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ELECTRICAL PERMIT
CITY OF PORT ANGELES
360-417-4735
Application Nunber
ApplicaEion pin number
Property address
ASSESSOR PARCEI, NUMBER:
Application sype deEcription
subdiwision Name . .
Property Use
Property Zonirg
Application valuation
21-oooo1o5o Date 9/21/21
559420
1410 ROOK DR
05 -30- 14 -7-2 - 0004 -0000 -
E],ECTRICAL ONI,Y
RESIDENTAI SF 9OOO
RSg RESDNTL SINGLE FAMILY
0
Application desc
GREEN CROW lNvEsl}{ENrs cO l,LC
PO BOX 2439
PORT ANGEI,ES WA 98352
UPPER IEFT ELECTRIC I,LC
1306 ROOK DR
PORT ANGELES WA 98362
1360) 45r- 7720
Permi ts
Additional desc
Permit Fee
Is6ue DaEe .
Expixalion Daie
200.00
I /2'7 / 2t
3 /26/22
ELECTRICAI NEW RESIDENTIAL
Plan Check Fee
valuatsion . .
00
0
oty Uni! charge Per
1 .00 120. oo00 EcH
2.00 4 0.0000 EcH
EIJ-R-SQPT FIRST 13OO
EI,-R-SOFT ADDITIONAL 5OO
Extension
120. 00
80. 00
Fee summary Charged
PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST TNSPECTTON
Pefinit Fee ToEal
Plan Check Totaf
Grand Total
200 .00
.00
200.00
200.00
,00
200 .00
.00
.00
.00
00
00
00
credited Due
REPORT SALES TAX
on your excise tax form
to the City of Port Angeles
(Location Code 0502)
INSPECl'tON TYPE DATE:RESULTS:INSPECTOR:
DITCH
SERVICE nln)er &R "fl&)
ROUGH.IN i)*tht 6)&
FINAL dzt )n'>@ W
COMMENTS:
Signature of owner or Electrical Contractor X
G:,EXCHANCE,BUILDING
Date
I
ELECTRICAL PERTVI IT APPLI CATION
Putrlic Works and Utilities Departrnent
321 E. sth Street, Port Angeles, WA 98352
36AA17 .47 35 | wvrv.cityofpa.us I electricalpermits@cityofpa.us
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Project Address 1410 rook rd
Prolect Description new construction home
n Single-Family Residential tr Duplex / ARU Building Square footage
INFOR
Name: north Pointe consctruction llc Email
Mailing Address Phone
Name upper left electric License:
lilailing Address
Email:
Expiration Date
Phone:
ECT D
Item
ServiceiFeeder 2OO Anip:
Service/Feeder 201-400 Amp.
Service/Feeder 401-600 Amp.
Service/Feeder 601-1000 Amp.
Service/Feeder over l OOg Amp.
Branch Circuit W €ervice 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 401-600 Amp.
Temp. Service/Feeder 601-1000 Amp.
Portalto Portal Hourly ..
Signal CircuiVLimited Energy - 1&2.DU
Manufactured Home Connection..- .
Unit Charqe (Quantity i Unit 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 ,,.-
-_r_$96.00
$64.00
Thermostat (Note: $5 for each additional)
TOTAL
Owner as deflned 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 tast 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.
8t24t21 chace botero
Date Print Name Signature 1! Owner ! Electrical Contractor / Administrator)
IElectrical Permit Applications may be submitted to City Hall or electricalpermits@cityofpa. us or faxed to 360.417.47111
1 - 2 SINGLE-FAIUILY
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