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ROUTING SLIP
Certificate of Occupancy
$47.00 Certificate/Inspection Fee
DATE
Address of Proposed Business
5;;1. ~ marr Ne
Applicant Ac.J.:ro N 8rc-tt..~ t mu t:fLo ('
Address ~ It;'tj D O~ rk.a.vJ~ fM..
5., ~I n N\ . CAJ A- qC(~q2.....
Phone: business 3lro"l '5J-?nh Jome 3tO-"<:Pl-7'6 rJ
New Business ............................ ( >< )
Transfer of Business location. . . . . . . . . . . . . . .. ( )
Change of Ownership . . . . . . . . . . . . . . . . . . . . .. ( )
New Building ............................. ( )
Remodel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ( )
Temporary Business ....................... ( )
Change of Use . . . . . . . . . . . . . . . . . . . . . . . . . . .. ( )
WILL THERE BE ANY OF THE FOLLOWING?
Construction changes. . , . . . . . . . . , . . . . . . . . . . . . . . .
Electrical changes. . . . . . . . . . . . . . . . . . . , , . . . . . . . . ,
Mechanical (heating, cooling, stoves) , . , . . . . . . , , . . .
Plumbing changes .........,..........,........
New or relocated signs. . . , . . . . . . . . . . , . . . . . . . . . , .
New septic tanks. . . . . . . . . . . . , , . , . . . . . . . . . . . . . . .
New sewer service ....................".......
Admission charged to patrons. . . . . , , , , . . . . . . . . . . .
Is this a home occupation? ,..,..........",.....
Excavation ot tilling ot lots ............. , . . . . . . . . .
Work done in City right-ot-way . . . , , . . . . . . . . . . . . . . ,
Is there sufficient off-street parking? . . . . . . . . . . . . , . .
New driveway openings , . . . . . . . . . . . . , . , . . . . . . . . .
A grading plan tor site drainage. . , , . . . . . . . . . . . . . , .
(parking lots, downspouts, etc.) ............".,..
Are the existing streets paved? ...................
Are there existing sidewalks? . . . . . . . . . . . . . . . . . . . . .
Is there curb and gutter? ,.,...............,.....
Other. . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . .
YES NO
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I hereby apply for a Certificate of Occupancy and acknowl-
edge that I have read this application and state that the
information I have supplied is correct to the best of my
knowledge.
-
REJECTED
Building Section
Public Works Department
Planning Department
Fire Department
City Clerk
P.B.I.A.
,III,
THE FOllOWING Will BE REQUIRED:
PERMITS
1) Building
2) Plumbing
3) Electrical
4) Mechanical
5) Sewer
6) Sidewalk installation
7) Driveway installation
8) Curb installation
9) Sidewalk obstruction
10) Water meter installation
11) Fire
@ Occupancy
13) Sign
14) Shoreline
15) Home occupation
16) Conditional use
17) Other
BUSINESS LICENSE
1) Taxi
2) Peddlers
3) 2nd Hand Dealer
4) Pawn Broker
5) Dance
6) Hotel - Motel
7) Fireworks
8) Ambulance
9) Tattoo shop
1 0) Other
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Signe~ - -_ - n- . n L
Comments / Conditions
1(91
FEE R;ECEIPT NUMBER
CITY OF PORT ANGELES
DEPARTMENT OF LIGHT
"APPLICATION AND ELECTRICAL PERMIT
A
~/p.-
PERMIT NUMBER
1-1
PERMITS WITH WRONG A R~SES ARE CANCELLED
Owner 0' InslallationBY' f:A-11 ~bl~
Owner's Address ~ ~ Installers Address ?....;, ,,,> I ' f' ~ e..JJ, ' .f..-14-;
Day Phone .. Installers Phone ~- ;?, Z~. -.' \
Application is hereby made for Permit to instal.1 Electric~1 Equipment as .tollows: I ...... \~ _ ~At:? ~ ~ / ""6-A)
II f?l'/f~~1-..I'G" 01.~ f&1or:-,.' ("'~d,Ji~:';- ~ct::-k.4~~,^k;:
t"'A f2-..CA/ ( r- Wiring Method ('.t'J,,] oJ I'r-'
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T~TAL FEE
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s/0rlJ
TIME TO COMPLETE
NO. STORIES
LEGAL OCCUPANCY
.
NUMBER AMP 120V 240V NUMBER AMP 120V 240V
use OF CIRCUIT CIRCUITS PEA '0 10QA FEE USE OF CIRCUIT CIRCUITS PEA '0 100R FEE
CIA 30 CIA 30
LIGHt SIGN / S:-~ 1)0( I~
LIGHT 50 VOLTS .,
OR LESS
CONVENIENCE MOTOR .
CONVrENIENCE - . MOTOR
APPLIANCE MOTOR .
DISH'fJASHER FIRE ALARMS .
DISPQSAL BURGLAR ALARM ,
RANGE MISC.
OVEN
WATElR HEATER
LAUNbRY -
DAYEI' REINSTALLATION LIGHT FIXTURE #
FUANI,'CE SUB TOTAL FEE ,
GAS... OIL
FURN '.\CE ENERGY FEE
ELEC"RIC BASIC FEE
ELECt'RIC HEAT OAJ::: ~
TOTAL FEE
ELECt'RIC HEAT SIZE OF SERVICE SWITCH OR CIRCUIT BREAKEA
, ,
A.C. UNIT AMP PHASE'
-
FEED~A SIZE OF SERVICE ENTRANCE CONDUCTORS
. .
SEAVICE A.W.G.
I SUB-TOTAL SIZE OF GROUND SIZE OF ENTRANCE SWITCH
I certib that the work to be performed under t
,19~-BY
Date Application made
e ORO
Pli'rmission is hereby giyen to do the above described work, according to t.he conditions hereon and according to the appr
specifIcations pertaining thereto, subject to compliance with the Ordinances-of the City of Port Angeles.
'. 'DIRECTOR OF CITY LIGHT
By ~d'441#
PLANS APPROVED' . , .' ',',
. 1;;~;S~d
WARNING
Notify Department of City Light by Street Address and Permit Number when ready for inspection. Work must not
be covered or current turned on before inspection and O.K. for covering or service has been given by'lnspector in
Writing on Permit Placard. A. - Permits Phone: 457.0411 Ext. 158.
PERMIT PLACARD MUST BE KEPT POSTED ON THE WORK - SEE OVER _
WHITE. OrigInal CANARY. Duplicate PINK. Triplicate WHITE CARD. Inspector's Report
OL YMP!C PRINTERS, INC.
., ,.
REPORT OF INSPECTOR
DATE OF VISIT MADE BY REMARKS
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11~1 '~'\ 1M dl V, ~O.K.
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FEE RECEIPT NUMBER
III
CITY OF PORT ANGELES
DEPARTMENT OF LIGHT
APPLICATION AND ELECTRICAL PERMIT
A
700
PERMIT NUMBER
-
TOTAL FEE
'1!!-
fP&
CONT. LIC. NO.
TIME TO COMPLETE
NO. STORIES
LEGAL OCCUPANCY
ELECTRICAL PERMIT ONLY NO OCCUPANCY OR USE ESTABUSHED UNDER THIS PERMIT
I
Site Address
.'
A-it1JC
e,
Owner \ Installation By
r
owner's,.~Address . ~ 11 ~ L L Installers Address
OayPhone --50, i-L=r::/ Installers Phone ~
Applicai'lon Is hereby made for P~rmit.to lns~all Electrical Equipment 85 follows: INS. -"
;d~~ l.~
WiringMethod~
.
AMP 24QV NUMBER AMP 120V 24QV
USE OF CIRCUIT . NUMBER PER 120V 100R FEE USE OF CIRCUIT PER l00R FEE
CIRCUITS CIR 10 30 CIRCUITS CIR 10 30
LIGHT SIGN I 'J./. fI' I 'J_/.'
UGHT 50 VOLTS
OR LESS
CONVENIENCE MOTOR
CONVENIENCE MOTOR
AF'PLIp-NCE MOTOR
DISHVJASHER FIRE ALARMS
DISPQ:SAL BURGLAR ALARM
-
RANGE MISC.
OVEN'
WATEn HEATER
LAUN'DRY
ORYE~ - REINSTALLATION LIGHT FIXTURE # .
FURNACE . SUB TOTAL FEE
GAS - OIL
FURNACE ENERGY FEE
ELECTRIC BASIC FEE
ELEC~RIC HEAT '7 j" ~
TOTAL FEE
ELEClrRIC HEAT SIZE OF SERVICE SWITCH OR CIRCUIT BREAKER
A.C.I.jlNIT AMP PHASE
FEEDER SIZE OF SERVICE ENTRANCE CONDUCTORS
SERVICE ..
A.W.G.
I SUB-TOTAL SIZE OF GROUND SIZE OF ENTRANCE SWITCH
I certify that the work to be performed under this permit WIll be done by the installer and In conformance with the N.E.C. Electncal Code.
OateAppllcatlon made -::;.. / 1-fS ,191ik By
, CONTRACTOR OR OWNER (OR AUTHORIZED AGENT)
Permission is hereby given to do the abqve described work, according to the conditions hereon and according to the approved plans and
specifications pertaining thereto, subject to compliance with the Ordinances.of the. it of Port Angeles.
DIREC R CITY LIGHT
.
II;
.
Date P,lermit Issued
1:,
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WARNING
P VED
Notify Department of City Light by Street Address and Permit Number when ready for inspection. Work m t not
be covered or current turned on before inspection and O.K. for covering or service has been given by Insp ctor In
Writing on Permit Placard. A.. Permits Phone: 457.0411 Ext. 158.
"
PERMIT PLACARD MUST BE KEPT POSTED ON THE WORK - SEE OVER _
WHITE. Original CANARY. Duplicate PINK. Triplicate WHITE CARD. Inspector's Report
OL YM~IC PRINTERS, INC.
DATE OF VISIT
(
7Ja1Z
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MADE BY
.
717
REPORT OF INSPECTOR
REMARKS
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CITY OF PORT ANGELES
DEPARTMENT OF LIGHT
APPLICATION AND ELECTRICAL PERMIT
A
000466
FEE R :::CEIPT NUMBER
PERMIT NUMBER
.
TOTAL FEE 2~ 6 VfMPet lasl> . rrOM All
CONT. Lie. NO. TIME TO COMPLETE NO. STORIES lEGALQCCUPANCY
ELECTRICAL PEAMIT ONLY
Site Address
M /'(tI'IJe.
NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT
DI2-,
IJf 1m- 5" l- 3
CORRECT ADDRESS IS RESPONSIBILITY OF APPLICANT PERMITS WITH WRONG ADDRESSES ARE CANCELLED
Owner BliP" OL-SerN Installation By ()L.,'(mPtt- /?'LeC-rteIL
Owner's Address ID?>c:J IN "i-rJ! Installers Address ~C)I .s. L/Nu> cl1,)
Day Phone 457 - q / f<;<; Installers Phone lf52;;,~ 303
Application is hereby made for Permit to install Electrical Equipment as follows: (#11:(. e GAS fJ 1,/ ..".~ .5
Wiring Method (!DMl> V /1
.
NUMBER AMP 240V NUMBER AMP 120V 24QV
USE OF CIRCUIT PER 120V l00R FEE USE OF CIRCUIT PER l00R FEE
CIRCUITS CIR 10 30 CIRCUITS CIR 10 30
LIGHT I 1./.00 SIGN I 4.{)O
LIGHT 50 VOL IS
OR lESS
CONVENIENCE MOTOR
CONVENIENCE MOTOR
APPLl:\NCE . ,.. MOTOR .
DISHWASHER FIRE ALARMS:
DISPCSAl BURGLAR ALARM
RANGE , MISC.
.
OVEf\ PV,*p. . '5 20."D
-
WATE8 HEATER : >. "
f!"'
lAUf\ JRY : , .
,.
DAYE ~ REINSTAllATION LIGHT FIXTURE # ",.t'
,
FUR;; O:CE SUB TOTAL FEE ...
~OIL '.
,. , ..
FURI\ i\CE ENERGY FEE
~'RIC BASIC FEE \..";
ELEC .RIC HEAT . ,
- ., , TOTAL FEE .- ,2.8,""'-
ELEC "RIC HEAT . ~ SIZE .OF SERVicE SWITCH.'OR CIRCUIT BREAKER
-
A.C, l NIT ; '.
_. AMP PHASE
FEED:~R .' .. " SIZE OF ,SERVICE ENTAA'Nce CONDl,ICTORS
.' .' ," I .
':, . ,
SERV CE 0 , ..
, " . . '. . . ,. ~. AW.G.
..
I SUB. TOTAL ., .
SIZE OF GROUND SIZE OF ENTRANCE SWITCH
.,'
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I certify that the work to:be performed imder:thisp~imit.will'be done by the installer and i~C. Electrical Code.
Date Application made III" , 19 '1r1)"" By . ~.."
. , ... ,', ' ",.
. CONTRACTOR OR OWNE'R JOR AUTHORIZED AGENT)
Permission is hereby given to do the above described work, according to the conditions hereon and accor~ing.t~ t~e approved plans and
speclt.catlons pertaining thereto, subject to compliance With the Ordinances, of the Cay of Port Angeles. ,""" -,.;. "
CT ~F,'C ,}!G~l' .
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Date Permit Issued
//-1- rr
/WARNING I
Notify Department of City Light by Street Address and Permit Number when ready for i'nsp'ection. Work must not
be covered or current turned on before inspection and O.K. for covering or service has been given by Inspector in
Writing on Permit Placard. A. - Permits Phone: 457-0411 Ext. 158.
PERMIT PLACARD MUST BE KEPT POSTED ON THE WORK - SEE OVER ~,' "
WHITE - Original CANARY. Dupllcate' PINK - Triplicate WHITE CARD. Inspector's ~port ,~
~,r. :
OLYMF C PRINTERS, INC.
REPORT OF INSPECTOR
DATE OF VISIT MADE BY REMARKS
II-(II-'f) -71I'J If)f( t'e(/e/? ('01-10" ,r /N s-L,g B
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O.K. FOR COVERING
J O.K. TO CONNECT SERVICE
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---,;g;?JfZ J. '~ 'J-. FINAL O.K.
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