CHIMNEY
COMMERCIAL HOOD DUCTS
MANUFACTURED HOMES
FOOTING SLAB
BLOCKING HOLD DOWNS
SKIRTING
BUILDING PERMIT INSPECTION RECORD
ACCEPTED
YES NO
FINAL
PLANNING DEPT SEPARATE PERMIT H's SEPA.
PARKING /LIGHTING ESA.
LANDSCAPING SHORELINE.
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL
ELECTRICAL LIGHT DEPT 417 -4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W PW/ CONSTRUCTION R.W
ENGINEERING 417 -4807 1 PW ENGINEERING
FIRE 417 -4653 I I I I FIRE DEPT
PLANNING,DEPT 417 -4750 11, �y I I I PLANNING DEPT
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BUILDING 417 -4815 I S UPS 17-1.--L- I I BUILDING
T Forms /Building Division/Building Permit (10 /01 /07).wpd
COMMENTS
DATE ACCEPTED BY.
FINAL DATE ACCEPTED BY.
DATE
ACCEPTED
YES I NO
09
Parcel Number
Project Type Brief Desc
Check all that apply
New Construction
Addition
Remodel
70e-roof
Demolition
Heat System
Floor Areas
Basement
1St Floor
2 Floor
3 Floor
Garage
Carport
Covered Porch
Deck
Shed
Other
Date O P rint Name
BUILDING PERMIT APPLICATION Print in ink
CITY OF PORT ANGELES
Attn. Building Permit Technician
321 E. Fifth St. Port Angeles WA 98362
(360) 417 -4815 fax (360) 417 -4711
Applicant or Agent
Property Owner
Property Owner's Address
Contractor /Engineer a //i/2 V
Contractor /Engineer's Address
License
notion.
r
�t/•e
.far -2
/936 z✓ sue— s
PROJECT ADDRESS YS6 4 5'
Heat pump wood burning clove o dace
Existing (sq. ft.) Proposed (sq. ft.)
Total footprint of structures sq ft. Lot size
T Forms/Building vision /Bldg Permit Appl 2006 Code doc,
Max. height of proposed structures ft. Occupancy group
Will a lawn sprinkler system be installed? Occupant load
Will a fire sprinkler system be installed? Construction type
For City Use Only
Date Received 7
Permit# ()R –`813
Date Approved
Phone 3Co
Phone
)1 4 733'
Phone 0
Expires
Lot Zoning
,r�Residential Commercial Multi- family Industrial
s rso P M 7 do/iLe47.S /74-,
Signature
et stove other
V� per sg ft.
sq ft. Lot coverage
of bedrooms
of full baths
of half baths
TOTAL VALUATION -7g59iU
1 have read and completed this application and know it to he true and correct. I am authorized to apply for this permit and
understand t at it is my responsibility to determine what permits are required, and to obt permits prier to ty ding on
projects
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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
04-00000595 Date
.480820
1936 W 5TH ST
06-30-00-9-0-0230-0000-
RES ADDITION
7/16/04
RS7 RESDNTL SINGLE FAMILY
3900
Owner
Contractor
CATES FAMILY TRUST
212 WHIDBY AVE
PORT ANGELES
OWNER
WA 983626542
Structure Information
Construction Type
Occupancy Type
Other struct info
NEW STICK FRAMED ROOF & PORCH
TYPE V NON-RATED
SINGLE FAM & CONGREGATES
TOTAL % LOT COVERAGE
CONSTRUCTION TYPE
HARD SURFACE AREA
NUMBER OF STORIES
EXISTING LOT COVERAGE
LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE
NUMBER OF UNITS
COVER
16.10
V-N
1. 00
1091.25
7000.00
36.00
1127.25
1. 00
_.
Permit BUILDING PERMIT -RESIDENTIAL
Additional desc
Permit Fee 120.75 Plan Check Fee 48.30
Issue Date 7/16/04 Valuation 3900
Expiration Date 1/13/05
Qty Unit Charge Per Extension
BASE FEE 92.75
2.00 14.0000 THOU BL-2001-25K (14 PER K) 28.00
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Special Notes and Comments
When roof gutters are installed. drains will located in dry
wells or piped to approved storm drain locations.
Proposal is to cover an existing porch for a total lot
coverage of 16%. No land use issues are noted.
Electrical load calculations and elctrical permits are
required.
Any modifications to the City'S electrical facilities will
be at the customer's expense.
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Other Fees
STATE SURCHARGE
4.50
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~
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 120.75 120.75 .00 .00
Plan Check Total 48.30 48.30 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 173.55 173.55 .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 stat ocal law regUla~ing nstr tion or the performance of
construction.
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Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T:IPLANNINGIFORMSI! 102.15 [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.
I INSPECTION TYPE DATE ACCEPTED COMMENTS
YES I NO
FOUNDATION:
FOOTINGS '7 - 'J.'l-,J'j. I L
WALLS ~
FOUNDATION DRAINAGEIDOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW / WATER
AIR SEAL
WALLS
CEILING I I
FRAMING R<!V+ 8hQ4fhll'l~ fj-;0-01 J..l,.
JOISTS / GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS / ROOF / CEILING >? - -g) -() J.I ,) Ll- ~~7.U'j'''1- ? -(1-~'#1 r+e ..~ I. L-
DRYW ALL (INTERJOR BRACED PANEL ONL Y)
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILING Ii J -::l-~ -0--1 I. L I
MECHANICAL
HEAT PUMP
GAS LINE
WOOD STOVE / PELLET / CHIMNEY
HOOD / DUCTS
PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT #'s:
WATERLINE / METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'s SEPA:
PARKING/LIGHTING 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. / PW/ CONSTRUCTION - R.W.
ENGINEERJNG 417-4807 PW / ENGINEERJNG
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 Ii!i -Q7~t)..J ~\.L. BUILDING
T:\PLANNINGIFORMSII 102.15 [11/14/2003]
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CITY OF PORT ANGELES
DEP ARTMENT 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
04-00000595 Date
.480820
1936 W 5TH ST
06-30-00-9-0-0230-0000-
RES ADDITION
9/15/04
RS7 RESDNTL SINGLE FAMILY
3900
Owner
Contractor
CATES FAMILY TRUST
212 WHIDBY AVE
PORT ANGELES
OWNER
Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
ELECTRICAL ALTER RESIDENTIAL
200A ALTER+BRANCH CIR.
66.90 Plan Check Fee
9/14/04 Valuation
3/14/05
.00
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WA 983626542
Structure Information
Construction Type
Occupancy Type
Other struct info
NEW STICK FRAMED ROOF & PORCH COVER
TYPE V NON-RATED
SINGLE FAM & CONGREGATES
TOTAL % LOT COVERAGE
CONSTRUCTION TYPE
HARD SURFACE AREA
NUMBER OF STORIES
EXISTING LOT COVERAGE
LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE
NUMBER OF UNITS
16.10
V-N
1. 00
1091.25
7000.00
36.00
1127.25
1. 00
Qty
1. 00
Unit Charge Per
66.9000 ECH EL-R OR RM 0-200 ALT SRV FDR
Extension
66.90
Special Notes and Comments
When roof gutters are installed, drains will located in dry
wells or piped to approved storm drain locations.
Proposal is to cover an existing porch for a total lot
coverage of 16%. No land use issues are noted.
Electrical load calculations and elctrical permits are
required.
Any modifications to the City'S electrical facilities will
be at the customer's expense.
Other Fees
STATE SURCHARGE
4.50
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 66.90 66.90 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 71.40 71.40 .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 Owner (if owner is builder)
Date
Signature of Contractor or Authorized Agent
Date
T:\PLANNING\FORMS\1102.15 [11114/2003]
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 DRAJNAGE/DOWN SPOUTS ~. I' . /'")
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # f) ~ IL~~'~ Iv-e-~.........,V~ b 'C......~
ROUGH-IN 1&- / 'Z:-.dA ~f( I rrl f'iJ-Ji.-. S. t...i..C.... '"-D-1.A-Y1 1\
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 W ALL/HOLD DOWNS
WALLS 1 ROOF 1 CEILING
DRYWALL (INTERJOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL 1 FLOOR 1 CEILING I I
MECHANICAL
HEAT PUMP
GAS LINE
WOOD STOVE 1 PELLET 1 CHJMNEY
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/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
/J YES NO
ELECTRJCAL - LIGHT DEPT. 417-4735 lie.!, Is-()(t IlOC 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 BUILDING
T:\PLANNING\FORMS\I 102.15 [11/14/2003]
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BUILDING PERMIT - APPLICATION
FOR OFFICIAL USE ONLY:
Date Rec.: 7-Z-~
Permit #: {")i.J ~
Date Approved: . \0 Oi
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, calI
PERMITS (360) 417-4815 FAX(360)417-4711
Appl ieanl 0' ~lJ? 0 (" v- f (' "'" t.,"l
Owner: .l<'~) bl"'v-+ eC>-~C"-5
Phone: '--I ~ ~cl -~' d./ ~----
Phone:
City: C~y t Akl-7eks
Phone:
Zip: 7Ai' 3b ~
Address: .;} I d, L0 ~ \ c\ .....)
Architect/Engineer:
c
Contractor ~-"- Jiv"- '('
State License #:
Exp:
Phone:
City: oL
W 5
Zip:
Address:
PROJECT ADDRESS: 1'130
LEGAL DESCRIPTION: Lot: -I!!IIf;' q
CLALLAM COUNTY PARCEL NUMBER:
ZONING:
Block:~ Subdivision: A lJ. '" t: II ~
cCo3cco qOOJ.~(j ~~
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 0 Demolition
o Repair 0 Sign
BRIEF DESCRIPTION OF THE PROJECT:
City:
Exp. Date:
o Stove
o Garage
o Deck
o Other
t0 c:.. ~
SIZEN ALUATION:
SF. @ $ /SF. = $
SF. @ $ /SF. = $
SF. @ $ /SF. = $
, 1;OTAL.vAL~ATION . $ 39oD. tJ(?
R 60 f-- ~ .s; 6 ~ f~sJ'I. c.^ lie. ,-
~
COMMERCIALIRESIDENTIAL: Occupancy Group: Occupant Load: Construction Type:
No.ofStories:--L Lot Size: 50 I<.. Existing Sq. Ft. (Oil ,'5 &ProposedSq.Ft. 3C,.C) =TOTALSq.Ft. '/1-7 :'-::
Total lot coverage , ~ t I %
ESAlWetIand(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other:
APPRO V ALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:
PLANNING USE ONLY:
BUILDING PERMIT APPLICATION SUBMITTAL: The Building Djvision 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 jt must be submitted at tIle time the building perrrrit application and construction plans are
submitted. All other pemrit fees are due at the time of permit issuance.
EXPIRATION OF PLAN REVIEW: Ifno pemrit is issued witlrin 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 Ulliform 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 correc .
understand that it is my responsibifity to determine what permits a.re '~e., ~ the itY's~~n3JI1at I st obt
T:\FORMS\APPS\BU11dmgpermlt.wpd Apphcant:~ . ?( L .
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authorized to apply for this permit and
'n such permits prior to work.
Mr. Robert G. Cates
212 \\1lldbv Ave.
Port Angeles. WA 98362-6542
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CITY OF PORT f'NGELES - ConstNction Plana
The Issuance of th~ permit based upon the~ plans, specifi-
cations and other d'Bta shall not prevent th. bl!i:Jing official
from thereafter re4uiring the correction f. errors in said
plans, specifications and other data. or lrom preventing
building operations being carried on theJeunder when in
vioj:1tion of all codes and ordinances 01, this juri
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212 Whidby Ave.
POIt Angeles. W A 98362-6542
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Mr. Robert G. Cates
212 Whidby Ave.
Port Angeles. WA 98362-6542
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212 Whidby Ave
Port Angeles WA 98362-6542
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IElECTR~CAl ~NSPECTION
WiRING REPORT
417-4735
DATE
PERMIT"
~ INs7f~)
/C;-12~OV . [<)'f-Stj~
OWfl;r;;::;r CdbJ
ho~ss ~ 91-_
LLi3~W,S.\)_
APPROVED NOT APPROVED
o ................... DiTCH ................... 0
o .............. ROUGH iN/COVER. . ... . .. . ..... 0
o .................. SERVICE .................. D
D .................... FiNAL. . . . . . . . . . . . . . . . . . .. D
......-. n ' .-
CORRECTiONS NEEDED:. .1//2.('''l ,-I( C .I!,'<LII~J} ~
'1 ,0 ()
Q.... J\ " .r ^_' "yVlvl.......J K..,,-;cV ..j # (; o/~e..
I I t'YJ Jt-t.~~q l.vU!;t. jJ Y;ce"", ~'" ;.-1t.~
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NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
- DO NOT REMOVE -
OLYMPIC PRINTERS, INC. (360) 452-1381
Property Owner:
ELECTRICAL PERMIT APPLlCATIOr"
!'Ok OFFICI A!. USE O~IL Y I'
IJdlclJ.;oc _____.__,
I'~""il~ ._.~_."_~_ _.__.__
11'loAlll'r<,'~,l
Valr 15>u~J "._.______
The Electrical Permit Application must be filled out complelefv.
Please type or reprint in ink. If you have any questions, please call (360) 417-4735
Fax number: {360} 4174711
0'1 -595
C 6.J'CO-5
'-/5"-5.,..,:r-
Phone: ~ ol ~-.J
Fax:
Phone:
Address:
City:
g~f-.
A..., f e.,[p~.,
wJ.c
Zip: '183 (., ;Z
Electrical Contractor:
License #:
Exp:
Phone:
Address:
,
City:
Zip:
INSTALLATION WIRED BY:
M-oWNER
o ELECTRICAL CONTRACTOR
/21 ()-vJ... ~ D~
~
Credit Card Holder Name:
Billing Address:
City:
Zip:
Credit Card Number:
Exp. Date:
5-1-h
'J<.. '-4 ~
~ - u,
VISA: MC:
PROJECT ADDRESS: 1'13(,.
w
TYPE OF WORK:
Check;:ill that apply:
DNew
&bIteration/Addition
tS-Residential 0 Multi-family
o Commercial
o Mobile Home
Sq. Ft
o Remote Meter 0 Detached garage 0 Hot Tub 0 Swim Pool 0 Septic Pump
o Low Voltage 0 Telecom. 0 Sign
*-\'I--\. ,"-,,'--
00
bo&
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^,,-j)k~o. etYJ~~t.o:
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o U l::;'lv~"- l()C"-:-~
Number of Circuits added or altered:
DESCRIPTION OF THE ELECTRICAL PROJECT:
M...~
:S.~ IV\. E.
\.~ \\I'-~.~
6v'-
Electrical Heat Load Additions and or Subtractions
Service Information
J Baseboard
] Furnace
] Heat Pump
] Fan-Wall
_KW
KW
TON_ LRA
KW
o Overhead Service
o Temp Service
o Underground Service
Voltage:
Phase: 0 1 0 3
Service Size:
Feeder Size:
. hereby certify that I have read and examined this application and know that same to be true and correct, and I am
wthorized to apply for this permit. I understand it is not the City's legal responsibility to determine what permits
lre required; it remains the applicants responsibility to determine what permits are required and to obtain such.
J
~
:/ELECTRICALPERMIT APPLICATION
/ItJt) 'I ).;j'l
Credit Card Holder's Signature:
"
Owner or Elec. Cant. Signature:
lZJL~ ~()D
Date:
Date: 9/ N/D 'f
,
DV
PERMIT FEE: $ tf>b. 90
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