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APPLICATION FOR WATER
City Water Division 1'/ ,~S-, 20_
Port Angeles. Washington '/ I @
I hereby apply for water to be furnished in accordance with rates and rules of the City for the
following premises: '.' _ ~
Name of Applicant: ,4jp J? h Oh 4 dVDWk..b-, + n J lP'i 7- 7.:::>Do
Address: '7(;'q :5 f~_ ~6~ -47'77
Renew~ New Servjce DBlk. ~ZB Lot Add
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Size of Service .P.,ft~ml' /% Meter Number DYt~\-Sil';'f cd),F<- 7'177
Service Left On 0 . Service Left Off 0 Signed fdt ctJo tJO f)
Installed by 1/1
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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
04-00000946 Date
.649856
709 S PEABODY ST
06-30-00-0-2-2840-0000-
COMM NEW CONST
11/02/04
COMMERCIAL OFFICE
201775
Owner
Contractor
ADOPTION ADVOCATES INT'NL
401 E FRONT ST
PORT ANGELES
(360) 452-4777
Structure Information
Construction Type
Occupancy Type
Other struct info
WA 98362
TERHUNE CUSTOM HOMES
POBOX 97
POULSBO
(360) 697-7000
3340 SF COMMERIAL OFFICE
TYPE V NON-RATED
BUSINESS:OFF/PRO/MED/REST
TOTAL % LOT COVERAGE
CONSTRUCTION TYPE
HARD SURFACE AREA
NUMBER OF STORIES
EXISTING LOT COVERAGE
LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE
NUMBER OF UNITS
WA 98370
18.90
V-N
2.00
1. 00
14000.00
2652.00
2652.00
1. 00
----------------------------------------------------------------------------
45.00
11/02/04
5/02/05
Plan Check Fee
Valuation
.00
201775
~
C)
-0
Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
RIGHT OF WAY
Qty
1. 00
Unit Charge Per
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 11/02/04 Valuation
Expiration Date 5/02/05
.00
201775
~
p
~
~r.L..
W
~
Qty
1. 00
Unit Charge Per
95.0000 EA SAN SEWER HOOKUP
Extension
95.00
----------------------------------------------------------------------------
Special Notes and Comments
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.
The project will result in a commercial structure in the CO
Zone for a total lot coverage of 19%. Setbacks are good.
Parking is adequate at present for the office use at 1:400.
No land use issues are noted.
Electrical load calculations and elctrical permits are
required.
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 t 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
T:\PLANNING\FORMS\1 102.15 [1 1114/2003]
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 UNLA WFUL TO COVER, INSULA TE 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 I I I
PLUMBING
UNDER FLOOR 1 SLAB
ROUGH-IN
Wf'TER LINE (METER TO BLDG)
cr;.s LINE
BACK FLOW 1 WATER
AIRISEAL
WALLS
CEILING I
FRAMING
JOISTS 1 GIRDERS
SHEAR W ALL/HOLD DOWNS
WALLS 1 ROOF 1 CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB I
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:
PARK1NG/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
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\1 102.15 [11/14/2003]
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number . . . . . 04-00000946
pin number . . . . . . .649856
Page 2
Date 11/02/04
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Special Notes and Comments
Any modifications to the City's electrical facilities will
be at the customer's expense.
Sanitary sewer connection inspection is required by
Public Works prior to back fill of ditch.
----------------------------------------------------------------------------
Other Fees
STATE SURCHARGE
4.50
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 140.00 140.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 144.50 144.50 .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:\PLANNING\FORMS\ 1102.15 [I 1/14/2003]
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
YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE/DOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN I
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
w.j\ TER LINE (METER TO BLDG)
(!As LINE
BACK FLOW 1 WATER
AIR SEAL
WALLS
CEILING I I
FRAMING
JOISTS 1 GIRDERS
SHEAR W ALL/HOLD DOWNS
WALLS 1 ROOF / CEILING
DRYW ALL (lNTERlOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILING I I
MECHANICAL
HEAT PUMP
GAS LINE
WOOD STOVE 1 PELLET 1 CHJMNEY
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 OCCUPANCYIUSE
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\1 102.15 [11/14/2003]