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Home My WebLink About214 Fogarty Ave - Building CITY OF PORT ANGELES riaNI DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 NMI Application Number 11- 00000690 Date 7/06/11 Application pin number 939640 Property Address ASSESSOR PARCEL NUMBER: 06- 30-09- 5-2-2715 -0000- REPORT SALES TAX Tenant nbr, name HARLAN N RUDOLPH on your state excise fax form Application type description RE -ROOF Subdivision Name to the City of Port Angeles Property Use (Location Code 0502) Property Zoning RS7 RESDNTL SINGLE FAMILY Application valuation 3000 Application desc TEAR OFF RE -ROOF THE HOUSE Owner Contractor HARLAN N RUDOLPH OWNER 214 FOGARTY AVE PORT ANGELES WA 983622514 (360) 457 -5036 Structure Information 000 000 RE -ROOF THE HOUSE Permit BUILDING PERMIT NO PR FEE Additional desc RE -ROOF THE HOUSE Permit pin number 188714 Permit Fee 109.75 Plan Check Fee .00 Issue Date 7/06/11 Valuation 3000 Expiration Date 1/02/12 Qty Unit Charge Per Extension BASE FEE 95.75 1.00 14.0000 THOU .BL- 2001 -25K (14 PER K) 14.00 Other Fees STATE SURCHARGE 4.50 Fee summary Charged Paid Credited Due Permit Fee Total 109.75 109.75 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 114.25 114.25 .00 .00 "Rao,' 3.19 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 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 law regulating construction or the perform ce of construction. J r) 0 7 79 _idt,,t,d, Date Print Name Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder) T:Forms /Building Division /Building Permit BUILDING PERMIT INSPECTION RECORD 0 PLEASE PROVIDE A MINIMUM 24 -HOUR NOTICE FOR INSPECTIONS Building Inspections 417 4815 Electrical Inspections 417 4735 Public Works Utilities 417 4831 Backflow Prevention Inspections 417 4886 IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Inspection Type Date Accepted By Comments FOUNDATION: Footings Stemwall Foundation Drainage Downspouts Piers Post Holes (Pole Bldgs.) PLUMBING: Under Floor Slab Rough -In Water Line (Meter to Bldg) Gas Line Q� Back Flow Water FINAL Date Accepted by l AIR SEAL: Walls Ceiling FRAMING: Joists Girders Under Floor Shear Wall Hold Downs r Walls Roof Ceiling Drywall (Interior Braced Panel Only) T -Bar INSULATION: �L Slab Wall Floor Ceiling MECHANICAL: Heat Pump Furnace FAU Ducts Rough -In Gas Line Wood Stove Pellet Chimney Commercial Hood Ducts FINAL Date Accepted by MANUFACTURED HOMES: Footing Slab Blocking Hold Downs Skirting PLANNING DEPT. Separate Permit #s SEPA: Parking Lighting ESA: Landscaping SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE Inspection Type Date Accepted By 7 Electrical 417 -4735 Construction R.W. PW Engineering 417 -4831 Fire 417 -4653 Planning 417 -4750 q., Building 417 -4815 3-11- 1 ,T T:Forms /Building Division /Building Permit V N 14 41 El H I I M I KC KC [a 10 1 0 1 0 1 1 10 1 1 1 0 O 1 N 1 0 10 M 1 10 a 1 N a 0 w x H 1 a H L O W H w z 1010 w W W W 0 0 41, M W X w a x x H u m a s m In 0 Ha 0: z 10 h r Hu o z 10 10 z O a I a H O (n 0' H 10 F .0 V1 u u z H 10 10 L4 41 w Hrl z 10 10 2 0 0 w 2 2 4122 a ry ro HH 1 44 H ry' •7 0 1 10! H 1a u a H N w 0 X s .G 10 CDU2 Z 0 0 4141 a m o q a 01 04, I 0 1 H E. In 0 1 H x x H a 1 W W a r E C Q 0 10 1 10 10 0 a 4 Ill �J 10 I 0 H W F. a a 111 o) Z a �r1 a 0D 1 H co 0) 0 z 0 0 1 A w oz 1 0 1 H 0 0 a w 00 1 0 W W N 10 10 0 10 10 1 o f 1 ((0 W \�Z I0w m 01 N x x 0 H 1 0 10 W H 1 a 112 a 1 2 1 0 1 2 U 0 1 1 1 w a zo w 1:4 F 21 100 m z 1 z az a o WE 02 W 1 a m au 010001 .ti F ro PROJECT STATUS UPDATE e°1e) Permit LAO 2-19- na.r l Date: �j' 16 rk I phoned the: Applicant at Property Owner Val( La n.., gado 1171-) at G J�" S OS b Contractor at I (left a phone message, or discussed): The permit (has expired, or will expire soon). What is the status of this project? Please call and schedule a final inspection. Or Submit a "permit extension request" letter. Or Let me know if the project is abandoned. ree y formal T:Forms /Building Division/Project Status Update 0\voin ik BUILDING PERMIT APPLICATION Print in ink T E CITY OF PORT ANGELES For City Use Onl Attn: Building Permit Technician Date Received 321 E. Fifth St., Port Angeles, WA 98362 (360) 417 -4815 fax (360) 417 -4711 Date Dat p Approved Applicant f In( p Phone 3 i y5 2 d3�' Property t ickylaji wner 91% 4"..1 Phone Property Owner's Address 2/g roe c 4 A de Contractor O }i ,N` r 'J Phone Contractor's Address License Expires E -mail PROJECT ADDRESS 2/z/ c; iC Parcel Number 0 6 30 6952_ 2'7 l Lot Zoning_ Re 1 Proiect Tyne Brief Description: p Residential Multi family Commercial Industrial Check all that apply New Construction Addition Remodel Repair Demolition 'Re -roof douse garage other ear off re -roof lay over one layer Heat System Heat pump wood burning stove gas fireplace pellet stove other Other Floor Areas Existing (sq. ft.) Proposed (sq. ft) Basement per sq. ft. 1 Floor 2 Floor 3 Floor Garage Carport Mai S 5 Covered Porch 1-Ca06 h l 660 Deck Shed Other TOTAL VALUATION ,'i 000 Total footprint of structures sq. ft. T Lot size sq. ft. Lot coverage Site Coverage the amount of impervious surface on a parcel, including structures, paved driveways, sidewalks, patios, and other impervious surfaces. (see PAMC 17.94.135 for exemptions) Site coverage Max. height of proposed structures ft. Occupancy group of bedrooms Will a lawn sprinkler system be installed? Occupant load of full baths Will a fire sprinkler system be installed? Construction type of half baths I have read and completed this application and know it to be true and correct. l am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required, and to obtain permits prior to Ovorki g on projects. Date `•7 C Print Name fr'Ci V j 1, (Ct /1 i�t 0 I Signature M elide T:Forms /Building Division/Bldg Permit.doc Clallam County Assessor Treasurer Property Details 81291 HARLAN N RUDOLP... Page 1 of 2 Clallam County Assessor Treasurer Property Search Results 81291 HARLAN N RUDOLPH for Year 2010 2011 Property Account Property ID: 81291 Legal Description: LOTS 4 5 BLK 27 FOGARTY DOLANS ADDN, 09 LOT COVE; Geographic ID: 063009522718 Agent Code: Type: Real Tax Area: 0010 PA 121 PORT ST CNTY H2 L WMP Land Use Code 11 Open Space: N DFL N Historic Property: N Remodel Property: N Multi Family Redevelopment: N X� Township: Section: Range: v Location V� Address: Maps co: Neighborhood: Cycle 5 Res Map ID: 3 P/ Neighborhood CD: 10955130 Owner Name: HARLAN N RUDOLPH Owner ID: 49757 Mailing Address: 214 FOGARTY AVE Ownership: 100.0000000000% PORT ANGELES, WA 98362 -2514 Exemptions: SNR /DSBL Taxes and Assessment Details Property Tax Information as of 07/06/2011 Amount Due if Paid on: 74,, NOTE: If you plan to submit payment on a future date, make sure you enter the date and click RECALCULATE to obtain the correct total amount due. First `Second Half Half Base Base Year Statement ID i Taxing Jurisdiction Amt. Amt. Penalty Interest Base Paid Amount Due j 2011 170102 ST SCH STATE SCHOOL $81.02 $81.01 $4.86 $4.86 $0.00 $171.75 2011 170102 CC -GEN COUNTY CLALLAM $44.73 $44.72 $2.69 $2.69 $0.00 $94.83 2011 170102 SD #121 SCHOOL DISTRICT #121 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2011 170102 CITY PORT ANG CITY OF PORT ANGELES $88.39 $88.38 $5.30 $5.30 $0.00 $187.37 2011 170102 PORT PORT OF PORT ANGELES $6.30 $6.29 $0.38 $0.38 $0.00 $13.35 2011 170102 NTH OLY LIB NORTH OLYMPIC LIBRARY $18.76 $18.75 $1.13 $1.13 $0.00 $39.771 .2011 170102 HOSP #2 HOSPITAL #2 $18.36 $18.36 $1.10 $1.10 $0.00 $38.92 i 2011 170102 WSMET PK DIST WILLIAM SHORE MET PARK DIST $5.58 $5.58 $0.33 $0.33 $0.00 $11.82 2011 170102 CITY_STORMWATER CITY STORMWATER $36.00 $36.00 $2.16 $2.16 $0.00 $76.32 2011 170102 WEED_CONTROL WEED CONTROL $0.82 $0.81 $0.00 $0.05 $0.00 $1.681 2011 170102 TOTAL: 5299.96 $299.90 $17.95 $18.00 $0.00 $635.81 2010 58810 ST SCH STATE SCHOOL $80.20 $80.21 $0.00 $0.00 $160.41 $0.00 i 2010 58810 CC-GEN COUNTY CLALLAM $42.68 $42.69 $0.00 $0.00 $85.37 $0.00 i 2010 58810 SD #121 SCHOOL DISTRICT #121 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2010 58810 CITY PORT ANG CITY OF PORT ANGELES $85.98 $85.97 $0.00 $0.00 $171.95 $0.00 2010 58810 PORT PORT OF PORT ANGELES $6.00 $6.00 $0.00 $0.00 $12.00 $0.00 2010 58810 NTH OLY LIB NORTH OLYMPIC LIBRARY $12.40 $12.41 $0.00 $0.00 $24.81 $0.00' 2010 58810 HOSP #2 HOSPITAL #2 $17.51 $17.51 $0.00 $0.00 $35.02 $0.00 2010 58810 WSMET PK DIST WILLIAM SHORE MET PARK DIST $5.57 $5.57 $0.00 $0.00 $11.14 $0.00 2010 58810 CITY STORMWATER CITY STORMWATER $36.00 $36.00 $0.00 $0.00 $72.00 $0.00' i 2010 58810 WEED CONTROL WEED CONTROL $0.82 $0.81 $0.00 $0.00 $1.63 $0.00 http: /websrv8. clallam. net /propertyaccess /Property. aspx ?cid =0 &year= 2010 &prop_id =81291 7/6/2011 When recorded return to I- 61 t// 0 Grimm o a 21(4 Foc,a44 -u P 11, IA) R3R� AALL 6(t;' (Owner Signatu Phone ri f s 7 3� 2009 1246643 Page 1 of 1 Protct Covenant Harlan Rudolph Clallam County Washington 12/22/2009 12 00 16 PM 1111 r' %YI+f9LCLri,' L!'"i Pi 11111 (ham 0Awf" 0(93 d ZONING LOT COVENANT I /WE the undersigned owner(s) of the following described property (Insert legal description and parcel number here) Fcaa.►(& r Do)c r �.s A t o 52.2_ 00 0t, 4.°43 a4'cj j 22 7 Za crovc, do hereby covenant that said property shall be designated as one zoning lot as defined in Section 17 08 130 "Z" of the Port Angeles Municipal Code. This covenant creates one inseparable building lot which may only be removed through compliance with Chapter 58 17 RCW (subdivision regulations) and /or the City of Port Angeles short subdivision regulations (Ordinance No 2222, as amended) This covenant shall be binding on the owner(s), heir(s), assign(s), and successor(s) in interest and shall be filed with the County Auditor's Office This covenant is for the mutual benefit of said owner(s), heir(s), assign(s), and successor(s) in interest and is for the further purpose of compliance with state and local land use and building regulations. This covenant may be enforced by injunction or other lawful procedure and covenant by the recovery of any damages resulting from non compliance. DATED this Pnnt4Name a k r 2.4r Lore t 5 131 27 day of 20r Print Name (Own: Signature) Phone3LPD S STATE OF WASHINGTON) ss COUNTY OF CLALLAM I. />70ICC a, C. 111 a I /d Notar Public in and for the State of Washington, do hereby certify that on tlnsaa day of �.CCC ro k 20g, personally appeared before me An, e I a 1-1 cz hen A dQ! D known to me to be the individual(s) described in and who executed the withm instrument and acknowledged that ti signed and sealed the same as �-hl r free and voluntary. act and deed for the purposes herein ment DEC ):1 1g RECEIVE 2 a zoos CITY OF PORT ANGELES Dept. of Community Development day of f�Le /27 frx.,/ GIVEN UNDEtM(IiTi6ND AND OFFICIAL SEAL this J s.S.sgi OIiA R ce, a t O rn '0 o 7 y a NOTARY PUBLIC in and for the St«te o C `�0 O /c 47 igt. Tn residing at Port Angeles. r/� 9 S T r 4jfl l 0'N'`\\\\\\ 20 09 L£• 5£l 041 �£1 1.02 ZOZ 0 LOZ' r 91Z IZZ 2 CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, W A 98362 Application Number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name . . Property Zoning . . . Application valuation 03-00001034 Date 11/26/03 214 FOGARTY ST 06-30-09-5-2-2715-0000- RES ADDITION RS7 RESDNTL SINGLE FAMILY 22500 Owner Contractor RUDOLPH HARLAN N 214 FOGARTY AVE PORT ANGELES OWNER WA983622514 Structure Information Construction Type Occupancy Type . . . . . Other struct info . . . . ADDNT ON LOWER FLOOR & SECOND STORY TYPE V NON-RATED SINGLE FAM & CONGREGATES NUMBER OF UNITS 1. 00 Permit Additional desc Permit Fee Issue Date Expiration Date ELECTRICAL ALTER RESIDENTIAL Plan Check Fee Valuation 51.90 11/26/03 5/25/04 .00 o Qty 1. 00 1.00 Unit Charge Per 46.7000 ECH EL-R OR RM 1-4 ALT CIRCUITS 5.2000 ECH EL-R OR RM ALT ADDNT CIRCUITS Extension 46.70 5.20 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 51. 90 51. 90 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 51. 90 51. 90 .00 .00 ~ ...... -t.,. ~ ~ J ~ 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 sp~tified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or I. al law regulating construction or the performance of construction. Signature of Contractor or Authorized Agent Date T:\PLANNING\FORMS\1 102.15 [11/1412003] II 2b,-63 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 UNLA WFUL 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 FOUNDA TION DRAINAGE/DOWN SPOUTS . !i /') ~ -,'. ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # j/()_.I/.:5 g,V't~L ~\ 11'.....-". , r. . V If-- IL:,:A;I/:\.../ ROUGH-IN 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 DR YW ALL (INTERJOR BRACED PANEL ONLY) T-BAR INSULA TION SLAB WALL / FLOOR / CEILING I MECHANICAL HEAT PUMP GAS LINE WOOD STOVE / PELLET / CHIMNEY HOOD / DUCTS PW UTILITIES / SITE WORK (Engineering Division) SEP ARA TE PERMIT #'50 WATERLINE / METER SEWER CONNECTION SANITARY STORM .,... PLANNING DEPT. SEP ARA TE PERMIT #'s SEPA: t-)(;f) rULQ' PARKING/LIGHTING ESA: 12~~f-as 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. PLAI\TNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 BUILDING T:\PLANNING\FORMS\1102. 15 [11114/2003] CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number ..... 03-00001034 Date 10/21/03 Property Address ...... 214 FOGARTY ST ASSESSOR PARCEL NL~4BER: 06-30-09-5-2-2715-0000- Application description . . . RES ADDITION Subdivision Name ...... Property Zoning ....... Application valuation .... 22500 Owner Contractor RUDOLPH HARLAN N OWNER 214 FOGARTY AVE ...... Structure Information ADDNT ON LOWER FLOOR & SECOND STORY ..... Occupancy Type ...... SINGLE FAM & CONGREGATES Additional desc . , Expiration Date . . 4/19/04 Expiration Date . . 4/19/04 ............................................................................AdditionalPermit ...... desc . . PLUMBING PERMIT 3.00 7.0000 ECH PL- EA. FIXTURE ON ONE T~AP 21.00 Fee summary Charged Paid Credited Due Permit Fee Total 509.00 509.00 .00 .00 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, pdvate 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 pedod 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 kn~w the same to be true and correct. Alt provisions of' laws and ordinances governing this type of work will be complied with whether sp,e'~ified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state o)~al la~qregulating cons~tr)uction or the pe~rmance of construction. /-~ / ~ " " - ' Signature of Contractor or Authorize~ Agen'~' Dat'~'~ -~i~a~ure ofbwner (if owner is buil~er(t.~ Date T:\PLANNING~IFORMS\1102.15 [4/2002] FOR OFF1CIAL USE ONLY: BUILDING PERMIT - APPLICATION Oate R 0: /O - q - O'3 Permit#: t~-- Fill out COMPLETELY and in INK. Your application and site plan MUST BE Date Approv~~ COMPLETE to be accepted for review. If you have any questions, call Date Issued: 7 ~ ~ (360) 41%4815 Applicant or, Agent: ~l(~J6'L~ ~X(~i)~ Phone:~¢ ~? ~ ~ ~chitecffEngineer: ~ Phone: ~ Con.actor / State License ~: ~ ~ Exp: ~ Phone: ~ ~ Address: '~ CiW:. '~ Zip: ~ eao cT ss: d ZON S¢: LEGAL DESC~TION: Lot: ~ ~ Block: ~ ? Subdivision: ~j ¥~/a~ Credit Card Holder Name: Billing Address: City: Credit CardType VISA__ MC # Exp. Date: TYPE OF WORK: SIZENALUATION: }l~ Residential [] New Constr. ~ Re-roof [] Stove ~[~ SF. ~ $ [] Multi-family ~1 Addition [] Move [] Garage SF. ~ $ /SF. = $ [] Commercial [~ Remodel [] Demolition [] Deck SF. ~ $ /SF. = $ . . [] Repair [] Sign [] Other TOTAL vALuATIO~ BRiEFDESCRIPTIONOFTHEPROJECT: (~ [%X '-',,C tc,.a4 ~J d-YC:_,a.,., , ,~,~ Io ~ ...... , .~, OJ&~,~ ,'%~.(- ,,;~x.~. ,,~ COMMERCIAL/RESIDENTIAL: Occupancy Group: Occupant Load: __ Construction Type: No. of Stories: -" Lot Size: ]502,3 Existing Sq. Ft..,~?_~ & Proposed Sq. Ft. Existing lot coxYage 4~ % & Proposed lot coverage ~ ~' % = mo~tal lot coverage /~'/, ~ % APPROVALS: PLANNING USE ONLY: PLAN: __ BLDG: DPWU: FIRE: ESA/Wetland(s): [] Yes [] No SEPA Checklist required? [] Yes [] No Other: 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 penmt application and construction plans are submitted. All other permit fees are due at the time ofpenmt 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 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 ttie 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 C~s, .~nd that I must obtain such permits prior to work. T:~FORMS~APPS\Buildingpennit.wpd Applican~z~'~~L/k~'/cL'~] /L; ~/' / /'''' ' I i [-"-F-'~--f.r -I-f-! [-7-- "'i ~---~, ~ ..... , !' -r .... r-~-. ~ ~-- '-+---' -' '~ -! i *f'---l- -- ,..\ - ~ . ELECTRICAL PERMIT APPLICATION FOR OFF,IClALJ.lSE~"ILYi05 DatelRec. 10 -- sf- Permit#: Date Approved: Date Tssue& The Electrical Permit Application must be filled out completelv. Please type or reprint in ink. If you have any questions, please call (360) 4174735 Fax number: (360) 417-4711' Il7l/''; 0 .3<1 Owner or Elee. Contractor Agent: Property Owner: /Jr;. vi G. ,U k! u. r!.) ~t? I. Address: c_f<l r:: rJ '^ r!.; ,If, ""', Electrical Contractor; - Phone: Fax: City: H;- rlJ Ayd P) License #; Phone3tO <:fS? 503C Zip: 9f&r.2 Exp: Phone: Address: City: 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: .2.J ~ ;;50-.r Jj AUf TYPE OF WORK: Check all that apply: 0 New )!'l.AJteralion/Addition ~esidential 0 Multi-family o Commercial 0 Mobile Home' Sq. Ft 0rD o Remote Meter 0 Detached garage ,o.Hot Tub 0 Swim Pool 0 Septic Pump: 0 tow Voltage 0 Telecom. . 0 Si~ Number of CirGuits added or. altered: :. ~. ' "j' :{ DESCRIPTION OF THE EL!,~TRIC~L PROJECT: 'f r Jl I' ,II 1-:,0. ' if h~r"'s C{Jr9-~;"" i:t2;vJ ..(hole '/:; el<l\l~~ k.r-<.....e Electrical Heat Load Additions and or Subtractions Service Information o Baseboard _ KW o Furnace KW 0 Overhead Service o Heat Pump TON LRA 0 Temp Service I8l Fan-Wall -iP-KW 0 Underground Service . .R' /r / () - l,j....' 0 .; e~""'Ittt-1J /#i -~ '1- Q~ I hereby certify that I have read and examirfed this application and know that same to be true and correct, and I an 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. Voltage: 2zU Phase: 1211 0 3 Service Size: .3:./D 19 Feeder SIZe: Credit Card Holder's Signature: Date: Owner or Elec. Cont. Signature: Date: --r1Zf);,[5[?11lJ1f7C- ouen !.oOO6() - uf0;Z{I(}6- -10 MD C07\ To au ~ -to />..Ace... C:/ELECTRICAlPERMIT APPLICATION ~ ..;j) /113/?J3 -rF'-(.{f[s>-n-D/YtEl:.. ~. 7D C-' -t s:~o PERMIT FEE: $ $E>/,90 rh7.;- rUT r-1- r-rT-r-l-I---1--1--"-rT-~ -~ ~;-T- r -1--"1--'--'-,-- .,-'---'1'---41 -+-~I +~ 1-. i ' '; I i 'ii I' U r-.-'~'----t--.f ---f-- .~-!n_--r ,.-~.;._--t.-i---!i---t--".+--f .-~. r-' - . :-__1 ,'-" +----r-~.--+. ,~~. -, ~~-- -i __u_ -~ ..-+--~_.-+---.~--- +--+ .....'t ','- ~ -t-'~'- --~...,._. ; I i I L I 1 1 ; : j I I I I I ;'--'i"---T"UT" i ~ 1 . . 'T-1-T-. t 1 :.~,._L_ , ~_ : ._ I~.,....~ I I I I '-"-;'- , I i , -- .- - I' , .... '.' _-}.._ _n , i 'or ; I -~. m., ,. ~ 'Ito.' 1'1-\ ~ FAT -il'j' N'I- '-1- I J... , i -'1 -. I ! i ! .. , : i I f.],1 --"r ~r ,- ...... _ _ ..1. , I ~. ~. , ..ij- n':_-1 I ; I I _I -i '1 !~~+~ 1\ ii' I , ! . I : , ' -I:t~~-r+=rr- ---1~ I ~fi.-t'j --l- - .. --. --, - --i--- rT...t- \ 1 ~_.l 1 Tl-l1 , ---+---'---r- - - -~f~t+ ,-Hi i -_.~" i 4--t- . "}----t:f'o." I ::jO.. 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