HomeMy WebLinkAbout1203 Campbell Ave IELECTRICAL PERMIT
CITY OF PORT ANGELES
360-4t7-4735
RESIDENTIAL HIGH DENSI?Y
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REPORT STATE SALES TAX
on your excise tax form
to the City of Poft Angeles
(Location Code 0502)
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Application Number
Application pin number
Property Address
ASSESSOR PA.RCE]. NUMBER:
Application E,'pe description
Suldivasion Name
Property Use
Propertsy Zoning
Application valuation
19- 00001912 Date l2/a4/J-9
o48264
1203 CAMPBEI.I, AVE I
06,30-14-s-3-0340-0000-
ELEC1'RTC.I\], ONIY
Application desc
DON NIVENS
PA BaX 272
SEQUIM
UPPER LEFT EIJECTR]C ILC
13 06 ROOK DR
PORT ANGELES WA 983 52
135A) 461-7't20
wA 983 82
Addi.tional desc
PermiL Fee
Issue DaEe .
Expination Date
120.00
72/A4/a9
6/A1/2A
Plan Check Eee
valuation
00
0
Qty Unit Charge Per
1.00 120.0000 ECH EL-R-SOFT FrRST 1300
ExEension
120.00
Charged Paid CrediLed Due
Permit Eee Total
Plan Check ToEal
crand TotsaI
L20
120
120.00
.00
120.00
.00
.00
.00
00
00
00
PERMIT WILL E)QIRE STX (6) MONTHS FROM LAST TNSPECTION
INSPECTION TYPE DATE:INSPECTOR:
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COMMENTS:
Signature of ow[er or Electrical Conkactor X Date:
ELECTRICAI NEW RESIDENTIAI
.00
.00
.00
RESULTS:
APPROVED
,COBRECTIONS NEEDED
ELECTRICAL INSPECTION
WIRING REPOHT
417-4736
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NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WTTHIN 15 DAYS
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1 - 2 SINGLE-FAMILY
EL E CTR ICAL PERM IT APPLICATION
Public Works and Utilities Department
321 E. sth Street, Port Angeles, WA 98362
360.417.4735 www.cityofpa.us I electricalpermits@cityofpa.us
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Project Address:
Project Description th q a.t- t+ Ne.rntw-"-^g-
L-.1 Srngle-Famrly Resrdentral ! Duplex / ARU Building Square footage
Name ,L, a .,/-e-
Mailing Address
Email:
Phone
OV1NER INFORMATION
ELECTRICAL CONTRACTOR INFORMATION
Name
[/ailing Address
Email:
License
Expiration Date:
Phone:
PROJECT DETAILS
Item
Service/Feeder 200 Amp.
Service/Feeder 201-400 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 Circuits '14
Temp. Service/Feeder 200 Amp.
Temp. Service/Feeder 201-400 Amp.
Temp. Service/Feeder 401600 Amp.
Temp. Service/Feeder 60'1 -1 000 Amp.
Portal to Portal Hourly
Signal CircuivLimited Energy - 1&2 DU.
Manufactured Home Conneclion
Renewable Elec. Energyr sKVA System or less
Thermostat (Note; $5 for each additional)
First 1300 Square Feet
Each Additional 500 square feel"
Each Outbuilding / Detached Garage
Each Swimming Pool / Hot Tub
unit Charqe
$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
Ouantitv IqE! (Quantity x Unit Charge)
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
WJ
TOTAL ,ZX'
Owner as defined by RCW 19.28.261 : (1 ) Owner will occupy the structure for two years after thas 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.
Afte. reading the above statement, I hereby certify that I am the owner of the above named property or a licensed electrical contraclor 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 MunicipalCode, and Utility ons and PAMC 14.05.050 regarding Electrical Permil Applications.
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Date Print Name Signature 1[ Owner ! Electrical Contractor / Adminastrator)
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[Electrical Permit Applications may be submitted to City Hall or electricalpermits@cityofpa.us or faxed to 360.417.4711]