HomeMy WebLinkAbout116 E 12th St (2)ELECTRICAL PERMIT
CITY OF PORT ANGELES
360-417-4735
RS7 RESDNTL SING].E FA]ITILY
0
REPORT STATE SALES IAX
on your excise tax form
to the City of Poft Angeles
(Location Code 0502)
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Application Number
ApplicaEion pin number
Propertsy Address
ASSESSOR PARCEL IiTOMBER:
Application t,,pe description
Subdivision Name
Property use
Propertsy Zoning
Applicatio valuation
19- 000015s3 Date ao/24/t9
017 913
116 E 12T1{ ST
06- 30-00 - 0 -3 - I025 - 0000 -
EI,ECTRICAT ONLY
ApplicaEion desc
DHP
ContracEor
C.C. BEAI]DETT ,fR/R. ,f
po box 27 52
PORT ANGELES
1360) 791-A411
Gutstman
wA 98362
BI.ACK DIAMOND ELECIRICAL COI{IR
502 BI,ACK DIAMOND RD
PORT ANGELES WA 98353
(360) 555-1035
Permi E
Additional desc
Permit Fee
fssue DaLe
Expiratlon DaEe
53 .00
to /24 /te
4 / 2t/20
ELECTRICAL ALTER RESIDENTTAI
Pfan Check Fee
Valuation
00
0
oty Unit ClErge Per1.00 53.0000 Ect{ EL-R- BRANCH crR wo/ sER EEED
ExEensio
53 .00
Fee summary Charged Paid CrediEed Due
53 .00
.00
63 .00
63 .00
.00
53 ,00
00
00
00
00
00
00
PERMIT WILL EXPIRE SIX (6) MONIHS FROM LAST INSPECTION
INSPECTION TYPE DATE:RESULTS:INSPECTOR:
DITCH
SERVICE
ROUGH.IN tilet /fr p
FINAL ,o)z /n D Yf
COMMENTS:
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Signature of olr11€r or Electrical Contractor X
Permit I'ee Total
Plan Check Total
6raad Total
Date:
ELl-2 sF
1 - 2 SINGLE-FAMILY
ELECTRICAL PERM IT APPLICATION
Public Works and Utilities Department
321 E. 5th Street, Port Angeles, WA 98362
360.417.4735 i www.cityofra.us I electricalpermits@cityofpa.us
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Project Address:
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Pro Description:Ducz-usr
Single-Family Residential E Duplex / ARU Building Square footage
Name:
lvlailing Address:
Email
phone: ?1o 7q7 tYl-7
OWNER INFORMATION
ELECTRICAL CONTRACTOR INFORMATION
Mailing Address
Email:
License
PROJECT DETAILS
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 401600 Amp.
Temp. Service/Feeder 601-1000 Amp.
Portalto Portal Hourly
Sgnal CircurULimited Energy - '1&2 OU.
Manufu ctured Home Connection
Renewable Elec. Energy: 5KVA System or less
Thermostat (Note; $5 for each additional)
First 1300 Square Feei
Each Additional 500 square feet"
Each Outbuilding / Detached Garage
Each Swimming Pool / Hot Tub
LJnit 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
$64.00
$120.00
$102.00
$56.00
$120.00
$40.00
$74.00
$110.00
Quantitv fgE! (Quantity x Unit Charge)
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
--7-.:3-TOTAL
Owner as defined by RCW.19.28.261: (1) Owner will occupy the structure for two years after this eleclrical 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 prope.ty or a licensed electrical contraclor I
am making the electrical installation or alteration in with the electrical laws, N.E.C., RCW. Chapter'19.28, WAC. Chapter 296-
468, The City of PortAngeles nicipal Code and PAMC 14.05.050 regarding Electrical Permit Applications.
o-?t-11
Date Print Name Signature Owner ! Electrical Contractor / Administrator)
IEleclrical Permit Applications may submitted to C ity Hall or epermits@cityoha.us or faxed to 360.417.47111
Name: