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ELECTRICAL PERMIT
CITY OF PORT ANGELES
360-417-4735
Application Number . . . . . .19-00001312 Date 8/2 7/19
Application pin number . . . 068640 REPORT STATE SALES TAX
Property Address . . . .. . . 3810 PAGE ST
ASSESSOR PARCEL NUMBER: Q�--30-16-5-S�0240-0000- on your excise tax form
Application type description ELECTRICAL ONLY to the City of Port Angeles
Subdivision Name . . . . . . (Location Code 0502)
Property Use . . . . . . . .
Property Zoning . . . . . . . PLANMW RESDNTL DmpMENT
Application valuation . . . . 0
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Application desc
Temp Service
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Owner Contractor.
------------------------ ------------------------ -
SHERRON ASSOCIATES, L.L.C� UPPER LEFT ELECTRIC LLC
1306 ROOK DR
BELLEVIEW PORT ANGELES WA 98362
BELLEVUE WA 58005 060) 461-"1720
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Permit . . . . . .. ELECTRICAL TEMPORARY SERVICE
Additional desc
Permit Fee . . . . 93.00 Plan Check Fee .00
Issue Date . . . . 8/27/19 Valuation . . . . 0
Expiration Date 2/23/20
Qty Unit Charge Per Extension
1.00 93.0000 ECH EL-TEMP SRV 0-200 SRV FDR 93-.00
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Fee summary Charged Paid credited Due
----------------- ------- -- ---------- -------- - ---------- -
Permit Fee Total 93.00 93.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 93.00 93.0,0 .00
NSPEMON TYPE DATE: RESULTS: INSPECrOR:
DUCH
SERVO
kNAL
An
COMMENTS:
PFRmrr wELL Expum six(6)moNTHs FRom LAST INSPWnON
Signature of owner or Electrical Contractor X Date:
1 - 2 SINGLE-FAMILY
3
ELECTRICAL PERMIT APPLICATION
Public Works and Utilities Department
321 E. 5th Street, Port Angeles, WA 983162
360.417.4735 'i www.cityofpa.us electricalpermits(��cityofpa.us
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Project Address: 2-e
Project Description.- toe,
El Single-Family Residential El Duplex/ARU Building Square footage:
OWNER INFORMATION
Name: Email:
Mailing Address: Phone:
F_
ELECTRICAL CONTRACTOR INFORMATION
Name: C-Q:� a X�i� License:
Mailing Address: Expiration Date:
Email: 01YV-Vath ,C_C)yV'\ -Phone:
PROJECT DETAILS
Item Unit ChaEge Quantily Total(Quantity x Unit Charge)
Service/Feeder 200 Amp. $120.00 $
Service/Feeder 201-400 Amp. $146.00 $
Service/Feeder 401-600 Amp. $205.00 $
Service/Feeder 601-1000 Amp. $262.00 $
Service/Feeder over 1000 Amp. $373.00 $
Branch Circuit W/Service Feeder $5.00 $
Branch Circuit W/O Service Feeder $63.00 $
Each Additional Branch Circuit $5.00 $
Branch Circuits 1-4 $75.00 $
Temp. Service/Feeder 200 Amp. $93.00 $ T'S� 6>
Temp.Service/Feeder 201-400 Amp. $110.00 $
Temp.Service/Feeder 401-600 Amp. $149.00 $
Temp.Service/Feeder 601-1000 Amp. $168.00 $
Portal to Portal Hourly $96.00 $
Signal Circuit/Limited-Energy-1&2 DU. $64.00 $
Manufactured Home Connection $120.00 $
Renewable Elec. Energy: 5KVA System or less $102.00 $
Thermostat(Note:$5 for each additional) $56.00 $
First 1300 Square Feet $120.00 $
Each Additional 500 square feet" $40.00 $
Each Outbuilding/Detached Garage $74.00 $
Each Swimming Pool/Hot Tub $110.00 $
TOTAL $
Owner as defined by RCW 19.28.26 1: (1)Owner will occupy the structure for two years after this electrical permit is finalized.(2)Owner is
required to hire an electrical contractor if above said property is for sale, rent or lease. Permit expires after six months of last inspection.
After reading the above statement, I hereby certify that I am the owner of the above named property or a licensed electrical contractor. I
am making the electrical installation or alteration in compliance with the electrical laws, N.E.C., RCW Chapter 19.28,WAC.Chapter 296-
46B,The City of Port Angeles Municipal Code, and Utility Specifications and PAMC 1 0 ding Electrical Permit Applications.
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Date "Pnint Name Signafure(n ero Electrical Contractor/Administrator)
[Electrical Permit Applications may be submitted to City Hall or epermits@cityofpa.us or faxed to 360.417.4711]