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Home My WebLink About906 W 16th St - Building f VORT ~ $~O~~t. rea "-~ ---- 'l.t\~ 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 04-00000243 Date .355404 906 W 16TH ST 06-30-00-0-4-4210-0000- RES FOUNDATION REPAIR 3/31/04 RS7 RESDNTL SINGLE FAMILY 300 Owner Contractor GRIGSBY, DAVID P. O. BOX 6791 BEND (541) 420-5522 OWNER OR 97708 Permit Additional desc Sub Contractor Permit Fee Issue Date Expiration Date ELECTRICAL NEW RESIDENTIAL STRAITS ELECTRIC 76.30 Plan Check Fee 3/31/04 Valuation 9/27/04 .00 o ~ C) ~ Qty Unit Charge Per 1.00 76.3000 ECH EL-RM-0-200 1ST SRV FEEDER Extension 76.30 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 76.30 76.30 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 76.30 76.30 .00 .00 t '"'- ~ ,S\ CIl , . 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 [11/14/2003] I 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 PLUMBING UNDER FLOOR / SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW / WATER AIR SEAL WALLS CEILING I I FRAMING JOISTS / GIRDERS SHEAR W ALLlHOLD DOWNS WALLS / ROOF / CEILING DR YW ALL (INTERIOR BRACED PANEL ONL Y) T-BAR INSULATION SLAB WALL / FLOOR / CEILING 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: PARKINGILIGHTING ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRICAL - LIGHT DEPT. 417-4735 3'~9.,b" IAc~ ELECTRICAL LIGHT DEPT CONSTRUCTION R.W./ PW/ CONSTRUCTION - R.W. ENGINEERING 417-4807 PW / ENGINEERING FIRE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 BUILDING T:\PLANNlNG\FORMS\1102.15 [11/14/2003] r/'- ~ ti CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DMSION 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 04-00000243 Date .355404 906 W 16TH ST 06-30-00-0-4-4210-0000- RES FOUNDATION REPAIR 3/31/04 RS7 RESDNTL SINGLE FAMILY 300 OWner Contractor GRIGSBY, DAviD P. O. BOX 6791 BEND (541) 420-5522 OWNER OR 97708 ......------- permi~--~-~-~-~------;~~~~;~-;;~;-=;;;~~;;;~---------------------- Additiorial desc Permit Fee Issue Date Expiration Date 47.00 3/31/04 9/27/04 Plan Check Fee Valuation . . .00 300 Qty Unit Charge Per BASE FEE Extension 47.00 ------------------------------------ ---------------------------------------- Perm! t . . . . Additional desc Sub Contractor Permit Fee Issue Date Expiration Date ELECTRICAL NEW RESIDENTIAL STRAITS ELECTRIC 76.30 Plan Check Fee 3/31/04 Valuation 9/27/04 .00 o ~ ~ ~ Qty Unit Charge Per 1.00 76.3000 ECH EL-RM-0-200 1ST SRV FEEDER Extension 76.30 -----;~~~~--~-~-~-~------;~~~;~-;~~;-----~----------------------------- Additional desc Permit Fee Issue Date Expiration Date 54.00 3/31/04 9/27/04 Plan Check Fee Valuation .00 o 1'1 ~ ~ - . Other Fees STATE SURCHARGE 4.50 ~ ~ ~ Qty Unit Charge Per Extension 47.00 7.00 BASE FEE 1. 00 7.0000 ECH PL- EA. FIXTURE ON ONE TRAP ------~--------------------------_.-----------------'------------------------ Fee summary Charged Paid Credited Due ----------------. ---...------ ---------- ---------- -..-------- Permit Fee Total 177.30 177.30 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 181.80 181.80 .00 .00 ~ Separate Permits are required for electrical work, SEPA, Shoreline, ESA,utilities, private and public improvements.'This permit bec;omes null and void if work or construction authorized is not commenced within 180 days, if construction or work Is suspended or ~bandoned for a period of 180 days after the work as commenced, or if require~ inspections have not been requestedwimin180 days tiom .the last Inspection. I hereby certify that I have read and examined this application and know the same to'be true and correct. AU provisions of laws and ordinances goveming this type of work will be complied with whether specified herein or not The granting of~ permit does not ::':::~n~1ve authority 10 violate or cancel the provisions of any :-;;:;;; regulating ;;:slructiOn or tho porfonnanco of Signature of Contractor or Authorized Agent Date Signature of Owner (if Date T:\PLANNING\FORMS\II02.IS [I 111412oo3J \ " ., ~"r't"...-:-. .,", I BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECfRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVBR; INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A C()NSPICUOUSLOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE , INSPECTION TYPE DATE ACCEPTED , COMMENTS YES I NO F9UNDATlON: FOC>JINGS W"~ ~ -v .......FOUNDATlOM DRAINAGE/DOWN SPOUTS t._ 2~JJ I_'.L ( CAL (LIGHT DEPT) SEPARATE PERMIT: # ROUGH:~IN I PLUMBING ~~ (p - 7-01-/ UNDER FLOOR I SLAB ROUGH-IN {,,~ "S-oJ./ J.L WATER LINE (METER TO BLDG) GAS LINE BACK FLOW I WATER AIR SEAL WALLS I CEILING I I , FRAMING JOISTS I GIRDERS SHEAR W ALLlHOLD DOWNS . WALLS I ROOF I CEILING DRYWALL (INTERIOR BRACED PANEL ONLY) T-BAR INSULATION SLAB WALL I FLOOR I CEILING I .. MECHANICAL HEAT PUMP " GAS LINE , WOOD STOVE I PELLET I CHIMNEY HOOD I DUCTS PW UTILmES I SITE WORK (EnSmeering Division) SEPARATE PERMIT II's: WATERLINE I METER SE~,CONNEC110N . , SANI'I'ARY STORM " PLANNING DEPT. SEPARATE PERMIT #'s SEPA: PARKINGlLIGHTlNG ESA: LANDSCAPING " ~S"ORELINE: ." ' " ., e FINAL INSPECTIONS REQUIRED P~OR TO OC€;UPANq/USE " " '7 RESIDENTIAL ' . DATE YES NO COMMERCIAL DATE ACCEPTED - . YES " NO , ELECTRICAL - UGHT DEPT. 4174735 ELECTRICAL . UGHT DEPT CONSTRUCTION R.:W.I PWI . CONSTRUCTION - R. W. " , ( ENGINEERING 4174807, . PWI ENGINEERING "- " . FIRE 4174~3 FIRE DEPT. PLANNING DEPT. 4174750 pLANNING DEPT. . ~ -7 -I'JJ.J T l~ " BUILDING 4174815 BUILDING. '.- T:\PLANNING\FORMS\II02.15 [11/1412003] PREPARED 6/03/04, 13:25:01 CITY OF PORT ANGELES ADDRESS CONTRACTOR OWNER PARCEL . . APPL NUMBER: 906 W 16TH ST INSPECTION TICKET INSPECTOR JAMES L LIERLY GRIGSBY, DAVID 06-30-00-0-4-4210-0000- 04-00000243 RES FOUNDATION REPAIR PERMIT: BPR 00 BUILDING PERMIT - RESIDENTIAL REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS BLFR 01 . 6{~VO~1 ~ P.r ----------------------------------- CONTINUED JLL BUILDING FOUNDATION REPAIR 541-420-0512 SuaDIV: PHONE PHONE : (541) 420-5522 PAGE DATE 7 6/03/04 ONTO NEXT PAGE ----------------------------------- PREPARED 6/03/04, 13:25,01 CITY OF PORT ANGELES INSPECTION TICKET INSPECTOR JAMES L LIERLY PAGE DATE 8 6/03/04 ADDRESS CONTRACTOR OWNER PARCEL . . APPL NUMBER: 906 W 16TH ST SUBDIV, PHONE PHONE , (541) 420-5522 GRIGSBY, DAVID 06-30-00-0-4-4210-0000- 04-00000243 RES FOUNDATION REPAIR PERMIT: PL 00 PLUMBING PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS PL2 01 6/03L04 I ~~ ~~ -------------------------------------- COMMENTS AND NOTES -------------------------------------- PLUMBING ROUGH-IN TIME, 17,00 PREPARED 6/07/04, 12:41:28 CITY OF PORT ANGELES INSPECTION TICKET INSPECTOR JAMES L LIERLY PAGE DATE 9 6/07/04 ADDRESS CONTRACTOR OWNER PARCEL . . APPL NUMBER: 906 W 16TH ST SUBDIV: PHONE PHONE : (541) 420-5522 GRIGSBY, DAVID 06-30-00-0-4-4210-0000- 04-00000243 RES FOUNDATION REPAIR PERMIT: PL 00 PLUMBING PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS 6/03/04 JLL 6/04/04 AP PL99 01 fl!ff07 04 ~LL PLUMBING FINAL David ------------ ----- -- - ------------ COMMENTS AND NOTES -------------------------------------- I PL2 01 PLUMBING ROUGH-IN TIME: 17:00 TIME: 17:00 "'1 PREPARED 6/07/04, 12:41:28 CITY OF PORT ANGELES INSPECTION TICKET INSPECTOR JAMES L LIERLY PAGE DATE 8 6/07/04 ADDRESS CONTRACTOR OWNER PARCEL . . APPL NUMBER: 906 W 16TH ST SUBDIV: PHONE PHONE : (541) 420-5522 GRIGSBY, DAVID 06-30-00-0-4-4210-0000- 04-00000243 RES FOUNDATION REPAIR PERMIT: BPR 00 BUILDING PERMIT - RESIDENTIAL REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS BLFR 01 6/03/04 JLL BUILDING FOUNDATION REPAIR 6/04/04 AP 541-420-0512 '""_O'__~__~___:~;;:::::::::::::: NEXT 'AG' ___________________________________ i1vtAILlv6 Fill out COMPLETELY aud iu INK. Your application and site plan MUST BE COMPLETE to be accepted for review. !fyou have any questions, call (360) 417-4815 P,d~ G tej / ,.g ~C; {}~ e:; 77cJ lr'" Applicant or Agent: DA VI 0 G ~ / 6 5 ~ y DA-UJ 0 G R/6515Y w/t7H 57 BUILDING PERMIT - APPLICATION FOR OFFICIAL USE ONLY: Date Rec.:'S - 2.h~ bY Permit#: oL{ - 243 Date Approved: Date Issued: A-I j;"Q 55 Phone: S- Y 1- Y..2 d - 5-S- .2... ::::> Owner: Address: 70 b Phone: City: II) ~;7 ~(rc./5 Zip: Architect/Engineer: Contractor Phone: State License #: Exp: Phone: Address: PROJECT ADDRESS: '1 () 6 LEGAL DESCRIPTION: Lot: CLALLAM COUNTY PARCEL NUMBER: City: W /t -rtl 5;7"" Zip: ZONING: Block: Subdivision: Credit Card Holder Name: Billing Address: PO.!> b 71'1 Credit CardType VISA MC # TYPE OF WORK: Jl1 Residential 0 New Constr. 0 Re-roof o Multi-family 0 Addition 0 Move o Commercial 0 Remodel 0 Demolition ~ Repair 0 Sign BRIEF DESCRIPTION OF THE PROJECT: /aIL f T ~FP,lfI1f City: gf'~O OR. c;77dg Exp. Date: SIZEN ALUATION: o Stove SF. @ $ /SF. = $ o Garage SF. @$ /SF. = $ o Deck SF. @ $ /SF. = $ IiJ Other TOTAL VALUATION $ .3 0 CJ. ~ CJ rovv';-'17i~P It'PPAIII(' COMMERCIAL/RESIDENTIAL: Occupancy Group: Occupant Load: Construction Type: = TOTAL Sq.Ft. % No. of Stories: Lot Size: Existing Sq. Ft. & Proposed Sq. Ft. Existing lot coverage _ % & Proposed lot coverage _% = Total lot coverage ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other: APPROVALS: PLAN : BLDG: DPWU: FIRE: OTHER:_ PLANNING USE ONLY: "-''''} , .. 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 it is my responsibility to determine what permits a.re required ,not t~e fjty's, and at ~ must obtain such permits prior to work. ---J)~ 3-2S'-ot/ T:\FORMS\APPS\Buildingpermit.wpd ApplIcant: 1/' Date: L PUBILlC WORKS & R/W PERMIT D Attached Notes OWNER/APPLICANT DON ROGERS 906 W 16TH Port Angeles, W A 98363 000/604-7102 PROJECT INFO Work is: Inside Traveled Road Plans Required: Start Date: Contractor: QWEST COMMUNICATIONS Performance Bond Required: Amount: Proof of Insurance: Work to Perform: Issued: 10/18/2004 Permit No: Work Order: 1421 o PROPERTY LOCATION 906 16TH ST W Lot: 2 Subdivision: Parcel No: Block: 442 TPA 0630000442100 I2<J Long Legal Value Work: $0.00 II Finish Date: I I 3601000-0000 $0.00 ~ Install D Repair D Watermain D Sanitary Sewer D Storm Drain ~ Underground TelelElec D Mise PROJECT NOTES place ssw across alley 20' at alley and in r/w to provide service FEES ASSESSMENT 1.) RIW Excav: $0.00 15.) Other San Sewer: $0.00 2.) Sidewalk: $0.00 16.) Sew Tap WyelMan Tap: $0.00 3.) Curb/Gutter: $0.00 17.) Sew Capl WIM Removal: $0.00 4.) Driveway: $0.00 18.) Alter Repair Sewer: $0.00 5.) Dwy Culvert: $0.00 19.) Storm Drain: $0.00 6.) Street Cut: $0.00 20.) Catch Basin per ea: $0.00 7.) Other RIW: $0.00 21.) Sewer System Dev: $0.00 8.) Fire Hydrant: $0.00 22.) Milwaukee Dr. Sew Ass: $0.00 9.) Res Water Serv: $0.00 23.) RIW Use Perm: $0.00 10.) Comm Water Serv: $0.00 24.) Admin Cost (D.R.A) $0.00 11.) Other Water Service: $0.00 25.) D.R.A. $0.00 12.)Water System Dev: $0.00 26.) Mise: $0.00 13.) San Sewer SFR: $0.00 TOTAL FEE: $0.00 14.) San Sewer MFR: $0.00 add unit 0 Amount Paid: $0.00 Receipt No: Inspection Fee: $0.00 Balance A )gJi .00 OC1 18 2004 . .:~1~ii~\~1!~ , I ~\ ",.~/" ~ " 'I';',{ih\~f{,~'\()l~ , '"....,."".i..'.J :, \~l~,~. 'i(t: ..~~J I \" '"J-f.""" i>.'f.., \~ . <:\r~i~~~1 . ''':'::~,:f~~ ~~\~f~ ;U "'t,\'''/''I'~g~~ " ,::"<!:Vl(;;fij~~~ , :.~;~. \1\~"1.-Q),.,; i~1 _ to perform work as ", I :;!~\l:r\'~~r~~ " ". <j.jT\,;)~'{r;;:;i nOTed hereon and as .<hown on anached drawing; 4' . . \ ".'" PLEASE se:.e A\(ACt+e b ...st'.ETi:~#' W. e-0+057J~~~:~i~?i,! ~ '--r CJ LJ.I;~ ~,.,;t\ l~ P~('\CJ2 v2.1""^ 1 O"\O~ .,"} I , ,/l D J20 t tt ;ED . .~,"0"} ILA """ l~VV LA.L.J..~~, ~ ~,~'l, I" ,11-.", I, n p'-O. \IJ -to ProJ\d.Q... &z.J)~khl)f\Q- .....{~k:!;*il SltaUli) '!j "" /1 "'~. ,-' /. " . I : .' ""\i:~,A,I~~\1 " l I r...L.r I P '1t t~ J 1, r"l Ir-. "'!,,'I.','I.~,,,< I".' ',",l'~' I~".~. ~ _ '.':!'\,,,'If.:; ;t\' ~) , ~r l 1 ,'~:,l\:I.>:~;(<t.:~:~ ,"'\;,; i l}l.>; '\~( 0~ L4~1 ift{;'j}fi;; ':.';;'~.~~i:~l1f;;i f.?I).~}.{ " " "~,d l ' ',i/~ I,fn!l' ,:l; . ,,, :)'I><~~i~::tf~~:;; "Y~:\I;"~')'!: '1";':CJ'l.),~~i ":~.:tvr; BY~0.~l1 * COntraclor X . OloVner\;:jr;;;~;~!H Q..lf. ....,.. ~A"'T'r~l.t ",. "<i/,I,It)f,,~ ~ 5, I I" n.II." ; E6\IJ flDOtll\. ';;.:'<' ;;~)r\i;'1 l'?6ot3 s. T(Z.l:Jt.nDkJJ ~>,; e'" THE ABOVE APPLrCA TION IS HEREBY GRANTED SUBJECT TO APPIJCANT'S:',<\:"l'r::{,~; , :-!~ \~li~ '::5 i' ''''~''':}~\~IA 'r '?<'f')r>:~ ;/ ,1<l.'1J , !~'2~,!~ i ' '.' "j "::;!;\ " '.:.~tl;~ I' ~',-~~ lrt~ ,lldl \ >..;, ,lbj1Wt.1 >l <!'t\11\:/(\ , 't~");g.i~.'jl l:_ ,'- .,~? , 1/"l'~ \~(',1 " 'l~< "', '14>~ . ;" '~'~~!(?~~\)1 " '"t;:) .OJ.,:f....\t , " 11'.I.'~:\j'("ll u' ':: ::"~~~:U;:,.:;,'~,I,:,r;.i'~'1 .- -'.' \,::':h(.f:.~:~\t~~'i OCT 14 2004 14:58 FR TRAFTON B 253 471 1324 ~~ c<ef~ :fl)~ TO 13604174709 '1/ (} ouawe WOFI<s P~rmit To Perform Work In Street Rillht-of-W~y APPL/CA nON is 'r~by m.de ro the municipality of PORI' /t]'Jfrr"rf>r:. Approved; Water Department - Superintendent Sewer Depanment - Superintendent The estimated time forcompletion of the above work Is Date beT ~?J:)L ComplYing With all Municip::l Ordinances; Notifying the Street Superintendent of the time the work will star:, and when It will flni$/!; Prosecuting the work ""irh dilig"l\c".and with due respeCT to all pro),arty. contractS, penons' rights and rhe interests and convenience of the PUblic; Dale Saving the M unicillaJity harmless from any and all damageD which may accrue ro any penon or property because of This installaTion or the malntenance ther"o(; Complying with followinf: special condition.; IO/; 1101 19 ........a.- ...,.1....' CIty tit BV~MuA . r ANGEU:S . P.02 r,':'. ;', OCT 14 2004 14:58 FR TRAFTON B 253471 Qwesl: Job # Wf7tJl../o51i4-46af1!1 1324 TO 13604174709 P.03 w I {() +~ .', ':.JMJf~~ ..iil"<"""'".~'J .:.i~,'.::~i/Y: ~~f{';.l '.. ';>";"W',, ~'; \;,', ,~~. ':~~':.{l:!,~~'.~ H',}M:t."~~" II " .~:l :.;~J)~:;\~M>t~~ " '.:., ,,;,).if;?,? .. 'r' . .' . ,'l~'"jJ,}, -.j '. :~\n,\-t,~ ' ,)' >~,~~, ~...;:~\ ,(",<;;-,1",,, ;'i :ij~:~W!~ jJr/"'l~\'-'-''l\'" , /':', d~'~,:'~i~~;:L~ '" 'I' t.,"\,J"" ,~:, :,:;);\fi."" 11':ti "'1'" 'Ii ",' "~d':, .~ ~i'\?;i:~: :~j , ' ".',' : !'~' I' .,~1 ,\ ".'2;~\';Jf ~ :; .' ,;..~, I~, !~~ , <~:"::'I;;j~;:~.~;ru.(r~1 . ''\'i",,}l( ''',:' '.'''" ,..~'~~~~,:, " >(.,2,~:,~~;,;,:;~".; ~ :Section; ~ J '1\; , ",,,~:,~~:,~'~,~M . . ..'.........Vnlp1i 'Towns'hio: (~"'4;1i,,/.~'.~1~1)'~ Range: en IJ,: :';If{[:~~~ ),.{.; "'''4/1 teie?hone service wiI'e ,~o de , 'J;. ~~2~' J~~ I '~~_';:; (,~ lj Q On.-. D~' '. .',' ,,'''~'~ ,. W "',/'i'"':,',,) -- -, v\'rt"s>1 ,,^,~,I ';i";;"'II~ -f)' \' ~\" - ' ,:;i, :'?':~<'~I ' }'^' "'':'''''1;/1 , ~, ~ 1 '{'Ii,' ~' . ;"~!;}'~(~:r! , :.,,:;~:~-~{t~';'il~I' ..,......,...0,' ':;i':li,izil ".< ''''1 '1~(\\ll -'\F:\f:~;kil .,' }~';;,/' \11] J, ,,~." ~;. , ",~"I~{.~;\ I .::.~':i4\~1 ** TOTAL PAGE.03 ** ~ LRI -- - I I t}ot I I ~ J(~\\ 50' This requesr for permir is for ,he piacemenr of underground 'Jur cusromer Llt the [oHowing address: qh(n w I(~ Tfl.- Sf This work ',vjjj require: Trenching in [he R/W (toral footage! 60' Push or bore :2 inch PVC or SIP under roadway (toral footage) dO' Push or bore 2 inch PVC or SIP under driveway (IOral footage) Push or bore 2 inch PVC or SIP under multiple driveways (toral fomage) o 03125/2004 10:03 FAX 3604574698 ," STRUT,S ELECTRIC, .. .7-.~.;o. .. --.;, .' ,___20Q4/FEB/IVF.Rl 09: lO AM CITY OF PA BI.llCDEPT ,uW: No,360 4174711 j" I Vlj lj. 1{\ 14J0l . p, 0.02 _ m_ t ELECTRICAL PERMIT APPLICATION SUA UfHCIAL ua. GMLY' - ........ -- -- .- ne EIedIICli _AliPuciltfiii\-.....n.<itIJled out ......alellolv. P_~arrwprtntln-.II'~__...-c-.p-Can~4fT~$ , 'F.....DUIIIber. (3GOl417-471f ' " O~ ' .2 7"3. , Clty!-fo r+ 4W.~ II ~ --- ---. Uco:cioetl:S~AIE*01SJl~ . CiIy: Port Angeles, WA 457-4698 Fa: " . . PIlone: "~I - 'iUl . S' 5 ~-, ZIp: ql?-.:::U...~ 9/05 Ph<>ne:452-'9164 ~ 98362 straits Electric 0Wner<< B=. 0IInIracIar ~ Prap"""OWnr. TI~ u ;J, G..- ; cesl::\"', ~ 'AIl.:--' <=tc>~ t.U. J I" -tr. sf El...t.Iwd~, I:t:r..its Electric _ P.O. Box 2914 452-9104 PIlan&: , . INSTAU.ATlONWlREOIlY:: l:IOWNER Jl!B.EamlCALCONYRACTOIl. ~~HoIderName: Straits E,lectr'ic " , BlmngA~: P.O. Box 2914' ~ ' 98362 ' Zip: ,,' X' . VJSA:..::-- MC: _ .~ _-'li' 96 Cc 1.0.\ ~ -\w-.S;t. 'TYPE 01' WORK: Check aD lI18l apply: 0 NeW .I" RllsIdenti81 [) Mu/II-famIJ~ [) Commercial . ~18rat1onfAdc!lticin' o MoiJikI I-Iome ,Sq.. Ft o RBlTlole M8tar :aDef8ched!lllt8lle o Hot Tub d8Wlm PoaJ DSIlptlc Pump . [) lJ:lwVonage [) TItIsc:om.. 0811 N_ of Cireulta added t1rallemd: . /1'/ A- , , ' DESCRlPTlONOFntEELEC?TRlCAL.PROJECrr; h-?UI~ e~"s~c t)#-.Z> ,-oW"", ",' ,&v(!; . . -.',' ~~ ~- ~""p~A/~----V-0ee- .v~ ~~,e ~ - A'Z>.ZJ ~~t::??;"; ~ .A-r ~L. - ~~ 41";""~G ~ 6; .o?i~U:-""d EleclrlcaI ~ LGlI!Jrf )\ddilions attd or.SubtractiDnS . 'oaf ~ Hf-Pfr.v u,AOs. '1'0 fo.l..-~"":' I ON -tI'~ 1- ~, 1,5'oo~" DOVem88lfServ!l:e ciHGat~ =TON ' LRA oTempSelVloe ::J FM-WaI _KiN LI Underground Senrice _ ,L(- T--51Hr OJIV:lU~. I. a ..; ,,~ 10 KLU ' :' r het8by c:ertlfy that I have resd 8IId examined thI3 BfJPI1cal1an and knowthtlt same to be true and correct, and I a~ iUthOff29d to apply for this pennit. I undenmmd it is not file City's J8ga/ 18SpO(IsibiIity to detemrine what ~ iI& I'9qufred; it mmains the applir;wrts respon$lbility to detenn/ne wflat pen,nits fU9 requir8d end to obf8illBUlfh. , . ServIce Ihfumll8Bon A-I-! 0 -rM-t.R.. fIIf.en, IT. Voltage: / ~.! .0 Phase: CII"f C 3 Se : Ij. ~ ~I t ;j f{E.ei(/ ::!ElEC1lUCAIPEAPPUCATlON I ,14-c istie,Tucker Date:~. '?s-oq oer.: -?,-2S .O~ Cnldlt Card Hold~s SIgnaturo: J PERMIT FEE: $ 7~ ,30 , . .J / z.S" j" r