HomeMy WebLinkAbout121 W. 1st Street Address:
121 W 1St Street
THEO.l'R 1Al�jGELES For City Use
CITY OF
Permit#
WASH I N G T O N , U . S .
Date Received:
321 E 5th Street [ ate Approved
Port Angeles,WA 9836
P: 360-417-4817 F: 360-417-4711 —✓
Email:permits@cityofna.us BUILDING PERMIT "PLICATION
Project Address: i - � � '-� _ �� tnc. -e fit
Phone: Lk - - 4 L L
Primary Contact: Com_ FIZZ` Email:
Names Phone
Property M ngg nddr Email
Owner U u Vd Mak �J I N
City State
e Phone
Contractor Address I t 1 Email
Information city l State zip
Ao
Contractor License# 1A Exp.Date:
Legal Description: Zoning: Tax Parcel # Project Value: (materials and labor)
�C� 3vx 155 I ot;t>� $ l't Cvf
Residential ❑ Commercial Industrial Public ❑
Permit Demolition ❑ Fire', , Repair 1:1Reroof(tear off/lay over) ❑
Classification For the fol wing. fill o' tooth pages of permit application:
(check New Const tion terior Remodel M Addition 11 Tenant Improvement ❑
appropriate) Mechanical �Plu bing ❑ Other ❑
Will a fire sprinkler system be ing 1Irrigation System? Proposed Bathrooms Proposed Bedrooms
X'or modified? Yes ❑ No 9 Yes ❑ No ES
Project Description ad-&\ 0-0--)V-Y L v-10\ 01 l
`Ts
Is project in a Flood Zone: Yes ❑ NoEl Flood Zone I _
If in a Flood Zone, what is the value of the structure before proposed improvement? $
I have read and completed the application and know it 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 and to
obtain permits prior to work. I understand that plan review fees are not refundable after review has
occurred. I understand that I will forfeit review fees if I withdraw the application before the permit is
issued. I understand that if the permit is not picked up/issued within 18o days of submittal,the application
will be considered abandoned and the fees will be forfeited.
Date L\'q—� `1 Print Name i 6U22A Signature �l
Residential Structures
For Office Use
Area Description(SQ FT) Existing Proposed $$value
Basement
First Floor
Second Floor
Covered Deck/Porch/Entry
Deck(over 30"or 21d floor)
Garage
Carport
Other(describe)
Area Totals
Commercial Structures
Proposed For Office Use
Area Descriptions(SQ FT) Existing Proposed $$Value , ,
Existing Structure(s) _
Proposed Addition
Tenant Improvement?
Other work(describe)
Site Area Totals
Lot/Site Coverage Calculations
Lot Size(sq ft) Lot Coverage (sq ft) %Lot Coverage(Total lot coverage=lot size)
Site Coverage(Sq Ft of all impervious) %of Site Coverage(total site coverage=, lot size)
Mechanical Fixtures
Indicate how many of each-type of fixture to be installed or relocated as part of this project.
Air Handler Size: # Haz/Non-Haz Piping Outlets:
Appliance Exhaust Fan # Heater(Suspended,Floor,Recessed wall) #
Boiler/Compressor Size: # Heating/Cooling appliance #
re
ration
Evaporative
Evaporative Cooler(attached,not # Pellet Stove/Wood-burning/Gas #
portable) Fireplace Gas Stove Gas Cook Stove/Misc.
Fuel Gas Piping #of Outlets: Ventilation Fan,single duct #
Furnace/Heat Pump/ Size: # Ventilation System #
Forced Air Unit
Plumbing Fixtures
Indicate how many of each type of fixture to be installed or relocated
Plumbing Traps # Fuel gas piping #of Outlets:
Water Heater # Medical gas piping #of Outlets:
Water Line # Plumbing Vent piping #
Sewer Line # Industrial waste pretreatment
interceptor Grease Trap) Size
Other describe :
T:\BUILDING\APPLICATION FORMS\Current BP Application\Building Permit 4-17-13.docx