HomeMy WebLinkAbout907 Georgiana St (2)Applica!ion Nudcer
Application pin nudber
Propelty Address
ASSESSOR PARCET NOUBER:
Applicacion, type descript j.on
Subdivision Name
ProperEy use
Propertsy zoning
Applicationvaluation .
ELECTzuCALPERMIT
CITY OF PORT ANGELES
360-417-4735
COMMERCIAl, OFFICE
0
18 - 00001151 DaEe l2/O6/1a
539124
907 GEORGIANA ST
05-3 0- 00 - 5- 8- 014 5 - 0000 -
ELE TRICAI ONLY
REPORT STATE SALES TAX
on your excise tax form
to the City of Poft Angeles
(Location Code 0502)
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ApplicaEion desc
Ethernet and Access cont.rol
Owner ConEractor
CLALLAM CO HOSP]TAL DIST #2
939 CAROLINE ST
PORT ANGELES WA 983523909
ANGELES COWUNICA?IONS INC.
102 ROSS hN.
PORT ANGELES, WA
PORT ANGELES WA 983 62
t360) 4s7-437s
Permit
Addi.tional desc
Permi! Fee
Issue Date .
ExpiraLion Date
126.00
72 / 06 /L8
6/04/L9
ELECTRICAL ALTER COMMERCIAI
Pl-an Check Fee
Valuation
00
Qty Uni! Charge per
1.00 95.0000 ECH EL
5.00 5. 0000 EcI{ EL
I,IMTTED 1ST 15OO SO ET
ADDNT I,IMITED T5OO SQ FT
Extension
95.00
30.00
Charged Paid Creditsed Due
PermiE Fee ToEal
Plan cnecK'10Ea1
126.00
.00
1.26 .00
t26
t26
. o0
.00
.00
.00
.00
.00
00
00
00
INSPECTION TYPE DATE:RESULTS:INSPECTOR:
DITCH
SERVICE
ROUGH.IN nhlm =R *
FINAI zh/m *\tr
COMMENTS:
PERMIT WILL EXPIRE StX (6) MONTHS FROM t-dST TNSPECTION
Signature ofowner or Elecirical Contracior X Date
0
ELcoM MU LTI.FAM I LY / COM tU ERCIAL
AP
Public Works and Utilities Department
321 Fl. 5th Street, Port Angeles, WA 98362
360 -4 I 7.4735 www.cityofpa-us I electricalpermits@cityofpa.us
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Project Address:C? &ee
P.oiect Descriplion .t?
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D ilulti Family Residential .€LCommerciat / tndustrial / public Bui lding Square footage:L/N Lc;;J
Name:
Mailing Address
Name:
Mailing
Email:
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Oate =-- *(E 'L; } i
tc/(tt Email n ,' ,noJn,
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UnltChalle
$132.m
5160.m
$225.00
sa88.m
t4r0.m
s5.00
$74.00
$5.00
$86.00
$102.m
5121.m
s164.m
sl85.m
s96.00
$88.00
496_00 ^ -;/-
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Phone:
License:,,] ?
L t)l
an /1-i)'1
Item
Servicei Feeder 200 Arnp.
ServicE/Feeder 201-4OO Amp,
Servica/Fe4der ,()1 6@ Amp,
Servic€/Fo€der 6O1n 000 Arnp.
Service/Feeder o/er 1000 Anp_
Branch Cirarit w/ Servi€a Feeder
Bran.h Cirq/d w/O S€rvice Feeder
Each Additional Branch Circuit
tsranch CirqJiE 1-4
Temp. Service/Feeder 200 Arnp.
Temp. Serviae/Feeder 201.400 Amp.
Temp. Scrvioe/Feeder,tolS0O Amp.
Temp. Seryicer'Her 60l -1000 A.np.
Portal to Po.tal Howly
Signal Circt iyLimited En€qy - Mu{i+Bm y
Signal Cir@itlLimited Energy/Fid 1 EOO sf - Cormerciat
(NoE: $5,00 tor each addilional I 5m sD
Renelvable Ebc. EneEy: sKVA System or bss
Thermostat (Note: S5 for each additionat)
Quantltv Totel (Qurntty x Uoit Charge)
$_
$_
$_
$_s_
$_
$_
$_
$_
5_
t_s_
$_
$_-z-
$113.00
t55.00
TOTALt
owner as defined by RCWI9'2E.261: ( l ) O^/ner will occlpy fie struciure for tvo years afier this eledicat permit b finalized. (z) omer i3required to hil€ an eledrical conbacto. if above said property is for sale, rent o. tease. permit expires afre; $x monthe ofiij in"p.anon.
Afr€r reading the above stabment, I hereby cenify that I am the ouner of the above nam€d property or a licens€d electrical contrador Iam mahrE the electrical installathn or altgration in conpliaoce wilh the electrical latvs , N.E.C., RCW. Chapt r 19.28, WAC. Chapts.296-
, The City of Port Municipal C7le, and LXility Specitications rcgarding Eleckjcal Perm( Applications_
1 /t'r,
Print Name Signalure (Owner Electracal Administrato0
OWNER INFORMATION
PROJECT DETAILS
ELECTRICAL CONTRACTOR INFORMATION
lElectrical PermitApplicalions may be submi[ed to City Hall or eleclricelpermits@cityofpa.us or iaxed to 360-4j7.47111
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