HomeMy WebLinkAbout523 W 4th StELECTRICAL PERMIT
CITY OF PORT ANGELES
360-417-471s
17-00001671 DaLe tt/30/L'1
14O624
523 W 4TH ST
05-30 00 0 0-7465-0000-
ELECTRICAL ONLY
RS7 RESDNTI SINGLE FN{IIY
0
REPORT STATE SALES TAX
on your excise tax form
to the City of Port Angeles
(Location Code 0502)
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ApplicaEion Nu ber
Application pin number
Property Address
ASSESSOR PARCEL NIJ'MBER:
Application !),pe description
Subdivision Name
Property zoning
Applica!ion valuation
Applj.cation desc
Ductless heat pump
WILSON, STEPHAN]E M
523 W 4TH ST
PORT ANGELES
BI,ACK DIAMOND EI]ECTR]CAL CONTR
502 BI,ACK DIAIqOND RD
PORT ANGEI,ES WA 983 53
(350 ) s5s - 103 s
wA 983 52
Permit
AddiEioral desc
Permit Fee
fssue Date
Expiration Date
53.00
t1/30/7'7
s/29/a8
EI]ECTRICAL ALTER RESIDENTIAI]
00
0
QEy unit charge Per1.OO 53.OOOO ECI] EL R BRANCH clR Wo/ sER FEED
Extension
53.00
Charged Paid Cr:edited Dr'1e
Permit Fee ToLal
Plan Check ToEal
Grand Total
53.00
.00
53.00
53.00
.00
63.00
00
00
00
00
00
00
INSPECTION TYPE DATE:RESULTS:INSPECTOR:
DITCH
SER\'ICE
ROUGH-IN
FINAL
COMMENTS:le
PERMIT WILLEXPIRE SIX (6) MONTHS FROM LAST INSPECIION
Signature of o'r,loer or Electrical Contractor X Date:
Plan Check Fee
ValuaEion
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CITY oE,POR,T A,NGELTs PTR T APPLICATIoN
Building Division /Electrical Inspections
321 East Fifth Street - Port Angeles lVashington, 98362
Ph: (360) 4174735 Fax: (360) 417-4711
Date /l- t t- tt X1 &2 Single Family Dwelling
' Plan Review May Be Required,Please Complete Electncal Plan Review Informatton SheetS??' t-,. .t TtJJob Address:
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Building Square Footage
Descripuof of above
Owner lnformationName: L, lL-S o ,
Mailing Address
City Slate: 7n
License # / Exp
Item
Servic€/Feeder 200 Amp.
Servicei Feeder 201400 Amp.
Service/Feeder 401 -600 Amp
Service/Fe€der 60'l -1 000 Amp.
Service/Feeder over 1000 Amp.
Branch Circuit W Service Feed
Branch Circuit WO Service Feeder
Each Additional Branch Circuit
Branch Circuits 14 Only
Temp. Seryicd Feeder 200 Amp.
Temp. ServiceFeeder 201-400 Amp.
Temp. Service/Feeder 401{00 Amp.
lemp. Service/Feeder 601-1000 Am p .
Portal to Podal Hourly
Signal Circuiv Limited Energy - 1 & 2 Family owelling
Manufacturcd Home Connection
Renewable Electrical Energy - sKVA System or Less
Thermostat
Note: $5.00 for each additional T-Stat
EW CO STRUCTIO'{ O LY:
First 1300 Square Ft.
Each Additional 500 Square Ft. or Portion of
Each Outbuilding or Detached Garage
Each Swimming Pool or Hol Tub
Contraclor I
Narne
lvlailing Address
City:State:_Api_
ax:
Total {Multiolied bv un Charqe)Unit Charoe
$ 120.00
$ 146.00
$ 205.00
$ 262.00
$ 373.00
$ 5.00
$ 63.00
$ s.00
$ 75.00
$ 93.00
$ 110.00
$'149.00
$ 168.00
$ 96.00
$ &.00
$ 120.00
$ 102.00
$ 56.00
$ 120.00
$ 40.00
$ 74.00
$ 110.00
Ph
Lioense # / Exp
@
fl cash tr
q
$
s
$
$
$
$
$
$
$
$
$
s
$
$
$
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Owner as defined by RCW.19.28.261: (1) Owner will occupy he structure for two years after tftis elecfical permit is finalized. (2) Owner is required
to hire an electrical contractor if above said prope(y is for sale, rent or lease. Permit expires after six months of last inspection.
lotal
or a liGnsed electrical mntractor. I am making
9.28, WAC. Chapter 296468, The City of porr
Applications.
Check
After reading fie above statement, I hereby certify trat I am the owner of fie above named property
tTe electrical installation or alteratlon in compliance wifi t"re electrical laws, N.E.C., RCW. C hapter 1
Angeles Municipal Code, and Util ity Specificatjons and PAit4C 14.05.050 regarding Electrical pemit
Signature of cal contractor 0r electrical administrator:e
Ac,"a 'nca,n* frW&lFO
Dated //- r7-r z e3a6t2a12 9b
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Phone:_Fax: _
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