HomeMy WebLinkAbout1831 W 7th St - Building
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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
04-00000144 Date
.138560
1831 W 7TH ST
06-30-00-0-1-4845-0000-
RES REMODEL
3/01/04
RS7 RESDNTL SINGLE FAMILY
1000
Owner
Contractor
WALTERS, MORRIS/JENNIFER
1825 W 7TH ST
PORT ANGELES WA 983635205
(360) 565-0477
OWNER
----------------------------------------------------------------------------
Permit BUILDING PERMIT -RESIDENTIAL
Additional desc
Permit Fee 62.25 plan Check Fee 24.90
Issue Date 3/01/04 valuation 1000
Expiration Date 8/28/04
Qty Unit Charge Per Extension
BASE FEE 47.00
5.00 3.0500 HND BL-501-2K (3.05 PER C) 15.25
QJ
'v'J
Other Fees
STATE SURCHARGE
4.50
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Fee sununary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 62.25 62.25 .00 .00
Plan Check Total 24.90 24.90 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 91. 65 91. 65 .00 .00
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Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and voidif 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.
?l-
Signature of Contractor or Authorized Agent
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
FOUNDA TION DRAINAGE/DOWN 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 Jf-lt~J./ ~J. l. I
FRAMING
JOISTS / GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS / ROOF / CEILING J-J-I"- -0"'" J.1-
DRYWALL (INTERIOR BRACED PANEL ONL Y)
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILING W -J~ -'OJ.t .J. i.... 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
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION RW. / PW/ CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW / ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 ?-I}.('-01 1-( V BUILDING
T:\PLANNING\FORMS\1102.15 [11/14/2003J
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BUILDING PERMIT - APPLICATION
FOR OFF1CIAL USE ONLY:
Date Rec. 2... 1'1-a l..L
pennit#:~'1- j
Date Approve: r..' / I
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
(360) 417-4815
er
.
Applicant or Agent:~
Owner: /'/l 0 C.
Address: I B ::>/ L)
Architect/Engineer:
<;r. Ll
Contractor ~
C{~ ~ !f.{Y'{.
fA .Jq /k:y.:>
I rt.. City: (Dlf'( A~
Phone:
5 C?C:;- 01)77
Phone:
Zip: rq50 z..,
Phone:
State License #:
Exp:
Phone:
Address:
PROJECT ADDRESS: (83/ 0.
LEGAL DESCRIPTION: Lot: \ ~
CLALLAM COUNTY PARCEL NUMBER:
City:
1--f~ s r
Block: It.{ 8 7P(t Subdivision:
00~Oo(j ~ 0111'1 0
Zip:
ZONING:
(LS 'l ~FO
Credit Card Holder Name:
Billing Address:
Credit CardType VISA__MC #
TYPE OF WORK:
__Residential 0 New Constr. 0 Re-roof
o Multi-family 0 Addition 0 Move
o Commercial &t Remodel 0 Demolition
o Repair 0 Sign
BRIEF DESCRIPTION OF THE PROJECT:
City:
Exp. Date:
o Stove
o Garage
o Deck
o Other
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SIZEN ALUATION:
SF.@$ /SF.=$ /000.
SF. @ $ /SF. = $
SF. @ $ /SF. = $
TOTAL VALUATION $
pr'lrh...v t" A rPbY t tv I.U-~ .-4. "VI ;....j tOn"",
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 g 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 ofthe date of application, the application will expire. The
Building Official can extend the time for action by the applicant up to 180 days upon WTitten 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 ana' 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.
Applicant: -yIiU,- C. {/.J~ Date: J'I PE(2,6if
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CITY OF PORT ANGELES - Construction Plans
The Issuance of this permit based upon these plans, speclfi-
c3tions and other data shall not prevent the bUilding otiicral
'rOr;! thereafter requiring the correction ot Grrors in sold
D!~ns, sppcifiCilticns and mher data, or from preve'itlrig
DtJ:\::.\r.1 Gr:H~r2t~ons b(~ing C.3rried on thereunder wrh:n in
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V.n;cal Datu", = NA VD 88
Horizontal Datu,., = NAD 83191
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This map is not intended to be used as a legal description.
This mapldruwing is produced by the City of Port Angeles for its own use and purposes.
Any other use of this 1IUJfJldrawing shall not be the responsibility of the City.
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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
04-00000144 Date
.138560
1831 W 7TH ST
06-30-00-0-1-4845-0000-
RES REMODEL
3/01/04
RS7 RESDNTL SINGLE FAMILY
1000
Owner
Contractor
WALTERS, MORRIS/JENNIFER
1825 W 7TH ST
PORT ANGELES WA 983635205
(360) 565-0477
OWNER
----------------------------------------------------------------------------
Permit ELECTRICAL ALTER RESIDENTIAL
Additional desc
permi t Fee 46.70 Plan Check Fee
Issue Date 3/01/04 Valuation
Expiration Date 8/28/04
.00
o
Qty Unit Charge Per
1.00 46.7000 ECH EL-R OR RM 1-4 ALT CIRCUITS
Extension
46.70
----------------------------------------------------------------------------
Other Fees
STATE SURCHARGE
4.50
Fee sununary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 46.70 46.70 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 51. 20 51. 20 .00 .00
'"7.-,.--,.-,
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~
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~
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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.
'11:1.6 e. lA )i'J'.-L:bl~
Signature of Owner (if owner is builder)
Signature of Contractor or Authorized Agent
Date
T:\PLANNING\FORMS\1102.15 [11/\4/20031
01 f.1-,tlLo-j
Date
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 DRAINAGE/DOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN I 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 W ALL/HOLD DOWNS
WALLS 1 ROOF 1 CEILING
DRYW ALL (INTERIOR BRACED PANEL ONLY)
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:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 13},101 IAeo ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W. 1 PWI CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW 1 ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 4] 7-4815 BUILDING
T:\PLANNING\FORMS\1102.15 [II/I4/2003]
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
04-00000144 Date
.138560
1831 W 7TH ST
06-30-00-0-1-4845-0000-
RES REMODEL
5/06/04
RS7 RESDNTL SINGLE FAMILY
1000
Owner
Contractor
------------------------
WALTERS, MORRIS/JENNIFER
1825 W 7TH ST
PORT ANGELES WA 983635205
(360) 565-0477
OWNER
------------------------------------
----------------------------------------
Permit
Additional desc
Sub Contractor
Permit Fee
Issue Date
Expiration Date
ELECTRICAL NEW RESIDENTIAL
CHANGE SERVICE
ELECTRIC SERVICE
76.30 Plan Check Fee
5/06/04 Valuation
11/02/04
.00
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Qty Unit Charge Per
1.00 76.3000 ECH EL-RM-0-200 1ST SRV FEEDER
Extension
76.30
---------------------------------------------------
Other Fees
STATE SURCHARGE
4.50
Fee sununary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 76.30 76.30 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 80.80 80.80 .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
T:\PLANNING\FORMS\1102.15 [11/14/20031
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 NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE/DOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN I I
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 ONL Y)
T-BAR
INSULA TION
SLAB
WALL / FLOOR / CEILING I
MECHANICAL
HEA T 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
ELECTRICAL - LIGHT DEPT. 417-4735 5~ 10 </ /feD ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W. / PW/ / / CONSTRUCTION - R.W.
ENGINEERING 4]7-4807 PW / ENGINEERING
FIRE 417.-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 4]7-4815 BUILDING
T:\PLANNING\FORMS\ 1102.15 [11/14/2003 ]
..
FROM
FRX NO.
Ma~. 04 2004 09:20RM Pl
ELECTRICAL PERMIT APPLICATION
I'OJl OFFlC:1A.L U"~2 ONLY
lloo',-;Un:"___
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Ullt ^Pt>,.:",~..t;
Ih.t~1.rJueG,_._,,_.__
The EJec:tric:aJ Permit Apl)lication mlJ!i1 be filled out com~letl!lly,
Pl.... typo or r.print in Ink. If you h... .ny q.....tlon.. pl..... c.1I (360) 411-4735
Fax numb.r: (360) 417-4111
tYI- /<1C/
OWner or Elee. Conlraclor Agon" . Phone: I-fS J.(H-i'2L1cax:_ J.f.5 'J--vlf'":itf
P,opony 0"",." ~o W....,t Phon.: \)''-S- b '4"7')
Address: \~"'3>1 V L +-- Cily: r~oo- ~ _ Zip: "'f n ,j
t":L l . ('u' ELec.::r I /
Eleetrl"", Conltaclor:J:,!,fddh-Lv ~ VI a. \1 h<_ L1cen.e#: -;S1: .~2....-f'P: q [1'1 05 Phone: li'5."L.. (p4~
Addr...: 8'2- Dr-"-p...t.;.r\Ja~ 'R.c:)Cily:Yb~+ /t:..n-y\~ Wf\- Zip: t1f<']"'""J
INSTALLATION WIRED BY:
DOWNER
o ELECTRICAL CONTRACTOR
Silllng Address:
Credit Card Number:
o III
ft~
Credit Card Holder Name:
Exp. Date:
Zip:
VISA: Me:
- -
pRD.lECT ADDRESS:
\ ~,?>l
l.A) "1 01-
20RK: Check alllhat apply: 0 New
_ esidential 0 Multi-family 0 Commercial
o Alleration/Addltion
U Mobile Home
Sq.Ft
CJ Remote Meter 0 Detached garage 0 Hot Tub 0 Swim Pool I:l Septic Pump
o Low Voltage q Telacom. 0 Sign
Number of Circulto added or altered: ___
DESCRIPTION OF THE EL.ECTRICAL. PROJECT: C~ ~
~Dt.., ~(~ j1.....,9. I ~ ?: Oi)
~ o...Il ~'-: cv.
Electrical Heat Load Additions and or Subtractions
Service Information
o Baseboard
(] Fumace .
o Heat Pump
o Fan-Wall
_KW
KW
TON LRA
KW---
o Overhead Service
D Tamp Service
o Underground Service
Voltage: ......b(.........
Phase: ~ 0 3
Service Size: ;LlDIl::;II
Feeder Size: '7/0
I. hereby certify that I have read and examined this application and know that same to be true and correct. and I am
authorized to apply for this permit. I understand it is not the City's legal responsibility to determine what permits
are required; it remains the applicants responsibility fa determine what permits are required and to obtain such.
. \\ . c"" C... H."",,, """"" ri!.I...t tJ p.,,~ D..., ,,/ ,
J~) ~~\ """"'..B"C'"""....,,~ D~. 'Iv
PERMIT FEE: $ 76.30
::IELECTRICALPERMIT APPLI CA TI ON
~ 5/;1c~
'i ~
ELECTRICAL PERMIT APPLICATION
FOR O!'FICIAL USE Ot-ltV
DaldRe~:
I'ClTnilN
UalcApproved:
Dale Issued
~r
The Electrical Permit Application must be filled out completelv.
Please type or reprint in ink. If you have any questions, please call (360) 417-4735 0"(- I..c.VA
Fax number: (360) 417-4711 /7
Owner or Elec. Contractor Agent
Property Owner:
IV7 0 {'
/831 bY.
'\oL{
Phone:
Fax:
Address:
L )4. It~,~
(+~ sf.
Phone:
)0,-0'177
Zip 'j' 9 '5 ( .. 3
City:
? ",,..-t ~I'\". & \
Electrical Contractor:
license #:
Exp:
Phone:
Address:
Cily:
Zip:
INSTALLATION WIRED BY:
,/oWNER
o ELECTRICAL CONTRACTOR
Credit Card Holder Name:
Billing Address:
City:
Zip:
Credit Card Number:
Exp. Date:
VISA:_ MC:
PROJECT ADDRESS: .I fl ~ /
U)
7tf
.<,r-;
TYPE OF WORK:
Check all that apply: 0 New
o AlterationlAddition
r4 Residential 0 Multi-family
o Commercial 0 Mobile Home
Sq. Ft
o Remote Meter 0 Detached garage 0 Hot Tub 0 Swim Pool 0 Septic Pump
Number of Circuits added or altered: .3
DESCRIPTION OF THE ELECTRICAL PROJECT: ~e.Y'\..LoJ.JL Cl~ eliis.X;"j eo.r('ort Cv'l d oS~f\ j. & X I z...
',"-\€1~ n~ ('M'~O(t ~c.... O\"'\'~J -ro<:>"". d. \\0 Dut\ds lov-e..rke..c.J \.'t* o...-J
o Low Voltage 0 Telecom. 0 Sign
~~ 'C-e- c.....\G..orll'^ ,
Electrical Heat Load Additions and or Subtractions
Service Information
:J Baseboard
:J Furnace
:J 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 1 have read and examined this application and know that same to be true and correct, and 1 am
wthorized to apply for this permit. I understand it is not the City's legal responsibility to determine what permits
Ire required; it remains the applicants responsibility to determine what permits are required and to obtain such.
--\ ~ 'f... \iJ) Credit Card Holder's Signature:
II :~ )) ~ \ft 1 \ OW"" m "". Co",. ,;'""",,,
Date:
11Jt.n ('__ LJ &2 -A fl/1JSJ
Date: IV FEtl,D1
:/ELECTRICALPERMIT APPLICATION
PERMIT FEE: $ f~, 70
thf7
,//~ft)Lv,
!..- / rr7
enf
/O([\..
ELECTRICAL PERMIT APPLICATION
FOR OFFICIAL USE ONLY
DatelRec:
Permit II:
Date Approved"
The Electrical Permit Application must be filled out comDletelv.
Please type or reprint in ink. If you hav~ any questions, please call (360) 417-
4735
Fax number: (360) 417-4711
"
Owner or Elec. Contractor Agent:
)
e
Property Owner:
Address: n Of) t.v 7tJ1.-
Electrical Contractor: Own f /
REQUEST INSPECTION 0
Phone' ~ r:;;2r-'!i):!7 Fax:
!f<::;;( ~Cj)e;?
:iP J P;3,(J
City:
fa rf /lnl1e !~J
(/
Phone:
License #:
Exp:
Phone:
Address:
City:
Zip:
INSTAllATION WIRED BY: ~OWNER , f EljTRICAl CONTRACTOR
Credit Card Holder Name' 6-5 ~ () Utf)I, '. . ,
Billing Addr'!ss: J r:; 0 ~ VJ, I City: f'a~#~/k
C,+, _ :
," .
Zip: 9!3 63
VISA:-- MC~
th J /
PROJECT ADDRESS' )906 ~7 . f/;rr1Jf/ge/~
I v
Check all that apply: 0 New
J-v/J/
TYPE OF WORK~
/SLAlterationl Addition
. hY7Jshl)-;c,'{t(!s-h//:J
v
SOO p+ D.pf((JX-
~Residential 0 Multi-family 0 Commercial 0 Mobile Home Sq. Ft
Remote Meter 0 Detached garage 0 Hot Tub 0 Swim Pool 0 Septic Pump
Number of Circuits added or altered: Q + /rv1e( C Aa1jf :2. aael 111/,
DESCRIPTION OF THE ELECTRicAL:ROJECT: rirli.r;hJ'}J vfs-kJcS 1 ;? /lev-' Cr'rcu/:...Jd d--
fo.l1fl ~f7r;mcl(J oJ /
o Low Voltage )tTelecom. 0 Sign
') 00 a vYll)
I
Electrical Heat Load Additions
PERMIT FEE:
Service Information
D Baseboard
D Furnace
D Heat Pump
~Fan-Wall
_KW
_KW
~ TON LRA
~KW-
pg:Overhead Service
o Temp Service
D Underground Service
Voltage: J;;ioh ~O.
Phase:)19:1 D 3 I
Service Size: ()..DO 4 t>1
Feeder Size: .
I hereby certify that I have read and examined this application and know that same to be true and correct, and I am
authorized to apply for this permit. I understand it is not the City's legal responsibility to determine what permits
are required; it remains the applicants responsibility to determine what permits are required and to obtain such.
Credit Card Holder's Signature:
Date: 6~))...()~
Date: (; -/7 --ocJ"
Owner or Elec. Cont. Signature:
C:/ELECTRICALPERMIT APPLICATION