HomeMy WebLinkAbout134 W Front St - BuildingEt
NAME OF PREMISES FSI 14/ tt,,
SERVICE ADDRESS. I '3
i
LOCATION OF DEVICE. L I N 8A R I(i SODA P J Y E c
ASSEMBLY WA 771
Manufacturer Model Size Serial No.
IS THIS AN APPROVED ASSEMBLY? YES 0. IS ASSEMBLY INSTALLED CORRECTLY' YESti'NO
DATE OF INSTALLATION F51 a "'UNKNOWN❑
Initial
Test
Repairs
Details
Test
Initial
Test
Repairs
Final
Test
NEB )Gil
DOUBLE CHECK VALVE ASSEMBLY
CHECK VALVE #1 CHECK VALVE #2
Leaked
Closed Tight C9''
Held at psi
Leaked
Held at g O psi
Cleaned
Replaced
REDUCED PRESSURE PRINCIPLE ASSEMBLY
Final Closed Tight lid'•
Held at t .n psi Held at psi
AIR GAP INSPECTION
REQUIRED MINIMUM SEPARATION YES
COMMENTS
I Date ?ime Tester
3-P5-11 eEYKeg
Backflow Assembly Test Report
City of Port Angeles
Public Works and Utilities Department
Water/Wastewater Collection Division
A .S A k fi Rlsi
!`/G/'r f7RteT
Cleaned Cleaned
Replaced Replaced
Signature
RELIEF VALVE
Did Not Open 0
Opened at psi
3 psi Buffer YES NO
Opened at
RP
DC
PVB
SVB
Leaked
Cleaned
Replaced
9G
Official Use Only
Assem.#
Received
la/ RPDA
DCDA
O Air Gap
AVB
PVB /SVB
AIR INLET
Did Not Open
Opened at psi
CHECK VALVE
Held at
REPAIRS
0
psi
AIR INLET Opened at psi
CHECK VALVE Held at psi
BACK PRESSURE NO YES
NO TYPE OF HAZARDS 9 i m /5'r 6A' f/
Line Pressure
Held Backpressure
#2 Shutoff Held
Cert. Test Kit
WHITE CUSTOMER COPY YELLOW PURVEYOR COPY PINK TESTER COPY
psi
YES E <0
YES L9' NO
Relief Valve Exercised YES c '/No
Passed Failed
frivwr rr al--
wE57
rsuant to the requiremens`of Section 10Pof t"Iie. Y 8,
vm of 'nuance this structure was in compliance w
or the
rt An9I s
Soho Asian L (Ovine
3i Fron St.
Don Hao /Doug,'
536 W 11 at 'P
'or ystem. Per IBC
vfiation Busness`
b 08 4 �d
Business name
Business address
Property owner
Property owner
Automatic fire sp
Use occupancy
Building permit nu
Type of construction
Occupant load.
CERTIF
cit
This certificate is issue
Code cert5ing that a
of the City regulatin
Post on the premises in a conspicuous place:
UPANCY
ision
06 International Building
h the various ordinances
308
05/13/08
Date
be removed except by the Building Official.
PREPARED 3/07/08 9 05 34 INSPECTION TICKET PAGE 4
CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 3/07/08
ADDRESS 134 W FRONT ST SUBDIV
TENANT NBR SOHO ASIAN BISTRO
CONTRACTOR
PHONE
OWNER DON HAO DONG LIAN MAI PHONE (360) 417 8966
PARCEL 06 30 00 0 0 1518 0000
APPL NUMBER 08 00000243 SIGNS
PERMIT SIGN 00 SIGN
REQUESTED INSP DESCRIPTION
TYP /SQ COMPLETED RESULT RESULTS /COMMENTS
BL99 01 3/07/08 JLL
BLDG FINAL TIME 01 00
March 6 2008 4 13 14 PM permits
DONG 425 829 1033
BLDG FINAL SIGNS
AFTERNOON
COMMENTS AND NOTES
CITY CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET PORT ANGELES, WA 98362
Application Number 08 00000243 Date 3/06/08
Application pin number 491044
Property Address 134 W FRONT ST
ASSESSOR PARCEL NUMBER 06 30 00 0 0 1518 0000
Tenant nbr name SOHO ASIAN BISTRO
Application type description SIGNS
Subdivision Name
Property Use
Property Zoning CENTRAL BUSINESS DISTRICT
Application valuation 1000
Application desc
3 SIGNS 63 3 SQ FT 63 3 SQ FT 6 SQ FT
Owner Contractor
DON HAO DONG LIAN MAI OWNER
536 W 11TH ST
PORT ANGELES WA 98362
(360) 417 8966
Permit SIGN
Additional desc 3 SIGNS
Permit pin number 121707
Permit Fee 217 00 Plan Check Fee 00
Issue Date 3/06/08 Valuation 1000
Expiration Date 9/02/08
Qty Unit Charge Per Extension
BASE FEE 00
2 00 85 0000 PER S SIGN WALL 25 SF+ 170 00
1 00 47 0000 PER S SIGN LESS THAN 25 SF 47 00
Special Notes and Comments
February 28 2008 4 51 11 PM sroberds
Signs will require permits even though they are individually
placed Sign area is ok Signs were placed without a
permit in CBD
Fee summary
Charged Paid Credited
Due
Permit Fee Total 217 00 217 00 00 00
Plan Check Total 00 00 00 00
Grand Total 217 00 217 00 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 has 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
Efate
a ;al z
Print Name Signature of Contractor or Authorized Agent Signature of ne /(if owner is, builder)
T Forms /Building Division/Building Permit (10 /01 /07).wpd
CALL 417 -4815 FOR BUILDING INSPECTIONS CALL 417 -4735 FOR ELECTRICAL INSPECTIONS.
CALL 417 -4807 FOR PUBLIC WORKS UTILITIES
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
FOUNDATION•
FOOTINGS
SHEAR WALLS WALLS
FOUNDATION DRAINAGE DOWN SPOUTS
PIERS
POST HOLES (POLE BLDGS.)
PLUMBING
UNDER FLOOR SLAB
ROUGH -IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS ROOF-/ CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T -BAR
INSULATION
SLAB
WALL FLOOR CEILING
MECHANICAL
HEAT PUMP FURNACE DUCTS
GAS LINE
WOOD STOVE/ PELLET CHIMNEY
COMMERCIAL HOOD DUCTS
MANUFACTURED HOMES
FOOTING SLAB
BLOCKING HOLD DOWNS
SKIRTING
ELECTRICAL LIGHT DEPT 417 -4735
CONSTRUCTION R.W PW/
ENGINEERING 417 -4807
FIRE 417 -4653 I
PLANNING DEPT 417 -4750 I
BUILDING 417 -4815 I
T Forms /Building Division/Building Permit (10 /0I /07).wpd
BUILDING PERMIT INSPECTION RECORD
YES 1 NO
FINAL DATE ACCEPTED BY.
FINAL DATE ACCEPTED BY.
PLANNING DEPT SEPARATE PERMIT I!'s SEPA.
PARKING /LIGHTING ESA.
LANDSCAPING I SHORELINE.
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY /USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE I ACCEPTED
YES 1 NO
ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W
PW ENGINEERING
I FIRE DEPT
1 PLANNING DEPT
1 BUILDING
I I I
1 I I
1 `I V8 t_I
Applicant or Agent J3aN (f,'sc) mks
Property Owner j
Property Owner's Address Z V TLIZaKT S
Contractor /Engineer
Contractor /Engineer's Address
License
PROJECT ADDRESS
Parcel Number
Project Type Brief Description.
Check all that apply
New Construction
Addition
Remodel
Repair
Re -roof
Demolition
gn
Heat System
Other
Floor Areas
Basement
1St Floor
2nd Floor
3 Floor
Garage
Carport
Covered Porch
Deck
Shed
Other
BUILDING PERMIT APPLICATION Print in ink
CITY OF PORT ANGELES
Attn Building Permit Technician
321 E. Fifth St. Port Angeles WA 98362
(360) 417 -4815 fax (360) 417 -4711
Sign 1
s; Z
Si ter, 3
f 3 `f A/ Fed 4 T
Residential
eo x c r
Un IQ
i t
Existing (sq. ft.) Proposed (sq. ft.)
Commercial
Total footprint of structures sq ft. T Lot size
Max. height of proposed structures ft. Occupancy group
Will a lawn sprinkler system be installed? Occupant load
Will a fire sprinkler system be installed? Construction type
T.Forms /Building Division /Bldg Permit Appl. 2006 Code.doc
Phone
For City Use Only
ate Received2 —0g
IPermit
Date Approved
Lf-r -96 6
(o-5 S —(o3
Expires
Soho As('ail 'Bi
Lot Zoning
Multi family Industrial
twall- mounted projecting freestanding awning other
Total sign area sa ft. Maximum allowed sign area sa ft.
Heat pump wood- burning stove gas fireplace pellet stove other
per sq ft.
TOTAL VALUATION ,f o ut
sq ft. Lot coverage
of bedrooms
of full baths
of half baths
T
OA
I have read and completed this 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 working on
projects. p /1
Date a 26 C1` Print Name l \W "G'1 Signature
id
-5/41 n-is-f--444 996
E.vorpitt auQ 2,75 1 37hugyl i e tl 71 C 135 ON-
V 1
54-Dfu 1119
m 4)7
14-05,v 0/1.:25
2, C
0
A siA f\r BtsgRo
T
V
1 3 1
t t(1 1W4
r
AS IAN' 81511Z0
k
VO
v.—. ,wm-
Print in ink
BUSINESS NAME o D iC.vt L' r 5 t -o
BUSINESS ADDRESS 13 L- I/V F kv ,c r"
Business mailing address 54kie
Opening date 3/( /OR
Brief description of proposed business
ACTION
New business
Transfer of business
location from a
PBIA location
Transfer of business
location from a
non -PBIA location
Change of ownership
Remodel
Temporary business
Change of use
For City use only
Department
Building
Fire
PBIA
Planning
City Clerk
Public Works
fotrv)ier -Iy Lt G tr-, ranl
CERTIFICATE OF OCCUPANCY APPLICATION Permit 0 1 t l
CITY OF PORT ANGELES
Attn Building Permit Technician
321 E. Fifth St. Port Angeles WA 98362
(360) 417 -4815 fax (360) 417 -4711
Approved I�I Rejected
Ir itials�&
datel Initials date
T'Forms /Building Division /Certificate of Occupancy Application
Days hours of operation
Type of construction
FEES
$50 i% Certificate Inspection
es 00 Parking Business Improvement Area (PBIA)
fee charged for downtown locations
/d
Phone
I Business owners name DO/4 Phone IdS r Pi /05 1
1 Business owner's home address sib W f('" S'(_ /�v 4�,o,p rag fr74 ?rte
PLEASE NOTE. SQe st9 perm Zt4 O
A Business License is also required for the following businesses Taxi Peddlers Second -hand dealer Pawn broker Dance Hotel
Motel Fireworks Ambulance Tattoo shop Contact the City Clerk at 417 -4634 for additional information
WILL THERE BE ANY OF THE FOLLOWING? I NO/
Electrical changes 1 t
New or relocated signs 7� q& G iittr fl't`
Construction changes
Mechanical changes (heating, cooling, stoves) 1 V
Plumbing changes 1
Fire sprinkler system changes 1 t/
Fire alarm system changes 1
Is this a home occupation? 1 V
Second -hand dealer or pawn broker? 1 V
New or relocated sewer or water service
Excavation or filling of lots 1 V
Work done in the City right -of -way 1
New driveway openings 1
Grading site drainage (parking lots, downspouts, etc.) 1 V
Landscape irrigation system (backflow devices) 1
Off- street parking
Existing streets paved
Existing sidewalks
Curb and gutter
Automatic fire sprinkler system required no
YES/
v
r/
Comments Conditions
Occupant Load
Zoning C ;A
/o
?4,0 +ri- 95gf
IF YES, CONTACT
Electrical Dept. at 417 -4735
Building Division at 417 -4815
Planning Division at 417 -4750
City Clerk at 417 -4634
Public Works at 417 -4807
Water Dept. at 417 -4886
Please sign up for utility
services at the cashier counter
Call for Certificate of Occupancy inspections before opening business
Building Department Inspection 417 -4815 Fire Department Inspection 417 -4653
Please provide a minimum 24 -hour notice for inspections
I hereby apply for a Certificate of Occupancy I acknowledge that 1 have read this application and state that the information I have
supplied is correct to the best of my knowledge
Date Print Name Q t 1 r 1 Signature
yes
CERTIFICATE OF OCCUPANCY
City of Port Angeles
Building Division
This Certification issued pursuant to the requirements of Section 301 of the
International Building Code certifying that at the time of issuance this structure was
in compliance with the various ordinances of the City regulating Building
construction or use. For the following
Use Classification: Business Building Permit No. 06-182 :Business ,Name: Li Garden
r
Group: B Type of Cons'ction: VN:_. Use Zoiie:=s; CA
Owner of Business: Yok Wing ±r Address: 134 W. Front Street Port Angeles, WA. 98362
Building Address: 134 W. Front Street
No. 101
7 r,f_Zf S7Z�Bu0 y
Building Official
1
Building Official
Port Angeles, WA. 98363
March 22, 2006
Date
Post on the premises intconspicuous place
Shall not be removed except by Building Official
L
I REs ".burz.o---- ROUTING SLIP
"N of Occupancy
6 4' S0950 00 Certificate /Inspection Fee
DATE 'A
Address of Proposed Business
1 4 VJ Fle&N T AT
Applicant "1.4 I) 1\1 6 L.I
Address 4 V\,) NV T
r
Phone business4.5 'O home
Brief description of proposed business
Legal Description Lot
Current Use of Property
Zoning Classification of Property
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 of:filling of lots
Work done in City.right -of -way
Is there sufficient off street parking?
New driveway openings
A grading plan for site drainage
(parking lots, downspouts, etc.)
Are the existing streets paved?
Are there existing sidewalks?
Is there curb and gutter?
Other
I hereby apply for a Qertificate of Occupancy and acknowl-
edge that I have r lad this application and state that the
information I have supplied is correct to the best of my
knowledge
APPROVED REJECTED
New Business
Transfer of Business Location
Change of Ownership
New Building
Remodel
Temporary Business
Change of Use
Block
YES NO/
Building Section
Public Works Department
Planning Department
Fire Department
City Clerk
(PB I.A.
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
12) Occupancy
13) Sign
14) Shoreline
15) Home occupation
16) Conditional use
17) Other
Date 2 /�2/O-,
\a'' °k0
G
Subdivision
THE FOLLOWING WILL BE REQUIRED
BUS)NESS 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
Signed
Comments Conditions
log
«2
L-I 9511 I' 3r2Awr ROUTING SLIP
Certificate of Occupancy
50 00 Certificate /Inspection Fee
DATF 4 6'
Address of Proposed Business
134 w Fteo►-IT GT
Applicant X= le VVtt.k (,l
Address 134 W 9-t2014T ST
Phone business4 O home
Brief description of proposed business.
Legal Description Lot
Current Use of Property
Zoning Classification of Property
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 of filling of lots
Work done in City right -of -way
Is there sufficient off street parking?
New driveway openings
A grading plan for site drainage
(parking lots, downspouts, etc.)
Are the existing streets paved?
Are there existing sidewalks?
Is there curb and gutter?
Other
APPPOVED
re
29
1(DO
22 -')0
REJECTED
41 SO
fZ T,od) T
Block
YES NO
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
Building Section
Public Works Department
Planning Department
Fire Department
City Clerk
PB I.A�
New Business
Transfer of Business Location
Change of Ownership
New Building
Remodel
Temporary Business
Change of Use
Date
Signed
THE FOLLOWING
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
12) Occupancy
13) Sign
14) Shoreline
15) Home occupation
16) Conditional use
17) Other
Comments Conditions
Subdivision
WILL BE REQUIRED
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
10) Other
P A
DATE fi/
Address f Propo d Business
/3 i 6T
Applicant 4-1- 44 Lb) d11)(
Address 7i Z Dr oet-v, Lt'_V k
APPR VED REJECTED
Legal Description Lot
Current Use of Property
Zoning Classification of Property
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 of filling of lots
Work done in City right -of -way
Is there sufficient off street parking?
New driveway openings
A grading plan for site drainage
(parking lots, downspouts, etc.)
Are the existing streets paved?
Are there existing sidewalks?
Is there curb and gutter?
Other
1 0
Phone business 7 55 home (R- K( 17
Brief description of proposed business. f 44
ROUTING SLIP tz'T' V 2Awl
Certificate of Occupancy
$50 00 Certificate /Inspection Fee
YES
7-
Block
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
Building Section
Public Works Department
Planning Department
Fire Department
City_Clerk
0 ;B I.A.
Date
Signed
os
New Business
Transfer of Business Location
Change of Ownership
New Building
'Remodel
Temporary Business
Change of Use
Subdivision
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
12) Occupancy
13) Sign
14) Shoreline
15) Home occupation
16) Conditional use
17) Other
Comments Conditions
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
10) Other
t ems
�f
f
o(,J 1 o
ole IAlIt\k LI
l 602-47e1(zab t Z �1
0
CERTIFICATE 'O'Fu'`4O-CCU PANCY
City of Port Angeles
Building Division
Group: B i Type of Construction: V -N
Owner of Business: Rick Unrue
Building Address: 134 West: "Front Street.
si
This Certification.issued pursuant to the requirements of SectiOn. of the
Uniforn% L uilding Code certifying that at the time of issuance this st ucture was
in compliance with.the ordinances of the City regulating Building
construction or use. For the following v
Use Classification: Restaurant Building Permit No. 04 -172 Business Name: n s h J ac k s
Use Zone: CBD
Address: 925 Water Street. Port Towrisend.WA 98368
I
Port Angeles. WA 98362
eote>nber 16.2004
Date
Pos on a pre tises r n a conspic ous place
Shall not be removed' except; ,bey Building Official
w K 3
DATE
Address of Proposed Business
0 3',' ,t4 ,i 5
Applicant
Address 2 60/ 7 r
i ter 7 c a f' I a m- t- '4
Phone business" lhome
o' 1� f., 3 W t' /9
Brief description of proposed business
Legal Description Lot
Current Use of Property
Zoning Classification of Property
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 of filling of lots
Work done in City right -of -way
Is there sufficient off street parking?
New driveway openings
A grading plan for site drainage
(parking lots, downspouts, etc.)
Are the existing streets paved?
Are there existing sidewalks?
Is there curb and gutter?
Other
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
APPROVED REJECTED
Azk
f ,,nn /e ,y+''
ROUTING SLIP
Certificate of Occupancy
$47 00 Certificate /Inspection Fee
3 s/V 37v
6,r St Ai 7
Building Section
Public Works Department
Planning Department
Fire Department
City Clerk
PB I.A.
New Business
Transfer of Business Location
Change of Ownership
New Building
Remodel
Temporary Business
Change of Use
A
Block r Subdivision iv= T HA.Pr
0 0/ J� LI Bit A A `s1r .t./ N#4-o7
(Iv
YES NO
x
Dt
x
Date
ned
i
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
12) Occupancy
13) Sign
14) Shoreline
15) Home occupation
16) Conditional use
17) Other
//r
Comments Conditions
1
„rte E� y
F
,J 14 e r te'
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
10) Other
jj
fl /l Q
f7»
DATE 0
Address of Proposed Business
Applicant /Pf ex a ,O Uri r Liel
Addr s 51o25-CU` Ted- 9�
d t ti eit '3o`i
cr1/�`- t
busil e- 3 "3 7home 3 /714-371. .76‘) x,2
Phone
Brief description of proposed business likgb LLIj£ T s _t�i5k
Legal Description Lot 9 Blo /C
Current Use of Property x1,1_60 -Air --f�J J/ew96/ M
1
Zoning Classification of Property
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 of filling of lots
Work done in City right -of -way
Is there sufficient off street parking?
New driveway openings
A grading plan for site drainage
(parking lots, downspouts, etc.)
Are the existing streets paved?
Are there existing sidewalks?
Is there curb and gutter?
Other
YES
NO
1C
X
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
Date
APPROVEDiEJECTED
04 °1114A Building Section
Public Works Department
Planning Department
Fire Department
City Clerk
PB I.A.
ROUTING SLIP 1-71_
Certificate of Occupancy
$47 00 Certificate /Inspection Fee
New Business
Transfer of Business Location
Change of Ownership
New Building
Remodel
Temporary Business
Change of Use
THE FOLLOWING WILL
PERMITS BU
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
12) Occupancy
13) Sign
14) Shoreline
15) Home occupation
16) Conditional use
17) Other
Comments Conditions
Subdivision imcT
Sinned
L
BE REQUIRED
SINESS LICENSE
1) Taxi
2) Peddlers
3) 2nd Hand Dealer
4) Pawn Broker
5) Dance
6) Hotel Motel
7) Fireworks
8) Ambulance
9) Tattoo shop
10) Other
e%
~ pORT ~
8....0~~~
r....
"-~
~
'l.,il",~
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:
Tenant nbr, name
Application description
Subdivision Name
Property Use . . . .
property Zoning . . .
Application valuation
04-00000147 Date
.673639
134 W FRONT ST
06-30-00-0-0-1518-0000-
IRISH JACKS
2/20/04
SIGNS
LSKP[ Wt?
4/ '2J1 (U&
CENTRAL BUSINESS DISTRICT
3380
Owner
Contractor
BARRON, DALE
2219 W SIMS WAY
PORT TOWNSEND
WA 98368
MILLER SIGNS
30 CHILDERS LN
SEQUIM
(360) 683-6790
WA 98382
Permit SIGN
Additional desc
permi t Fee 150.00 Plan Check Fee .00
Issue Date 2/20/04 Valuation 3380
Expiration Date 8/18/04
Qty Unit Charge Per
5.00 30.0000 PER S- SIGN ALL 25-
Extension
150.00
~
L
Fee summary
Charged
Paid
Credited
Due
Permit Fee Total
Plan Check Total
Grand.. Total
150.00
.00
150.00
150.00
.00
150.00
.00 .00
.00 .00
.00 .00
E
,7
6
~
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
construction.
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.
I INSPECTION TYPE DATE ACCEPTED COMMENTS
I YES I NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION 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 1 WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS 1 GIRDERS
SHEAR W ALL/HOLD DOWNS
WALLS 1 ROOF / CEILING
DRYW ALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL 1 FLOOR / CEILING I
MECHANICAL
HEA T PUMP
GAS LINE
WOOD STOVE / PELLET 1 CHIMNEY
HOOD / DUCTS
PW UTILITIES / SITE WORK (Engineering Division) SEP ARA TE PERMIT #'s:
WATERLINE / METER
SEWER CONNECTION
SANIT AR Y
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. 4]7-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W.I PWI 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 [11114/2003]
BUILDING PERMIT - APPLICATION
FOR OFFICIAL USE ONLY
Date Rec:.2 - '2C' Ci.f
Pelmit # D 'I-I r7
Fill out COMPLETELY and in INK. Your application and site plan MUST BE
COMPLETE to be accepted for review. If you have any questions, call
(360) 417-4815
Date Approved:
Date Issued:
Applicant or Agent:
Phone:
Owner: .:r Er <;; /-( J pq- c (c.. S
Address: 13'-1 W r:--~+ ~,. City:
Architect/Engineer: ! t.1 (( (,-€:,,'-- S (~..A- >-
Contractor /J/{ { ( (c..c:-~ S { 7t sState License #:
Phone:
F:: ~ v -+ 4-\.A~~Lcp s
Phone:
Zip: f'<;j 5>& ~
~c;,3-L-(q0
Phone: (fl SF:;-Cc '1 7" :)
Zip:
ZONING: ey~~
Exp:
Address:
City:
PROJECT ADDRESS: . ?-, q
LEGAL DESCRIPTION: Lot:
CLALLAM COUNTY PARCEL NUMBER:
I ..>..). \-r15"{~:T
.
~..,. -L-
""- ' ~,. J
B
_ j)4-J e.
Ba .rr-CJI/t.
IOn:
Credit Card Holder Name:
Billing Address:
Credit CardType VISA
TYPE OF WORK:
o Residential 0 New Constr. 0 Re-roof
o Multi-family 0 Addition 0 Move
o Commercial 0 Remodel 0 Demolition
o Repair ~Sign
BRIEF DESCRIPTION OF THE PROJECT:
MC
#-
Exp. Date:
ION:
o Stove :St'. @ $ ISF. = $
o Garage SF. @ $ ISF. = $
o Deck SF. @ $ ISF. = $
o Other TOTAL VALUATION $
r:;C.VSN VIAe> Vi\. -r-f:".'=> ( ri2-c ~Z=c. '((0--.
"3> -~ ~o
s ( <::...."....J
co
COMMERCIALIRESIDENTIAL: Occupancy Group:
Occupant Load:
Construction Type:
= TOTAL Sq.Ft.~ rP
%
No. of Stories: Lot Size: Existing Sq. Ft. q (-:;2 & Proposed Sq. Ft.
Existing lot coverage _ % & Proposed lot coverage _% = Total lot coverage
rIfi
PLANNING USE ONLY: //IJ.. )/).<r~,>()<i<J"'''.(_ ,'J" ) if//} i-.t'oJ
, t/;.~ '
Ilr) 0.1' - 'n iJ
. I
APPROV
PLAN~
BLDG:
DPWU:
FIRE:
OTHER:
ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other:
BUILDING PERMIT APPLICATION SUBMITTAL: The Building Division can provide you with information on the application and
plan submittal requirements if you have questions.
VALUATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applicant. This figure will be reviewed
and may be revised by the Building Division to comply with current fee schedules. Contact the Permit Coordinator at 417 -4815 for assistance.
PLAN CHECK FEE: IF a plan check fee is due it must be submitted at the time the building permit application and construction plans are
submitted. All other permit fees are due at the time of permit issuance.
EXPIRATION OF PLAN REVIEW: Ifno permit is issued within 180 days of the date of application, the application will expire. The
Building Official can extend the time for action by the applicant up to 180 days upon WTitten request by the applicant (see Section 107.4 of
the Uniform Building Code, current edition). No application can be extended more than once.
I hereby certify that I have read and examined this application and know the same 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 ,not the City's, and that I must obtain such permits prior to work.
APPlica~~ ~r. Date: -7- ;7-0 ..C' <(
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360-683-6790
1190 Carlsborg Rd.
Sequim. Wa. 98382
@
FRONT
Double-sided blade sign, Cedar or HDU,
wI raised 23k gold leaf Ielters, attached to
buiding wI 1/4- welded steel bracket, which
is lagged to building wI 318"' galvanized bolls,
wI expansion shields, into concrete walt
Bottom of sign at least S' above sidewalk.
20 sq. ft
48
1
1124
120
FRONT
314"' MOO Plywood signs wI raised letters (1fT foam) attached
to building wI 00. 10 coated screws into studs, 24" ole
20 sq. ft. x 2 = 40 sq. ft.
SIDE
CITY OF PORT ANGELES .
°~ DEPARTMENT OF COMMUNITY DEVELOPMENT - BUII~DING DIVISION
321EAST 5TH STREET, PORT ANGELES, WA 98362
Property Zoning .......
()
Additional desc
Expiration Date . . ?/15/03
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 ast
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 lo, cai law regulating construction or the performance of
construction.
~' · I/ /
Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date
T:LPLANNING~FORMS~1102.15 [4/2002]
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. ITIS 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
YESINO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
WATER LINE
GAS LINE
BACK FLOW / WATER
AIR SEAL
WALLS
CEILiNG
FRAMING
JOISTS / GIRDERS
SHEAR WALL
WALLS / ROOF / CEILING
DRYWALL
T-BAR ~
INSULATION
; SLAB [
WALL / FLOOR / CEILING
MECHANICAL
HEAT PUMP
WOOD STOVE / PELLET / CHIMNEY
HOOD / DUCTS
PWUTILITIES/ SITEWORK (EnglncehngDivi$ion) SEPARATE PERMIT #'$:
WATERLINE / '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. / PW/ CONSTRUCTION - R.W.
ENGiNEERING 417-4807 PW / ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDiNG 417-4815 /-~'b ~0 '~ ~- ~k/ BUILDING ¢~//2 O'J? ~/'t
T:\PLANNING~FORMS\ 1102.15 [4/2002~
. u.~-~o~ ~44~ FOR OFFICIAL USE ONLY:
'd'c~'~'~ll~'~, Date Rec,:/ ~
BUILDING PERMIT - APPLICATION ~.~:
DAte A~ovcd:~
~ Issued:
~ The Building Pe~it ~pplicaa'on must be~lled out com~ietely. '
Please ~pe or print in in~ If you have any questions, please call 417~815
Own : hon :
Address: ~G ~ h'~ City: ~ ~f ~e~ Zip:.
~chitecUEn~neer: Phone:
Contractor ~ ~ d Liccns~ ~: Exp: Phone:
Ad.ess: City:. Zip:
PRO,CT ~D~SS: ~%~k ~ i~ ~ ZON~G:
LEG~ DESC~PTION: Lot: Block: Subdivision:
CL~L~ COUNTY P~CEL N~BER: Credit Card Holder Name:
Billing Address: City:
Credit Card ~: Exp. Date: VISA MC
~E OF WO~: SIZEN~UATION:
~ Residential ~ New Comff. ~ Re-roof ~ Wood-stove SF. ~ $ /SF. =~
~ Multi-f~y ~ AddiSon ~ Mow u G~age SF. ~ $ /SF. = $
~ Co~ercial ~ Remodel ~ Demolition ~ Deck SF. ~ $ /SF. = ~
~ Repair ~ Si~ ~ TOTAL VALUATION $ ~ ~ ~ ~
B~EFDESC~IONOFTHEPRO~CT:, , ~ ~ c~-~ ~' c ~ , ~,~' ~' ~- % ~ ~.
No. of Stories: Lot S~e: % Lot Coverage: %
E~sfing Lot Coverage: /sq. fl. + Proposed Lot Coverage: /sq. ff. = TOTAL LOT COVE~GE: /s~
PL~G USE ONLY: ~ APPROVES: PL~~~
~/,~'- .)G~Z~C¢ //~ ~., ~,.~.'~ / ' /, new
ESeetl~d(s): B Yes o No SEPA Ch~cMist requ~ed? ~ Yes ~ No O~er: OT~R
B~DING PE~IT ~PLICA~ON S~MI~: Four a~lication and site ¢lan must be filled o~t eompletel~ to be acce~ted for
re~ie~. The Buil~g Division c~ provide you ~ more detailed ~fo~tion on ~e application and plan sub~al r~quirements.
co~let¢d application, sit~ plan (for additions) ~d bulldog cons~ction plans are to be sub.tied to ~e Building Division.
V~UATIO~ O~ CONSTRUCTION: In all ~ases, a valuation amount must be entered by the applicant. T~ fig~e ~11 be reviewed
and ~y be revised by the B~ld~g Division to co~ly ~ c~ent fee schedules. Contact the Pemfit Coordinator at 417-4815 for assistance.
PL~ CBECK ~EE: Your p!~ check fee is due at ~e t~e ~e bulldog pe~t application and cons~ction plans ~e sub~R~d. All other
p~t &es are du~ at ~ t~e of~t iss~ncc.
EXPIATION OF PL~ ~W: If no pe~t is issued within lg0 days of the date o[application, ~s application *viii expire.
Bulldog Official c~ extend the ~e for action by ~ applicant up to 180 days upon ~itt~n request by ~e applican[ (s~e Sec[on 107.4
th~ Umto~ Building Code, c~ent ~dition). No application can be extended more than once.
[ hereby cert~ that l have read and examined th~ application and ~now the same to be true and correct, and I am authorized to apply for
this pe~it. I understand it is not the C ~s legal respons~bd~ to ~termme w~t permits are required; it remains the applicant'~
responsibili~ lo determine what permi~ are required and to obt~ucd ( f
Applicant: ~ ~D Date:
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
........... INSPECTION REPORT ...........
REQUEST:
Date / ~ ~/'~--~ *~ ~) ~ Time Received by /~' (phone, person)
Location of Work to be inspected /'~_~.~ ~I //~/~(~.~ ~--
Name of person requesting inspection
Address of person requesting inspection Phone No..~
Type of Inspection (circle appropriate one): Permit No.
Sewer Foundation Framing Chimney Plumbing ~ Sewer Excav. Other
INSPECTION NOTES: -~--~'-~ ~- ~
Date / -//~:~ - (~ 3 Time By
Inspected:
/
Remarks:
RESTORATION REQUIRED ...... YES NO
SURFACE RESTORATION:
SURFACE TYPE: [] Unimproved []Gravel []Asphalt [~]PCC [~]Other
[] Repaired by City Work Order #
[] Repaired by Permittee [] COMPLETE
[]No Damage Found [] INCOMPLETE
(Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE)
'(I
'\oi r..?
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
.~21 EAST 5TH STREET. PORT ANGELES. WA 98]62
Application Number
pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
05-00000036 Date
.937672
13 4 W FRONT ST
06-30-00-0-0-1518-0000-
ELECTRICAL ONLY
1/14/05
CENTRAL BUSINESS DISTRICT
o
Owner
Contractor
BARRON, DALE
2219 W SIMS WAY
PORT TOWNSEND
WA 98368
OLYMPIC ELECTRIC
4230 TUMWATER
PORT ANGELES
(360) 457-5303
WA 98363
--------------------------------~-------------------------------------------
Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
ELECTRICAL ALTER COMMERCIAL
WATER HEATER cfkc.
61.30 Plan Check Fee
1/14/05 Valuation
7/13/05
.00
o
Qty
1. 00
Unit Charge Per
61.3000 ECH EL-COMM ALT <5 CIRCUITS
Extension
61.30
""'-
\ .
--At
"-
Fee summary Charged Paid Credi t,.ed Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 61.30 61.30 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 61.30 61.30 .00 .00
"-
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I
COMMENTS! ACTION NEEDED
ELECTRICAL PERMIT INSPECf.lON RECORD
CALL 4) 7-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER,
INSULATE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE ACCEPTm COMMENTS
YES NO
III '('H
KUUUli-IN! COVER
~hK V lCh
/~ ~/,;~. I A'el/' I
, /
--
GENERAL COMMENTS:
PW-II02,lS (4196)
o~
~.-:~
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
321 EAST 5TH STREET, PORT ANGELES. WA 98362
ELECTRICAL PERMIT
Issued: 7/24/97
Permit No:
5992
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
CITY OF PORT ANGELES 134 136 FRONT W
321 E. 5TH ST Lot: 8
Port Angeles, WA 98362 Block: 15 Long Legal:
360/000-0000 Sub: TPA
T: S: parc No:
CONTRACTOR-----------------------------DESIGNER---------------------------------
BOB'S ELECTRIC
1227 DEER PARK RD.
PORT ANGELES, WA 98362
360/457-6887
,
000/000-0000
PROJECT INFO--------------------------------------------------------------------
prj Type: COML.REMODEL prj Value: $0.00
Occ Type: Cnstr Type: ADD CIRCUITS
Occ Grp: Occ Load: Land ~se: CBD
Electrical Heat
Baseboard KW:
Furnace KW:
Heat Pump KW:
Fan/Wall KW:
o
o
o
o
Service Type
Riser
X Overhead Service
Underground Service
Temp Service
Voltage:
Diameter:
Service Size:
Feeder Size:
120,208
-1 X-3
225 AMPS
200 AMPS
PROJECT NOTES-------------------------------------------------------------------
NEW BREW PUB---UTILIZING OLD 1200 AMP SERVICE IN BASEMENT.
FEEDING 225 AMP PANEL AND 200 AMP PANEL
PROJECT FEES ASSESSMENT---------------------------------------------------------
Service: $156.00
Additional Feeders: $52.00
Circuit Wiring: $0.00
Temp Service: $0.00
$0.00
Misc
TOTAL FEE:
Amount Paid:
$208.00
$208.00
---------------------------------
---------------------------------
TOTAL FEE:
$208.00
Balance Due:
$0.00
COMMENTS/ACTION NEEDED
/'
ELECfRICAL PERMIT INSPECfION RECORD
CALL 417-4735.FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER,
INSULATE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE ACCF.PTED COMMENTS
1 YES I NO
NT~ ,
ROUUH.:mTCOVER lH.2-1 qr 7<'
'leE 2../ II -~
F'f'i\lAT I..o..../q I 6lX I 'J VV'- T
GENERAL COMMENTS,
PW-II02.15[4I96)
01/13/2005 08:20
3604523498
OLYMPIC ELECTRIC
PAGE 0..
n1.ctrieal Contractor
C Annu31 Pumlt 0 Alarm
~
Wjjl
Q Owner -t"llii:i....:?'
::J Carnival ~mmtrclDI
ELECTRICAL WORKPERMlT APPLICATION
o Request Inspection
o Residential CJ Residential Malnt. 0 Signs 0 Thermostat 0 Teleeom.
Job wired by
rilectrieal Cnntractor DOwner
ln~tAl1ntion dC.!Icription
Electrical C:Ofltnct('T name
~~I/ &/lnc-
P as s mililins .sddrcNS
~~ ;;;mv~/?r
~;;% :;:: ZIP
Te':ct:m 't7~~r FA~mb<~ ~ 3
7- ?)"
T...icen!ic number
OLY~rrr~DI
IVIJllJr__ - -
~ ~,;--::'--" ...--.."
------'j, \ ',-', ,--- ., \ ))
\ r--~ f:~\!/::~--_-:::'-,
'---1}'---~ l ...."/
\r , S.J:€ _u___
\ ''------
D Cash
o ClJeel:#
I hcrtby certify that I am the Qwner of lhe abo....e n;limed prope1ty or a licensed
electrical contractOJ:" (or the firm's authorized (lgent) and am making the electrical
in!ltaJlation or alterotioJl in compliance with the elecmcallaw. Chapter 19.28 RCW.
~rcdil Card
Card # ,
Visa
Mastercard
Discover
o
CJ\
\
c::s>
W
(}
Sitnature or owner! r1ec:tricnl co"trJIl:=to... n... electrical ftclminblrlt......
x
Expiration Date
of card
{nspcction fee
$6/~
I)..e
^I'I'Mvet1liy
/' THERMOSTAT
"- Dm. AI'fI"'Ivetl By
/' DITCH
D~le ^flptllV\:ld B~
SER\1CE
Om. "fllll'l'lved By
FEEDER
DI'II~ ^l1fIrowo:! B}'
/' WALLS
I'"suhit;on Only
DnlD Approved Uy
CO\ler
"UllIC .Al'rmvCll By
'-
CElLlNG
InS\llation Only
Covet
I)lllc
AI'PfO"el'I ~y
Electrical Load Additions and or subtractions_
o NO LOAD CHANGES
o Base~oard KW
CJ Furnace KW
CJ Heat Pump _ To" _ LAR
o Fan-Wall KW
Service InlormBllon
Q Overhead SelViee
o Temp Service
CJ Underground ServrOl:!
Vo~age
Pha.. 0 1 11"3
Service Size:
Feeder Size:
Jnspcctj('lfl
Dale.
Area, Building or Eq1.1ipmenl Jn~pected
Actinn Taken
Electrical
JnSl'ectt:lr
#'-<JvI!..?J