HomeMy WebLinkAbout222 W 12th StELECTRICAL PERMIT
CITY OF PORT ANGELES
360-4t7-4735
RS7 RESDNIL STNGLE FAI4IIY
0
REPORT STATE SALES TAX
on your excise tax form
to the City of Port Angeles
(Location Code 0502)
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tJ
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a\Appli-cation Nudber
Applicatlon pin nulnber
Property Address
ASSESSOR PARCEL NUMBER :
Application Eype description
Subdivisio Name .
ProperEy Use
Property zoning
Application valuation
19-00000?25 Date 5/ l-7 /1-9
5 51975
222 W t2TIl ST
05-30- 00 - 0-3 - 7830 - 0000 -
EI,ECTRICA], ONI,Y
ApplicaEion desc
Spa / Generator
Oi^,ner Contractor
KENNETII NORMAN,fACOBSON
10 03 s L s?
POR? ANGEI,ES WA 983535319
ANGELES ELECTRIC
524 E. 1ST ST.
PORT ANGELES
(36O) 452-9264
wa 983 62
PermiE
Additional desc
Permit Fee
fssue DaLe
Expiration Date
ELECTRICAL A],TER RESTDENTIAL
1-4 CIRCUITS
75.00 Plan Check Fee
5 /t-t /L9 va] uat ion
a1-/r3/19
o0
0
Qty Units Charge Per
BASE FIIFI
Extension
75 .00
Fee summary Charged Paid Credited Due
Permit Fee Total
Grand Total
75 .00
.00
75 .00
75.00
.00
75.00
00
00
00
00
00
00
INSPECTION TT?E DATE:INSPECTOR:
DITCH
SERVICE
ROUGI{.IN ulw)n -d(AP
FINAL <)z /,"t 4v
COMMENTS:
PERMM WILL EXPTRE STX (6) MONTHS FROM LAST TNSPECTION
Signature of owtrer or Electrical Contractor X Date:
RESULTS:
05/16/2019 10:39 Frl-I 360 452 9265 AnSeles E lectr ic
1 .2 SING E.FAMILY
ELECTRICAL PERM IT APPLICATION
hrblic Works and Utilities Department
321 E. 5th Street, Port Angeles, \YA 98362
360.41 7.4735 | wrvw.cityotpa.us I elec tslg)cityofpa.
ProjectAddress:
Project Description:
E Singls-Family Residential E Duplex /ARU Building Squars footage:
Name:Email:
Aoool/ooo1
fr^,r;;f,;p
1'o
3
TFt:I
ls
Maillng Address:h-: r :2 gTaecf Phon6:-77,5-711{
Name:
Mailing Address:
Emaii:
ll6m
Service/Feeder 200 AmP.
Service/Feeder 201.400 AmP.
Servic€/Feeder 40 1$00 AmP.
Servic€YFeoder 60'l-1 000 AmP.
Service/Feeder over 1000 AmP.
Branch circlit W Ssrvice Feeder
Branch Circuit WO Se&ice Feeder
Each Additional Branch Circ it
Branch Circuits 1-4
Temp. SeMcey'Faoder 200 AmP.
Temp. servlee/Feeder 201'400 Amp.
Exoiration Dare, --.@.4J-28pnane:3uo 4b4?.b*
License:A t F a4bD
(Qu.ntltY x Chorge)
s
A.urnllfv
s120.00
5146.00
s205.00
5262.00
$373.00
55.00
s63.00
ss.00
s75.00
$93.00
$1'r0,00
'a!{o"r
s
$
s
si
$
$
$
$
$
Temp. Se
Temp, Service/F Amp.
Portal to Podal Hourly
Signal Circ1lit/Limited
l\,lanufacturGd Home
TOTAL
owner as defined bY Rcw19.28.251: (1) Owner will occupv lho sfucfurs ior ttYo ygara sft.r this olec-tlcal Parmlt ls in.lE d- (2) Orrne. it
rsquired to hiro an eloclrical contrador if abovo said PrcP€ttY 18 ior sate, rent or l€a8e'Fsrmlt sxplE after str moflths ol lalt i pec,lon'
Afier reading the above statam€nt, I hersby cartify that I 6m lhs otYnsr ot tl13 abov. nam.d Prop€lty or ! tic€nrdd Ebc,trical conts8do.. I
am making the electricat installation or alteration in complianca with the olectdcsl lsw3, N.E'C., RCW.Chapter 1 9.2E, WAC. ChaPtBr 29€'
468,of PortAngeles Code. and Utillty and 14.05 P€rmit Appllc.tiofls
b Contractor /Administrator)Print Name Signature (f! Owner
OWNER INFORMATION
ELECTRICAL CONTRACTOR INFORiiIATION
PROJECT DETAILS
[Electrical Permit Applications may b€ submittsd to city Hall or el€ctricalpermits@clvoha'us or faxod to 360'417 '47111
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