HomeMy WebLinkAbout1132 Hazel St - Building CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DiVISION
321EAST 5TH STREET, PORT ANGELES, WA 98362
DUIL./JI/~ /"/-/~MI I ISSUED: 3/08/2002 PERMIT NO: 13274
OWNER/APPLICANT PROPERTY LOCATION
1132 HAZEL ST
C.C. HOSTELRIES
1132 HAZEL Lot: W 1/2,5 ALL 6-10
Port Angeles, WA 98362 Block: 11 [] Long Legal
360/452-9663 Subdivision: PENN PARK
T: S: Parcel No: 063008581107000
CONTRACTOR ARCHITECT
SCHOENFELDT CONSTRUCTION N/A
682 BUCHANAN DR.
Port Angeles, WA 98362 , 98360-0000
206/457-1695 360/000-0000
PROJECT INFO
Project Value: $500.00 SFD Units: 0 Commercial: 0
Project Type: FLOOR REPAIR SFD SQ FT: 0 Industrial: 0
Occupancy Type: Garage: 0
Occupancy Group: MFD Units: 0
Construction Type: MFD SQ FT: 0
Zoning Use: RS7
PROJECT NOTES /'-{
LOWER 4' X 7' SHOWER FLOOR (.~
RECEIPT#8810
FEES ASSESSMENT
Building Permit: $23.50 Misc Fee 1: $0.00
Plan Check: $0.00 Misc Fee 2: $0.00
State Surcharge: $4.50 Misc Fee 3: $0.00
House Moving: $0.00
Manufactured Home: $0.00
Sign: $0.00 TOTAL FEE: $28.00
Plumbing: $0.00 AMOUNT PAID: $28.00
Mechanical: $0.00
BALANCE DUE: $0.00
Radon: $0.00
Separate Permits are required for electrical work, S EPA, 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 pedod 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[
aws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
)resume to give authority to violate or cancel the provisions of any state or Ioca_~l la~/~ul~g~r the performance of
;onstrucUon. --'~/ ~/~~~////, //~ /~///
Signature of Contractor or Authorized Agent ~ Signat[Jre of Owner (if owner '~il~er) / Date
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROV1DE A MIN1MUM 24 HOUR NOT1CE. ITIS UNLAWFUL TO COVER,
INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB S1TE
INSPECTION TYPE I DATE IYEsACCEPTEDI NO COMMENTS
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
PLUMBING
UNDER FLOOR / SLAB
i ROUGH-IN
WATER LINE
GAS LINE
BACK FLOW / WATER
AIR SEAL
FRAMING
JOISTS / GIRDERS
SHEAR WALL
WALLS / ROOF / CEILING
DRYWALL
T-BAR
INSULATION
S~;~L / FLOOR / CEILFNG I I
MECHANICAL
HEAT PUMP
WOODSTOVE / PELLET/CHIMNEY / INSERT
HOOD/DUCTS
PW UTILITIES / SITE WORK ( Engineering Div~ sion) SEPARATE PERMIT #'s:
WATERLINE / METER
SEWER CONNECTION
SANITARY
STORM
PLANNING BEFT. SEPARATE PERMIT#'s SEPA:
PARKING/LIGHTING BSA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL BATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEFT
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 '~- BUILDING
C:~APPL,WPD
.
Sito Address;
Installed By:
Owner/Business:
Owner/Business Address:
ELECTRIC HEAT
o BASEBOARD KW ~
o FURNACE KW ~
o HEAT PUMP KW ~
pl FAN/WALL KW -3--
.
DetailslDescription: A-v.
A-r~ -
~ ~5 ~cV
CITY OF PORT ANGELES LIGHT DEPARTMENT
321 E. Fifth Street
Port Angeles, WA 98362
(206) 457-0411
PERMIT NO. .S-dl7J
'7/26/p.s:-
DATE
ELECTRICAL PERMIT
o READY FOR
INSPECTION
License Number:
o WILL CALL FOR
INSPECTION
Phone:
1:S.
Phone:
Sq. Ft.
~ RESIDENTIAL 0 RISER
o COMMERCIAL 0 OVERHEAD SERVICE
o NEW CONSTRUCTION 0 UNDERGROUNI}SERVICE
$ REMODEL VOLTAGE: ptJp~
o ADD/ALTER CIRCUITS ,/, II.
o SERVICE UPGRADE/REPAIR ~ 1 'fJ 0 3 'fJ /"_~
SERVICE SIZE CPrX/ AMPS
o TEMPORARY SERVICE FEEDER SIZE /tfJ() AMPS
/&0 ~ ~d /0 Ituv-
~
aJ~~ A v.u- . .
.
~
W.S. No. SERVICE SIZE
CAPACITY:
o O.K. 0 NOT O.K.
ACTION REQUIRED: 0 CHANGE TRANSFORMER
o INSTALL SERVICE POLE
DATE
ENGR.
o OVERHEAD SERVICE APPROVED
o CHANGE SERVICE WIRE
o OTHER
o Ditch Inspection O.K.
Ji\ ~ Rough-in/cover O.K.
V' '" O.K. to connect service
o Final O.K.
Notify Port Angeles City Light by Street Address and Permit Number when ready for inspection. Work must not be covered
before inspection and O.K. for covering has been given by the electrical inspector in writing on either the Wiring Report
or on the Building ~it. PHONE 457-0411, EXT. 224.
~ .. NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT
.~ $
Electrical Inspector
Installer:
.
~
WHITE - File by address
OLYMPIC PRINTERS INC
Permit/Receipt No.
:YcP73
New Meters
----
#40
Permit Fee
PINK - Top: Eng, Bottom, Customer
GREEN - Top: Meter Dept., Bottom: City Hall
CITY OF PORT ANGELES
LIGHT DEPARTMENT
N:
18303
ELECTRICAL PERMIT
Port Angeles, wasblngtonmm....____.._.1i:.:.?Lmm.mmm..m..m, 19__S.!:l
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 d6 electrical work as listed below.
Address __njj)k.mml::f~.~Jf..~m__J__fp.t!__mt'!:N..t;,!f.H.$.. Occupancy____~{P.Ilf..m1iQ.mjf.mm____
Owner tll:t-H.P.,rr1_.__J:ll.:m..HOsn:~.i~~m______m TenanL__:Ff.J:r!!JL__~.___bW.N.titl!.____mm.m__.__
Wiring Contractor .__OJ,:fMf.J.f:..m./i./,,If.!:.rr.il:<__._____.______.__ By__.n.;;;r:aJ:f1J.m..:cV."-~.#J5,m.mmm__n__.__
LIght OUtletS.mnnnm...m'l...m._.._n... Service, volts .n...I.:z....Q..'~.'.k~J..Q.mn. Type of Wiring:
Re-ceptacle Outlets________.._!..f?....n....... No. wires ..0......00.0..':1...________00..._...._ Armored Cable ..............................
Drye,. KW mm__.........__t/;..I1.....n...... Size wlresn...::l!I.~n:::ni...f?n_n Non.Metalllc m.__m...~.m...mm__
,J'j A ~ ~ Knob & Tubenmnnnm...nn...mnm.
Range, KW....__nn......n.fV.. .rn. Main fuse ...0000...........0000...........00....
If, RIgid Conduit .h.....hhh...m....hhm
Water Heater: Enclosure n._.___~~~n:..L..._....... Metallic Tubing mn........_._.n........
KWh.__nn...nh.hh./!jP.....m
Heat: KW.h.nn._....h.....~.m____..___...
Type of wiring:
Entrance Cable ....n....h_...m.......___
Ser. NO.nnnn___hn..__n 00...._.................
Raceway _._.___________..__.........._........._
Circuits, Llght..nnm.m~..mm.mmmm
Utility ...................::=::...00_..0.0......_.
\ Heat nnn.m..mm....!..__m..mm...mm
, -
Range ..............................__..........._.
-
Water Heater ....._..._____........._......_
Motor .___..__...__.._____~__._......._..._...
Dryer _..._hn..n._h.nnnn~n.n_...n.....n.
Furnace -.----._............=:._.....nm._mm.
Motors: size, volts and phase:
....mm....n...nt/jA..'..........nnnm
h....n...nnmm:::(nnhn.......m.m.hh..m
......:n...n..m.m.f...n.n.m...m.h...h......
Rigid Conduit .......n___mn
V'"
Metallic Tubing .....___00........
Current transformers:
No. & Slzenn.......#/P.mh........h...
Scr. No...................... .0000.00......_........
\~ Ser. NO....nn....h.n_...n_.n...................
Total Loadnm...............h..h_..
Ser. NO..n._.n____._.... .......h___nn___..._n
Total .__m.........~Lnh.............
Remarks: --n--M:.m.4.f.r..!j!f..r:.__m.t)~~nnn.l5!!<:it.m.~S"..__n.MJLm.H:~.~};fk__m~'_:::____mm.m____
--f:i:o.--A1tJ.f!..mme..I;f.Jf.QC'.f._____.':rP.mmm~Il.~fl!!-Jl!i.k__jt/..m.NA.w..nmG.&r.!?y?.=mmm____.......
n;FTJ!Y.~.r;.lim.STXJ/..e.'iJ/.yJ!.mh_M:..nn__E~:rnnnJ:NP.h__...(2€!'..mm.l!:.~.CL~.J.'T':J.____m__mm__m.
;~.:?:v.__~.m.m__m______ ::~.~.~2~~=~..__.__ By 9Jd~--~~ .
NOTICE-Current must n()j; be turned on until Certificate of Inspection has been issued. If work is .~~--:~:~ '--
cealed due noUce must be given the Inspector so that work may be inspected before concealment.
NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION
N~ 1 8 3 0 3
ELECTRICAL PERMIT
Address u.J/~k..H.A;..IfJ,,__.um<ft..r,uu...m.em_:.mE-1I..G.,,;,),;!;..~___.mu Datem_m.~__dL:::u~.qh_____n__um
Owner ma.Je.k!r)!!JlI1__...t!d9..ll.tJT.':L__l::f.()~T..1!J".JC..l..t:Sm__..nnm TenanL.m:i!AtnJ!m.nAs'h..V'fJ!.!'!lf.f
Wiring Contractor____(2l:dm.e./I,/:.m_uiifblf...~.'r:n;;<..UUhUh__Um__.n.m....h.mm__n...mm By____:;:[].~u.u~.LLIJ:..I'..~.r;:,uuu__
NOTICE-Current must not be turned on until Certificate of Inspection has been issued. If work 1~ to be con-
cealed due notice must be given the Inspector so that work may be inspected before concealment.
1M Olympic Printers, Inc.
/
CITY OF PORT ANGELES
UGHT DEPARTMENT
ELECTRICAL PERMIT
1''1:
I I 0 If I
r-.
....,..,/ y-
)<7" ..- <::'.....- _ n <:,..1
Port Angeles, Washlngtonm.m_..m...m_.............mmm.mm..m._m.. 19..',.._.
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. /"
Address .//3..?:.__~~.m...m.-..::-:....---m.-..m..--........ occupancy.._..A~;r<'L~.lt.,.-----..----..---......
Owner C:t.I}t&",... /~~~~.'=',:?2-!.mi{~i./~L~:.'XTenant.......,Zif::,;~~".'t.~.j?!:!l-:~:.'::':...!.l!l'd:!1..- ,-
Wiring ~.~:~~~~o~.::__::~:/!-f~1!.~<L..[1d~::..X--(;,c:::--.. By.....___m.mm..m..........mm...._..m.._....__.....m...'
, -"r/d ;.to
Service. volts ...~::.:.~....................... Type of WirIng:
No, wires "'~:~"Aj'C"'I--Tf--i[.::i4 d c:: 1~~i.t~}iA?--"""''''---''''''
Size w;f~;,:.;?_~::-.:.!7"'~"_h.':'''~-'-:-'/ ~I \ 'N~-Meta.lUc ..............--.................
<P't;O /t Knob & Tube.__......__.........__..__........
Main fuse ...../1..............__...............
-
(;1
Enclosure __....m..::":":'.:___....______......___
Llgbt Outlets............u..............u...__.....
;I-
-I
.;L
Receptacle Outlets..............--...............
Dn;er, KW n..n~.un.....____....____...____...
. /"-'
Range, KW hh___I.'2....._______________..___..
Water Heater:, ' -AI.:
Kw..I:::'1f..I::..f!!....!.l,r'
Heo', KW......J/..!f0,c"...............
."",
_,Motors: size, volts and phase:
10 ,k I..., "'_ 4'_.Q....
;;i.:(?lU;;:::;.:.;,:z{C~~:::::::::::
Type of wiring:
Entrance Cable ...00........................
~ _lJ,n
Rigid Conduit ."::':':'.___00...___..............
Metallic Tubing ..00___:.................00
Current transformers:
No. & Size.............n........................
RIgid Cc>ndult ....n..nn...................
Metallic T~blng h...n.............___....
Raceway ......................._....._._..._
Circuits, Light..___.........n..___n......___.......
Utility............................................,
Heat .......................................-..-..
Range ....................................,;.......
Water Heater ...............................
". ...
C .........'.'.n~.:.;;;..n.......nn..................n......n
/1 ,(" J Se'. No,..........................,................., Motor ....n.......................................
; :;. :./i:i~~!:~.:=:::::::::::::::::::::::: Ser, ~o, ......................,............."...,.. ~:r~~~~.::::::~~~:::::::::::':~:~:::,::::::::~
~1 IF 1-e-~Tk<r;:;:2rf.-?!..~..f"t .. :::: ::::::::::::::::::::~::::::::::::::::::.:::::: c I- ; 'r;~t ,:/~,!:.~..cJ?...c-?: /fLu'-
-'1 ' I)ema~ks: __...:_::.rm..~-'?t..._...n_(l!{~-;...:___.{!!fi.-!:';;t~........mm...m..__:;.m.._000............000...._............
o-.~.~~.~:t:.~.......___...m....m..__........m.....i.S{_'d.....m2t..:".t..',"''''r..,'~!.'!m&,:~',e'..m.__.m......................~:.m__
......_........__.....___.....___....____...._.._.....___m._.__.....j:~;,~!dJd.,;,,'~~",,_....1!.L?.r.d:..m.__.m_.__...m......'.:>,......
Pel'mit Fee Treas, Rece~Pt ..-' . 9./ ( /-{7{ ( I' .
. I!'tJ 0 Q., /7- c7, /f't;e.Jee-t4/l Itl-#<.-/
$_...................000............... NO.....mm..m............. By _....000._..000...__.....000......000._....000____......__............
NOTICE-Current must not be turned on until Certificate of Inspection has been issued. It work is to be con.
cealed due notice must be given the Inspector so that work may be inspected before concealment. :.....
..........
NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION
N~ 1 7 8 4 7
ELECTRICAL PERIYIIT
,
\
Address.........................................................................................................................~,..........Date..._.........._.._.._..........-......-......-.........
owner" '::-,n~;...,.......n...........n--......_n-uun-...--.-.._.......n......-nnu......-nn........nn..........n.>;enant...,....nnnn......n........n....n..._n...........n,n..nn
Wiring Cont'ractor ...........00........00............_......_....................................._....................................... By....nun.....nu......................n.........n......:.
"
NOTICE-Current must not be turned on until Cert1f1cate ot Inspection has been issued. If work Is to be con-
cealed due notice must be, given the Inspector so that work may be inspected before concealment.
1M Olympic Printers. Inc.
CITY OF PORT ANGELES
LIGHT DEPARTMENT
ELECTRICAL PERMIT
N~
17823
)d - / r ?;2
Port Angeles, Washlngton___.__._L~___m___m_..._.__..mmmm__mmmm., 19___..m
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 d6 electrl.cal work as listed below.
Address _//;J.?_____.,~_:?::::_~_Vm____________________________m.__ occupancy___L"'""L-:!_____~__m~
- - r
Owner _________m_________m____.m____mm_____mm____________~____. TenanLm_____m.___...____._.mm________,___.m______m..m._mm_..
Wiring Contractor n((-_'!'.&_"':_'_m__~(f?.~:__n___.__m_ By.______.______...m__mm____m__n________.____m__m._.______
Light Outlet.........___........._.........._.._._...
Service. volts ....00.000000..........................
Receptacle Outlets...............................
No. wires .........................0000..........
Dr'yer, KW........................n......n.u.....
Size wires..................nnnn.n......_..
Renge, KW..........nn.n.......n..........
~'"ater Heater:
Main fuse .................n.nn...n..........
Enclosure nnm..mm..................n..n
KW.....................
Type of wiring:
Entrance Cable .n.......
Ht~a.I: KW........n..............n.nnnn................
Motors: size. volts and phase:
Rigid Conduit
Metallic Tubing .m.......................
Current transformers:
No. & Size.......................................
Ser. No..............................................
Ser. No..............................................
Ser. No. .............................................
Type of Wiring:
Armored Cable ..............................
Non-Metalllc .................................
Knob & 'Tube................................_
RIgid Conduit .............._................
Metallic Tubing ...........................
Raceway ..............................._......_
Circuits. Light....................__mm...........
Utillty......................._....................
I.Ieat ...............................................
Range ................................n...........
Water Heater ...............................
Motor .............................................
Dryer ....__....__..................................__
Furnace .........................'_n.................
Remark:~t.:n:~~__~;~';~~:_.::__._~~::_~:g:~::~:::.:_~~.__:_::.:::...___m__m_m.____~:~_~:__~::._.:::~::_.:_:~:_:.___~_:~:::.::
- / '
u....-..uun_n_n.._n_un_nnn.._...nn_nn.u.._n_nnnnu..h..._.__nnnn..u..nunnnn.....u_.nnnh.....n_n.n....nnnnnu...nnnnn__O".n
:.~5i~__-:::-_.:---.----::~_~.~:__~~_~_~~~.~...-......----m-m---.--:;-::-..~Z~_~;J;~~=d,_,_
,'/ -.-
NOTICE-Cnrrent must not be turned on until Certificate of Inspection has been issued. It work Is to be con.
cealed due noUce must be given the Inspector so that work may be inspected before concealment.
NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION
ELECTRICAL PERMIT
N~ 1 7 8 2 3
Address..................._...................................................................................................................Date..._......_n_......_.........._......_......_.........
Owner ............n...................u........_.._.............._n_.............._...............______................__.... Tenanl.......n...n......nn.....................................n.....
,
Wiring Contractor ..................................................n......._....__.........U.....n...__........................____n.. Bynn.u.........__nn........................................
\
NOTICE-Current must not be turned on until Certificate of Inspection has been issued. If work Is to be COD-
cealed due noUce must be given the Inspector so that work may be inspected before concealment. ..
1M Olympic Printers. Inc.
2007-1207099
Page 1 of 1 Qui t Claim Deed
Port Angeles City Of
Clallam County Washington 08113/200701:5330 PM
111I ~'I"'j, rt~l'" ,lotl,:lolli ,IIsI' ,1~!,IT,I"~II..~~tlrL~~'1I11111
II?~ IV Hft-:ceL sr if
Filed at the requC5r of:
CITY OF PORT ANGELES
C'IY AUomey's Office
P.Q, Box 1150
POrt Angcles,WA98362
"0. S ;539
CLALLAM COUNTY -bJ-
TRANSACTION EXCISE TAX
~~~E AUG 1 3 2007
AMOUN1:G-
COj.TY T4:1~R h' a
'3YI: jiJJP a. -Ie t iJ ,
The GRANTOR, CITY OF PORT ANGELES, a municipal corporation, for an"d in f
consideration of the following described City right-of-way having been vacated in Ordinance No.
3259 , 3269 and 3286 and the requirements of said ordinance having been fulfilled, subject to the
perpehlal requirement that the conditions of said ordinance shall continue to be complied with, does
convey and quit claim to Clallam County Hostelries, Inc the following described real estate situated
in the County of ClaHam, State of Washington:
I
A portion of the north half of the Madrona I Haze] alley aburting Lots 7-] 0, Block II,
Pennsylvania Park Additiou, Townsite of Port Angeles, Clallam County, Washington.
QUIT CLAIM DEED
Dated the I O.t:Lday of
GfJJ~tf
,2007.
By:
C Y. OF PORT!;l'I/GELES
ct~;L~ ..
aren A Rogers, Mayor
STATE OF WASHINGTON)
)5S.
COUNTY OF CLALLAM )
On the IDio.l...dayof ccr ~ , 2007 before me, the undersigned, a Notary Public in and for the State of
Washington, duly commissIOned and sworn, personally appeared KAREN A. ROGERS and BECKY J. UPTON, to me
known to be the Mayor and City Clerk of the CITY OF PORT ANGELES, the municipal corporation that executed the
foregoing instrument, and acknowledged the said mstrument to be the free and voluntary act and deed of said municipal
corporation, for the uses and purposes therein mentioned, and on oath stated that they are authorized to execute the said
instrument.
Notary Public
State of Washington
JEANIE M. DEFRANG
MY COMMISSION EXPIRES
Mey 2., 29' 1
9-<L-C>.~ ~D-.S\I'C>-"-Y
Notary Public in and for the State of Washington
Residing at Port Angeles
My commission expires: sf.;;. ~ 11.,
,
Parcel Lookup
Parcel Number 0630085811070000
Site Address: 1132 W HAZEL ST PA
I Quit I I Back I
Taxpayer:
CLALLAM COUNTY HOSTELRIES INC PO BOX 2199
PORT ANGELES, WA 98362-0286
Title Owner:
CLALLAM COUNTY HOSTELRIES INC PO BOX 2199
PORT ANGELES, WA 98362-0286
Description:
PENNSYLVANIA PARK ADDITION
W2 LT5 &ALL LTS6-10 BL 11
Value Summary:
Note: Listed values do not reflect adjustments made for exemption programs such as
Senior/Disabled or Current Use programs (except Commercial Forestland properties).
Land Value: 0
Improvements Value: 0
Total Assessed Value: 0
Property Characteristics:
Note: Use Code is for Assessor's purposes only. Contact the appropriate planning or
building departments for Zoning and allowable usage of property..
Use Code: 1700 INST LODGING
Land Size (acreager .00
Note: Acreage is not listed for all properties in the
Assessor's records. More information about land size.
Tax Status:
Tax Code Area:: 0010
Note: Zoning and zoning codes change constantly. Verify all
zoning with the appropriate planning or building department.
Building Characteristics: (Click on Bldg. # for more details)
# Bldg. Type Bldg. Style Total S.F. BD BA
Tax History
Sales History
~ I Back I
111,089,71411
http://apps.clallam.net/website/sitisy.pgm?parcel=0630085811 070000
Page I of 1
1/4/2007
ELECTRICAL PERMIT APPLICATION
FOR OFFICIAL USE ONLY:
DateR.ec.:
Permit II: ~~ :If
Da" Approved: 3 ~
Date Issued: r,J: ZI I
The Electrical Permit Application must be fiUed out completely.
Please type or print in Ink. If you bave any questions, please call (360) 417-4735
Fax number: (360) 417-4711
Applicant and/or Agent: CoklYl A-n ~;c Phone:
Property Owner:
Address:
Fax # qS-uZ - 75'"1''1
Phone:
City:
Contractor
License #:
City:
Zip:
Exp: Phone:
Zip:
Address:
Credit Card Holder Name: ' 1]0 h bit. (). C:Jk:.m 11-1../
Billing Address: SZz. W. lIP ~/.
CreditCardN":mber
Permit Fee: /I LlY ?.r
CitY. /bd-4,.Jc.. Zip:7A':NZ.
Exp. Date:
PROJECT ADDRESS:
LEGAL DESCRIPTION: Lot:
113Z
dZcL
ZONING
Block:
Subdivision:
CLALLAM COUNTY PARCEL NUMBER:
TYPE OF WORK:
D Residential D Multi-faffiily D Commercial D Mobile Home
Elcctrical p'ermit rees are based on WAC 296-46-910
BRIEF DESCRIP1:ION OF THE PROJECT: W (R c'
~/~.
Elcctrical Heat Load Additions
Service Information
D Baseboard
D Furnace
D Heat Pump
D Fan-Wall
KW
_KW
KW
KW
D lUser
D Overbead Service
D Temp Service
o Underground Service
Voltage:
Pbase: DID 3
Service Size:
Feeder Size:
Comments:
I hereby certifY that I have read and examined this application and know the same to be true and correct. and I am authorized to apply
Jor this permit. I understand it is not the City's legal responsibility to determine ",*at permits are required; it remains the applicants
responsibility to determine what permits are required and to obtain sLt 6f-<1 c:!~
PW-l102_2J(rcvJ/.OO] Credit Card Holder's Signature: /}/a-O 1..1<- <!.Q. ~Date: :5/"/00