HomeMy WebLinkAbout1366 E 8th St - Building Application Number 08- 00001264 Date 10/06/08
Application pin number 217120
Property Address 1366 E 8TH ST
ASSESSOR PARCEL NUMBER 06-30-11-5-5- 0350 -0000-
Application type description ELECTRICAL ONLY
Subdivision Name
Property Use
Property Zoning RS7 RESDNTL SINGLE FAMILY
Application valuation 0
Application desc
Furnace heat pump
Owner Contractor
MICHELENA FIDEL SIMPSON ELECTRIC
1366 E 8TH ST 243036 W HWY 101
PORT ANGELES WA 983626610 PORT ANGELES WA 98363
(360) 457 -9270
Permit ELECTRICAL ALTER RESIDENTIAL
Additional desc v
Permit pin number 135772
Permit Fee 46 00 Plan Check Fee 00
Issue Date 10/06/08 Valuation 0
Expiration Date 4/04/09 (��VJJJ V
Qty Unit Charge Per Extension
1 00 46 0000 ECH EL -R OR RM 1 -4 ALT CIRCUITS 46 00
Fee summary Charged Paid Credited Due
Permit Fee Total 46 00 46 00 00 00
Plan Check Total 00 00 00 00
Grand Total 46 00 46 00 00 00
Ti.
1 SPECTION ELECTRICAL
TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE
I� OUCH IN
FINAL
/oh loe RP -z-kr
OMMENTS:
Application Number 08- 00001189 Date 9/19/08
Application pin number 477057
Property Address 1366 E 8TH ST
ASSESSOR PARCEL NUMBER 06-30-11-5-5- 0350 -0000-
Application type description ELECTRICAL ONLY
Subdivision Name
Property Use
Property Zoning RS7 RESDNTL SINGLE FAMILY
Application valuation 0
Application desc
T -stat
Owner Contractor
MICHELENA FIDEL ALL WEATHER HEATING COOLING
1366 E 8TH ST 302 KEMP RD
PORT ANGELES WA 983626610 PORT ANGELES WA 98362
(360) 9813
Permit ELECTRICAL ALTER RESIDENTIAL w
Additional desc
Permit pin number 134809
Permit Fee 35 00 Plan Check Fee 00
Issue Date 9/19/08 Valuation 0
Expiration Date 3/18/09
Qty Unit Charge Per Extension
1 00 35 0000 EC EL -LOW VOLTAGE 35 00
S
Fee summary Charged Paid Credited Due
Permit Fee Total 35 00 35 00 00 00
Plan Check Total 00 00 00 00
CAO
Grand Total 35 00 35 00 00 00
4
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1 SPECTION ELECTRICAL
TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE
l� OUGH IN
i 0(/q
FINAL
0/q/ah
OMMENTS:
Application Number 08- 00001106 Date 9/05/08
Application pin number 305378
Property Address 1366 E 8TH ST
ASSESSOR PARCEL NUMBER 06-30-11-5-5- 0350 -0000-
Application type description ELECTRICAL ONLY
Subdivision Name
Property Use
Property Zoning RS7 RESDNTL SINGLE FAMILY
Application valuation 0
Application desc
Security system
Owner Contractor
MICHELENA FIDEL HI TECH SECURITY INC
1366 E 8TH ST 723 E FRONT ST
PORT ANGELES WA 983626610 PORT ANGELES WA 98362
(360) 452 -2727
Permit ELECTRICAL NEW RESIDENTIAL
Additional desc
Permit pin number 133710
Permit Fee 40 00 Plan Check Fee 00
Issue Date 9/05/08 Valuation 0 a
Expiration Date 3/04/09 v
Qty Unit Charge Per Extension
1 00 40 0000 EL -LOW VOLT SYS =2500 SQFT 40 00
Fee summary Charged Paid Credited Due
Permit Fee Total 40 00 40 00 00 00
Plan Check Total 00 00 00 00
Grand Total 40 00 40 00 00 00 (X)
4.1A
I SPECTION ELECTRICAL
TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE
I* OUGH-I IN
/filio 4q
FINAL
OMMENTS:
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
32] 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 . . . .
08-00001182 Date
408592
1366 E 8TH ST
06-30-11-5-5-0350-0000-
FIDEL MICHELENA
MECHANICAL APPL. PERMIT
9/17/08
RS7 RESDNTL SINGLE FAMILY
12901
Application desc
INSTALL HEAT PUMP
Owner
Contractor
FIDEL MICHELENA
1366 E 8TH ST
PORT ANGELES
(360) 457-1356
WA 983626610
ALL WEATHER HTG & COOLING INC
302 KEMP ST
PORT ANGELES WA 98362
(360) 452-9813
Permit MECHANICAL PERMIT
Additional desc INSTALL HEAT PUMP
Permit pin number 134726
Permit Fee 64.80 Plan Check Fee .00
Issue Date 9/17/08 Valuation 0
Expiration Date 3/16/09
Qty Unit Charge Per Extension
BASE FEE 50.00
1. 00 14.8000 ECH ME- INSTALL 100- FAU 14 .80
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 64.80 64.80 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 64.80 64.80 .00 .00
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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 regulating construction or the performance of
construction.
Signature of Owner (if owner is builder)
T:Forms/Building DivisionlBuilding Permit (0511 3/08).wpd
BUILDING PERMIT INSPECTION RECORD
o
~
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CALL 417-48]5 FOR BUILDING INSPECTIONS. CALL 4]7-4735 FOR ELECTRICAL INSPECTIONS.
CALL 417-4807 FOR PUBLIC WORKS UTILITIES. CALL 4] 7-4886 FOR BACKFLOW PREVENTION INSPECTIONS.
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT AND APPROVED PLANS AT THE JOB SITE.
(X)
~
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES I NO
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 FINAL DATE ACCEPTED BY:
BACK FLOW / WATER
AIR SEAL
WALLS
CEILING I
FRAMING
JOISTS / GIRDERS
SHEAR W ALL/HOLD DOWNS l
WALLS / ROOF / CEILING
DRYWALL (INTERIOR BRACED PANEL ONL Y)
T-BAR
INSULA TION
SLAB
WALL / FLOOR / CEILING
MECHANICAL
HEATPUMP/FURNACE/DUCTS
GAS LINE
WOOD STOVE / PELLET / CHIMNEY ~1:.Jo...Zl""az. DATE -Sw ACCEPTED BY:
COMMERCIAL HOOD / DUCTS
MANUFACTURED HOMES
FOOTING / SLAB
BLOCKING & HOLD DOWNS
SKIRTING
PLANNING DEPT. SEPARATE PERMIT I/'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. C.
ENGINEERING 417-4807 PW / ENGINEERING ~
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
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Sep 16 08 12:49p
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BUILDING PERMIT APPLICA TION 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
For City Use Only.:
Date Receive~ - \ ~ ....Og
Permit # O. - \ \ '6'2..
Date Approved
, Phone
Phone
.31RrJ-L/QZ-tjYJ ~
^l57-135{P
-;'lf52-1913
CZ~!IJ q
Phone
Parcel Number
PROJECT ADDRESS
Expires
Praieet Tvoe & Brief Descriotion:
Check all that apply
C New Constr~m'",
o Addition
o Remodel
o Repair
oRe-roof
o Demolition
o Sign
~eat System
o Other
Lot
Zoning
)/Residential
I
o Commercial
o Multi-family
c Industrial
o wall-mounted 0 projecting 0 freestanding 0 awning
Total si n area s , ft. Maximum allowed si n area s . ft.
. Heat pump 0 wood-burning stove 0 gas fireplace 0 pellet stove 0 other
o other
Floor Areas Existinq (SQ. ft.) Proposed (sq. ft.)
'-Basement @$ per sq. ft. = $
15t Floor
2M Floor
3rl1 Floor
Garage
Carport
Covered Porch
Deck
Shed
Other
TOTAL VALUATION $ I~ 9tJl. R5
Total footprint of structures sq. ft. - Lot size sq. ft. = Lot coverage %
Max, height of proposed structures ft. Occupancy group # of bedrooms
Will a lawn sprinkler system be installed? Occupant load .!! of full baths
Will a fjre sprinkler system be installed? Construction type # of half baths
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 thaI it is my responsibility to determine what permits are required, and to obtain permits prio~ing on
proJec~ It 1B. -rn r l 9' -~
Date ~r~ og Print Name.... l1P1Y1e . ~j ,t1(~ '5 Signature W~ _ 5
T:Forms/Building DivisiGnlBldg Permit Appl.-2006 Code.doc . P .
Q '1rf' /
FEE RECEIPT NUMBER
'.CITY OF PORT. ANGELES .
DEPARTMENT OF LIGHT
APPLICATION AND ELECTRICAL PERMIT
.J}OO{}(l8-
A -
PERMIT NUMBER
OQ0003
.
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'TOTAl FEE.
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CONT. LIC. NO.
TIMETO COMPLETE
- ," ELECTRICAL PERMIT ONLY NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT
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~ CORRECT A;15'RESS IS RESPPNStBIUTY OF APPLICANT " PERMITS WITH WA.ONG ~DDRESSES. Afl,E C~NCELLEO; j'
I/t. ,Installation By 8;p',} $I,,~r
- :'0 ." ..
Owner's Address (';..',n -<- Installers Address '/:2~? ~t?}- &,.1:
Day Phone /1.,-;. - 4044 Installers Phone f..5P-t 8'Kf '
Application is hereby made for Permi! to install Electrical Equipment as follows: '1//1-");- I:i .o'jl<:iV 1!J.f/~~
c
Site Address
Owner
. Wiring Method '.~4.~
.'
NUMBER AMP 12QV. 24QV NUMBER AMP 120V 24QV
USE OF CIRCUIT PEA - 100R FEE USE OF CIRCUIT PER 10QR FEE
CIRCUITS CIR 10 30 CIRCUITS CIR 10 30
LIGHT /~ /r;" SIGN
50 VOLTS .
LIGHT OR LESS
..
CONVENIENCE MOTOR
CONVENIENCE MOTOR
APPLIANCE '-/ . MOTOR
DISHWASHER " FIRE ALARMS
DISPOSAL , BURGLAR ALARM
RANGE / U" MISC.
OVEN I I.I-.u
WATER HEATER 'J
.. .~ . 5uJ'{;;,+a I J ;Z'l~
LAUNDRY ~.o
DRYER / . REINSTALLATION LIGHT P(XTURE #
FURNACE SUB TOTAL FEE
GAS - OIL
FURNACE ,I- t()",O J~~ ENERGY FEE
ELECTRIC . +~;.~
2. ' .5. fj;iI- BASIC FEE
ELECTRIC HEAT /10
TOTAL FEE
ELECTRIC HEAT SIZE OF SERVICE SWITCH OR CIRCUIT BREAKER
..
A.C. UNIT I '10 '100 AMP. I PHASE
FEEDER / SIZE OF SERVICE ENTRANCE CONDUCTORS
SERVICE 4/k, 9'k.::;), \/.2 AW.G.
. I SUB. TOTAL 4;, ,,, di~' ' :l- .jilt>
,-- SIZE OF GROUND SIZE OF ENTRANCE SWITCH
.
~ate Application made
,194 By
Date Permit Issued
.mf'
I WARNING
NTRACTOR OR OWNER (0
Permission is hereby given to do the above described work, according to the conditions hereon and accord In 0 the approved plans and
specifications pertaining there'to, subject to compliance with the Ordinances of the City of Port Angeles,
. . DIRECTOR OF CITY LIGHT'. ~
BY. ,I;f~ :eY7'~-7?-r;'~L~' \'
_ PLANS APPROVED ,;I' "
Notify Department of City Light by Street Address and Permit Number when ready for Inspection. Work must not
be covered or current turned on before inspection and O.K. for covering or service has been given by,lnspector in
Writing on Permit Placard. A. . Permits Phone: 457-0411 Ext. 158,
PERMIT PLACARD MUST BE KEPT POSTED ON THE WORK - SEE OVER -
WHITE. Original CANARY. Duplicate PINK, Triplicate WHITE CARD . Inspector's Report
OLYMPIC PRINTERS, INC.
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REPORT OF INSPECTOR
~dAT~O~vlsh " '
MADE BY
REMARKS
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CITY OF PORT ANGELES
LIGHT DEPARTMENT
ELECTRICAL PERMIT
Port Angeles, wasb1ngton__....__m__!/I:.__.:.~...m.l(t:,__m__.mm__.__, 19K.j!
In accordance with the City Ordinance to regulate the installation, extension, or repair of elec-
trical equipment in, on, or about any building or other structure in the City of Port Angeles, per-
mission is hereby granted to do electrical work as listed below.
J7;;; 0 (;;; - E 8 ;:J hL/
Address __L__m________m...____..m'...~~._m...__.__._________.________________m.m. Occupancy_____________.._.m__._______.._mm.m___
owner~.!0.':!';,{--...;{;:.:::d.~"'J2{e_:?_m---------- Tenant..-;.--Z,--.:----------.;....m.;/--...m7;:'--......mm-.
Wiring Contractor _._mm_.mmm.m_.mm.mm__..___m..___.....______. f!fF-=:".if!c::C:.%=<~e2;~7.~m.....
Light Outlets....................__._.......__.__._.. Service, volts __..........................__._....... Type of Wiring:
Armored Cable ..............................
Receptacle Outlets..............._...............
No. wires ......................________..___.___
Dryer, KW.............................___..._______
Size wires...____....n______.....__........._..
Non.Metallic .........................___.....
Knob & Tubeh............h.........__d...~
RIgid Conduit ......._.......................
Metallic TUbing hoo......__...............
Raceway __............................._.._.._
Circuits, Light.___.___.____________._____._____._..__
Utility........__...................................
Range, KW ___.____._._......__.._____._______
Water Heater:
KW..___________________._____________
Heat: KW.h___._............h...n___n_____n_._......__.
Motors: size. volts and phase:
.----::::::::::::::::::::::::::::::::::::::::::1-.::::::
Heat _____..........................................
Range ._.._._..______________._____________________
Water Heater m____m..m___..m_..__._.
Motor .............__.h.________h___________.....
Dryer __.n._____.....h_______________ _____ __......_
------------------.--------.-m---7------m.
Furnace .........................
Total Load - --------- ---r..m.
,
___..._U...nnU_n____..nu.uUh_nnn_nuuun.u.uh.____..un...nun....hn__n_nunnun._..unn.unuuUUnn..unuuhd_.n...nununnn...u
Permit Fee Treas. Receipt "'? C /
$_:I.;;,l..P,f:-:_______............_ No"Q...Lo...,Y'.... By ______&..,...C~~:-2~::?f::.....__._____
, / F /'"
NOTICE-Current must not be turned on until Certificate of Inspection haa been issued. It work Is to be con.
cealed due notice must be given the Inspector so that work may be inspected betore concealment.
NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION
N~ 1 8 2 1 7
ELECTRICAL PERMIT
Address /--1._(/.{...__-::._____?:.:.m_lm~.__/'l!.4v.:L?:.~__m_{~':":__m___._____ D.tem_.__~::__.c:~._~_._!_..:;:._.m_m______
:~::: ::-~~~;~:;~:;d~?::::::::::::::::::::::::-::::::::::::::::::_.~~:._~t.:~~3,lZ~~~o
-....---- , . --- //' \
NOTICE-Current must not be turned on until Certificate of Inspection haa been issued. It "work is to be con~
cealed due notice must be given the Inspector so that work may be inspected before conceaIme:i!t:'"
1M Olympic Printers, Inc.
IB/Bl/2BB8 B8:35
457927B
lRllE C IE ~ VI I!IClSON ELECTRIC
PAGE Bl
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OCT 0 2 2008
ELECTRlCAL WORKPERMI1' APPLICATION
UGHT DEPT.
Job ",ired by
o ElectricAl Contraclor 0 Owner
Installation de~ption
CI CGmmerdBl )I RKldeatlAl
ONe" J9Altend1Addlllon
11=
Pr...l... .7tor" ..10/ .j _ 1/1/1 '_ / J '
c...o n t',I1It1it- Lf1.((dl.'eJ{N1_~
Adduu or ibSpecclo, ~ ,.....tI.
136" c....~..!I-
City POl'f-f !ln9-e1~
PbORC Dumber rD, .911~ It I peet: 011I:
Lf~ -1
Own~r 4.'\' defi,,~J by RCH'.19,28.261.'(1) Dwlre'- .....il1 occupy ,lte ,nr"cJrlrr!or two
YI!(Jr.!' aflr?r ,hi;r eler;tri('fJ1 fX"I7"lf if firu2IIzed. (2) Owner if rtq.dpoed to hi~ aJt deerricaJ
cmZ/f'QCMr if tlbo~ SQ;d f"'opt!rty tf for stde. rent or 't'(1.ff!..
After reading the above: $13tcmcnt, J hereby certif;i that I am the 0Vr't117T of the al>>ve
named property or a ljC'eft.~d electrical contractor, 1 Im'I m3lring the clectriCftl i'1!1tal-
Jlltion or altcnllh", i" cClft1pli:lncr! with the electricAl I:\W$. N.E.C., RCW. Otapter
HUB. WAC. Ch:\ptcr 29(....468. 11lt City of Port Af'l,geles Munidpal Code, and
Utility Speci cn1iC'>nll.
Sleft.tD 0 ownu. rltttrJul
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)-'1 CIR~
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)-v.-r na..e..v
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N
0-
-J:;:..
o Cash 1:1 Check #
9l'CreditCanl G:> Mast~ o;scover
.Card# __.l2z:.:L~__,--___~
trACtor or ~lettrle.1 .dltlinl~tratar
"J~C.Q
o NO LOAD CHANGES
o Baseboard _ t(W
~Fumac. ~ t(W
jit.H<lat Pump .;2.J.1.Ton _ LAR
o "an.Wan _ t(W .
o
Date: /0 -
bl c;.lIPM
-of
Expirntion Date
ofean!
,
o Ovam.ad S.rvice
Q Tamp Service
i:l Undarground &lrvlca
Vollag.
PhaseO,03
Service Size: _
FosdarSIZll:
SAME DAY INSPECTION. CALL BEFORE 7:410 AM 360-417-4735
ROUGH-,IN THERMOSTAT r SERVICE
(elt'! (OB "/'I'rP ",,' "", ^P!'")~sd ('7
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,r FlNAL DITO:l ,r FEEDER
/ofj,{CS ~/ "- Ollie I\lIptovo:d 8y "- ",", Appn:I'I'IldDy./
lnspection Ao:a, 9u;lding Dr Equipment Inspected Action Taken Electrical
Datc:: Inspec:toT ".-.....
10-" .0'6 OK. P-fV l!'WsA g?,~
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leg-lle1 C8 -(lOb I
FROM
HI-TECH ELECTRONICS
FRX NO.
360 452 8560
Sep. 03 2008 08:5iRM. Pi
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~le~tl'ical COntraClor 0 Owner
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o Cash 0 Check II
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I h,:-!:=l:'! .:etnty that I am the owner of the above utum:d ptopcrcy or a lic~I1.Secl
d-=':;;l.l:..~ ..;.:.!)mu:tOL' (or th~ fiIm's authori:!.ecl ac;:c:nt) and am lua.king lhc electrical
inslolil;;,ci..;n Jf alt~l1ti~ in conlph:mc~ wnh the eiectr\callaw, ChapTcr 19.28 RCW.
o Credit ClIl.d
Card #
VISa
Mflst~rcard
Djscover
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electriC.lI.l contc:aCTor ur el~c(ric:al :ulmll\istrnIor
Expiration Dale
of card
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FEEDER ."
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~"sul.,ion ;;11 <f ! lnsuhuion Only
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Cover Cover
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THERMOSTAT
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D1TCli
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Fleetri~~1 Loe.d Ad~itions and or sub:t.rAillo~
Q NO _C"O CHANGES
:J. ;;:::.s,:;ov.;,rCl _ KW
o F ~lr:,,!.C.? KW
o haa! pump _ Ton _ LAA
o Far-Wall _ KW
Service InTormfuion
I :'. .;p .:.:t ~ iJ D \ _A.rC'a. Buildiag or b.quipm~nt. Inspected Action 'fllkel\ Eli:CmciJl
. ~.:.te lnspe':IClr
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o Overhea.d Servjce
Q "I' amp Service
o Underground S~rvi(;a
Voltage ____
Phase 0 1 II 3
Service Size:__
Feeder Size:
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Sep 16 08 12:49p
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08-1\81
$
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o Electrical Contractor 0 OwlJgHT 0
SEP 1 .7 lOO/LECTRICAL WORK PERMIT APPLICATION
Job wired by
InstalloliQI: descriplion
Q Commercial ,. Residential
o New Cl Altered/Addition
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P~rc ascr's mailing address
312K.em (LSfrRe.
~ . CI'" ZIP
T' , hon, ~I') Y'J i4 , FAX ~!2- I !Fr 7
7--- 7 --uk -sn
Premises o".j":nccrr"f ~ D.:l.mC I'
Cah ('~ rVh(j,~ i'l1a
Adj'3'I;&'P'Gion f(f11 sf-
C;ly W-r Jl11tJ~~ W l.\.-. 1<?3tPz..
~dUI' inspeclion:5f!O--l.f51'13!5f17
Owner"as defi'lca b)' RCWJ9.18.261:(I) Owner wi/! occupy the srrUClttrefar two
yttar.s after (his electrical permir is finalized. fZl Own!!r i:> required /0 hire tn1 e/eclricoJ
contractor if ai)()"!c ~ajd property is for sale, rent or Ico.l."c
After rc<lding :he above 51~:emenl, I hcreb)' certify (hat I :un the owner of the .above
named property or a licensed c:lectricul contractor. I am m<lking the electrical instal-
lation or alleralion in compliance 'oIl"ith the electrical laws, N.E.C.. RC\V. Chapter
19.28, WAC. Chapter 296-46B, Tbe City of ?orl A:lgeles Municipal Code. ::md
Utility Specifications,
Sign"U';;;:;;;'ihtT:ar ;;1; OT 'l~I:~:: adi;;7J"
LV T-snt wr~
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o Cash Cl Check #
':i!lCre<lit Card VIsa
Card #
Mastercard
Discover
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----------------
Expiration Date
of card
I ~ns~e 5;fo ()
Servfc~ tnfnrmatiml
::J NO LOAD CHANGES
:J Baseboard _ KW
EiI Fumace /!i KIN
~Heat Pump --3. Ton _ LAA
D Far-Wall KW
blrai:tlons
SAMF, DAY INSPECTION. CALL BEFORE 7:00 AM 360-417-4735
"\
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o Overhead SeNice
o Temp Service
D Underground Service
Vol1age
PhaseD 1 03
Service Size: _
Feeder Size:
'- [)al~ ^I'PK\Ood Uy ./ \ Vale "P?<t>'oxlBy) > D:ate ApPIl'lVe:;ll.ly <
FIl\"AL '\ ( DITCH J
~/ ~~j tiff 'T<kJl I I FEEDER."ro"..) j
,
"ppn)Y~d Br ./ D~te Apprl'l;~:;l D,. "- Dale
Inspection Area, Building or Equipment Jns;>>ecled AClicn Taken Electrical
D3te lnspector
q-,g-O'b OK REv,EWr;f':, Zx: ji()
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ROUGH-IN
101ft{ /tJP,
TI:lERMOSTAT
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SERVICE
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