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Home My WebLink About1106 W 16th St - Building raRr 4,t W CITY OF)PORT ANGELES PERMIT APPLICATION Building DirrisionlEteetrieal Inspections tai �t<9t 321 East Fifth Street—P.O.Box 11501 Port Angeles Washington,98362 '`' Ph: (360)417-4735 Fax: (360)417-4711 L`LE(,'TR. M Date: ll Z ~f3 X 1 &2 Single Family Dwelling IN"�'Pr-cl'joj11s * Plan Review May Be Required, Please Complete Electrical Plan Review Information Sheet Job Address: /10(. W lo" Building Square Footage: Description of above 4 fO-Gu a A— Owner Information Contractor Ljor ation Name, 17�0 1 Name: 4g Mailing Address: Mailing Address: City State: Zip: City: State: Zip: Phone: Fax: Phone: Fax: License#1 Exp, License#I Exp. L �- Item Unit Charge Olt Total(Qtv Multiplied bV Unit Charge) ServicelFeeder 200 Amp. $120,00 $ ServicelFeeder 201-400 Amp. $146.00 $ ServicelFeeder 401-600 Amp $205,00 $ ServicelFeeder 601-1000 Amp, $262,00 $ ServicelFeeder over 1000 Amp, $373.00 $ Branch Circuit Wl Service Feeder $ 5.00 $ Branch Circuit W10 Service Feeder $ 63.00 $ Each Additional Branch Circult $ 5,00 $ Branch Circu its 1A $ 75.00 $ Temp.Service/Feeder 20C Amp. $ 93.00 $ Temp.ServicelFeeder 201-400 Amp, $110.00 $ Temp ServicelFeeder 401-600 Amp. $149.00 $ Temp,ServicelFeeder 601.1000 Amp. $168.00 $ Portal to Portal Hourly $ 96.00 $ Slgnal Circuit)Limited Energy-1&2 Family Dwelling $ 64.00 $ Manufactured Home Connection $120,00 $ Renewable Electrical Energy-5KVA System or Less $102.00 $ Thermostat $ 56,00 $ Note:$5,00 for each additional T-Stat NEW CONSTRUCTION ONLY: First 1300 Square Ft. $120.00 $ Each Additional 500 Square Ft.or Portion of $ 40.00 $ Each Outbuilding or Detached Garage $ 74.00 $ Each Swimming Pool or Hot Tub $110.00 $ $Total Owner as defined by RCW,19,28,261:(1)Owner will occupy the structure for two years after this electrical permit is finalized.(2)Owner is required to hire an electrical contractor if above said property is for sale,rent or lease, Permit expires after six months of last inspection. After reading the above statement, I hereby certify that I am the owner of the above named property or a licensed electrical contractor.I am making the electrical installation or alteration in compliance with the electrical laws,N.E C.,RCVW.Chapter 19.28,WAC. Chapter 296-468,The City of Port Angeles Municipal Code,and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications. Signature of own , rical contractor or electrical administrator: ❑ Cash K Check ❑ CrediS Card� X Dated: J �'ry ��[� O110112012 n ELECTRICAL PERMIT CITY OF PORT ANGELES ? 360-417-4735 Application Number 13-00001360 Date 11/25/13 Fo Application pin number . . . 873440 Property Address . . . 1106 W 16TH ST ASSESSOR PARCEL NUMBER: REPORT SALES TAX 06-30-00-0-4-4003-0000- Application type description ELECTRICAL ONLY on your excise tax form Subdivision Name , . . . . . Property Use . , , , . , . . to the City of Port Angeles Property Zoning . . , . . , . RS7 RESDNTL SINGLE FAMILY (Location Code 0502) Application valuation . , , . 0 Application desc Ductless heatpump Owner Contractor FAIRCHILD, 70DI BLACK DIAMOND ELECTRICAL CONTR 1106 W 16TH STREET 502 BLACK DIAMOND RD PORT ANGELES WA 98363 PORT ANGELES WA 98363 ( 36) 457-5913 (36)) 565-1,035 Permit . , . , . ELECTRICAL ALTER RESIDENTIA14 Additional desc y Permit Fee 63,00 Plan Check Fee ,00 Issue Date 11/25/13 valuation . . . . 0 Expiration pate 5/24/14 Qty Unit Charge Per Extension 1100 63.0000 ECH EL--R- BRANCH CIR WO/ SER FEED 63.00 Fee summary Charged Paid Credited Due Permit Fee Total 63,00 63.00 .00 .00 Plan Check Total 00 .00 00 .00 Grand Total 63,00 63.00 .00 .00 V INSPECTION TYPE DATE: RESULTS: INSPECTOR. DITCH SERVICE ROUGH-IN FINAL COMMENTS: PERMIT WILL EXPIRE SIX(6)MONTHS FROM LAST INSPECTION Signature of owner or EIectrical Contractor X Date: G:EXCH NOMBUILOING CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Zoning . . . Application valuation 03-00001038 Date 10/23/03 1106 W 16TH ST 06-30-00-0-4-4003-0000- RES REMODEL 500 Owner Contractor FAIRCHILD, JODI 1106 W 16TH STREET PORT ANGELES WA 98363 (360) 457-5913 OWNER Permit Additional desc Permit Fee Issue Date Expiration Date BUILDING PERMIT - NO PR FEE ENCLOSE GARAGE 47.00 Plan Check Fee 10/23/03 Valuation 4/21/04 .00 500 Qty Unit Charge Per BASE FEE Extension 47.00 Other Fees STATE SURCHARGE 4.50 ......... -..... ~ <3' Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 47.00 47.00 .00 .00 Plan Check TotaL .00 .00 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 51.50 51.50 .00 .00 c - ~ ,"",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 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 herem 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 Y- lOr' 2YD3 Date T \PLANNING\FORMS\l102 15 [4/2002] BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE IT IS UNLAWFUL 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 ACCEI'TED COMMENTS YES NO FOUNDATION. FOOTINGS WALLS FOUNDA TION DRAINAGE ELECTRICAL (LIGHT DEPT) SEPAM TE PERMIT H ROUGH-IN PLUMBING UNDER FLOOR / SLAB ROUGH-IN WATER LINE GAS LINE BACK FLOW / WATER AIR SEAL WALLS CEILING I FRAMING JOISTS / GIRDERS SHEAR WALL WALLS / ROOF / CEILING /0 '-23-<.>3 TLL DRYWALL T-BAR INSULATION SLAB I WALL / FLOOR / CEILING iOI'1-4/0711 MECHANICAL , HEAT PUMP WOOD STOVE / PELLET / CHIMNEY HOOD / DUCTS PW UTILITIES I SITE WORK (Engmeenng DIvISIon) SEPARATE PERMIT H"s WATERLINE I METER SEWER CONNECTION SANITARY STORM PLANNING DEPT SEPARATE PERM1 r #'s SEPA PARKING/LIGHTING ESA LANDSCAPING SHORELINE FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRlCAL - LIGHT DEPT 417-4735 ELECTRlCAL LIGHT DEPT CONSTRUCTION R W / PW/ CONSTRUCTION - R W ENGINEERING 417-4807 PW / ENGINEERING FIRE 417-4653 FIRE DEP r PLANNING DEPT 417-4750 I PLANNING DEPT BUILDING 417-4815 I V22IlX'S HL BUILDING lcr? ~ JL T \PLANNING\FORMS\1102 15 [4/2002] BUILDING PERMIT - APPLICATION FOR OFFICIAL USE ONLY Date Rec ID-ZS-C>.3 Penmt # / Cl 3 B Fill out COMPLETELY and in INK. Your application and site plan MUST BE COMPLETE to be accepted for review. Uyou have any questions, call (360) 417-4815 Date Approved Date Issued ApplIcant or Agent: J 0cLf. - 'hzi (f'j, J j d Owner: J1Xit - ~cjr J # d Address:_IIOw W. ) I 0 ~ City: Phone: 5IPo L/57~ SV/__5 ZIp: q83to~ Architect/Engineer: Contractor State License #: Exp: Phone: Address: CIty: PROJECT ADDRESS: 110 (0 IN / UTt- ZIp: ZONING: LEGAL DESCRIPTION: Lot: CLALLAM COUNTY PARCEL NUMBER: Block: SubdivisIOn: Credit Card Holder Name: Billing Address: Credit CardType VISA MC # TYPE OF WORK: o ReSIdentIal 0 New Constr. 0 Re-roof o MultI-family 0 AdditIOn 0 Move o Commercial 0 Remodel 0 DemolItion o Repair 0 Sign BRIEF DESCRIPTION OF THE PROJECT: W City: Exp. Date: o Stove o Garage o Deck ~Other Nt!:>11 - SIZEN ALUATION: SF. @ $ /SF. = $ SF. @ $ /SF. = $ SF.@$ /SF.=$ TOTAL VALUATION COMMERCIAL/RESIDENTIAL: Occupancy Group: Occupant Load: ConstructIOn Type: No. of Stories: Lot Size: EXlstmg Sq. Ft. & Proposed Sq. Ft. Existmg lot coverage _ % & Proposed lot coverage _% = Total lot coverage APPROVALS: 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 mformatIOn on the applIcatIon and plan subrmttal requirements If you have questions. V ALUA TION 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 Perrmt Coordmator at 417 -4815 for assistance. PLAN CHECK FEE: IF a plan check fee is due it must be submitted at the tIme the bUIlding perrmt applicatIon and constructIon plans are submitted. All other permit fees are due at the tune of perrmt Issuance. EXPIRATION OF PLAN REVIEW: Ifno perrmt IS Issued withIn 180 days of the date of applIcatIOn, the application will expire. The Buildmg 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 BUlldmg 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 responslb1l1ty to determme what permits are required ,not the edy's, and that I must obtain such permits pnor to work. ApplIcant: ~ :-dCJ v, cAitl Date: 10 C;2?-o3 {/ V T \FORMS\APPS\BUlldmgpenmt wpd ~ ~ ~ Q ~ \t'"~ ~~ C' ~ '-t ~ ..--- m - - - - - -" } ~ -"_~~~'''-~::V''''~_"""" ~ "P'=-:-, -~ ~~-'-=-="'" "",..:T..=n::-"","..IL:i.~<:;C~~_"""'''-,<'''<d ~ ~ ~r ~\I ~~ ~IM ~I ~i '-~~ I 'O.O<.S-f--""~-- ---- ~i I ~ -"- ~ .. ~.. "".." ~ ~ l~ ... I ~ ! I x I ~~ ~ ~~ , ~ Q) "1s- .-' - ~a ~CL r~ .JL v ]# if> L.-Jtl'!' 11!!~ -~~~~~ -.."""'1 r...,.............=:- ~~-~ -- - _______ ~___.~_=~-=--~~~..aI~.-..-.. - .-..--~ -::r- .J. ~ -:r~\ ~ -:;;:> ~--- -~- ..---..- -~~-- rl!J......Ba.~~.... ~ ~ <6 " ",.~ ~~ (\.) · 'S ~ I~ ~ ~ .~ 5 (? ~ ~ ~ ~ ..s:. ~. V\ ~ til ~ ~ ~ ~ 't ~~ V\ PREPARED 10/23/03, 12 28-34 CITY OF PORT ANGELES INSPECTION TICKET INSPECTOR JAMES L LIERLY PAGE DATE 11 10/23/03 ---------------------------------~-------------------------------------------------------------- ADDRESS CONTRACTOR OWNER PARCEL . APPL NUMBER 1106 W 16TH ST SUBDIV- PHONE PHONE (360) 457-5913 FAIRCHILD, JODI 06-30-00-0-4-4003-0000- 03-00001038 RES REMODEL ------------------------------------------------------------------------------------------------ PERMIT: BNOP 00 BUILDING PERMIT - NO PR FEE REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ---------------------------------------~-------------------------------------------------------- BL3 01 10/23/03 ~ BUILDING FRAMING Jod1 Fa1rch11d request1ng a fram1ng 1nspect1on around 4 00 P M today Ph# 460-6985 -------------------------------------- COMMENTS AND NOTES --------------------------------______ PREPARED 10/28/03, 12 53 04 CITY OF PORT ANGELES INSPECTION TICKET INSPECTOR JAMES L LIERLY PAGE DATE 5 10/28/03 ADDRESS CONTRACTOR OWNER PARCEL APPL NUMBER 1106 W 16TH ST SUBDIV PHONE PHONE (360) 457-5913 FAIRCHILD, JODI 06-30-00-0-4-4003-0000- 03-00001038 RES REMODEL PERMIT, BNOP 00 BUILDING PERMIT - NO PR FEE REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS BL3 01 10/23/03 JLL 10/23/03 AP BLI 01 10/24/03 JLL 10/24/03 AP BL99 01 10/28/03 JLL,4 Vi BUILDING FRAMING Jod1 Fa1rch11d request1ng a fram1ng 1nspect1on around 4 00 P M today Ph# 460-6985 BUILDING INSULATION INSULATION JODY 460-6985 BUILDING FINAL TIME 17 00 F1na1 Jod1 460-6985 -------------------------------------- COMMENTS AND NOTES -------------------------------------- ~I r It-...{; ~ V) VIO/Lij aU G)(h:rw~ !2:- PREPARED 12/22/03, 12 41 27 CITY OF PORT ANGELES INSPECTION TICKET INSPECTOR JAMES L LIERLY PAGE DATE 5 12/22/03 ---------------~-------------------------------------------------------------------------------- ADDRESS CONTRACTOR OWNER PARCEL APPL NUMBER 1106 W 16TH ST SUBDIV PHONE PHONE FAIRCHILD, JODI 06-30-00-0-4-4003-0000- 03-00001038 RES REMODEL (360) 457-5913 PERMIT: BNOP 00 BUILDING PERMIT - NO PR FEE REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS BL3 01 10/23/03 JLL 10/23/03 AP BLI 01 10/24/03 JLL 10/24/03 AP BL99 01 10/28/03 JLL 10/28/03 DA BL99 02 12/22/03 ~ BUILDING FRAMING JOd1 Fa1rch11d request1ng a fram1ng 1nspect1on around 4 00 P M today Ph# 460-6985 BUILDING INSULATION INSULATION JODY 460-6985 BUILDING FINAL TIME 17 00 F1nal JOd1 460-6985 f1n1sh exter10r sld1ng and recall/J1m BUILDING FINAL perm1t w111 be on the bench, she sa1d you have already been here before and all you needed to do lS slgn off on the sld1ng 457-5193 -------------------------------------- COMMENTS AND NOTES -----------------------------_________ .' :.' CITY OF PORT ANGELES LIGHT DEPARTMENT PERMIT NO, ~ V ~ 0 1/;}..,~/;j'7 f ELECTRICAL PERMIT DATE Site Address: / /tJ t J./C- It.. o READY FOR o WILL CALL FOR INSPECTION INSPECTION Installed By: -::)", v' b: r <><- I License Number: Phone: Owner/Business: Phone: Owner/Business Address: Sq, Ft. 0"'Residential Heat KW iO o Baseboard ~urnace/Boiler o Heatpump tJ Other o Commercial/Industrial load Total Connected load (attach breakdown) Total Motor load (attach breakdown) DetailslDescription: 0,700 / CI K....> B"New Construction o Remodel o Service update/alter/repair J;;Y6verhead o Underground/ d Voltage I 2 ,-:_ Z- Z 0 Q-1' 0 0 3 RJ Service size ~ dc) Amps o Temporary o Add/alter circuits o Auxiliary power (list below) o Special equipment (iist below) A-.-/o S-e,e J, 'c ........ , ,~f':J L.:c,d . W.S. No. Service Capacity: 0 O.K. 0 Not O.K. o Ditch inspection O.K. It",~ROUgh-in/cover O.K. /)P' ~ O.K. to connect service 1 'd Final O.K. ,~IJV7<... Site Address: e-J. rfc f-~ //O~ Installer:_ J <:L h /....d. [(Lc...- Size Comments Date Hold for: 0 Easement 0 Letter o Signed up for service/meter o Meter Department notified for installation o Fire Department notified of inspection o Plan Review approved/pending Permit/Receipt No. ,;)0 New Meters <:> Notify the Department of City Light by Street Address and Permit Number when ready for inspection. Work must not be covered or electrically energized before inspection and O.K. for covering or service has been given by the Inspector in Writing on the Wiring Report or the Building Permi!. PHONE 457.0411, EXT.158 or EXT. 224. ~ NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT J 0 D.E.. Inspector Amount paid WHITE - lile by address YELLOW - lile by number PINK - Top: Eng, Boltom: Cuslomer GREEN - Top: Inspector, Boltom: City Hall . Ol.VOolP1C PRINTERS. INC. Installed By: CITY OF PORT ANGELES LIGHT DEPARTMENT ELECTRICAL PERMIT PERMIT NO. /9~s /1/17/1/ . . DATE . Site Address: o READY FOR INSPECTION License Number: o WILL CALL FOR INSPECTION Phone: OwnerfBusiness: Phone: OwnerfBusiness Address: Sq. Ft. o Residential Heat KW o Baseboard 0 Furnace/Boiler o Heatpump 0 Other o Commercial/Industrial load Total Connected load (attach breakdown) Total Motor load (attach breakdown) o New Construction o Remodel o Service update/alter/repair )("Overhead o Underground! . /7) Voltage /~!?'t--=:.. >-110 030- Service size /d-<J Amps Jl1 Temporary' o Add/alter circuits o Auxiiiary power (list below) o Special equipment (list below) Detai Is/Description: !~, cS~ . W.S. No. Service Size Capacity: 0 O.K. 0 Not O.K. Comments o Ditch inspection O.K. o Rough-in/cover O.K. 'R O.K. to connect service 4Uf f Final O.K. Date Hold for: 0 Easement 0 Letter o Signed up for service/meter o Meter Department notified for installation o Fire Department notified of inspection o Plan Review approved/pending Installer: IIOf.o ~ IL I Site Address: . Notify the De artment of City Light by Street Address and Permit Number when ready for inspection. Work must not be covered or electrically energized before Inspection and O.K. for covering or service has been given by the Inspector in Writing on the Wiring Report or the Building Permit. PHONE 457.~11, EX.T. 158 or EXT. 224. T~ NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT Tf .J 6 ':!!! Inspector Amount paid WHITE - file by address YELLOW - file by number PINK - Top: Eng, Bottom: Customer GREEN - Top: Inspector, Bottom: City Hall OLYMPIC PRINTERS. INC. v i INSPECTION TYPE ELECTRICAL PERMIT DATE: RESULTS: INSPECTOR: CITY OF PORT ANGELES 360-417-4735 -� Application Number 15_00001217 Date 9/28/15 ROUGH -IN application pin number . . , 221452 Property Address . . . . . . 1106 W 16TH ST r ASSESSOR PARCEL NUMBER; 06- 90- 00 -0 -4- 9003 -- 0000 -- REPORT SALES TAX Application type description ELECTRICAL ONLY on your excise tax form Property Name Bro ert Use to the City of Port Angeles Property Zoning . . , . , , . R97 RESDNTL SINGLE FAMILY (Location Code 0502) Application valuation . . , . 0 Application desc Detached garage --------------------------------------------------------- ------------- - - - - -- Owner Contractor -------- ---------- -- -- -- FAIRCHILD, JODI ------------------------ SIMPSON ELECTRIC 1106 W 16TH STREET 243036 W HWY 101 PORT ANGELES WA 98363 PORT ANGELES WA .98363 ( 36) 457 -5913 (360) 457 -9270 Permit `, , . , , . ELECTRICAL NEW RESIDENTIAL Additional desc , , Permit Fee . , , , 74.00 Plan Check Fee ,00 issue Date 9/28/.15 valuation . . . . 0 Expiration Date 3/26/16 Qty Unit Charge Per Extension 1.00 74.0000 ECH EL- R- 0UT2D /DTCH GAR IN /S.EP 74.00 Fee summary Charged Paid Credited Due Permit Fee Total 74,00 74,00 00 .00 Plan Cheek Total 00 op .00 00 Grand Total 74.00 74.00 .00 .00 i INSPECTION TYPE DATE: RESULTS: INSPECTOR: DITCH SERVICE ROUGH -IN t FINAL CORWENTS: r PERMIT WILL EXPIRE SIX (6) MONTHS FROM FAST INSPECTION Signature of owner or Electrical Contractor X Date.: G:IEXCI IANGEIBUILDING , f T ��— - Gam-' J �`? / 1 ';7 CITY OF )PORT ANGELES ]PERMIT APPLICATION Building Division/Fiect;ricni Inspections 322, East fifth Street P.O. ,Rox 1150 / fort Angeles Washington, 98362 Ph. (360) 417-4735 Fax: ($GO) 41.7-4711. Date: " Plan Review May Be Job Address:/ Building Square Footage; Description of above —1 & 2 Single Family .Dwelling �P P WVe Electrical Plan Review information Sheef V 0►mar info alien ,,n Nomo: ' is l r �.�G! t Mailing d s. - .. I / t9 L State: Zip: Phone: pax, .� Llcens; # 1 Exp, ^- item ServlcelFeeder 200 Amp, Unit Charge Service/Feeder201- 400Amp. $120,00 $146.00 ServicelFeeder 401.600 Amp $ 205,00 ServicwFeeder 601 -7000 Amp, $ 282 262.00 Service/Feeder over 1000 Amp. .00 $ Branch Clrcuft 41i/ Service Feeder $ 5.00 Branch Circuit W/p Service Feeder $ 69,00 Each Additional Branch Circuit $ 5,00 Branch CIMUlts 1.4 $ 75.00 Temp, Service/ Feeder 200 Amp, Temp, ServicelFeeder201-400Amp, $ 93,00 Temp. Service/Feeder 401 -GOO Amp. $110.00 Temp, Service/Feeder 601-1000 Amp, $149.00 $166.00 Portal to Portal Hourly $ 96,00 Signal Circuits Limited Energy -1 & 2 Family Dwelling Manufactured Homa Connection $ 64.00 Renewable Electrcal Energy - 5KUA System or less $120.00 $102,00 Thermostat $ 56,00 Note; $5,00 for each additional TStat N CO UCT' _N.ONLY: First 1300 Square Ft. $120,00 Each Additional 500 Square Ft, or Portion of $ 40.00 Each Outbuilding or Detached Garage $ 74.00 Each Swimming Pool or Hot Tub $110.00 Y� /t INS"'EuPONS X01 f ;h C�GJ 1� Contracts Infam►e an� Name: �T;h 5C �r ffzr� GL ii M$Iling Add s: � ca�� City; � Stato ip Phan ;, . �: Fax :. License # /Exp,_ vtat :� Mvrtti {sect b.�Unit Charnel Owner as defined by RCW.19.28.261: (1) Owner will OCCUPY the structure for tM years after this electrical permit is finalized, (2) Owner is required to hire an elecWcai WntrRetor if above said property is for sale, rent or lease. Permit expires after six months of last inspection, After reading the above statement, I hereby certify that I am the owner of the above named property or a ltoensed electrical contra-.,,tor. I am making the electrical installation or atlaratian incompliance with the electrical taws, NEG., RCW. Chapter 19.28, WAG, Chapter 296.468, The City of Port Angeles Muhtcipai Code and Utility Spedfcartfons and PAMG 14.05.050 regarding Electrical Permit Applications, Signatu f a er, electrical cant or electrical administrator. b Caeb ❑ Check mdlt Card a Dated; ":2: