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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DNISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362 0 3- & ! 0
Application Number
property Address
ASSESSOR PARCEL NUMBER
Application description
Subdivision Name
Property zoning
Application valuation
03-00000610 Date 10/30/03
3130 CITY LIGHTS PL
06-30-15-7-6-0030-0000-
RES NEW SFR
RS7 RESDNTL SINGLE FAMILY
172629
Owner
Contractor
FOSNES KENT R TERHUNE CUSTOM HOMES
PO BOX 7066 POBOX 97
TACOMA WA 984060066 POULSBO WA 98370
(360) 697-7000
Structure Information NEW 2480SF SFR
Construction Type TYPE V NON-RATED
Occupancy Type SINGLE FAM & CONGREGATES
Other struct info NUMBER OF UNITS 1 00
71?fD~ uF
----------------------------------------------------------------------------
Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
PUBLIC WORKS RES WATER SERV
DROP IN WATER METER
150 00 Plan Check Fee
10/30/03 Valuation
4/28/04
00
172629
Extension
BASE FEE I5a 00-....
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ~_.__.- -- - -"
Qty
Unit Charge
Per
Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
RIGHT OF WAY
45 00
10/30/03
4/28/04
Plan Check Fee
Valuation
00
172629
Qty Unit Charge Per
1 00 45 0000 ECH RIGHT OF WAY PERMIT
Extension_
(" 45 00
----------------------------------------------------------------------------
Permit SANITARY SEWER HOOK UP
Additional desc
Permit Fee 95 00 Plan Check Fee
Issue Date 10/30/03 Valuation
Expiration Date 4/28/04
00
172629
Qty Unit Charge Per
1 00 95 0000 EA SAN SEWER HOOKUP
EX~_E;!J:lsio:tt
. 95 00
Other Fees SEWER SYSTEM DELV CHARGE C~45 00
STATE SURCHARGE 4 50
PW WATER SYSTEM USE FEE 1025 00
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 290 00 290 00 00 00
plan Check Total 00 00 00 00
Other Fee Total 1774 50 1774 50 00 00
Grand Total 2064 50 2064 50 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
con tion.
~
Signature of Owner (if owner is builder)
Date
T \PLANNlNG\FORMS\ 11 02.15 [4/2002]
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . INSPECTION REPORT. . . . . .
REQUEST
Date It>/; V 10'3 Time Received by
/ J/~ ~ .
Location of Work to be inspected ~ L/ ~ &p t...L."
Name of person requesting inspection (!. ~' ..e-X.C,
Address of person requesting inspection Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final~ Other
(phone, person)
03-&10
INSPECTION NOT~ ,;;;
Inspected Date / fi :1I e
Remarks
Time
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RESTORATION REQUIRED
YES
NO X
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
Date
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . INSPECTION REPORT. . . . . . . .
l/t-i JrX3 Time
Received by
REQUEST
Plumbing
--J.c::- (phone, person)
II
C,~_L~~,
~ ~ / FiC'cAOIt TI () n
Phone No
Permit No 03~/O
Fin~wer ~ther
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
Sewer Foundation Framing Chimney
il/W
~
INSPECTION NOTES r/z" ! -
Inspected Date 7J. 1~ Time
Remarks
f' (,
By
I I :f
I
"
.If':'
RESTORATION REQUIRED if:& YES NO
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SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel D Asphalt D PCC
D Other
D Repaired by City
[] Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING 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
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT #
ROUGH-IN I
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
WATER LINE
GAS LINE
BACK FLOW / WATER
AIR SEAL
WALLS
CEILING I I
FRAMING
JOISTS / GIRDERS
SHEAR WALL
WALLS / ROOF / CEILING
DRYWALL
T-BAR
INSULA TION
SLAB
WALL / FLOOR / CEILING I
MECHANICAL
HEA T PUMP
WOOD STOVE / PELLET / CHIMNEY
HOOD / DUCTS
PW UTILITIES I 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 I YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRlCAL LIGHT DEPT 417-4735 ELECTRlCAL
LIGHT DEPT
CONSTRUCTION R.W / PW/ CONSTRUCTION R.W
ENGINEERING 417-4807 PW / ENGINEERlNG
FIRE 417-4653 FIRE DEPT
PLANNING DEPT 417-4750 PLANNING DEPT
BUILDING 417-4815 BUILDING
T"\PLANNING\FORMS\1102.15 [4/2002]
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
32\ EAST 5TH STREET, PORT ANGELES, W A 98362
Application Number
property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Zoning . . .
Application valuation
03-00000610 Date 10/30/03
3130 CITY LIGHTS PL
06-30-15-7-6-0030-0000-
RES NEW SFR
RS7 RESDNTL SINGLE FAMILY
172629
Owner
Contractor
FOSNES KENT R TERHUNE CUSTOM HOMES
PO BOX 7066 POBOX 97
TACOMA WA 984060066 POULSBO WA 98370
(360) 697-7000
Structure Information NEW 2480SF SFR
Construction Type TYPE V NON-RATED
Occupancy Type . . . .. SINGLE FAM & CONGREGATES
Other struct info. . .. NUMBER OF UNITS 1.00
Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
PUBLIC WORKS RES WATER SERV
DROP IN WATER METER
150.00 Plan Check Fee
10/30/03 Valuation
4/28/04
.00
172629
BASE FEE
Extension
150.00
oJ
Qty Unit Charge Per
45.00
10/30/03
4/28/04
plan Check Fee
Valuation
.00
172629
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a.s:.--I-
Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
RIGHT OF WAY
Qty Unit Charge Per
1.00 45.0000 ECH RIGHT OF WAY PERMIT
Extension
45.00
Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
SANITARY SEWER HOOK UP
-
95.00
10/30/03
4/28/04
Plan Check Fee
Valuation
.00
172629
ct
-:-to
Qty Unit Charge Per
1.00 95.0000 EA SAN SEWER HOOKUP
Extension
95.00
Other Fees
SEWER SYSTEM DELV CHARGE
STATE SURCHARGE
PW WATER SYSTEM USE FEE
745.00
4.50
1025.00
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T
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 290.00 290.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 1774.50 1774.50 .00 .00
Grand Total 2064.50 2064.50 .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.J5 [4/2002]