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Home My WebLink About926 Caroline St - BuildingThis certificate is issue Code certifying that a of the City regulatin Business name Business._address Property owner Property owner Automatic fire spnkier.'system Use occupancy ��;lassf cation Building permit numbee—. Type of construction. F!° Tr�- ti Occupant load. P CERTIF Cit o iort Ange Post on the premises in a conspicuous place. C.0 PAN CY Division rsuant to the requiremen 'is of Section 11 tJR f fhe 2%6 International Building ssuance this structure was in compliance Ala h the various ordinances rng oc nstruconoruse f or the followin mini'stratji:oin roiine CIaIIam C=® z 939 Carofi_ne Pe rl!B! Business 05/05/08 Re -issue date shl =l t be removed except by the Building Official. e 5 s ~~ CITY OF PORT ANGELES DEPAR1MENT OF COMMUNITY DEVELOPMENT - BUILDING DMSION 321 EAST 5TH STREET, PORTANGELES,WA 98362 Application Number Application pin number .' Property Address ASSESSOR PARCEL NUMBER: Tenant nbr, name Application type description Subdivision. Name Property Use . . . . Property Zoning . '.' Application valuation 05-00000483 . , 628060 926 CAROLINE ST 06-30-00-5-8-0065-0000- . OLYMPIC MED. CTR. COMM REMODEL Date 6/17/0,5 COMMERCIAL OFFIcE -1500 Contractor CLALLAM CO PUB HOSPITAL DIST 2 DBA OLYMPIC MEDICAL CNTR PORT ANGELES WA 983623909 OWNER . ,..,....;....---------------------- Structure Infonnation 000 000 ---------------------- L" "':~ c; - :,:,'i', Construction Type . . .'. . TYPE II ONE HOUR Occupancy Type .. . .. . . HEALTH CARE 'permit . . . . . Additional desc . ,Permit pin number ..:' Permit Fee Issue Date Expiration Date . BUILDING PERMIT - COMMERCIAL INTERIOR REMOD. 52209 77.50 Plan Check Fee 6/17/05 Valuation 12/14/05 ~ ~ ~~-----------------------------------------------~----------~------------- 50.38 1500 ~ ~ - ~ (1:l S)2. . . Qty Unit Charge Per' Extension 47.00 30.50 BASE FEE 3.'0500HND BL-501-2~ (3.05 PE~ C! ~-----------------------------------------------'--~------------------------- 10.00 Other Fees .. . .. - . . . . . -'-'. STATE SURCHARGE 4,,50, -----------------------------~--------------<-------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ...--------- Permit Fee Total 77.50 77.50 .00 .00 Plan Check Total 50.38 50.3.8 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 132.38 132.38 .00 .00 " ___.,' .\)r.. ,c. -n~:, ;f- ~ ), ~ Separate Permits are required for electrical work, SEP A. Shoreline, ESA, utilities, private and public improvements. This pe.rmii~eC9rnes null and void if work or construction authorized is not commencedwithin 180 days, ifconstruction orworkls suspencjed o(a~p~ned for a period of 180 days after the work as commenced, or if requlredlt;lspectlons have not been requested within 18pdaysfromthelast 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 ordinanc s governing this type of work will be complied with whetherspecified herein or not. The granting of a permit ~oes not presume to giver;:Ority to violate or cancel the provisions of any state or local law regulating construction or the performance of construe' . -' b ont ror Authorized Agent Date Sigriature of Owner (if owner is builder) Date T;\Policies\1102_15 buildingpennit inspection recordOS.wpd (1/412005) ^;',..:.'Y -ynn1;f;i~~.?'~~X~ft~[~rr,~:SEV~~jjTr(Y;f;~:'?;~':,'.': RECORD CALL 417-4$15 FORBUILDlNGlNSPECfIONS. CALU417-4735 . FOR ELECfRICAL INSPECTIONS; t' ......... CALL417-4807 FORPUI3L1<::: WORKS UTlLITIESii ...... .....>i. .....< PLEASE PROVIDE A.MIl'-fIMU~.f~1iH0TJR.N0TICE...ITIS'U1YE/l.~/JULTO'COVER, INSULATEOR~ONPEALANY1fORKBEFORE lNSPECTM#lDAc,C~PTED. PO~1'~ERMrr IN A C,ONSPICUOUSLOCATI()N. KEEP PERMIT CARD AND APPROVED PLANS AT JOB-SITE. '.' INSPECTION TYPE ,..; 'i DATE" I . ACCEI'TED '. COMMENTS I YES NO . ! FOUNDATION: ..... . FOOTINGS . WALLS . FOUNDAnON . DRAINAGE 1 DOWN SPOUTS PffiRS .. POST ROLES (poLE BLoGS.) . 0: .. PLUMBING , . . ......... .., UNDER FLOOR 1 SLAB . ROUGH-IN . ... WATER LINE (METER TO BLDG) .' '. GAS LINE BACKFLOW/WATER. . .. .' .' AIR SEAL WALLS CEILING' I I ..' .Co ." FRAMING . .' .. JOISTS / GIRDERS '. SHEARWALUHOLD DOWNS '. W ALLSI ROOF I CEILING ,fttJ!11 I f/'i DRYWAll (INTERIOR BRACED PANEL ONLY) ..' T-BAR. . .' INSULATION SLAB . WALL 1 FLOOR 1 CEILING I I MECHANICAL HEAT PUMP! fWNACE 1 DUCTS GAS LINE . WOOD STOVE 1 PELLET 1 ClllMNEY .?c. . COMMERCIAL HOOD 1 DUCTS MANUFACTURED HOMES . FOOTING ISLAB . . BLOCKING ~ HOLD DOWNS . SKlRTING . . . PLANNING DEPT. SEPARATE PERMIT #'s SEPA:' P ARKlNGlLlGIITING . ESA: LANDSCAPING . . .' SHORELINE: . '.' ... 'FINALINSPECTIO!"SREQUIRED PRIOR TO OCCUPANCY/lISE' ....... ,0; ~. . RESIDENTIAL .' ..' DATE .. YES NO COMMERCIAL DATE ACCEPTED .', .. YES NO' . . ELECTIuCAL ELECTRICAL - LIGHT Dan 417.4735 .. LIGHT DEFT ,. . . . y CONSTRUCTION R.W./PWI CONSTRUcnON. R.W. '~-.,. ENGINEERING 417-4807 .P\y IE1'fG~ERING -, .' .' . "\ .' FIRE...... 417-4653 FIRE DEPT. PLANNING..DEfT. 417-4750 PLANNING DEPT. BUILDING 417-4815 ~.,~O\ ~ BUILDING I T:\Policies\l102_15buildingpenmt inspectiGn recordOS.wpd [1/412005] ! .. ------- PREPARED 8/12/05. 12:26:14 CITY OF PORT ANGELES ADDRESS TENANT, NBR: CONTRACTOR OWNER PARCEL . . : APPL NUMBER: 926 CAROLINE ST OLYMPIC MED. CTR. INSPECTION TICKET INSPECTOR: JAMES L LIERLY CLALLAM CO PUB HOSPITAL DIST 2 06-30-00-5-8-0065-0000- 05-00000483 COMM REMODEL PERMIT: BPC 00 BUILDING PERMIT - COMMERCIAL REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS BL3 01 6/17/05 JLL 6/17/05 AP BL99 01 ~fe- BUILDING FRAMING 06/17/2005 01:00 dave 417-8628 06/17/2005 03:39 BUILDING FINAL FINAL 08/12/2005 09:47 DAVID 417-8628 PAGE DATE SUBDIV: PHONE PHONE PM DYASUMUR --------------------------- 6 8/12/05 -------------------------------------- COMMENTS AND NOTES -------------------------------------- PM JLIERLY ---------------------------- AM PBARTHOL PREPARED 6/17/05, 13:57:33 CITY OF PORT ANGELES INSPECTION TICKET INSPECTOR: JAMES L LIERLY PAGE DATE 1 6/17/05 ADDRESS . . 926 CAROLINE ST TENANT, NBR: OLYMPIC MED. CTR. CONTRACTOR OWNER . . . CLALLAM CO PUB HOSPITAL DIST 2 PARCEL . . : 06-30-00-5-8-0065-0000- APPL NUMBER: 05-00000483 COMM REMODEL SUBDIV: PHONE PHONE PERMIT: BPC 00 BUILDING PERMIT - COMMERCIAL REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS BL3 01 t ~ ~ ~~~~~~~~o;~i~~o PM DYASUMUR ___________________________ "f"'\' '\_~U,~--- dave 417-8628 -------------------------------------- COMMENTS AND NOTES -------------------------------------- FOR OFFICIAL USE ONLY: BUILDING PERMIT - APPLICATION Dare Rec.: el111it #: t?G~ Fill out COMPLETELY and in INK. Your applicatior:. and site plan MUST Bb/: ~Approved: CO:MPLETE to be accepted for review. If:you have any qnestions, call I!> 11~ PERMITS (360) 417-4815 FAX(360)417-4711 Date Issued: Applicant or Agent: OL'J M?' c... M'4\:>.c..AL C\2.N\\z{\- Owner: ~"",IL.. Phone: l..f \1- gf::,~ Phone: Address: '13; CACJ.o\....\4\3'l.- StUd'\" Architect/Engineer: Contractor 01..., ,.,. f\L Address: City: ?~_ zipff B 3'2. - 3~o Cf Phone: M\1.l~!.- ,-,t"i\:'r"L-State License #: Exp: J Phone: City: 'J2b . CA.to~..., \\- % Zip: ZONING: PROJECT ADDRESS: LEGAL DESCRIPTION: Lot: CLALLAM COUNTY PARCEL NUMBER: Block: Subdivision: ... ...."".,. "c.....:,... Credit Card Holder Name: Billing Address: Credit Card Type "VISA T1TE OF WORK: o Residential 0 New Constr. 0 Re-roof o Multi-family 0 Addition 0 Move ~Commercial ~Remodel 0 Demolition . 0 Repair 0 Sign BRIEF DESCRIPTION OF THE PROJECT: Abi> Fk:o'1."\""O C- G.\L\Nb City: MC # Exp. Date: o Stove o Garage o Deck o Other SIZEN ALUATION: SF. @ $ /SF. = $ SF. @ $ /SF. = $ SF. @$ /SF.=$~ . TOTAL VALUATION $ ~S-a:; COMMERCIAL/RESIDENTIAL: Occupancy Group: .p ~1l"\~'\\ON~ ) iN iCI2'ni f<f="MD()/--J Occupant Load: Construction Type: No. of Stories: Lot Size: Total lot coverage Existing Sq. Ft. & Proposed Sq. Ft. = TOTAL Sq. Ft % ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other: APPRO V ALS: PLAN: BLDG: DPWU: FIRE: OTHER:_ PLANNING USE ONLY: 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 currentfee schedules. Contact the Permit Coordinator at 417-4815 for assistance. PLAN CHECK FEE: IF-a plan checkfeeis dueitmustb-e.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: If no 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 R105.3.2 of the International Building/Residential Code, 2003) No application can be extended more than once. J hereby certify that J have read and examined this ap understand that it is my responsibility to dete~ J wh r T:\PoJicies\BL-J J02_13.wpd Applicant: ion and know the e to be true and correct. I am authorized to apply for this permit and ,not the City's, and that J must obtain such permits prior to work. G//~7o ~ . Date: ( . : .':~". , , ~:' ..-:;! " . -- '0 . (j " ~, .. J or: ~ ..D VJ ~ 'L r 0 ~ ./ d- o- 1 : '2 "~, ',-1 4- A' -'1 '0 4- -' 'cl J' ~ ./.., r- ~\- ~. ,.. ('~J ~ ). 0 -9 f. . &. N' cr-: .If. II II . . (1__- n. \ \ t. - -.b. . ~ ~... ... f /--- ~ '1t'^ II~~ II ....:l I I ,\.h ~ ~ 1 . .. $ =..::1 .,':)'^ . ~ j i .J ' ~?~1 '-JI ~ - - --.",.... ----I (, , ~ II I ~ Ii .. ~ y \2A~ ~ ~A-,t-{,~t-'( .' .' \ ) OF PORT ANGELES - ConstrUctio~ Plans uance of this permit based upon these plans, specifl. and other data shall not prevent the building official ereafter requiring thli correction of errors in said specifications and other data, or from preventing buil oper~tions being carried on thereunder when in viola , n of all codes and ordinances of this jurisdiction. , &. 10 tClO~ nt.. Approval Date By }{ l t..o~~~ :t~ '14\i~ ,)._~' 1 -., t:s.1-~ r-u_u- S ""r~ CITY OF PORT ANGELES PUBLIC WORKS - ELECTRICAL DIVISION :l21 EAST 5TH STREET. PORT ANGELES. WA 98362 .M.t'.t:'......I".;c:U"..LUll .L'lJumner Application pin number Property Address ~SSESSOR PARCEL NUMBER: Application type description Subdivision Name Property Use Property Zoning . . . Application valuation Owner 6/20/05 05-00000495 Date 112355 92hcAROLINE ST 06-30-00-5-8-0065-0000- ELECTRICAL ONLY COMMERCIAL OFFICE o CLALLAM 'CO PUB HOSPITAL DIST 2 DBA OLYMPIC MEDICAL CNTR PORT ANGELES WA 983623909 Permit . . . . . Additional desc . Permit pin number Sub Contractor Permit Fee Issue Date Expiration Date ELECTRICAL ALTER OLYMPIC/ 52308 _ OLYMPIC ELECTRIC 78.70 6/20/05 12/17/05 Contractor OLYMPIC ELECTRIC "4230 TUMWATER PORT ANGELES (360) 457-5303 WA 98363 COMMERCIAL Plan Check Fee Valuation " .00 o Qty Unit Charge Per 1.00 78.7000 ECH EL-COM ALTO-200 SRV FDR Extension 78.70 Fee summary Charged Paid Credieed 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 (> .... COMMENTS! ACTION NEEDED '~~:1>',c ~ ~ l\~ ~ t ~ ~ tA '\ ELECfRICAL PERMIT INSPEQ'JON RECORD CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFULTO COVER. INSULA TE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEF1'ED. INSPECTION TYPIt GENERAL COMMENTS: KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE NO COMMItNTS rw-U02.1J (4196) .)~ wf. Q ~. CITY GFPORT ANGELES. DEP ARTMENTOF'CQ~ DEVELOpMENT. - BUILDING DIVISION .321 EAST 5TH STREET, PORT ANGELES, W A 98362 , . " Application Number ~tication pin number Property Address ASSES~OR PARCEL NUMBER: J\.pPt.i:q~.t..~on type description Subdivision Name Property Use Property Zoning . . . Application valuation 05~00000441 . Date 903748 926.;'928 CAROLINE ST 06-30-00~5;'8~0065-0000~ '~":ROOF' 6/09/05 <;oMMERCIALOFFICE 5200 - OWner cont.::~gtor -----~--~--------------- CLALLAM CO PUB HOSPITALDIST 2 DBA OLYMPIC MEDICAL CNTR PORT ANGELES WA 983623909 LARIiyi'li.ROOFING 352 AvIs ST. PORT . 'ANGELES PORT.. A':NaELES (360')152-2215 WA 98362 _.- - --- - - - ----- - - - -------- - - - - -- - - -- -----~--- --- -";;'~-.--.~"~-- -- - -- -- --------- - --- . Permit . . . .. BUILDING PERMIT - NO PRFEE Additional desc. TEAR-OFF SHAKES, FELT,cQMp Permit pin number 51466 Permit Fee 148.75 Issue Date 6/09/05. Expiration Date .12/06/05 Plan Check Fee Valuation . . .00 5200 -,! ' ~,' ":'t~' < ~'," '!,;' BAsE FEE 4.00 14.0000 THOU BL-2001-25K (14 PERK) Qty Unit Charge Per Extension 92.75 56.00 . ~"~ ~? ~~ ~ . - - -- - ~~~~~ - ;~~~ - - ~ - ~- ~ - ~ - ~ - ~ - ~- ~ ~ ~ -- ;~~~ - ;~~~ -- -- -- - -,. - - -- -- - ~ ~ ~ ~ - -- -- ---------------------------------------------------------------------------- ,,-:~\,'/~,; Fee. swmnary Charged Paid Credited Due ----------------- ---------- ----------, ---------- ---------- Permit Fee Total 148.75 148.75 .00 .00 Plan Check Total . .00 .00 .00 .00 Other Fee Total 4.50 4.50. .00 .00 Grand To.ta1 153.25 153.25 .00 .00 .~ a "-.,,\"'- . EXPtt<eO '-jt~!O~ ~ .:s ~ T:\Policies\II02_15 building permit inspection reCQrd05.wpd [11412005] .=.-c- Separate Permits are requiredior~lectricalwOrk,.SERA'.~horeline. ESA. utilities,privatealld publicimpIQ.v.em~ntS. IhlscpenPlt~om~s null and void it ~()rkorC()nstnJctiori authorized is .not coinm~nced within 180 dayS~ ~,Cgnstruction or YlO-~ Is suspEtnded of,abllndoned for a periodof180 daysaff~rthe. work as commericed,orJf,.required Inspectlo~~'lfa~~,not been rElql,lest~d wlth!n180c:hlys:fro'tn!hela~t inspection. Jhereby certify that I have read and examl~ed this application and~nowthe same to be trueand.eorrecl All provision~ of laws and ordinances go c. . ing this type of work will be cOmplied with whether sp~ifi~hl:lrehi or not ThE)..9r;:mting. ofa PE:lnnitdoes:~ot ~~;:;:;~~n~:r:o volate or cancel the provisions of any state or I<lcaHaw regulil1lngCOnstrUction or'the pei!oiinance ill Signature of Contractor or Authorized Agent Date Signatureof.Owner(it oWner is builder) Date " r:,"".' ,.'c." ." " I 1:'.:.:':.<';,.,,'_':.. ',:;.:,:,' . -':")!f;,;:,-:t::^:,( ."'" ':>:T""~;'~~:0~"ii'~l:1:';~o-{itl:~;?"!'~~~~~?:~:f:::F-r-'~(~t':::;"" i'~~1b~~i~;~~~ BUILDING PERMIT INSPECTION RECORD ", . ;,,-," CALL 417-4815 FOR BUILDING INSPECTIONS.CALL 417-4735 FOR ELECTRlCALINSPECTIONS. . . .' .',. . ..,CA~I..417:4807 FOR PUBLIC WORKS UTILITIES PLEASE PROVIDE A MINIMUM 24 HbUR NOTICE; JTIS UNLAWFUL TOqOVER,'JNSULATE.ORCOJyCEAL.AW WORI(BEFORE, INSPECTED AND ACCEPTED.POSTi>>ERMIT IN A CONSPlCUOUS)..OC""TION. . KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE. . / FOUNDATION DRAINAGE / DOWN SPOUTS. '.. PIERS POST HoLES (poLE BLDGS.) PLUMBING' .......... . UNDER FLOOR/ SLAB ROUGH-IN W An!R LINE (METER TO BLDG) GAS LINE" BACK FLOW/WATER AIR SEAL WALLS CEILING FRAMING JOISTS (GIRDERS SHEAR WALL/HOLD DOWNS WALLS / ROOF lCE1LING DRY\VALL(IN1"ER10RBRACED PANEL ONLY) T-BAR"; .,. "X;V...,'. .. lNSULA110N . SLAB;' .... . . DATE ACCEPTED I YES" I NO '. ;,.. .... '. .t; " . ,'. '.' ,co . . . , f ..... . ;.....'j FOUNDATION: FOOTINGS. WALLS, COMMENTS .' '.. : INSPECrION .TYPE . ". .' '. . ;. ......'" 'i ;' '" J '. I t. '. I. . ... . .-' ", . , '. -::- I WALL/FLOOR/CEILING . MECHANI<::AL""'\ . HEAT P\JMp't FiiRNACE I DUCTS GAS LINE WOOD STOVE /-PELLET / CHIMNEY COMMERc1AL.lI00D / DUCTS MANUFAC11JREDHOMES FOOTING / SLAB BLOCKING &.HOLD DOWNS SKIRTING I I I . . . . ~~'..~ . . , I 'i , i' . . . SEPA: " . ESA: ,'" ..' P1+,-NN~.NqD~~. SEPARATE PERMIT #'5 PARK1~~!C?~Nt;; ~"F@"';;/ ." , '; .' ; ...- ".... .' RESIDENTIAL ... I ,.... .' ..i-' . . .,~7:.\~~~' 'YES; ,,; "1'10 " '. >>; J\ .,' '. ", ~. '. . "- '. '.' .: .. . ....... :; 'o' SHO~:" FINAiJINSPECTIONS REQUIRED PRIOR TOOCCUPAN.GXty~ :c . ...." DATE YES NO COMMERCIAL ',i (" ',. '. '.' ,,' . .,. ELECTRICAL-LIGHTDEPT. .. 417-4735 ELECTRICAL"'> L1GHTDEPT . "f '., : DATE , :' " ,;., . CONSTRUCTION R. W./ PWI ENGINEERING FIRE' 417-4807 417-4653 '. :0 , ". COblSTRUCTION - R. W. /r P\\ff~G~RlNG ..- miE DEPT ~ 4." i ,....., ., :; .), '~:,~. . PLANNINqD/3PT', ., ....4IH?50 BUILDING' 4174815; T:\PQlicies\llo2 IS,building pennil inSpection reconiOS.wpd [1/412005] :"-:;",i:~:::~.~i}i~f ,,::,-,,;:~,4; _'_~:;'A:'::~:;,~: '<<<D--'~~~~ ~7;' PLANNING DEPT. BUILDING ".'::,;, ,;,:-,,:,,:" ". . c. OI~VY)piC uf\~ICQI ~ieJ ere€, 40 'ti% ('p,roLne- Da.uid~ ~~ 4Jl- gc'ocg (}ffi~ ,.1 4-11 8tc"G7 ~ ~~o 70 {~ ~_~ Clo.-' ~ 15,- 3o-"G3 7' (0 - 7 ~,-- .cr I~rtc:, :-tJ"""'". ""v\ 4 '-" \ j r)'(Ylp' ('I_,ll, _ L r(~J n11 r ~ i ' t ---'" . (/ . -' \ --b G' 0"0'5 . d(Cun d4JWnS-p.9l;( ;/ " f 1 - L I. + L-~~l~:J~al~, ~~:r\ n _ 1 30 (iQrp 5 qat J'{)ud I CD 9<s. 5~(iq~+ Jabor ~Q! labyr ~\ ~ Ccl:tt clach w1 ;sce1 ~s 47-4~ cAU 8-11 ~ 3C- - I Co 3 Ie ~lS.- 16.- 11S~- 5{)~- :SO,,- 150:- ~,- ,$,,- ~~- 100 .- lS~- croj- '/00 - '~ . . '. , fi' ,I Ii :i .1, r if 1\ . ~ ~. ~ 110.- (S~O.J- Slnd:5~h -r-D ()()p~Q4rs&S:--- . . J~ 145.30 ~[ ,,1 I ! f ." Cl Eledrteal Cont,aetor DOwner. ELECTRICAL WORKPERMlT APPLICATION o Request Inspection o Annual Permit 0 i\.Jarm 0 Carnival 0 Commerdal 0 Residential 0 Resldendal Maio.. 0 Sign. (;I Tb..moOl.t ~Telecom. " Installation description Job wired by :Jll Electrical Contracto, Cl Owner E~'l eOnlraetot ,.me Lie,""" numb<>- J!o'U ~ j) II-nr e II-&u # (-r- t;,.l[.L E:S ca"'.... ,hll c.f TIDAl S. Putchaset"'$ mailing add'h Vr. A,~f-b/1..r /9~ A- "A/ReN/"'" , Ciry~r ..4"'~E5 Stale ZIP 9 G , WA- i 5'- < d) 5 r:;f) Telephone number . fAX number 3{,o- YS"7- '1:>7.r 9S7-(}OI.:J.. preml:iJownet's. n_Pl" ~ ~ Iynl"c.. 1)/(!,A-L.. rElL Addre,. 01 IdspeetloD 9;1,6 C,4-~()L/#C- 92.g City A /I, 11. r tVertaE:s' o Cash Cl Check # I hereby certify th3t I am the owner of the above named property Qt' a licensed Cl Credit Card VISa ~rcard\ Discover electrical contractor (or the firm's authorized .ag:ent) and am making the eh:ctrical installation or alteration iJl compliance with the electrkal taw, Chap1er 19.28 RCW. Card # ().(!! _E<..~_ _-_ _ __.____ SlgnatQre of OWJlU, electrlu.1 c:olltra~tor or ele:d.-iCl1l1 administrator " Expiration Date ' ( ~nspection fee (:) (J1 / WALLS Insulation 0I'l1:)- D*'.- Approyed By COVet Oafe Approy~By ( CliJLING Insulation Only Dalll: AIlI'f<lved 5Y Cover 081e App",~5)' ( 'fHERMOSfAT " \.. tlat~ ""wruv<<! By DJTClJ "" 'C D.I~ Aj)pI'Ovo!llj 5y / SERVICE 1 naIf' ApPl'Ov<<l5y J!EIDER Dale ~yo!lljl;ly ~ ~ ~ Electrical Load Additions snd or subtractions (;I NO LOAD CHANGES 1:1 Ba.ebOald KW o FumaCQ KW [J Hea.t Pump Ton LAR (;I Fan~W.1l KW Serviee Information Insp~ctlon Area., Building or Bquipment Inspected Eltctrical Date Action Taken Jnspc<:tor d) / , (J \ lV~ ~ , V"\ # /~ / "" [J Overhead Service o Temp Service Q Underground Service Voltage Phase (;I 1 1:13 Service Size: feeder Size: ELECTRICAL WORK PERMIT APPLICATION o Request Inspection . o Residential 0 Residential Mainl. 0 Signs 0 Thermostat 0 Telecom. )[ Electrical Contractor Installation description Job wired by DOwner f!..EMoPE L I () FFI (E Electrical contractor name License number O/'I"'I'/C Eledn'c Co Purcil'aser's mailing address '1,:2.30 7i1 #1 Ultlfe/: City P<JYt finjeJe;s State ZIP /IlA 1i%3 Telephone number F';J;ut~3'19 8 , 4,j,- S703 Premises owner's name . ONe . Address of inspection < 92.! ~J//le- 9.J.&, ~t. NE City P (J'r'f 1m, 'Ie lis , . ~' o Cash o Check # " J hereby certifytliat.i~am,'the owner ,of the above named property or a licensed o Credit Card Visa Mastercard Discover electrical contractor (oc'the firm's a~thorized agent) and am making the electrical installation or"alteration in compliance with the electrical law, Chapter 19.28 RCW. Card #, - . . . ---------------- Signature of owner. elcctri,cal contractor or electrical administrator Expiration Date X ~ fJ!. ,'l3tzrW/v of card ( SnsQS". qtJ ,., , . ' " WALLS " . Insulation Only :t ,,' ,', " .. Dale Approved By { Cover Date Approved By /' CEILING Insulation Only : " , Date Approved By Cover Dale Approved By '- ./ /' THERMOSTAT Date Approved By DITCH Dale Approved By SERVICE Dale Approved By FEEDER Dale Approved By Electrical Load Additions and or subtractions o NO LOAD CHANGES o Baseboard KW o Furnace KW o Heat Pump Ton LAR o Fan-Wall KW Service Information o Overhead Service o Temp Service o Underground Service Voltage PhaseD1D3 Service Size: _ Feeder Size: Inspection Date Area, Building or Equipment Inspected Action' Taken Electrical Inspector ..? ;NY , ., 't, b. p~ bll - 'riP 440 ,