HomeMy WebLinkAbout3916 Nygren PlELECTRICAL PERMIT
CITY OF PORT ANGELES
360-4174735
RS9 RESDNTI SINGLE FA}III,Y
0
REPORT STATE SALES IAX
on your excise tax form
to the City of Port Angeles
(Location Code 0502)
t!
s\{.E
Application Nufilcer
Application pin nurber
Property Address
ASSESSOR PARCEL NUMBER:
Application i:)'pe description
Subdivision Name
Property Use
Property Zoning
Application valuatsion
18-00001574 Dare 10/05/18
327368
3 916 NYGREN PL
06-30- 1s - 5-3 -0100- 0000,
EIJECTR]CAI] ONLY
Application desc
Ductless heat p',rmp
SANDRA IIARTIN
] 915 NYGREN PL
PORT L}iIGELES
{:60) 45? :105
BLACK D IANIOND ELECTRICAT CONTR
502 BI,ACK DfAIV1OND RD
PORT ANGEI]ES WA 9836]
(360) 56s-103s
wA 983621904
Permit
AddiEional desc
Pernit Fee
Issue Date
Erpiration Date
Qty Unii Charge
1.00 63.0000
E],ECTRICAI, AIJTER RESIDENT]AL
EL-R- BRANCH crR wo/ sER FEED
53 .00
10/os/1s
4/A3/1e
Plan Check Fee
Vafuation
ECI,I
00
c
Extsension
53 .00
Fee sunmary Charged Pa id Credited Due
Permit Fee Total
Plan Check Total
Grand Total
53.00
.00
53.00
63.00
' 00
63.00
00
00
00
00
00
00
INSPECTION TYPE DATE:RESULTS:INSPECTOR:
DITCH
SERYICE
ROUGH.IN
FINAL
COMMENTS:8><-
PERMIT wlLL EXPIRE STX (6) MONTHS FROM LA.ST TNSPECTION
Signature of owner or Electrical Contractor X Date:
EL{-2 sF
ELECTRICAL PERM IT APPLICATIO N
Public Works and lltilities Department gCI r ZA321 E. 5th Street, Port Angeles. WA 98362
360.417.4735I www.cityofpa.us I electricalpermits@cityofpa.us .IIECIRICAL
tNsPtcit0ils
ECHUED
1lo
3
Project Address
Project Description
cfu
\q
{F.
q (*4-
Do eir€-S )
\ASingle-Family Residential D Duplex i ARU Building Square footage
OWNER INFORMATION
Name A'\-f?^,Email
Mailing Address Phone \to -"(r 7_ilo5-
ELECTRICAL CONTRACTOR INFORMATION
Name License
lvlailing Address
Email:
Expiration Date
Phone:
PROJECT DETAILS
Item
Service/Feeder 200 Amp.
Service/Feeder 201-400 Amp.
Servicei Feeder 401600 Amp.
Service/Feeder 601-1 000 Amp.
Service/Feeder over'1 000 Amp.
Branch Circuit W Servic€ Feeder
Branch Circuit W/O Service Feeder
Each Additional Branch Circuit
Branch Circuits '1-4
Temp. Service/Feeder 200 Amp.
Temp. Service/Feeder 201400 Amp.
Temp. Service/Feeder 401600 tunp.
Temp. Service/Feeder 601-1000 Amp.
Portal to Portal Hourly
Signal Circuiulimited Energy -'l&2 DU.
Manufactured Home Connection
Renewable Elec. Energy: sKVA System or less
Thermostat (Note: $5 for each additional)
First 1300 Square Feet
Each Additional 500 square feet"
Each Outbuilding / Detached Garage
Each Swimming Pool / Hot Tub
468, The City of Port An Municipal Code and
/a-{ -(
Date Print Name
IElectrical Permit Applications may
Unit Charoe
$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
$120.00
$40.00
$74.00
$110.00
Quantitv fglhl (Quantity x Unit Charge)
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$TOTAL
Owner as defined by RCW 19.28.26'1: (1) Owner will occupy the structure for two years afler this electrical permit is finalized. (2) Owner is
required to hire an electrical contractor if above sajd 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 lhe electrical installation or alteration in compliance lectrical laws, N.E C., RCW Chapter 19.28, WAC. Chapter 296-
and PAMC 14.05.050 regarding Electrical Permit Applications.
Jto
gnature Owner ! Electrical Contractor / Administrator)
be subm to City Hall or epermits@cityofpa.us or faxed to 360.417 .47111
9iq8\
1 - 2 SINGLE-FAIVILY