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Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER;
Application type description
Subdivision Name
Property Use
Property Zoning .
Application valuation
08-00000699 Date
606956
435 W 6TH ST
06-30-00-0-0-9448-0000-
ELECTRICAL ONLY
6/17/08
RS7 RESDNTL SINGLE FAMILY
o
Owner
Contractor
Scofield, Ben
435 W SIXTH ST
PORT ANGELES
WA 98362
SHAMP ELECTRICAL CONTRACTING
PO BOX 383
PORT ANGELES WA 98362
(360) 452-1689
Permit
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
ELECTRICAL NEW RESIDENTIAL
128124
75.00
6/17/08
12/14/08
Plan Check Fee
Valuation
.00
o
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0\
Qty
1. 00
Unit Charge Per
75.0000 ECH EL-RM-0-200 1ST SRV FEEDER
Extension
75.00
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 75.00 75.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 75.00 75.00 .00 .00
s
~
. -
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SPECTION ELECTRICAL
TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE
OUGH-IN .
~.
oS>
FINAL
l~ VB
OMMENTS:
~:.
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr, name
Application type description
Subdivision Name
Property Use
Property Zoning .
Application valuation
08-00000693 Date 6/16/08
599346
435 W 6TH ST
06-30-00-0-0-9448-0000-
GOLDEN DREAM PROPERTIES
RES REPAIR
RS7 RESDNTL SINGLE FAMILY
15000
Application desc
NEW PLMBNG, FRONT/REAR PORCH & STAIRS, FNDTN, ETC.
Owner
Contractor
GOLDEN DREAMS PROPERTIES INC.
81 WEST ST.
SEQUIM WA 98382
(360) 460-2271
Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
GREEN COTTAGE BUILDERS
111 E. 13TH ST.
PORT ANGELES WA 98362
(360) 808-3637
BUILDING PERMIT -RESIDENTIAL
VARIOUS RESIDENTIAL REPAIRS
128025
277.75 Plan Check Fee
6/16/08 Valuation
12/13/08
111.10
15000
Qty Unit Charge Per
Extension
95.75
182.00
BASE FEE
13.00 14.0000 THOU BL-2001-25K (14 PER K)
Permit . . . . .
Additional desc .'
Permit pin number
Permit Fee
Issue Date
Expiration Date
MECHANICAL PERMIT
VENT FAN AND HEATERS
128033
131.25 Plan Check Fee
6/16/08 Valuation
12/13/08
.00
o
lih6lj 0/
J ~ "tJ
(3 ~ Og.
Qty Unit Charge Per
BASE FEE
1.00 7.2500 ECH ME-VENT FAN
5.00 14.8000 ECH ME-INSTALL FLOOR/WALL FURNACE
Extension
50.00
7.25
74.00
Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
PLUMBING PERMIT
MOVE WTR HTR, NEW TRAPS ETC
128041
121.00 Plan Check Fee
6/16/08 Valuation
12/13/08
.00
o
Qty Unit Charge 'per
Extension
50.00
42.00
BASE FEE
6.00 7.0000 ECH 'PL- EA.FIXTURE ON ONE TRAP
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 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 r lating construction or the performance of
construction.
T:Forms/Building Division/Btiilding Permit (10/0 I/07).wpd
Signature of Owner (if owner is builder)
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BUILDING PERMIT INSPECTION RECORD
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 LOCA TIaN.
KEEP PERMIT CARD AND APPROVED PLANS AT .lOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
SHEAR WALLS / WALLS
FOUNDATION DRAINAGE / DOWN SPOUTS
PIERS
POST HOLES (POLE BLDGS.)
PLUMIlING
UNDER FLOOR / SLAB
ROUGH.IN
WATER LINE (METER TO BLDG)
GAS LINE FINAL DATE ACCEPTED BY.
BACK FLOW / WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS / GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS / ROOF / CEILING
DR YW ALL (INTERIOR BRACED PANEL ONL Y)
T-BAR
INSULA nON
SLAB
WALL / FLOOR / CEILING
MECHANICAL
HEAT PUMP/FURNACE/DUCTS
GAS LINE
WOOD STOVE / PELLET / CHIMNEY FINAL DATE ACCEPTED BY
COMMERCIAL HOOD / DUCTS
MANUFACTURED HOMES
FOOTING / SLAB
BLOCKING & HOLD DOWNS
SKIRTING
PLANNING DEPT. SEPARATE PERMIT U's SEPA:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W. / PW/ CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW / ENGINEERING
FIRE 417.4653 FIRE DEPT.
"PLANNINGDEPT.",... '.- .":.~1774750 . " PLANNitle; DEPT . ". .' ,,,",.:,, -.".,;~, "
.. -
BUILDfNG 417-4815 BUJLDfNG
T Forms/Building DiVIsion/Building Permit (1010 1/07).wpd
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
i,
'l;"
Application Number
Application pin number
08-00000693
599346
Page
Date
2
6/16/08
Qty
1. 00
1. 00
1. 00
Unit Charge
7.0000
15,0000
7.0000
Per
ECH
ECH
ECH
PL- EA. INSTALL WATER PIPE
PL- EA. BLDG SEWER
PL- EA. WATER HEATER
Extension
7.00
15.00
7.00
Special Notes and Comments
June 16, 2008 12:31:42 PM sroberds.
The entrance stair replacement will result in a shorter run
of stairs that is taller than the previous stairs. The
location will remain nonconforming, i.e., within the front
setback, but will be less than the existing. No land use
issues are anticipated.
Other Fees
STATE SURCHARGE
4.50
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 530.00 539.00 .00 .00
Plan Check Total 111.10 111.10 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 645,60 645.60 .00 .00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements, This perlT) it 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 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.
Date
Print Name
Signature of Contractor or Authorized Agent
Signature of Owner (if owner is builder)
,', ,~
T:FormslBuilding DivisionlB'uilding Permii (1010 1107).wpd
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BUILDING PERMIT INSPECTION RECORD
"
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
SHEAR WALLS / WALLS
FOUNDATION DRAINAGE / DOWN SPOUTS
PIERS
POST HOLES (POLE BLDGS.)
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN b-- ~ y -08' ~L-L
WATER LINE (METER TO BLDG)
GAS LINE FINAL \ 2.- 3-0 3 DATE :r LL- ACCEPTED BY:
BACK FLOW / WATER
AIR SEAL 6-2.4-08 ::r LL
WALLS
CEILING
FRAMING
JOISTS I GIRDERS
SHEAR W ALL/HOLD DOWNS ,
-
WALLS / ROOF / CEILING
DRYWALL (INTERIOR BRACED PANEL ONL Y)
T-BAR
INSULATION
SLAB
WALL I FLOOR / CEILING
MECHANICAL
HEATPUMP/FVRNACE/DUCTS
GAS LINE
WOOD STOVE / PELLET / CHIMNEY FINAL \ lc- 3 -0'& DATE -:JL- L. ACCEPTED BY.
COMMERCIAL HOOD / DUCTS
MANUFACTURED HOMES
FOOTING / SLAB
BLOCKING & HOLD DOWNS
SKIRTING
PLANNING DEPT. SEPARATE PERMIT Ii's SEPA:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGI-IT DEPT
CONSTRUCTION R. W. / PW/ CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW / ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNIN,GmEPT. ~",1-"""'-,' .; 417-4.750. , -' . PLANNING' DEPT. :,,,:.; ',' e' ,-
<.. ""
\2:~ 3--03 ;ru." ..-
BUILDING 417-4815 BUILDING
CALL 417-4815 FOR BU[]~DING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS,
CALL 417-4807 FOR PUBLIC WORKS UTILITIES .
PLEASE PROVIDE A MINIMUM 24 I-lOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE"
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. _ 0
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE, &. 0<;;)
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BUILDING PERMIT AcpP~LleA'-TION Print in ink
CITY O~ PORT ANGEL.ES ~ iii p~~7 ~ For City Us Onl :
Attn: BUI!dlng Permit Technician ..y'" ~ - 'f\ef. ate Received b -q -08
321 E. Fifth St., Port Angeles, WA 98362 ~ 0 00>) 0",)) if"' r~. rmit # ()'is - 093
(360)417-4815 fax(360)417-4711 cl-~'\ r~"",,'b\.rJ$' ~teApprovedl,'I&lofl'
/ :<~~ l!i. \1) !' 6-
. ......,..- '? ~ .- ~ I ~~ '21 ~ \9\"'\ ~
Applicant or Agent ~ . I>I:.N:J ?) j11 lifJ ( Ci"I i e " Cj'" Phone
Property Owner -SLM J.l:e _\ '^-'^-~ v~ Go \J.~ Dretijn> Phone
Property Owner's Address 8'1 Wes S'. .e....v: \.V}\ 7 pi'"l)F4'tt'es kc
Contractor/Engineer .~ G I' ~V\ Q.o ".e .(3f..L~ I r~r Phone '0 OlE, ~ J (.3 '7
Contractor/Engineer's Address (f It:. I .:::I ~ ,Sf, ';7Ci"f+ A~~J2--tw 9 t ~ F.2
License # Expires
..
<C.I~
....,.
PROJECT ADDRESS
Parcel Number
..
"'5'7
t./fJ, n 71
~3S
Lot
Zoning RS.~
Proiect Tvpe & Brief Description:
Check all that apply .
o New Construction
o Addition
)(Remodel
~Repair
oRe-roof
o Demolition
o Heat System
o Other
Floor Areas
Basement
1 sl Floor
2nd Floor
3rd Floor
Garage
Carport
Covered Porcht. ^
Deck ,
Shed
Other
Total footprint of structures
XResidential
o Commercial
o Multi-family
o Industrial
o Heat pump 0 wood-burning stove 0 gas fireplace 0 pellet stove 0 other
Existinq (Sq. ft.)
TOTAL VALVA TlON $
sq. ft.
%
Lot size
sq. ft. = Lot coverage
Max. height of proposed structures
Will a lawn sprinkler system be installed?
Will a fire sprinkler system be installed?
ft.
# of bedrooms
# of full baths
# of half baths
Occupancy group
Occupant load
ConstrLiction type
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 required, and to obtain permits prior to working on
projects. . . ~~
Print Name ~ t3eVt/GtWl..~ .J~t.)'~el J Signature" ..
\J /~ ~
T:Forms uil ing Division/Bldg Permit Appl.-2006 Code.doc V
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FEE RECEIPT NUMBER
, CITY OF PORT ANGELES,
DEPARTMENT OF LIGHT
APPLICATION AND ELECTRICAL PERMIT
A
/01 i
PERMIT NUMBER
.
'J) ,
,. f( €s
-TOTAL FEE ~6 Ol) , .
-
CONT. lie. NO. TIME TO COMPLETE NO. STORIES LEGAL OC~UPANCY
.. - -
ELECTRICAL PERMIT QNL Y NO OCCUPANCY OR USE ESIABUSHED UNDER THIS PERMIT
Site Address
3S-:- W ~ P.
REel ADDRESS IS RESPONSIBILI OF APPliCANT
:,t./.r1"lUI C-'rk
PERMITS WITH WRONG A
Installation By
Installers Address
c...
Owner
Owner's' Address
Day Phone Installers-Phone
Application is hereby made for Permit to install Electrical Equipment as follows:
(('iflA-c-'l. (bMi.' W/A..~c1~A1 'i.J "h'1 17M
S'C<.vlce
4-YJ
b "/A-c'i
,
-He..
~iring Method
.'
NUMBER AMP 120V 240V NUMBER AMP 120V 240V
USE OF CIRCUIT PEA l00R FEE USE OF CIRCUIT PER- l00R FEE
CIRCUITS CIA 10 30 CIRCUITS CIA 10 30
LIGHT SIGN ,
LIGHT ' ' SOVOL T5
OR LESS
CONVENIENCE" , -' MOTOR ..
CONVENIENCE . MOTOR ' --
APPLIANCE -- MOTOR
DISt:tWASHER ,.. FIRE ALARMS -
DISPOSAL BURGLAR ALARM
RANGE MISC.
OVEN i
WATER HEATER
LAUNDRY
DRYER " REINSTALLATION LIGHT FIXTURE #
FURNACE .. SUB TOTI'\L FEE
GAS - OIL
FURNACE ENERGY FEE
ELECTRIC' BASIC FEE
ELECTRIC HEAT ,
TOTAL FEE ,"
ELECTRIC HEAT SIZE OF SERVICE SWITCH OR CIRCUIT,BREAKER
, --
,
A.C. UNIT AMP PHASE
FEEDER , SIZE OF SERVICE ENTRANCE CONDUCTORS
., ..
SERVICE A.W,G. ,
,
.., "I SUB-TOTAL ,..
SIZE OF GROUND SIZE OF ENTRANCE SWITCH
, . . -
I certify that the work to be performed under this permit will be done by the installer and in conformance with the N,~.C. Electrical Code.'
Date Application made
,19
By
CONTRACTOR OR OWNER (OR AUTHORIZED AGENT)
Permission is her~by gtYl?n to do.t.he above de~crU:led work, according.to.the conditions hereo_n and according to the'approved plans and
specifications pertaining thereto, subject to compliance with the Ordinanc s f the. 'y of Port An Ie'
.. 01 CTO 0 CITY LIGHT
~/tr If! '
.
Date Permit Issued
WARNING
PERMIT PLACARD MUST BE KEPT POSTED ON THE WORK - SEE OVER -
WHITE. Original CANARY. Duplicate PINK. Triplicate WHITE CARD. Inspector's Report
REPORT OF INSPECTOR
DATE OF VISIT MADE BY REMARKS
""
,
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~f-:t 17 I! (t'i O.K. FOR COVERING
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1,."1." ~ O.K. TO CONNECT SERVICE
! , FINAL O.K.
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ELECTRICAL INSPECTION
WIR!NG REPORT
417-4735
I DATE
f-!JiliifJCTOR
L~I::l A IV', ~
I ADDRi~~
I PERMIT 1/
oB-of,qq
I'N~
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o
APPROVED NOT APPROVED
o .... . . . . . . . . . . . DITCH. . . . . . . . . . . . . . . . . 0
0................ ROUGH IN/COVER............... 0
D. . . . . . . . . . . . . . . . . . SERVICE. . . . . . . . . . . . . . . . . . . 0
D... ............. FINAL....................~
CORRECTIONS NEEDED{!:?LAN. K ";:1..:1',,'\'E- \fD\2..---2""I'-i~
. ~~ASi'---JP,i'- 1'1~'---J/O.-124)~( '). -r ?<.ATL
FCI2... rL&r-JAc~ ~/...JI!"-L.-I[Z.l.oC...AL NEc_IiO-IL~)
~"i-kOUf7_ [)NU>~ E..l--t:;<?TQI~
$26zh.f:L/J""/ );If:..._ 1'-1. oS' 'I/O bMrz..IEAK'El::.
f-bL.t>.rJ J< N~tf (JFJ .7) (R~v. .voLA-l'.\T~ +-
bF"CI 7l2.0'lZ:..C-T Q.ITl:W\2... 'i2~~Ac<J~..s
N.i2:. C- 210.8 "'3)
NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
- DO NOT REMOVE -
OLYMPIC PR!NTERS, INC_ (360) 452-1381
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Il-ORKS&'
ELECTRiCAL INSPECTION
WIRiNG REPORT
417-4735
DATE
7j==ob-ra
OWNER/CONTRACTOR
~r-/PrJV\Y
ADDRi]?:5' W
"E-~l2...lcAC
G -s; -J
APPROVED
D . ....
D... ...
~.....
D...........
NOT APPROVED
......MCH.................D
. . . . . . . . . . ROUGH IN/COVER. . . . . . . . . . .. .. D
. . SERVICE. . . . . . . . . . . . . . D
. . . . . . . FINAL. . . . . . . . . . . . . . . . . . D
CORRECTIONS NEEDED:
-_.2fL.c.0f2.€.. -+- S ox:2.0~T <y vc
.35'2, -SO
t-J r;::c
?~C.\Ja,~G,~Dvt--.lD~ Ff...LE.~\)~
~oND1)CTOI'2- N~ 25.0,/,4 13
NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
- DO NOT REMOVE -
OLYMPIC PRINTERS, INC, (360) 452-1381
I OAT!::
6-zj)-Og
OWNER/CONTRACTOR
SH~g?
ADDRESS
'-135"" W
ELECTRICAL iNSPECTION
WIRiNG REPORT
417-4735
PERMIT It
og- O~ '1
INSP=CTOR
~
'E-L'E: C 12..t C-
05-r
APPROVED NOT APPROVED
o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 DITCH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Do 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ROUGH IN/COVER 0 0 0 0 0 0 0 0 000000 o)l2l
Do 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SERVICE 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Do 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FINAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
CORRECTIONS NEEDED:
or, ~c;:...ill<.~_~'-C:I!:.~:,~'E
{, 0 ~l~ c.. 33'--L. 30
N M GA B_L_~_
.... ,
~ <>i ~T1\'--<";::I\-'Cl;..L F"ol':..
XoL.bLLS,.J,jo_1f." JF"" U~Ut
~TIl:.~/,..}../y- J{/iEC-- I..tQ
~T~f:.10I2. CUlL ~E_gILQJ)_\~tJ/EL 2/Q.52-L
NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
- DO NOT REMOVE -
OLYMPIC PRINTERS, INC. (360) 452-1381
O~
@OU1/001"
06/10/2008 14:38 FAX
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ELECTlUCAL WORK PERMIT APPLIC
411- l\'1
\
ION
~
~~~;~
Jub wir~d by
[J Electrical Contractor 0 Owner
IIl~LaIIHljllll tlcscripliull
Cl Cn(JIln~n,:ial ct-1i:~sidential
~
.~
AlEC
~lo?
JUN 1. 1 2008
OWl/l'I" a.1 llt:/illl'(( ".1' NCW,I!} :/j' 2M:(/) OWllt'" will OCt'II/I1' illI: 1(1"II1'1""t'.1"'" tWII
years after Ihi.l" d/!/..'IJ'iCfJJ /J(!l'mir j,)'Jillfll/tcl/. (1) Uti'"c" j,1 fL'(Jllirl'u fv !,jrl: UtI dl!l..'lri/..'uJ
c:OrlrrrJctOr if "b(Jvf: J{Jill properl)' 0." fIJI- sale. ,.,wt ur 11!1l.rl'..
Aflcr re,llJinl:; ,he:. Bbo~.: ..t:ucmCf\t, I hereby .:er\ir)' ,hOlt I am Ihe owner or Lnc: ubO\l('
l\1Jmcu property or :1 IiCCI\;;CJ d.::cl,'i.;al Cl)lllnl~tur. I aO\ making the cl""clflC'ul inst~l-
Itltian or Qlh:r:uiOIl in cnmpliOlnce wiLh Lhe c:lcctricnJ lnw$, N,F..C.. RCW. Chapter
19,'28. WAC'. Cbaplcr 2')6-4<,B, The ('il)' of Porl AUl::cha Mu"jcl('J~1 ('ude, :U\ll
Utility Sptci(ic<ations.
Si&: fUn: of owner, elccrritul contractor or dcClric:l1 lldmlJll' r,Hor
X Date:/;:,
Electrical Load Additions and or subtractions
o NO LOAD CHANGES
o Baseboard KW
o Furnace KW
o Heal Pump _ Ton ...-_~ LAR
o Fan-Wall _ KW
o Cash 0 Cheek #
t71'- -+t \-t.
o Credit Card
Cord /I
Visa
Mastercard
Discover
Expiration Date
ofcilrd
Servlce.lnformatlon
o Overhead Service
o Temp Service
U Underground Service
VOllago 240
Pnase~ , 0 ~
Service Size; ZW_
Feeder Size:
SAME DAY INSPECTION, CALL 8EFORE 7:00 AM 360-417-4735
IWllGIl-I~ TIlEIlMOSTAT
(,...-~~ lR.,) I',,, -;';,;;;,~"",-
FINAL DITCH
.~
SRllvrCE
7/~/cs 'f!!'J',
FEEDER
~lilY
1)..11.:
.,'i;I;~:;~:!~.
I tJ'~
^J'Fll,v~1l 1I~
InspCClion
Dale
Arca, Building or Equipment Inspecll:':L1
AClion Taken
Ello:ctric I
Inspccl r
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