HomeMy WebLinkAbout1105 W 15th StELECTRICAL PERMIT
CITY OF PORT ANGELES
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RS7 RESDNTL SINGLE FAMILY
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REPORT STATE SALES TAX
on your excise tax form
to the City of Port Angeles
(Location Code 0502)
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\s\9Application Number
applicaE.ioa pin nuilcer
Property Address
ASSESSOR PARCEL NUMBER:
Appf icatsion ts).pe description
Su.bdivision Name
ProperLy Use
ProperEy zonirg
Applicatsion valuatsion
19- 00001328 Date 8/29/L9
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1105 W 15TH ST
05- 30- 00 - 0 -4- 1280 - 0000 -
ELECTRICAT ONLY
Application desc
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cltRrsToPHER / LTNDSAY MtjRxAY
1105 W 15TIl ST
PORT ANGELES WA 983637037(360) 77s-0445
BLACK D]A]VION'D ELECTRICAL CONTI
502 BI,ACK DIAMOND RD
PORT ANGEIES WA 98363
(360) 55s-1035
Permit
Additional desc
Permit Fee
Issue Dafe
Expiration Date
53 .00
B/2e/le
2/2s/20
ELECTRICAL ALTER RESIDENIIAL
Plan Check Fee
Valuation
00
0
Qty Unit Charge Per
1.OO 63.0000 ECH EL-R- BRANCH CIR WO/ SER FEED
Extension
63 .00
Paid Creditsed t\re
Permit. Eee ToEal
Plan Check Total
Grand Total
63.00
.00
53.00
53 .00
.00
53 .00
00
00
00
.00
.00
.00
PERMM WILL EXPIRE SIX (6) MONTHS FROM I-A.ST INSPECTION
INSPECTION TYPE DATE:RESUI,TS:INSPECTOR:
DITCH
ROUGH.IN 1J,l ln R WD
FINAL qh)) n ff s
COMMENTS:
Signature of owner or Electrical Contractor X
Owner
Charged
SERYICE
Date:_
ELl-2 sF
ELECTRICA L PER MIT APPLICATION
Public Works and Utilities Department
321 E. 5th Street, Port Angeles, WA 98362
360.4 17.47 35 www.cityofpa.us electricalpermits@cityofpa.us
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Project Address
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CO
ect Description Doc-TzEs{
Name
Single-Family Residential E Ouplex / ARU Building Square footage
/l-t?.JY,Email
i/ailing Address Phone ()-- O'f
O!\NER INFORMATION
ELECTRICAL CONTRACTOR INFORMATION
Name
Mailing Address
Email:
License:
Expiration Date:
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PROJECT DETAILS
Item
Service/Feeder 200 Amp.
Service/Feeder 20'1400 Amp.
Service/Feeder 401600 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 CirqJits 1-4
Temp. Service/Feeder 200 Amp.
Temp. Service/Feeder 201-400 Amp.
Temp. Service/Feeder 401€00 Amp.
Temp. Service/Feeder 601 -1 000 Amp.
Portal to Portal Hourly
Signal Circuiulimited Energy - 1&2 DU.
Manufactured Home Connection
Renewable Elec. Energy: sl(VA System or less
Thermostat (Note: $5 for each additional)
First '1300 Square Feet
Each Additional 500 square feet''
Each Outbuilding / Detached Garage
Each Swimming Poot / Hot Tub
Unit Charoe
$120.00
$146.00
$20s.00
$262.00
$373.00
$s.00
$63.00
$5.00
$75.00
$93.00
$110.00
$149.00
$168.00
$96.00
$64.00
$120.00
$102.00
$56.00
$120.00
$40.00
$74.00
$110.00
Ouantitv fgE! (Quantity x Unit Charge)
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$TOTAL
Owner as deflned by RCW 19.28.261: (1) Owner will occupy the structure for two years afrer this electrical permit is flnalized. (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 certify that I am the owner of abov e named property or a licensed electrical contractor. I
am making the electrical installation or alteration in compliance laws, N.E.C., RCW Chapter 19.28, WAC. Chapter296-
468, The City of Port A Municipal , and Utility nd C '14.05.050 regarding Electrical Permit Applications
-u.t,
Date Print Name Owner ! Electrical Contractor / Administrator)
[Electrical Permit Applications may be submitted to C
Si
ll or eperm @cityofpa.us or faxed to 360.417.47'l1i
1 - 2 SINGLE-FAMILY