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APPLi'CATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
DEPARTMENT OF PUBLIC WORKS --CITY OF PORT ANGELES, WASHINGTON
BUILDING DIVISION
DATE _1 /�5� Applicant to fill in between heavy. lines
Permit No. Date Permit Issuec
d'
Valuation
BuildingC BuildingPermit fee
jj E. �' cLA..s oI~ WORK __._..
Address ' 1 w ZO E . r 1/``/� � 8 -�-- �
_ Plan Checking Foe
— �/► j/r----------- ------ --- New I Demolish Total $ 'p
_---.----_ - -----•--_ -
p I NAME—��� Y'�'`t-�,-Gb it C Alteration Repairr
.....
Add- a / i�Gf Addition - _ ove Treasurer's Receipt No. ...
� I MuJ A....r�cs � _ ------ •-- -- - - F
Use of building e .� r'� Life of Permit .._36) ek
--- _.
Ph_ No. - Size of building Height
- - --- ------ --- APPlicaticn taken by ..1..Cv• ...... .......... .
0 NAME _� CS No. of rooms No. of Families
----- - _ -.- ----- ------ Date review completed ........
� No -.-Of- floors Sine of iot P •••••••••
Z Address Z-� '1 1 - -- -- - ---- ----- - _ _
,,, /( L� -}%t No. of Bldgs. Use of Bldg. Total Floor Area
, Sq. Fr.
7O Now on lot Now on Lot
City �A Ph. No. --- -- -- - - -- -_ ..._- _ ---- ---
--- —-------- --- SPECIFICATIONS
n r _ _ FOUNDATION Area of Lot Sq. H.
ZNAM ��.� � — Gn C Material ---- -Exterior Piers -_ ------ -- -
-� Address --- - --- - - -- --- ---.- Type Construction I II III IV V
Width of Wail
City Footing Sins e, r -- ----- F R 1 H r HT N
Ph. No. - Height YGf. Z - - - - Use Zone �'` j'1
NAME v
w Address
n City Ph. No.
License No.
Plans and Specifications submitted. ............
Plot Plan I ) Property Line
Q
0
a`
a
Material
- Size
pacing
Span
Beams
---
- -
-----
Joist 1st FI. "
---
--
Joist 2nd Fl.
Joist Ceiling_
Roof Rafters
Exterior Studs
Interior Studs
_ COVERING
Exterior Walls _ Roof
Interior WallsReroofing ' ''
Heat: Wood Gas Oil Electric
I hereby acknowledge that I have read this application
and state that the above is correct and agre comply with
all City Ordinance and State Laws regula g bui ding con-
struction.
SIGNATURE OF W
PERMIIEE .......... ... :!............`�.......
LEGAL DESCRIPTION
Subdivision -
Lot No. Block No.
—4- _
Variance or Conditional Use Permit
Occupancy Group A E I H(F R M
1 Cp 3 4 5
Fire`7_.one 1 2 3
APPROVED,, �J---JV
Director of Dept. of Inspections
SPECIAL and UNUSUAL COND
3
NS
3707A Rev. 7.77 q
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