HomeMy WebLinkAbout1005 Georgiana StCOMII1ERC IAI, OFFICE
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REPORT STATE SATES TAX
on your excise tax form
to the City of Port Angeles
(Location Code 0502)
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Application Number
Application pin nunber
Property Address
ASSESSOR PARCEL NUMBER:
Application E)?e description
Subdivision Name
Property Use
Property zoning
Appficatsion valuation
19- oo0o15oo Date 9 /26 /L9
110000
1OO5 GEORGIANA ST
05 - 30 - 00 -s - 8- 0220 - 0000 -
ELXCTRICAL ONLY
Appfication desc
DHP
CLALIAM CO PT]B HOSPITAL DIS? 2
DBA OI]YI{PIC MEDICAI] CNTR
PORT ANGELES WA 983623909
SIMPSON ELECTRIC
243036 W HWY 101
PORT ANGELES
(360) 151-921a
wA 98353
PerrTrits
Additional desc
Permit Fee
Issue Date
Expiration Date
ELECTRICAIJ ALTER COMMERCIAL
1-4 CIRCUITS
85.00 Plan Check Fee
9/26/19 va'luatjon -
3 /24 /20
BASE FEE
.00
0
Extension
85 .00
Oty Unit Charge Per
Charged Paid Credited Due
Permi! Fee ToEal
Plan Check Totsal
Grand'fota]
86. 00
.00
86.00
86 .00
.00
86 .00
00
00
00
.00
.00
.00
PERMTT WLL EXPIRE Slx (6) MONTHS FROM Lr'ST NSPECTION
INSPECTION TYPE DATE:RESULTS:INSPECTOR:
DITCH
SERVICE
ROUGH-IN 1c't ,3 -t f .F *,L2
FINAL ,t" "-l- t ?P @
COMMENTS:
Signa ture of owner or Electrical Conhactor X Date:
ELECTRICAL PERMIT
CITY OF PORT ANGELES
360-417-4'735
[/ULTI-FAIMILY / COMM ERCIAL REC
lEp tELECTRICAL PERTVII T APPLICATION
Public \lbrks and Lltilities Dcpalrmenr
3ll l-.. 5th Street, Port Angeles. SA 98162
-160.41 7.47,15 i u,rvu,.citvofpa.us I clectricalpcrrnitslOcityofla.us
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5 t|u
Project Address 1005 Georqiana St. Port An qeles
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Project Descraption Hook up Ductless HP
[ lilulli-Family Residential m Commercial / lndustrial / public Buitding Square footage
OWNER INFORMATION
Olymoic Medical Center Email
Mailing Address 939 Caroline St Port Angeles, WA Phone:360417-7479
Name Simpson Electric LLC
N4a iling Address P.O. Box 10Bo
License:SIMPSEL9T3RQ
Expiration Date 121',t112019
Item
Service/Feeder 200 Amp.
Service/Feeder 201 -400 Amp.
Service/Feeder 401-600 Amp
Service/Feeder 601 -1 000 Amp.
Service/Feeder over 1000 Amp.
Branch Circuit W Service Feeder
Branch Circuit WO Service Feeder
Each Additional Branch Circuit
Branch Circuits 1-4
Temp. Service/Feeder 200 Amp
Temp Service/Feeder 201 -400 Amp.
Temp Service/Feeder 401 -600 Amp.
Temp. Servrce/Feeder 60'1 -1 000 Amp.
Portal to Portal Hourly
Sign / Outline Lighting
Signal CircuiVLimited Energy - Mutti-Family
Signal Circuiylimited Energy/First 15OO sf - Commerciat
(Note: $5.00 for each additional 1500 sf)
Renewable Elec. Energyr 5KVA System or less
Thermostat (Notet $5 for each additional)
Ouantitv fltal (Quantity x Unit Charge)Unit Charoe
$132.00
$160 00
$225 00
$288.00
$410.00
$5.00
$74 00
$5.00
$86.00
$102.00
$121 00
$164.00
$185.00
$96.00
$88 00
$88.00
$96.00
14 86.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$113.00
$56.00
86.00 TOTAL
Owner as defined by RCW 19.28.261: (1) Owner will occupy the structure for t\r/o 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 certity 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-
468, The City of Port Angeles Munacipal Code, and Utility Specifications and PAMC 14.05.050 regardang Etectrical permit Apptications.
9125t2019 Andrew P Simpson
Date Print Name Signature (E Owner p Electrical Contractor /Administrator)
[Electrical Permit Applications may be submitted to City Hall or electricalpermits@cityofpa. us or faxed to 360.417.47.1.1]
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ELECTRICAL CONTRACTOR INFORMATION
Email. dlsimpsonsl @gmail.com phone. 360_457-9270
PROJECT DETAILS
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