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HomeMy WebLinkAbout707 MILWAUKEE DR. ,: �� =e ,. APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY permit_ No. Date Pertn't Is ued DEPARTMENT OF PUBLIC WORKS -CITY OF PORT ANGEL ES, WASHINGTON (' r v - ILDING DIVISION -�/.-• DATE _ �-��- _ Applicant to fill to between heavy lines � .. Valaation tstw�re>•ct I� Building �-y CLASS OF WORK Building Permit Fe. Address 1Q7- AIJAat�_ �w - _ _ - --- - New -! Demolish Total f 9 I NAME M� � _. V J ' � ^-- Alteration Repai► ' �4 a____ Treasurer s Rccc t o. --_ __ - - Moil Address f195S --L Addition Move T ' / "-" Use of buildingM� _-- Liie of Permit c ^' City Size of building Height _ I�f Application taken by , t NA1dE `r No. of rooms No. of Families O �. _._ _ ..___ I Oats review completed .. ..... . ........ ... -� - . " - No. of floors ,Sins uF tot _ _ Z Address No. of Bld s. - Use of Bldg. j .� _,_ —_ .__ 5 I 9 `��Q Total nee► Area Sq• p. zo Now on lot Now an lot ( )lif C;ty Ph. No. .- _._ Lot coverage - _— ----- ,C'j - SPECIFICATIONS Area of let n NAME �j� �FOUNDATION --� �'!! Material -�y Exterior Piers Z - __ l Type Construction I, 11, III, IV, Address _ - width of Wall IJLJV- _ �� I�'��"�/�. yP r — _ ____ - -- _ �_ �, FR, 1-Hr, HT, n� City Footing Sine X Qr o _ _. �__ _ __ _ - --- - Use Zone 7e Ph. No. ? L Height i V I NAME �T Material Silt* Spacing Spool s Beams VX ' j occupancy Group A, E, I, H, B, �$�, M _ _Address _ Wit I n - _ n city Ph. No. Joist 1"it- + - - -n. - --- --------'-- -- - - Other Permit Numbers: _ License No. Joist Cei�rtg _ � — '-- —' Roof Rafters Plumbing R/w -- -- -- L —_ —_-- --- -- - •' Plans and Specifications submExt itted / "!r% • • • • • • • • . erio-r Shtds Sewer-_,.-- ____ .__..... _ --• Plot Plan ( ) Property line Interior Surds_- COVERI 0 --- Exterior Walls - ' Roof _ - - APPROVE-0 -- ^ � v � •.. ...... ... . Director Dept of Inspections l .. Interior Wails _ 1--Roroofing Heat: Wood - Gas _-- Oil - Electric ✓ SPECIAL and UNUSUAL CONDITIONS I hereby acknowledge that I have read this appliertion and state that the above is correct and agree to comply with a - all City Ordinances and Sta°e Laws regulating building con -1 - 1 J� v a struction. } , } SIGNATURE OF r✓ / ro PERMITEE - -- - c N j PROP v"s - - LEGAL DESCRIPTION 0 1 EXISTIIv Subdivision �`n----- H.�� _ _s_ _ _- o BUILDING,i lot No. �- ol o •c _ _-- _-.__... _. .. ...-•__ _.__�._.�_-.- U. ( ► n � � � treat Variance or Conditional Use Permit ___ _,_ - CITY OF PORT ANGELES DEPARTMENT Or PUBLIC WORKS BUILDING DIVISION REQUEST FOR INSPECTION Date_f�-' --- __Timed Received by (phone person) Location of Work to be inspected . Name of person requesting inspection Address of person requesting inspection _ _ ----------- -----____.� Phone N o . Type of Inspection (circle appropriate one): Sewer Foundation FramingPermit No. Chimney Plumbing Final Other Inspected: Date�' � d Tame Remarks: %I -- I ! /.V /Vl14� �laLL.__L�rr. �wr�v� by (continue on reverse side if necessary) CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING DIVISION REQ11EST FOR INSPECTION Date J� Time ��(� Received by!phone,?person) Location of Work to be inspected Name of person requesting inspec Address of person requesting inspection Type of Inspection (circle appropriate one): Sewer ( Foundatio� Framing Chimney Plumbing Final Other Inspected: Date Remarks: —_- Phone No. Permit No. 7-2-5T Time by A; (continue on reverse side if necessary) CITY OF PORT A NG E LE DEPARTMENT OF PUBLIC WORKS BUILDING DIVISION REQUEST FOR INSPECTION Date Time Received by t7'(phone person � Location of Work to be Inspected j i—I Name of person requesting iiispectiun— Address of person requesting inspection Phone Na. Type of Inspection (circle appropriate one): Pern, it No. Sewer Foundation Framing Chimney Plumbin Final Other ,� 1 . . - Inspected: Dite----- Time (continue on reverse side if necessary) by Date _-`--_--__-:. CITY OE PORT ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING DIVISION REQUEST FOR INSPECTION _Time Received Location of Work: to be inspected.----- ff � 4� Name of person requesting inspection_.[�.i-_6j- Address of person requesting inspection------ _ Phone No Type of Inspection (circle appropriate one): Permit No. Sewer Foundation Framing Chimney Plumbing Final Other Inspected: Date- �' ��' �� Time Remarks: _ _lam___ ?.11/5 (phone, person) by __ R I2l�tf — (continue on reverse side if necessary) g � —*U..1L y AZ CITY OF ANGELES PORT DEPARTMENT OF PUBLIC WORKS BUILDING DIVISION REQUEST FOR INSPECTION Date ' Received by --K) /- -- C hon person} Location of Work to be inspected____��GC-�,_ Name of person requesting inspection._&,4Mtt Address of person requesting inspection Type of Inspection (circle appropriate one,: Sewer Foundation Framing Chimney Plumbing incl Other Inspected: Date'-- - __Time by Remarks: �- 'continue or re,eerse side if necessary) Phor e No. Permit No. CITY OF PORT ANGELEO OFPARTMEN'r OF PUBLIC WORKS BUILDING; DIVISION iJ REQUEST FOR INSPECTION Date_ � � _. .._._Time Received by � `412 r _� oqe, person) Location of Work to be inspected Name of person requesting inspection___ Address of person requesting inspection Type of Inspection (circle appropriate one): Sewer Foundation Framing Chiriney Plumbing Inspected: Date h-mmIce i Time 4. Phone No.. Permit No. 375) Final Other .continue on reverse side if necessary) by— V1, DATE ED) Ell" NO PL?►NS Phone 4lc nl. I CHECK LIST • �� +�� � .ri:lrl�'�•��,:-�'�'1111��.;J �i�'S'I.C�r:CI�:�' D,Itc Received k 24. Kitchen Ventilation Gate Checked (Vol. I I) �- ! r 25. Roofing (Sec. 3202) C�i�G�a�lA4i5 Permit r4Lurber 26. Exterior WaI A. Coverings V�,luationp�(SEc. 1707 2514 2516 Street Address 2 %j J { Chp. 29,47) fX6*,�N" 27. Interior Wall coverings 1/Z���i(�(1U 1. Legal Pequir nts (Chp. 3) � _ y --:s-� 28. Glass Doors 2. Zoning 6' nance(Chp . 54 ; See.. 1717 d) Y112 j 3. Fire Zone (Chp. 16 Thl. 5I:; 29. Special Hazards (Sep• . 1411) Sec. 1403, 2203) ,3 Flood Plain 4. Occulaancy Group (T)l. 5A; Slid Hazard Sec. 1401) �j' � ( th ' " 41 0� R - 7 5. Type of Construction (Chprs. 17, 22) 30. Other Vertical Openings -- ��, Stairways, etc. �j,�!f10/���'���GdS 6. �tion or. Property: F�N � -'R�''S 1C15 - . Setbac}:s & Clearances 1 C -E& /I t/4731. Structural -- (Zone ord; 5A, Chp. 22) -Foundation, (Chp. 29) B, p IntCoverage Footings 7. 't 3110 - 5�-�-- Pa , s 8' 8. Floor Area, Sangls (5C) � i� � 1 .* -Reinforcement: Footings Height (TU. 5D) L._ Z Pads 10. Occupan-`- Load (r11. 33A) �— -•Beams: (Chp.25) 11. kits (S.�c. 3302, 3303, 3305) Of � 12. Furred. Spaces (Sec. 2517, 4 3205, 370 1 � -Floor Joi_sts(TB.25T;�g/6�'��8'�6� � 1 Sete. 2517 ow 2r12,12?2�3'� 13. San, ion (Sec. 1405) , r per 2x1� 04, Light & Ventilation (Sec. 1405)fOfP ` OK_ -Ceiling Joists ('[b.l . 25U; Sec. 2518) 15. Q, tJc�.--=Lrage ''or Carport 2xl0/b','% (Chp. 15 Sec--.-' 1412) ea_ -Rafters (Tbl. 25V & W),12 16. Fire-Pesistive Separations 4T�j►fl'x -Trusses (Tbl. 5B; Sec. 1409) s,� l C/o 56 - Heating System (Vol. TT) h a�'(,y,�j)'j�, -Headers (Sec. 25I8) Wllj9�--�rj2 Chimneys and Ili replace % /fit% _ . Sec . 2 518) (Chp. 371) i , 19-Combustion Detector � t7 -Sheathing:Walls It'�( rr tf �clt U'd�l (Th1.25s,25p, Sac. 25].8)/X6� ?0. Ventilation, ,Foundatis and Roofs f7Qo.'(sec. 217, 321D) 32. Tnsulat ion: '1. Underfloor Clearance A. Above (Sec. 2517) " B. Under C. Walls y . Underfloor Access (Sec. 2517) /II i. Attic Access (Sec. 3205) --- 33. Other Department::: A. I'lannIlLg H. Engineers C. Public Works -APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY DEPARTMENT OF PUBLIC WORKS -CITY OF PORT ANGELES, WASHIAGTON BUILDING DIVISION ISODATE - )?O - Applicant to fill in between heavy lines Rv,ld,np Address 70`%1%/fa( CLASS OF WORK Key T'r Co �' I NAME New � ✓ 'Demolish M - Alteration I -- T _ '_'_ Repair Address � ��?-- � / Addition Move— _ Use of building - - m . City �. Ph. No.� m —''—•`—"---- Sita of building NAME � g �(Lj.�r �rrtA+s�U.W�- �� ��,�oo,, No. of rooms v—' O �rtV- of Families Z Address No. of floors : Sine of tot �,��� --ism No. of Bldgs. Use of Bldg. I C'h' Ph. No. --- — Now on lot Now on t p NAME Pp, - A Address City -.... - �`------ ,a Ph. No. nNAME -- --- - — -- = Addrr%% — n City _ Ph. y I No_..�_._ -- License No. No. Plans and Specifications submitted Plot Plan Property Line n City _ Ph. y I No_..�_._ -- License No. No. Plans and Specifications submitted Plot Plan Property Line a. o X c I PROPS EOS m OR EXISTING a o a BUILDING o ` P�i�! 6 �W' 15T f. I J / -r/ M U. 6 Street 1I07A Ret 7 17 of SPECIFICATIONS FOUNDATION Material C I Exterior - - Piers of Wall II • rl �i... - alix f� Footing Sits 7/�' 'r jfi �/��X 7i�•. 0 Height _-. _ ---- Material Sirs Spacing - Span - Beams _ _-- Joist Tst Fl.- ioistt Fl... 10% n •i — r Roof Raftsrst #� Exterior `Studs "- Interior Stud_ !°+ %y4 Exterior WallsRoof Interior Reroofing Heat: Wood as Oil Electric y- I hereby acknowledge that I have read this a Pl ton and state that the above is correct and agree to comply with III City Ordinances and .State Laws regulating building con. struction. i SIGNATURE OF . 11 r _. PEI;MtTEE .... ---yv,� `. ... LEGAL DESCRIPTION Subdivision tA,t Na: slack No. _ Voriwice or Conditional UsePermit Permit No. Date Pe it is I } $ -• 7JG.60. Valuation I / huilding Permit Fee,__ Plan Chocking Total - - _ _� - ------ —` Treasurer's Receipt No. .. Life of Permit .()/Z. 1 Application taken by. +V Date review completed ... �� ... .. ........... Total floor A►so llei/ - q Ft Sq. H. Type Construction 1 !II III - IV ,/�`, FR 1•Hr HT �N� Use Zone a< Occupancy Group A E H 1B Fire Zone 1 2 f � APPROVED ...�� -- _Director -of Dept. of Inspections SPECIAL and UNUSUAL CONDITIONS ow, ps oWI/ _ I0T /'1i/wa��� Dr 1* f gS �4"�,""' ��P CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . . . . . . . . INSPECTION REPORT ........... REQUEST: Date _z._:__ C/ - Time 0,146 CAA' Received by /�L_ (pho Cperson)) Location of Work to be inspected Name of person requesting inspection "), , -1 ad o c k cle. _ Address of person requesting inspection r_C9= E_ekI.4 / /c' Phone No. F.X�r Type of Inspection (circle appropriate one): Sewer Foundation Framing Chimney Plumbing INSPECTION NOTES: P mit No. / 6, �- Final Sewer Excay. Other Inspected: Date l � �� Time By I/ _ Remarks:)'c &g ye J c�AA;zN9ea- L-je,.,e- _,Z/4 e ls? Ge 11 sA,-� e 1P tlee 4�i`� ��� s��.1'�1 "s .6pck1L���� 6Ve'f� n ) Sc__ -J U�'r� i'J��'! G`t! 6 fQ r i r S �' G�G4 �' fdl1�� '��s 00 RESTORATION REQUIRED ...... YES.NO _+mot ► L Q g y kfCPP. /, s SURFACE RESTORATION: SURFACE TYPE: I Unimproved EGravel [rj Repaired by City (� Repaired by Permittee No Damage Found �epraiQ�� Asphalt (] PCC Work Order # �1; [._] COMPLETE [`j INCOMPLETE ❑ Other (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) � t4 O n • � �erp •• O A •n YYY� _ y Aw 3 a r - M "L7 rr � Y a« -0 0 _ w YLn T' •• ;may^ `e �2 -2--, 0 c+rryp . • i.. \ 'mom N t7 _ �:•�tcrz "n• rr � • O. y b 6 N , . y b ; C f O r •• �1•*9 O?-nv f tf tilt 1' C. a o Y ro �� T • o t. v CZ_ o n•o.rd. J w _ ,9w - OR jr 0 'J. - i - - - • 'M 1 �J _ j,-j(j 77, r~ zr •.. m .y � a r• � `G a � t a .�.. a H <T N iCcn " M rn r •. r r •. / C C: r --4 -. i r* Ut c t x .t F .• rio .� f • 111 C 11 X 3 -< m m ._ -� ..' '. - Vr.. i•t ram+ CD W a, • - - v In m r cl • -. �. ._ -. _ m O fi • • • • . Cl ❑ ❑ N N N N N Pr r•'► rr R, r1' r- s a a a a w a r+ r• c► rr rr r+ O C7 O O •� 1 i z M vvfD� m n r, r• r• r• r• 1••• r• fir_ ❑❑❑❑ ❑ - - _ r V. rf.:f, i/. f �-^ .y •+ .y 7 f7 ►. r) ry n 1 r- `4EOV h� J n O C a ft) •pp + �+ a Cl :1 �Z H F cct r�C =+ O O ^ • N a 0 a 7 ro N •. Z. fL: - to•�n I O C7 O N �^ a "C - 9 rr m ►Oi aC ra O d a s-) w ' rC ? 1••• m m cr r• _ m 7 son o n c -71 Ll - rf N• Co to Qm CltO C mt1 '7 C O C • ^'1 •- a so d ct p aC. -�•� -7 C:)G N m C- T -• N C1. m ► N O a r.; U - m [a C uui !,I ooc ws�� Q O + T O gyp* c- m O r; o r• r ro Cr rt, M + rr) - C rU + r r7 ,- a lb j n 1 ci 9 fo 77 ,1 O m V m J z ro r•.. :ri CIO t 1; RECLAIMED m OR SCRAP I ,� ,m Q „1 ifl m --r -- > n - j r+ P �1 N i o n_ n 0 D x -4 C o0 m R I� CG s c •� • m D v rn N - �- X O o S C r C "� .... 2) r. I r' � -1 o ,m U D to �i Z 0-� ` ch -+ z z D on CA U3 £ Ia► CD J \ C Ci O -� - m i 3 -n o `_� O p -V 7C O < era O (1) o E PC C] C7 $ rn D z m - t r �, a o -1 M • f , (� D -� c D O rn N � 2 z Z o a z°c> m U' w o �^^ ^� D �M � m � D m � n 1 o f� Z I (� o t k z r P 4 1 oQ CG Z3 .94 u INFORMATIONAL [_j COST OUT &RETURN S 11 E ET __---_ OF ___ - -- I - k OF PORT qHC CITY OF FORT ANGELES 140 WEST FRONT sT.. P.O. BOX 1150 PORT ANGELES, WASHINGTON 99 362 &$C I C W 0475�w PHONE (206) 457.0411 February 20, 1986 Mr. Gerald Tobias 707 Milwaukee Drive Port Angeles, Washington 98362 Re: Repair to Sewer Service at 707 Milwaukee Dr. Dear Mr. Tobias: The City of Port Angeles Public Works Department has completed repairs to the sewer service at the above referenced address. The total cost of this repair is $2,229.95. The Public Works Department is billing you for the materials cost of $263.95 (see work order enclosed). The reason for the bill is that it is the property owner's responsibility for main- tenance of and/or repair on a side sewer service. The damaged pipe was crushed and was presumably caused by other utility construction at that location and, as there was a question as to responsibility, the City has agreed to absorb the labor and equipment costs in the amount of $1,966.00 which would leave you only the cost for materials which we feel is a more than equitable division. Should you have any questions or comments regarding this invoice, please contact Ken Ridout of my staff at 457-0411, Ext. 122. km Enclosure cc: City Manager Ver r 1 s, Jaci N. Pittis P. E. , Director of Public Works ............ P"n ;,tOr, ;; pfnT CITY uiGIN-dit SUILO NG !Y �.'► REQUEST: Date CITY OF SORT ANGELES DARTMENT Or PUBLIC WORKS ...........INSPECTION RESORT ........... Time Received by ____A (phone, person) Location of Work to be inspected Name of person requesting inspection Address of person requesting inspection____Phone No. Type of Inspection (circle appropriate one): Permit No. Sewer Foundation Framing Chimney Plumbing Final Sewer Excay. Other INSPECTION NOTES - Inspected: Date —Time y Remarks: _ RESTORATION REQUIRED ...... YES NO SURFACE RESTORATION: SURFACE TYPE: ❑ Unimproved []Gravel ❑ Asphalt ❑ PCC ❑ Othe( [-J Repaired by City Work Order # ❑ Repaired by Permittee [] COMPLETE ❑ No Damage Found ❑ INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . . . . . . . . INSPECTION REPORT .......... . REQUEST: Date _ _ Time f -� Received by (phone, pt Crs�on) Location of Work to be inspected Name of person requesting inspection Address of person requesting inspection rnone Imo. Type of Inspection (circle appropriate one): Permit No..� himne , umbin , Final Sewer Excay. Other _ Sewer Foundation Framing Cyg INSPECTION NOTE �(/ ?A3 Time 2 �� Inspected: Date - Remarks: RESTORATION REQUIRED ...... YES NO SURFACE RESTORATION: SURFACE TYPE: U Unimproved U Gravel II Asphalt I PCC ❑ Other _ Ej Repaired by City Work Order # [) Repaired by Permittee [_] COMPLETE ❑ No Damage Found ❑ INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS ...........INSPECTION REPORT ........... REQUEST: Date_ JZJPTime-_lh� Received byKJ(phone erson) Location, of Work to be inspected Name or person requesting inspec Address of person requesting inspection Type of Inspection (circle a ,wiate one)DPIumbin Sewer Foundation (Framing_:)himne Final _ Phone No. Permit No. Sewer Excay. Other _4i� INSPECTION (VOTES: Inspected: Date &U343 Tim,�e / "�� By /� � _ �Pnnarks- RESTORATION REQUIRED....... YES_ NO SURFACE RESTORATION: SURFACE TYPE: ❑ Unimproved ❑ Gravel ❑ Asphalt [I PCC 1-1 Repaired by City Work Order # C1 Repaired by Permittee [J COMPLETE No Damage Found ❑ INCOMPLETE El Other (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) CITY OF PORE' ANGELES DEPARTMENT OF PUBLIC WORKS ........... INSPECTION REPORT ........... REQUEST: I/ Y Date _ —Time--,— � Received by (phone, person) Location of Work to be inspected d ;�_ r T) 0 Name of person requesting inspection Address of person requesting inspection Phone No. 7 - t 51�g Type of Inspection (circle appropriate one): Permit No. 9.# -C)- Z Sewer Foundation Framing Chimney Plumbing Final Sewer Excay. 8e -7tVt-TN, INSPECTION NOTES - Inspected: / Inspected: Date Time By Remarks: RESTORATION REQUIRED ...... YES NO Other SURFACE RESTORATION: SURFACE TYPE: ❑ Unimproved ❑ Gravel ❑ Asphalt ❑ PCC ❑ Other ❑ Repaired by City Work Order # ❑ Repaired by Permittee ❑ COMPLETE ❑ No Damage Found ❑ INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) .PORT.44fQ 5 �eC I C W 0�� CITY OF PORT ANGELES 140 WEST FRONT ST. , P O BOX 1150 PORT ANGELES, WASHINGTON 99362 PHONE (206) 457.0411 Date: March .16. 1984 TO: Ked-Ter Construction 2417 W. 16th Port Angeles, Washington 98362 Re: Permit Inspection Dear Permittee: On _ October 6, 1983 , Permit No. 9592 was issued to you by the City of Port Angeles Public Works Department. Please advise the Building Section if the work on this permit is complete and/or ready for inspection. Please call 457-0411, Extension 120 within 10 days and regJest an inspection appointment for your project. Foundation Inspection Framing Inspection Rough -in Plumbing Inspection X Final Inspection (707 141IM91 it ,a^, Right -of -Way Construction Permi� g Y Permit Expired (either final inspection or renewal required), Sincerely, PUBLIC W0,RKS DENT. RECEIVED DUF�"- 04RECTOR OFFICE EI;CiR, SOLID WASTE SEWER!WATER t 1SU MNG �NG7dEER!NG t "LE Fv1. 4 t i)PY r, Building Official Building Section Department of Public Works '0"►"`*1 CITY OFPORT ANGELF:S PUBLIC WORKS - BUILDING DIVISION 321 BAST STI I STREET, PORT ANGELES, WA 98362 BUILDING PERMIT Issued: 3/02/99 Perlr.it 1d0: 11004 Conditions: OWNER/APPLICANT--------•-----`----------PROPERTY FRANK SILVERNAIL 707 MILWAUKEE DR 707 MILWAUKEE DR Lot: 3 Block: Lonc1 Legal: Port Angeles, WA 98363 Sub;. SP 78-5-].7 Sub 360/452-2273 S : Parc IT,,): T : CONTRACTOR------------ TOPNOTCH 1235 W. 9TH STREET Port Angeles, WA 98362 360/457-7441 000/000-•0000 PROJECT INFO---------"—""'—""--'— -----__._._`'FD $8,200.00 ------- -------------------------------------- UNITS: 0 MFD UNITS: 0 Prj Value: SFD SQ FT: 0 MFD `3Q FT: 0 Prj Type: RE —ROOF Occ Type: Occ Group: Occ Load: 0 COMMERCIAL: 0 GARAGE: 0 INDUSTRIAL: Cnstr Type: Land Use: RS9__.,._.___----.---------------- ---- PROJECT NOTES NOTES ------•-----'----•--- AD� X 4' SKYLIGHT TEAR OFF/SHEATH/COMPOSITIO•N O PROJECT FEES ASSESSMENT--------"`—`--'--""'"--- $0.00 __ _ _____.______ ------"-"'—`— $0 . 00`� BUILDING PERMIT $149.75 --` $000--------'"RADON $0.00� PLAN CHECK $0.00-------'--" $4 50--------""'—" $0,00 $0.00� R' STATE SURCHARGE . $0.00 $0. 00 HOUSE MOVING $0.00------"—"'"`-- $0,00 $0.00 MANUFAC HOME $0.00-------------- $0.00 SIGN $0.00 --------------- $0.00 TOTAL FEE: $154.25 PLUMBING $0.00---•---------`— $0.00 AMT PAID: $154.25 MECHANICAL $0.00—•-----•-------- $0.00 ----------------------- ----------- $0.00-------------- $0.00 BAL DU $0.00---•----------- THIS PERMIT DOES NOT REQUIRE A SERA, SHORELINE OR ESA PERMIT Applicant Staff Date RW__ SANIT.'\RY WATER_— DWY STORM_ DRA U l HhKc Separa'le Permits are required for electrical work, utilities, private and public improvements. This permit becomes null and void ti 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 6 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 performan a of construurbg Signature of Contractor or Authorized Agent _Date — Si nature o ' ner if owner is builder Date ronH H P:! 13 )-3 Hx-7 o � F3H0 xx~h iTJHH oz H O 0 O H H H O d H CT] O r•3 y aH y C' ntro''7 y cn r� r 1-3 M x n rn H171 s-3 x m FOLD HARMLESS for ENTRY ONTO PRIVATE PROPERTY The undersigned agrees that they will save and hold the City of Port Angeles harmless from, and defend the City against, any and all claims and causes of action for personal injury or property damage to third persons arising out of or in any way connected with the entry by the City of Port Angeles onto the property described as: o (Do 0 0 0 0 and adjacent areas onto the undersigned's property for the specific purpose of performing the following: We understand that the City will restore these premises to as good a condition as they were in prior to the work and that this permission is granted for a period of time not to exceed _ ( ) calendar days. DATED this Z Q day of ;\ 2000. STATE OF WASHINGTON ) ss. County of Clallam 1 On this date, before me the undersigned Notary Public in and me knownfor the Sto be thindividuals personally appearetate of Washington, d `_ cC? �iJ who executed the foregoing and acknowledged to me that they signed the same for the uses and contents ther:,in mentioned. DATED this o day of � , LA , 2000. ; r'•�p UTAq�'':9� ExP. 03.01-04 z F WAS�'� vweoos I��F/I)IIIINI�� NOTARY PUBLIC for Washington, residing at �VZ o1�— iV1y commi:ision expires: - 1- LL 7 K)rH H y x � F3 0 z xq0 C+7HH �z H00 �H Mo c (JHC] 0 q z n y C H zC7h" y Mn H M 0 r