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Home My WebLink About1036 W 12th St - BuildingPREPARED 12/01/09 8 04 05 INSPECTTON TICKET CITY OF PORT ANGELES INSPECTOR JAMES LIERLY ADDRESS 1036 W 12TH ST TENANT NBR STEVE /DEBORAH FUSON CONTRACTOR OWNER STEVE /DEBORAH FUSON PARCEL 06 30 00 0 3 7045 0000 APPL NUMBER 09 00001212 MECHANICAL APPL PERMIT PERMIT ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS ME99 01 i SUBDIV PAGE 7 DATE 12/01/09 PHONE PHONE (360) 460 6367 MECHANICAL FINAL TIME 01 00 November 30 2009 11 39 42 AM 1pangrle STEVE 477 9062 MECHANICAL FINAL PELLET STOVE AFTERNOON PLEASE CALL HIM 30- MINUTES BEFORE YOU GET THERE SO HE CAN MEET YOU THERE COMMENTS AND NOTES Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Tenant nbr name Application type description Subdivision Name Property Use Property Zoning Application valuation Application desc PELLET STOVE INSTALLATION Owner STEVE /DEBORAH FUSON 682 KEMP ST PORT ANGELES (360) 460 6367 Permit MECHANICAL PERMIT Additional desc INSTALL PELLET STOVE Permit pin number 156950 Permit Fee 60 65 Issue Date 11/19/09 Expiration Date 5/18/10 Qty Unit Charge Per 1 00 10 6500 EA Fee summary Charged Permit Fee Total 60 65 Plan Check Total 00 Grand Total 60 65 T:Forms/Building Division/Building Permit CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES WA 98362 WA 98362 09 00001212 207232 1036 W 12TH ST 06 30 00 0 3 7045 0000 STEVE /DEBORAH FUSON MECHANICAL APPL PERMIT RS7 RESDNTL SINGLE FAMILY 3000 Contractor OWNER Plan Check Fee Valuation BASE FEE ME STOVE /FIREPLACE /MISC APP Paid Credited 60 65 00 00 00 60 65 00 Date 11/19/09 Extension 50 00 10 65 Due 00 00 00 00 0 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned fora period of 180 days after the work has commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. /1/19/0q D bb bush., G Date Print {lame Signature of Contractor or Authorized Agent Signature 61 Of owner is builder) BUILDING PERMIT INSPECTION RECORD PLEASE PROVIDE A MINIMUM 24 -HOUR NOTICE FOR INSPECT IONS Building Inspections 417 4815 Electrical Inspections 417 4735 Public Works Utilities 417 4831 Backflow Prevention Inspections 417 4886 IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED POST PERMIT IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Inspection Type Date Accepted BY Comments FOUNDATION Footings Stemwall Foundation Drainage Downspouts Piers Post Holes (Pole Bldgs PLUMBING Under Floor Slab Rough -In Water Line (Meter to Bldg) Gas Line Back Flow Water AIR SEAL. Walls Ceiling FRAMING Joists Girders Under Floor Shear Wall Hold Downs Walls Roof Ceiling Drywall (Interior Braced Panel Only) T -Bar INSULATION Slab Wall Floor Ceiling MECHANICAL. Heat Pump Furnace FAU Ducts Rough -In Gas Line Wood Stove Pellet Chimney Commercial Hood Ducts (FINAL MANUFACTURED HOMES Footing Slab Blocking Hold Downs Skirting PLANNING DEPT Separate Permit #s SEPA. Parking Lighting I ESA. Landscaping I SHORELINE. T:Forms /Building Division /Building Permit Inspection Type Electrical 417 -4735 Construction R.W PW Engineering 417 -4831 Fire 417 -4653 Planning 417 -4750 Building 417 -4815 FINAL Date Accepted by Date l a Accepted by 3 FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE Date Accepted By Applicant S 7 e. 17) e n k a Re n Property Owner s57 e Delob -ras Property Owner's Address 6 S. hemp S� !Contractor De_b b 1. s o Contractor's Address some License PROJECT ADDRESS 1036 t✓ 5 7 Parcel Number 9cf Oc 3000 0 370 4J000 Project Type Brief Description. Check all that apply New Construction o Addition Remodel Repair Demolition Re -roof Heat System Other BUILDING PERMIT APPLICATION Print in ink CITY OF PORT ANGELES Attn Building Permit Technician 321 E. Fifth St. Port Angeles WA 98362 (360) 417 -4815 fax (360) 417 -4711 Residential Expires House o garage o other tear off re -roof lay over one layer Heat pump' o wood burning stove gas fireplace let stove other Floor Areas Existing (sq. ft.) Proposed (sq. ft.) Basement 1St Floor 2nd Floor 3 Floor Garage Carport Covered Porch Deck Shed Other Total footprint of structures sq ft. Lot size sq ft. Lot coverage Site Coverage the amount of impervious surface on a parcel including structures paved driveways _sidewalks patios, and other impervious surfaces. (see PAMC 17 94 135 for exemptions) Site coverage Max. height of proposed structures ft. Occupancy group Will a lawn sprinkler system be installed? Occupant bad Will a fire sprinkler system be installed? Construction type Phone Phone %n s sec. Phone. E -mail Lot 9 'Multi- family o. Commercial For City Use Only' Date Received i -19 -(R Permit i i -121v Date Approved 24 o -t 7 7-- 0 4'(O 3 (07 61 11- 913 Zoning 3L 3 7c) per sq. ft. TOTAL VALUATION 3000 of bedrooms #of full baths of half baths Industrial i have read and completed this application and know it to be true and correct I am authorized to apply for this permit and understand that it is my responsibility to determine what permits are req..ired, and to obtain permits prior to working on project Date ii ��9 Print Name -2)- �`'J`° .7 Signature 6---6 T Forms /Building Division /Bldg Permit.doc Application Number 06 00000413 Application pin number 983103 Property Address 1036 W 12TH ST ASSESSOR PARCEL NUMBER 06 30 00 0 3 7045 0000 Tenant nbr name DEBBY FUSON Application type description RE ROOF Subdivision Name Property Use Property Zoning RS7 RESDNTL SINGLE FAMILY Application valuation 500 Contractor FUSON STEVEN OWNER 1036 W 12TH ST PORT ANGELES WA 983637214 Owner Permit BUILDING PERMIT NO PR FEE Additional desc Permit pin number 76273 Permit Fee 50 00 Plan Check Fee 00 Issue Date Valuation 500 Expiration Date 10/30/06 Qty Unit Charge Per Other Fees BASE FEE CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 Fee summary Charged Paid Credited Due T• \Policies \1102_15 building permit inspection record05.wpd [1/4/2005] Date 5/03/06 Extension 50 00 STATE SURCHARGE 4 50 Permit Fee Total 50 00 50 00 00 00 Plan Check Total 00 00 00 00 Other Fee Total 4 50 4 50 00 00 Grand Total 54 50 54 50 00 00 /_a3 06 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after the work as commenced or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances goveming this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date CALL 417 -4815 FOR BUILDING INSPECTIONS. CALL 417 -4735 FOR ELECTRICAL INSPECTIONS. CALL 417 -4807 FOR PUBLIC WORKS UTILITIES PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE. INSPECTION TYPE FOUNDATION: FOOTINGS SHEAR WALLS WALLS FOUNDATION DRAINAGE DOWN SPOUTS PIERS POST HOLES (POLE BLDGS.) PLUMBING UNDER FLOOR SLAB ROUGH -IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW WATER AIR SEAL WALLS CEILING FRAMING JOISTS GIRDERS SHEAR WALL/HOLD DOWNS WALLS ROOF CEILING DRYWALL (INTERIOR BRACED PANEL ONLY) T -BAR INSULATION SLAB WALL FLOOR CEILING MECHANICAL HEAT PUMP FURNACE DUCTS GAS LINE WOOD STOVE PELLET CHIMNEY COMMERCIAL HOOD DUCTS MANUFACTURED HOMES FOOTING SLAB BLOCKING HOLD DOWNS SKIRTING PLANNING DEPT SEPARATE PERMIT #'s PARKING /LIGHTING LANDSCAPING RESIDENTIAL ELECTRICAL LIGHT DEPT CONSTRUCTION R.W PW/ ENGINEERING 417 -4807 FIRE 417 -4653 PLANNING DEPT 417 -4750 I BUILDING 417 -4815 T• \Policies \1102_15 building permit inspection record05 wpd [1/4/2005] BUILDING PERMIT INSPECTION RECORD 4 DATE ACCEPTED FINAL DATE ACCEPTED BY. I `J YES 1 NO FINAL SEPA. ESA. SHORELINE. 417 -4735 ELECTRICAL LIGHT DEPT CONSTRUCTION R.W PW ENGINEERING I FIRE DEPT I 1 1 PLANNING DEPT 1 1 1 BUILDING 1 COMMENTS DATE ACCEPTED BY. FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL DATE ACCEPTED YES I NO V BUILDING PERMIT APPLICATION Fill out COMPLETELY and in INK. Your application and site plan MUST BE COMPLETE to be accepted for review If you have an) questions, call PERMITS (360) 4174515 FAX(360)417 -4711 Applicant or Agent:L b.., s o .m Owner 5.6 e_ Phone. 3 to 0 I io 0 co 3 6 7 Address: 10 3 b LAD 7 City r o r{ A 54- s W 14 Zip 9 9 5 co 3 Architect/Engineer Phone: Contractor/`2 \JN State License Exp Phone: Address: City Zip PROJECT ADDRESS 1 0 3 (o 1 m 5 P A- ZONING a s '7 LEGAL DESCRIPTION Lot: 9 Block. 3 -7 0 Subdivision. 1 4 CLALLAM COUNTY PARCEL NUMBER. TYPE OF WORK. Residential New Coast X Re -roof Stove Multi family Addition Move Garage Commercial Remodel Demolition Deck Repair Sign Other BRIEF DESCRIPTION OF THE PROJECT 11 a -uo'�• COMMERCIAL/RESIDENTIAL. Occupancy Group No. of Stones: Lot Size: Existing Sq Ft. Total lot coverage PLANNING USE ONLY ESA/Wetland(s) Yes No SEPA Checklist required? Yes No Other Phone: 3 y S t Li 07 SIZE/VALUATION SF /SF SF /SF SF /SF TOTAL VALUATION Soo 00 q -c.c C- ZO Occupant Load. Construction Type: Proposed Sq Ft. TOTAL Sq Ft. _513 0 FOR OFFICIAI2SE 0NIY Date Rec.. e Permit 4 ee -4:1 3 Date Appro•"ef Date Issued. G. c, IF? prOK APPROVALS PLAN BLDG DPWU FIRE OTAFR. VALUATION OF CONSTRUCTION In all cases, a valuation amount must be entered by the applicant. This figure will be reviewed and may be revised by the Buildmg Division to comply with current fee schedules. Contact the Permit Coordinator at 417 -4815 for assistance. PLAN CHECK FEE. IF a plan check fee is due it must be submitted at the tune the building permit application and construction plans are submitted. All other permit fees are due at the tune of permit issuance. EXPIRATION OF PLAN REVIEW If no permit is issued within 180 days of the date of application, the application will expire. The Building Official can extend the time for action by the applicant up to 180 days upon written request by the applicant (see Section RI 05.3.2 of the International Building/Residential Code, 2003). No application can be extended more than once. l hereby certify that I have read and examined this application and know the same to be true and correct. I am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required not the City's, and that I must obtain such permits prior to work. T• �FORMS\BldgPerrnitform.wpd Applicant: U-6 "7 x Date: 8. ~~". . . :CI'I'Y OEPQ~'I'AN<.TELES ,. .'.. . '., DEPARTMENT OF COMMUNITY DEVELOPMENT. -BUILDING DIVISION 321. EAST 5TH STREET; PORT ANGELES, WA 98362 Application Number PropE;!rty A.d~f:lss . AsSESSOR PARCEL NUMBER: Tenant nbr, name . . . Appgc~~.:j.gn. d~sc:::ription Subdivision Name Property ZoniIlg.f. .'. . Application valuation 03~00000507 Date 7/02/03 1036 W 12TH ST 06 -30- 00:'0:'3 -7045'".0000- DEMO EXISTING. CARPORT DEMOLITION o OWner Contractor) ----------~~---~---~-~-- FUSON STEVEN B 1036 W 12TH ST PORTA}lGELES OWNER WA 983637214 ------.. Structure Information DEMO EXISTING CARPORT ConstructionType. . . . . TYPE V NON-RATED- . Occupancy Type . . . . . . GARAGES, CARPORTS, SHEDS -~,---~-----------------------------~~-------~--~~~---------~~--------------- . ~ , Permit . . . . Additional desc Permit Fee Issue Date EXPiration Date DEMOLITION Plan. ~eck Fee Valuation . . 47.00 7/02/03 12/29/03 .00 O~ Qty Unit. Charge Per EXtension 47.00 BASE ~E Fee sununary Credited Due Paid Charged perDdt Fee Total Plan Check Total Grand Total 47.00 .00 47.00 47.00 .00 47.00 .00 .00 ..00 .00 .00 .00 Separate ~ermlts are. required for electrical work, SEPA;ShCl(eline, .ESA, utillti~s, private and public improv~iilents'THi~~~€'b,-col11tJ. null and void if work or construction authorized is not commenced within 180 days, if construction or work IS~Ut!PQn~~a'()raba'lldontJd foraperiodqU 8~..~ays afterthe w()rk as commenced, or if required Inspections have not been requested wWtlirl~q'~~ys)tr()rilthe .Iast Inspection.. I.hereby certify that I have read and examined this application and know the same to be.true andcorrect.;:A.lI:RtoSlI~ions.J~1 laws and ordinanc~s governing this type of work will be complied with whether specified herein or not. .The gra!ltil'lgof~.pe!'Jl1i~.,(!()El~'l'1ot presume to give authority to violate or cancel the provisions of any state or local law regulating construction or theperforrn~rceof construction. . - .-- . '... ....;. ' Signatu"'o! Con...ctor or Authorized Agent . Date Slgnat~n~ ::;; ;4.~ . T:\PLANNING\FORMS\II02.15 [412002] BUILDING PERMIT INSPECTION RECORD . , _ ....... _ _ _ . ,', ,'_ _ ",'-:~:-~'~,.A,> CALL 417-4815 FOR BUILDING INSPECfIONS.l'LEASE PROVIDE A MINIMUM 24 HOUR NOTICE. . ITIS UNLAWFUL TO COYER, INSULATE,OR:CONCEAL ANY WORIf BEFORE INSPECTED AND ACCEPTED, POST .PERMIT IN A CONSPICU()US LOCATI()lIt . . . . - . KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE ACCIi;PTED . 'ili\ c COMMEl'nS' ..' ",<.:.: ~\.... ,"..:Ct;'., . " .. YES NO .' ". .;-, , . ."T'n "'.' FOUNDATION: FOOTINGS , WALLS , -c- , . FOUNDATION DRAINAGE . . . .. " ., ELEcTRICAL (LIGHT DEPT) SEPARATE PERMIT: # " '.' ,..'....... .. ','.,; ROUGH-IN I I I '\:J..,- " '.. ' :;. . ~[, '::., pLUMBING .. .) .. ~... UNDER FLOOR I SLAB .' ,...."..' 't.... , - ,. ROUGH~IN .. .' . . WATERLINE . '. GAS LINE : 'i.,. .... "..J,. , BACK FLOW I WATER '. " .i" AIR SEAL ,. ;.,'" !..LU\.' WALLS ",,'. r -.'Y,' . CEILING I . .. .: 'l' ,. FRAM}NG . >: " JOISTS I GIRDERS SHEAR WALL . WALLS I ROOF I CEILING DRYWALL T-BAR . .. INSULATION ..' . SLAB . WALL I FLOORI CEILING . MECHANICAL '. .' HEAT PUMP . WOOD STOVE I PELLET I CIDMNEY '.' . HOOD I DUCTS '. '. .; PW UTILITIES I SITE WORK (Engineering Division) SEPARATE PERMIT #'s: . WATERLINE I METER SEWER CONNECTION .'. SANITARY '. '. STORM . PLANNING.DEPT, . SEPARATEPERMIU's .' SEPA: p ~RKINGILIGHTING . '. '. ESA: LA.\'lDSCAPI~~_d . .' .' SHORELINE: " .. .' .... ." ',' I' ,- ~ :.; :;:'~::; ~1'::'1;, . Ii )'\'JFINAL J~SPEC1'lQl'!S'R,EQUI~ PRIO~TO;()~CP"~S:VfUSE h"'i;,':' '.:' " , " . I RESIQENTIAi. .) j"'"'' I"i' DATE::))'\ji YES NO COMMIi;JtCIAL if'.' ,1:;: !>,\T~, "~' '?:;. .'. ".0 ..~" "~ij.~Sj::~PTEp , .;....... ,.., '~, I: .' .' ,:':,. lJi Yl!'.&!l'\, : / ). ,,,,,.NO . ,'.; ELEctIucl[' ,. " "" ELECTRICAL ;lJGHT DEPT. .~17~735 ~.. " ,,: II"" ) :Ie: ''c'; ':-",-!, .') . , :~,i':,".o': '. L1GHTDEPT "i." " I'i' ." '.. CONSTRUCTION R. W.I PWI .' CONSTRuc-dON : R.. W. . '.'n.:.' .,\i". .... ." ENG~EE\UNG .j417-4807 PW I ENGINEERING I, ., Flkr \~"\\ . ~~",",;~-~", '.(i'746~ "~~.....'~". FIRE DEPT. " .' pLANNING DEPT. 417'475,0 ; ~" :.; .} PLANNING DEPT. .,......, .' . " I.... ,/' BUILDING'; ','" , 1!1.-I:Il.~<. _t' J.. 1:: I." :: , , .. . 411-4815;.. BUILDING . , ...., .... " ~, '.. , . T:\PLANNING\FORMS\1102.15 [412002) , BUILDING PERMIT - APPLICATION I FOR OFFICIAL USE ONLY: Date Rec.:~-/5-6 ~ Permit #: C;;-O 7 Date Approved: Date Issued: Fill out COMPLETELY and in INK. Your application and site plan MUST BE COMPLETE to be accepted for review. If you have any questions, caU (360) 417-4815 Applicant or Agent: Dc.'ob'j f=l..\t!.ow") Owner: .5f.e.,,,e.' D.&.b~ Fu~C)", Address: 10!l2. (..0. '2. ~ Architect/Engineer: Phone: 31#0-"'+&"7-<."107 Phone: City: ?o..i. A"c;-..Ic$. LUA- Zip: qSbc.2... Phone: Contractor State License #: Exp: Phone: Address: PROJECT ADDRESS: 10 "'3 ~ LEGAL DESCRIPTION: Lot: 8 CLALLAM COUNTY PARCEL NUMBER: City: W I.;). ~ ~T. Block: 0'70 Zip: ZONING: l2-~-' Subdivision: Ot;S6CDo3 rDlf ~ Credit Card Holder Name: Billing Address: Credit CardType VISA MC # TYPE OF WORK: o Residential 0 New Constr. 0 Re-roof 0 Stove o Multi-family 0 Addition 0 Move 0 Garage o Commercial 0 Remodel IIlI Demolition D. Deck o Repair 0 Sign 0 Other BRIEF DESCRIPTION OF THE PROJECT: _.De. r'Y'\ n City: Exp. Date: SIZEN ALUATION: SF. @ $ ISF. = $ SF. @ $ ISF. = $ SF. @ $ ISF. = $ TOTAL VALUATION $ eo ~/:ct{~~ Q..o.."... 1>6...-1- COMMERCIALIRESIDENTIAL: Occupancy Group: Occupant Load: No. of Stories: Lot Size: Existing Sq. Ft. & Proposed Sq. Ft. Existing lot coverage _ % & Proposed lot coverage _% = Total lot coverage Construction Type: = TOTAL Sq.Ft. % APPRO~ . PLAN : BLDG: DPWU: FIRE: OTHER:_ PLANNING USE ONLY: ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other: BUILDING PERMIT APPLICATION SUBMITTAL: The Building Division can provide you with information on the application and plan submittal requirements if you have questions. VALUATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applicant. This figure will be reviewed and may be revised by the Building Division to comply with current fee schedules. Contact the Permit Coordinator at 417-4815 for assistance. PLAN CHECK FEE: IF a plan check fee is due it must be submitted at the time the building permit application and construction plans are submitted. All other permit fees are due at the time of permit issuance. EXPIRATION OF PLAN REVIEW: Ifno permit is issued within 180 days of the date ofapplication, the application will expire. The Building Official can extend the time for action by the applicant up to 180 days upon written request by the applicant (see Section 107.4 of the Uniform Building Code, current edition). No application can be extended more than once. I hereby certify that I have read and examined this application and know the same to be true and correct. I am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required ,not the City's, and that I must obtain such permits prior to work. . XV~a-~ 5t1S/03 T:\FORMS\APPS\Buildingpermit.wpd Apphcant: Date: CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUiLDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number ..... 03-00000508 Date 7/02/03 Property Address ...... 1036 W 12TH ST ASSESSOR PARCEL NUMBER: 06-30-00-0-3-7045-0000- Application description . . . RES ADDITION Subdivision Name ...... Property Zoning ....... Application valuation .... 840 Owner Contractor ................................................ ...... Structure Information NEW 70SF FRONT PORCH ..... Per. it ...... BUILDING PERMIT - NO PR FEE Additional desc . . Expiration Date . . 12/29/03 desc · . NEW 70SF PORCH & RE-ROOF Issue Date .... 7/02/03 Valuation .... 840 Expiration Date . . 12/29/03 Fee suau~ary Charged Paid Credited Due Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date T:\PLANNING\FORMS\ 1102.I5 [4/2002] CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS ........... INSPECTION REPORT ........... REQUEST: Date ~, !/J/'~/r~-~l! Time ,J~ :~ Received by ~. ~ ~person) Location of Work to be inspected '~ ~ ~,~ .~ ~ re ~ Name of person requesting inspection / ~ ~ ~ (~) / ~ ~ ~-~ Address of person requesting inspection Permit No. Type of Inspection (circle appr~riate one): _ Sewer Foundation Fram~himney Plumbing Final Sewer Excav. Other ~STO~TIOffi 8~OHI~ED ...... ~fiS ~O SURFACE RESTORATION: SURFACE TYPE: [] Unimproved [~]Gravel [--]Asphalt [~PCC l~Other [] Repaired by City Work Order # F} Repaired by Permittee [] COMPLETE []No Damage Found [] INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT [DATE) FOR OFFICIAL USE ONLY: BUILDING PERMIT - APPLICATION Date t6%6 Fill out COMPLETELY and in INK. Your application and site plan MUST BE Date Approved: COMPLETE to be accepted for review. If you have any questions, call (360) 417-4815 Date Issued: Applicant or Agent: L')c. bb~3 V,...~.,~,-., Phone: s~.~-%5 7 ~ ~.,-t o7 Owner: .T:,~,~.. *, -E)~,,~..3 ~'uac~ Phone: ~,,.-o- q-~"t- Ad&ess: t.~2. ~e~,~ S~. Ci~: Pa~L ~S~t~, ~ Zip: ~chitecffEngine~: Phone: Con,actor State License ~: Exp: Phone: Ad&ess: CiW: Zip: PRO~CT~D~SS: to~u ~. tZ~ ~. ~-~ ~le~,~ ZO~G: LEG~ DESC~TION: Lot: ~ Block: ~70 Subdi~sion: ~n=i~ CL~LAM CO~ P~CEL ~BER: ~ ~ ~7~ Credit Card Holder Name: Billing Address: City:. Credit CardType VISA MC __ # Exp. Date: TYPE OF WORK: SIZENALUATION: m Residential [] New Constt. [] Re-roof [] Stove [] Multi-family [] Addition El Move [] Garage SF. ~ $ /SF. = $ [] Commercial [] Remodel [] Demolition [] Deck SF. ~ $ /SF. = $ ] aa O ~'~ [] Repair [] Sign [] Other gro,,~ TOTAL VALUATION $ BRIEF DESCRIPTION OF THE PROJECT: COMMERCIAL/RESIDENTIAL: Occupancy Group: Occupant Load: __ Construction Type:_ Ne. of Stories: ! LotSize: ?oOC3 Existing Sq. Ft. /ff~3 & Proposed Sq. Ft. Existing lot coverage % & Proposed lot coverage % = Total lot coverage ~_ ~, t t % .- APPRg~ PLANNING USE ONLY: PLAN4 DPWI FIRE: ESA/Wetland(s): [] Yes [] No SEPA Checklist required? [] Yes [] No Other: OTHER: BUILDING PERMIT APPLICATION SUBMITTAL: The Building Division can provide you with information on the applicahon and plan submittal requirements if you have questions. VALUATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applicant. This figure will be reviewed and may be revised bY the Building Division to comply with current fee schedules. Contact the Permit Coordinator at 417-4815 for assistance. PLAN CHECK FEE: IF a plan check fee is due it must be submitted at the time the building permit application and construction plans are submitted. All other perrmt fees are due at the time of permit issuance. EXPIRATION OF PLAN REVIEW: If no permit is issued within 180 days of the date of application, the application will expire, The Building Official can extend the time for action by the applicant up to 180 days upon written request by the applicant (see Section 107.4 of the Uniform Building Code, current edition). No application can be extended more than once. I hereby certify that I have mad and examined this application and know the same to be true and correct. I am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required ,not the City's, and that I must obtain such permits prior to work. T:\FORMSk&PP$,Buildingpcrmit.wpd Applicant: ,~z~ C-~"--o.x~:~ Date: .D-,//~/O3 CITY OF PORT ANGELE~ -- The {~su~n~ ~ t~s ~ ~ ~ ~ and ~her d~ ~ .~ ~ ,~,n o~ ali c~es and or~inanc~ ~ 3~3(c) - Uniform Building FILE