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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
4/09/04
04-00000100 Date
.323400
1723 S 0 ST
06-30-01-5-5-0010-0000-
RES NEW SFR
RESIDENTAL SF 9000
RS9 RESDNTL SINGLE FAMILY
74944
Owner
Contractor
HENNINGS, KAREN
2202 W 16TH ST
PORT ANGELES
(360) 452-5909
Structure Information
Construction Type
Occupancy Type
Other struct info
OWNER
WA 98363
NEW 1372 SF SFR W/ATT 528 SF
TYPE V NON-RATED
SINGLE FAM & CONGREGATES
TOTAL % LOT COVERAGE
CONSTRUCTION TYPE
NUMBER OF STORIES
EXISTING LOT COVERAGE
LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE
NUMBER OF UNITS
GARAGE
21.00
V-N
1. 00
1. 00
9007.00
1900.00
1900.00
1. 00
Permit PUBLIC WORKS RES WATER SERV
Additional desc
Permit Fee 670.00 plan Check Fee .00
Issue Date 4/09/04 Valuation 74944
Expiration Date 10/06/04
Qty Unit Charge Per Extension
1. 00 670.0000 EA PW W/M SFR 3/4" 670.00
Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
RIGHT OF WAY
45.00
4/09/04
10/06/04
Plan Check Fee
Valuation
.00
74944
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 .00
Issue Date 4/09/04 valuation 74944
Expiration Date 10/06/04
Qty Unit Charge Per Extension
1. 00 95.0000 EA SAN SEWER HOOKUP 95.00
special Notes and Comments
The site is located in the Madrona woods Subdivision. The
residential structure may NOT be finaled until
infrastructure for the subdivision is installed and
04-/DV
/723 S
/6 Y
ur'
/
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 orwork 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 Contractor or
rized Agent
Date
Signature of Owner (if owner is builder)
Date
T:\PLANNfNG\FORMS\IIOZ.15 [1111412003]
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, W A 98362
Application Number . . . . . 04-00000100
pin number .323400
Page
Date
2
4/09/04
special Notes and Comments
approved.
Building address sign shall not be less than 6" & not more
than 12" in height. Numbers colors must contrast with wall
color they are mounted on. (Ord. 14.36. 050-El
When roof gutters are installed, drains will located in dry
wells or piped to approved storm drain locations.
Other Fees
SEWER SYSTEM DELV CHARGE
STATE SURCHARGE
PW WATER SYSTEM USE FEE
745.00
4.50
1025.00
Fee summary Charged Paid Credi ted Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 810.00 810.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 1774.50 1774.50 .00 .00
Grand Total 2584.50 2584.50 .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 reguiating construction or the performance of
construction.
Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T:\PLANNING\FORM$\] ]02.]5 [I 1/1412003}
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
REQUEST:
Date (,-q -0'-1
Time /2..., PM
Received by De>'L"L:S E (phone, person)
Location of Work to be inspected ( 7 "Z. 3 50. "0"
Name of person requesting inspection 'iJeVl '^ I'" C-.
Address of person requesting inspection eo.. f Yo...rJ
Type of Inspection (circle appropriate one):
Sewer Foundation Framing Chimney Plumbing Final
(7"/- 15 Phone No.
. permi~
Sewer Excav. 0 er tUcL+e- v ')
INSPECTION NOTES:
Inspected: Date C, -'1 - o<{
Remarks: rJ~;.J I ';.c 3/<('
Time
Se.rVl~~
2- ~ PM.
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RESTORATION REQUiRED...... YES
NO 'X
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SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved DGravel
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
[] Asphalt [] PCC 0 Other
Work Order # 1'f7o, - 03/
[] COMPLETE
[] INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. INSPECTION REPORT. ....
REQUEST:
/! ~-
Date (p, / 01 Time L Received by --r;-=- (phone, person)
. "1,/ /~ /1/'1IJ In.
Location of Work to be inspected / /, -5//7;:3 dIJ--r"LEA ueST '- CZq'~
c. I t~c'L:J "-
Name of person requesting inspection z; 'V a c-- '
Address of person requesting inspection Phone No.
Type of Inspection (circle appropriate one): Permit No.
~'OO'd"'O' '''mi., Chlm.", P'ombl., Fl.., SOW" E,<aV. 0""
INSPECTION NOTES: / I L!--
Inspected: Date Lf ! if / 01 Time
Remarks:
D1-?}'J
OC/-/ou
By
RESTORATION REQUiRED...... YES NO
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SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved OGravel . 0 Asphalt 0 PCC
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
REQUEST:
Date
Time
Received by
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
II
J 7 z ~ :5 () 1/
~~
Phone No.
Permit No. O</-/DO
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other
Inspected: Date
Remarks:
INSPECTION NOTES:
/ /zllc.,;;
I ,
Time 'rtZ2 4"1--''-.
By
.,j 4/U l)f):F; {uS
RESTORATION REQUiRED...... YES NO
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20 "f- 4" J?ile
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
1,:'Mj;r4i1i!EiiliL~IIii!:Ii;iWiitmJi!lliiQjililijl;L~D~1lljl~1.::iiijifkiliW;~:it~~i;I~.l!llli;itiJii~;~~~~!ll!lIhl!tli~~~t~~!<<~i;i~_~~i'il~~i~I~~'U~"~iiuiJt~~l&~~i:~~~ili~r~i_~r.:j;j~"~,d&~~;~,j;,;,\'ii'~:i;i~ji'ljl"",;,j;~;~~~,1;;~;;:E2:I:~:!;'<
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CITY OF PORT ANGELES
DEP ARTMENT 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
04-00000100 Date
.323400
1723 S 0 ST
06-30-01-5-5-0010-0000-
RES NEW SFR
4/09/04
RESIDENTAL SF 9000
RS9 RESDNTL SINGLE FAMILY
74944
Owner
Contractor
HENNINGS, KAREN
2202 W 16TH ST
PORT ANGELES
(360) 452-5909
Structure Information
Construction Type
Occupancy Type
Other struct info
OWNER
WA 98363
NEW 1372 SF SFR W/ATT 528 SF
TYPE V NON-RATED
SINGLE FAM & CONGREGATES
TOTAL % LOT COVERAGE
CONSTRUCTION TYPE
NUMBER OF STORIES
EXISTING LOT COVERAGE
LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE
NUMBER OF UNITS
GARAGE
21.00
V-N
1. 00
1. 00
9007.00
1900.00
1900.00
1. 00
~
'?
l;J
permi t
Additional desc
Permit Fee
Issue Date
Expiration Date
PUBLIC WORKS RES WATER SERV
670.00
4/09/04
10/06/04
Plan Check Fee
Valuation
.00
74944
Jj)
Qty
1. 00
Unit Charge Per
670.0000 EA PW W/M SFR 3/4"
Extension
670.00
-::
Permit . . . .
Additional desc
Permit Fee
Issue Date
Expiration Date
RIGHT OF WAY
\J
45.00
4/09/04
10/06/04
Plan Check Fee
valuation
.00
74944
V)
,
Qty
1. 00
Unit Charge Per
45.0000 ECH RIGHT OF WAY PERMIT
Extension
45.00
Permit SANITARY SEWER HOOK UP
Additional desc
permi t Fee 95.00 Plan Check Fee
Issue Date 4/09/04 Valuation
Expiration Date 10/06/04
.00
74944
Qty
1. 00
Unit Charge Per
95.0000 EA SAN SEWER HOOKUP
Extension
95.00
Special Notes and Comments
The site is located in the Madrona Woods Subdivision. The
residential structure may NOT be finaled until
infrastructure for the subdivision is installed and
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 [11/14/2003]
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
I YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDA TION DRAINAGE/DOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN
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 ALLIHOLD DOWNS
WALLS 1 ROOF 1 CEILING
DR YW 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 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W.I PWI CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW 1 ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
T:\PLANNING\FORMS\1102.15 [11/14/2003]
:lf9'ORT~
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number . . . . . 04-00000100
pin number . . .323400
Page
Date
2
4/09/04
Special Notes and Comments
approved.
Building address sign shall not be less than 6" & not more
than 12" in height. Numbers colors must contrast with wall
color they are mounted on. (Ord. 14.36.050-E)
When roof gutters are installed, drains will located in dry
wells or piped to approved storm drain locations.
Other Fees
SEWER SYSTEM DELV CHARGE
STATE SURCHARGE
PW WATER SYSTEM USE FEE
745.00
4.50
1025.00
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 810.00 810.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 1774.50 1774.50 .00 .00
Grand Total 2584.50 2584.50 .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 Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T:IPLANNINGIFORMSIII02.15 [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
I YES 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
FRAMING
JOISTS / GIRDERS
SHEAR W ALL/HOLD 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 #'5:
WATERLINE / METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'5 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 R.W. / PW/ 5"- 9-0~ OS 'T,:' CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW / ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
T:\PLANNING\FORMS\1102.15 [11/14/2003]