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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
04-00000968 Date
.420488
805 E 5TH ST
06-30-00-0-1-7570-0000-
COMM FOUNDATION REPAIR
10/21/04
Application Number
Pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
RS7 RESDNTL SINGLE FAMILY
4000
Owner
Contractor
PAGE TTE DAVID B
DAVID B PAGE LIVING TRUST
EDMONDS WA 98020
OWNER
Structure Information
Construction Type . . . .
Occupancy Type . . . . .
FOUNDATION REPAIR
TYPE V NON-RATED
SINGLE FAM & CONGREGATES
---------------------------------------------------
Permit BUILDING PERMIT - COMMERCIAL
,I Additional desc FOUNDATION REPAIR
Permit Fee 120.75 Plan Check Fee 78.49
Issue Date 10/21/04 Valuation 4000
Expiration Date 4/20/05
Qty Unit Charge Per Extension
BASE FEE 92.75
2.00 14.0000 THOU BL-2001-25K (14 PER K) 28.00
--------------------------------------
--------------------------------------
Other Fees
STATE SURCHARGE
4.50
Fee summary Charged Paid Credi ted Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 120.75 120.75 .00 .00
Plan Check Total 78.49 78.49 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 203.74 203.74 .00 .00
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 ordina~s gover ing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to lJ'iv,r'authori to violate or cancel the provisions of any state or local law regulating construction or the performance of
constructi9n. ,/
('/'/ <-
ignature of Contractor or u oozed Agent Signature of Owner (if owner is builder) Date
Tr'~LANNING\FORMS\1102.15 [11/14/2003J
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BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULA TE 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 DATE ACCEPTED COMMENTS
YES NO
-- (Ii.' )
FOUNDATION: h'Lih( ccfr..>r) h:?(hll )- /1-/(; .01 j)-/
FOOTINGS
WALLS
FOUNDATION DRAINAGEfDoWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN I I
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW / WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS / GIRDERS
SHEAR W ALLfHoLD DOWNS
WALLS / ROOF / CEILING
DRYW ALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL / FLOOR I CEILING 1 I
MECHANICAL
HEAT PUMP
GAS LINE
WOOD STOVE / PELLET / CHIMNEY
HOOD / DUCTS
PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT #'s:
WATERLINE I METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'5 SEPA:
PARKINGfLlGHTING 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.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 1/1.- I L O~ 7U? BUILDING
T:\PLANNINGIFORMS\1102.15 [11/14/2oo3J
BUILDING PERMIT - APPLICATION
FOR OFFICIAL USE ONL V:
Date Rec.: ,0 ~ 2/-04
Permit#: ()L/ - '16tl
Fill out COMPLETELY and in INK. Your application and site plan MUST BE
COMPLETE to be accepted for review. If you have any questions, call
PERMITS (360) 417-4815 FAX(360)417-4711
Date Approved:
Date Issued:
Applicant or Agent: -:S-o..(Y\.l.~ A\~~c..~~ Phone: 1j;2$-J...f7~- 35<1D
Owner: \:)o..\J L ~ a..~/~ Phone: Ii 2{ - 3 \ '1 - / t. 3 'f
Address: <r,O~ io...Kt.. ~o.\\l}.('\JU"" City: t:J(Y'Iol"\~5 Zip: 9~0.2G,
ArchitectlEnuineer: Ai / A. Phone: A) / A
o' I '
Contractor ~o..mt...c, A\~p~ StateLicense#:~~.s"t.ID'1'"' Exp: Oi I 05 Phone:.t;..z5"-~?g-35'10
Address:/.s''72l\ ~ ;'8~Avlt. W City: €~mor'\J~. I Zip: 98o:LC,
PROJECT ADDRESS: ~O~ E. o-.~-t ~#-.sA P. A . 0A, ZONING: R.es
LEGAL DESCRIPTION: Lot: 10. \\ Block: \ '15 Subdivision: Goue.(f'l merct \OW(\5.u: I k d p, f\.
CLALLAM COUNTY PARCEL NUMBER: 0(0 - .30 .- 00 .- 0 \ '1 ~'7 0 - nr~
T +J 0
C<edit Cud Hold" Nam" ~o..", "-,., ~"-<-\.*
Billing Address: \'- ?)~ O'\.7"'b;~ ~~c..w ~ City: Cdmr:,r"\J, ~
Credit Card Type VISA M ~_ #
TYPE OF WORK: SIZEN ALUATION:
D Residential D New Constr. D Re-roof D Stove SF. @ $ /SF. = $
D Multi-family D Addition D Move D Garage SF. @ $ /SF. = $
D Commercial D Remodel D Demolition D Deck SF. @ $ /SF. = $
" Repair D Sign. D Other TOTAL VALUATION $,/..j I O<X"l co
BRIEF DESCRIPTION OF THE PROJECT: . Re.~a..c.~ ('G44-t'........ ~e,()"t"rI. PO~* (,VI SAmE
I \ / . '. J I .
tJ P (} cdte... L...J :0;'- m 0 "i "" ~nq tP I An c.J.,."...s i /Isle. /1 u 0. DC! .- B.e.-rrtvr
/ I I I
COMMERCIAL/RESIDENTlAL: Occupancy Group: Occupant Load: Construction Type:
No. of Stories: Lot Size: Existing Sq. Ft. & Proposed Sq. Ft. = TOTAL Sq. Hili l ~O~
Total lot coverage %
Exp. Date:
ESAlWetland(s): DYes D No SEPA Checklist required? DYes D No Other:
APPROVALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:_
PLANNING USE ONLY:
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 a ruction 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 of application, the application will expire. The
Building Official can extend the time for action by the applicant up to 180 days upon WTitten request by the applicant (see Section R105.3.2
of the International Building/Residential Code, 2003). 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 cor" . I am a orized to apply for this permit and
understand that it is my responsibility to determine what permits are required ,not the .City's, an/lthat ust obtai uch permit rior to work.
. I I
T:\RVESS\BLDG-forms-brochures\2003-Buildingpermit.wp9 ApplIcant: Date: /'0/ Z-i O~
I I
2004/0CT/21/THU 10:43 AM EDMONDS ESCROW
FAX No,
P,001/001
GOLDEN HOME BUILDERS, INC.
1233 Olympic View Drive
Edmonds, Washington 98020
(206) 776-2141
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Look Up a Contractor, Electrician or Plumber License Detail
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A business registered as a construction contractor with L&I to perform construction work within the scope
of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment
of account and carry general liability insurance.
License Information
License ALBREHS021DT
Licensee Name ALBRECHT HOME SERVICES
Licensee Type CONSTRUCTION CONT RACTOR
UBI 601864002 Verify Contractor Premium
Status
Ind. Ins. Account
Id
Business Type INDIVIDUAL
Address 1 81 MAC LANE
Address 2
City SEQUIM
County CLALLAM
State WA
Zip 98382
Phone 3606812360
Status EXPIRED
Specialty 1 GENERAL
Specialty 2 UNUSED
Effective Date 3/30/1998
Expiration Date 3/25/2000
Suspend Date 5/21/2000
Separation Date
Parent Company
Previous License
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Role
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https://fortress.wa.gov/lni/bbip/detail. aspx?License= ALBREHS021 DT
10/21/2004
. - . Look Up a Contractor, Electrician or Plumber License Detail
Page 2 of2
ALBRECHT, JAMES A
I OWNER
03/30/1998
Bond Information
Bond Bond
Company Account Effective Expiration Cancel Impaired Bond Received
Bond Name Number Date Date Date Date Amount Date
AMWEST
#2 SURETY 111001773 03/25/1999 OS/21/2000 $6,000.00
STAR INS
#1 CO SP5202665 03/25/1998 05/04/1999 $6,000.00
Savings Information
No Matching Information
Insurance Information
Company Policy Effective Expiration Cancel Impaired Received
Insurance Name Number Date Date Date Date Amount Date
AMERICAN
STATES
#2 INS CO 01CE3579412 03/25/2000 03/25/2001
AMERICAN
STATES
#1 INS CO 01CE3579412 03/25/1998 03/25/2000
Summons / Complaints Information
Tax
Summons I Cause Warrant Dismissal Complaint Complaint Judgement Judgement
Complaint Number Id Plaintiff County Date Date Amount Date Amount
THOMAS
BUILDING
CENTER
#1 002001889 INC CLALLAM 03/15/2000 $0.00 $0.00 (
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Washington State Dept. of Labor and Industries. Use of this site is subject to the laws of the
state of Washington.
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Staff only link
;;., 'WlSblngton
Visit access.wa.goY
https://fortress.wa.gov/lnilbbip/detai1.aspx ?License= ALBREHS021 DT
10/21/2004
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DNISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
04-00000812 Date
.535596
805 E 5TH ST
06-30-00-0-1-7570-0000-
RE-ROOF
12/27/04
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 g erning this type of work will be complied with whether specified herein or not. The granting of a permit does not
presum~eive auth ri to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction
Ic-2.-l-o
Application Number
pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application descr1ption
Subdivision Name
Property Use
Property Zon1ng . . .
Application valuation
RS7 RESDNTL SINGLE FAMILY
22500
Owner
Contractor
PAGE TTE DAVID B
DAVID B PAGE LIVING TRUST
EDMONDS WA 98020
LARRY'S ROOFING
352 AVIS ST.
PORT ANGELES
PORT ANGELES
(360) 452-2215
WA 98362
Permit
Add1t1onal desc
Permit Fee
Issue Date
Expiration Date
BUILDING PERMIT - NO PR FEE
TEAR OFF, TORCHDOWN
386.75 Plan Check Fee
12/27/04 Valuation
6/26/05
.00
22500
Qty Unit Charge Per
Extension
92.75
294.00
BASE FEE
21.00 14.0000 THOU BL-2001-25K (14 PER K)
Other Fees
STATE SURCHARGE
4.50
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 386.75 386.75 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 391.25 391.25 .00 .00
t::::)<( P'\ R.'C:j:?
0/Z'/OS
Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
T IPLANNING\FORMS\1102.15 [11/1412003]
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