HomeMy WebLinkAbout138 Forest Ave (3)ELECTRICAL PERMIT
CITY OF PORT ANGELES
360-417-473s
RS7 RESDNTL SINGLE FAMITY
0
REPORT STATE SALES IAX
on your excise tax form
to the City of Port Angeles
(Location Code 0502)
-_0
I
=NIApplicatsion Nuiber
Application pin number
ProperEy Address
ASSESSOR PARCEL NUMBER:
Applicatsion tl?e descriptsion
Suldivision Name
Property Use
Property zoninq
Application valuation
19 -OOOO1122 Dare 7 /26/L9
261904
138 FOREST AVE
05-3 0- 0 9- 5 -2 -3 542 - 0000-
EIECTRICAI ONIJY
AppficaEion desc
Garage addition
Contractor
BOBBI C FABELLANO ET A!
13 8 FOIREST AVE
PORT ANGELES WA 9A3522515
OI,,INER
Permit
Additional desc
Permit Fee
lssue DaEe
Expirat.ion Date
EI,ECTRICAI, AITER RESTDENTIAI,
1 4 CIRCUTTS
75.00 Plan Check Fee
1/26/L9 valuaEion
t/22/20
_ 00
0
Extension
75 .00
oty Unit Charge Per
Fee summary Charged Credited Due
Plan check Total
Grand Total
75 .00
.00
75 .00
?5 .00
.00
?5 .00
.00
.00
.00
.00
.00
.00
PERMT' WILL EXPTRE SIX (6) MONTHS FROM LAST TNSPECTION
INSPECTION TYPE RESULTS:INSPECTOR:
SERVICE
ROUGH-IN t)ul z,&YS
FINAL tls)zo =N7 .&
COMMENTS:
Signature of ou,ner or Electrical Contractor X Date:
DATE:
DITCH
tT- - ]
ELECTRICAL PERM IT APPLICATION RE(
IUL:Puhlic Xrorks and Utilities Depaltment
321 E. 5tir Strect, Port Angcles. \tA 98-152
160.-1 t 7.+7,r5 | wrvu,.cityolpa.us I electricalpenritsr@cityolpa.us
138 Forest Ave
o
3
N
f'Project Address
Project Description install outlets/lights in garage addition- plus clean up old outlet/lights
336I Single-Family Residential ! Duplex /ARU Building Square footage
Name rngswo Email mpus.ne
138 Fonest Ave 360460:0815Mailing Address Phone
Name License:
Mailing Address
Email:
Expiration Date
Phone:
Item
Service/Feeder 200 Amp.
ServiceiFeeder 201-400 Amp.
Service/Feeder 40'1 -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 20'1 -400 Amp.
Temp. Service/Feeder 401€00 Amp.
Temp. Service/Feeder 60'1 -1 000 Amp.
Portalto Portal Hourly
Signal CircuiyLimited Energy - 1&2 DU.
Manufactured Home Connection
Renewable Elec. Energy: 5KVA System or less
Thermostat (Note: $5 for each additional)
Ouantitu fgEl (Quantity it Charge)
$120.00
$146.00
$205.00
$262.00
$373.00
$5.00'
$63.00
$5.00
$75.00
$93.00
$110.00
$149.00
$168.00
$96.00
$64.00
$120.00
$102.00
$56.00
5
$
$
$
$
$
$
$
$
$
$
TOTAL
Owner as defined by RCW'19.28.261: (1) Owner will occupy the structure for two 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 certify 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 PortAngeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications.
712512019 MarkHollingsworth
1 - Z UINULts-FAIVIILY
CONTRACTOR INFORMItrloN
:te
PROJECT
q
q
$
$_
$
.1--
9120.00
$40.00
$74.00
$110.00
Date Print Name Signature (Ul Owner I Electrical Contractor / Administratoo
[Electrical Permit Applications may be submitted to City Hall or electricalpermits@cityofpa.us ot faxed lo 360.417 .4711)