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ELECTRICAL PERMIT APPLICATION
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"'j'"rJe =!edric:::a.: PelrT'iit Appiicalion m!J~ bc.fiUeg p.!'Lc:2qJ..2,let&..u:.:
Please t)/P" o( ~epriot in ink.. If iO~ hava. Dny questions. ple-8se call (3SD) 417-4735
FlI~ number: (360) 417-4711
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Add,'.ss: 2.(,1)3 TT...;:. cuy: A
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Address.~\f^,/I'r' 82", CI!y......J--:".
INSTA~LATION WIRED BY: ,:; OWNER ~~L CONTRACTOR
Ltf"> :L-~ '-f,2..Y'
4S "}......i;.(..'1)
Zip: 'tY1 '..
Phone:.!:J52- '-h'2!7
Zip: 9~3 Go ':2",_
Credit Card Holder Name:
Billing Address:_
Credit Card Number:
em
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Zip:
vtSA:_ Me:
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PROJECT ADORESS:.....-~ 0\ :>
TYPE OF WORK: Check all thal apply: 0 New
o A1terationlAddItion
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~
o Residential ::J Multi-family
"Commercial ::i Mobile Home
Sq. Ft
lA.()O
o Remote Meier 0 Detached garage u Hot TiJb C; Swim Pool
::I Septic Pump
o Low Vollage 0 Telecom.
'-S
o Sign
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Number of Circuits added or alterod:__
DESCRIPTION OF THE ELECTRICAL PROJECT:
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h-A
:J Beseb:>ard
:J Furnace
::J tieat Pump
"'!'Fan-Wall
_KW
KW
TON LRA
=:iKW -
l.:' Overhead Service
[) Temp Service
. Q underground Service
Service Inforrr>..ldi!;m
Vcltage: I....P/......O
Phase: ~CJ 3
Service 5i>e: 2co~
Feeder 51>e:
Electrical Hoet Load Addition.. and or Subtractions
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, hereby'certify that I have read arld examined this application and know that same to be true and correct, and I an;
3i.11;horized to apply for this pemlit. I understand it is not the City's legal responsibility to determine what permits
3re required; it remainS the applicants responsibility to determine what permits are required and to obtain such.
Credit Card Holder's Si9nature:~~QJJ' J DBte:-*-
Ownor or Elec. Cont. Signature: ~,J" >> (j?JJ' ~ Dete: lolzh
,
PERMIT FEE: $
~ :/ElECTR,CALPER MIT APPLlCA 7JON
>- ,..-.,
IEI!ECrlRl~CAIL ~INIS~ECr~OINl
W~IRlH\!IG IRllElPORl
417-4735
PERMIT"
tYI- 978
;(b.fA'A'J?AG ~'/f~_
A.DDRESS
L7tJ( .:5, O. .::5/_
APPROVED NOT APPROVED
o ................... DITCH .... .............. 0
D .............. ROUGH IN/COV .. .. .... ...... D
D..................~~~..................D
D .................... FINA .................... 'let
CORRECTIONS NEEOEO@
Oi-
NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
- DO NOT REMOVE -
OLYMPIC PRINTERS, INC. (360) <452-1381
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CI~'Y OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
pin number . . . .
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use
Property zoning . . .
Application valuation
04-00000101 Date
.486634
1701 S 0 ST
06-30-01-5-5-0040-0000-
RES NEW SFR
RESIDENTAL SF 9000
RS9 RESDNTL SINGLE FAMILY
69610
Owner
Contractor
PAULSEN, SHAWN
1214 COLUMBIA ST
PORT ANGELES
(360) 452-5203
Structure Information
Construction Type
Occupancy Type
Other struct info
OWNER
WA 98362
NEW 1199 SF SFR W/ATT 524 SF
TYPE V NON-RATED
SINGLE FAM & CONGREGATES
TOTAL % LOT COVERAGE
CONSTRUCTION TYPE
NUMBER OF STORIES
EXISTING LOT COVERAGE
LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE
NUMBER OF UNITS
Permit . . . .
Additional desc
Permit Fee
Issue Date
Expiration Date
MECHANICAL PERMIT
76.00 Plan Check Fee
4/09/04 Valuation
10/06/04
Qty
Unit Charge Per
4.00
BASE FEE
ME-VENT FAN
7.2500 ECH
Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
PLUMBING PERMIT
132.00
4/09/04
10/06/04
Plan Check Fee
Valuation
Qty Unit Charge Per
BASE FEE
8.00 7.0000 ECH PL- EA.FIXTURE ON ONE TRAP
1. 00 7.0000 ECH PL- EA. INSTALL WATER PIPE
1. 00 15.0000 ECH PL- EA. BLDG SEWER
1. 00 7.0000 ECH PL- EA.WATER HEATER
Permi t . . . .
Additional desc
Permit Fee
Issue Date
Expiration Date
BUILDING PERMIT -RESIDENTIAL
807.25
4/09/04
10/06/04
Plan Check Fee
Valuation
Qty
Unit Charge Per
BASE FEE
4/09/04
GARAGE
19.00
V-N
1. 00
1. 00
9007.00
1723.00
1723.00
1. 00
-
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.00
o
-
Extension
47.00
29.00
't1V\
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I -;
\)
.00
o
:
Extension
47.00
56.00
7.00
15.00
7.00
flfi.
:i
.00
69610
Extension
667.25
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 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
constr n.
Date
T:IPLANNINGIFORMSI1102.15 [11/14/2003]
Signature of Owner (if owner is builder)
Date
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS 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 SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE/DOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN I
PLUMBING
UNDER FLOOR 1 SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW 1 WATER
AIR SEAL
WALLS
CEILING I
FRAMING
JOISTS 1 GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS 1 ROOF 1 CEILING
DR YW ALL (INTERlOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL 1 FLOOR 1 CEILING I I
MECHANICAL
HEAT PUMP
GAS LINE
WOOD STOVE 1 PELLET 1 CHIMNEY
HOOD 1 DUCTS
PW UTILITIES 1 SITE WORK (Engineering Division) SEPARATE PERMIT #'5:
WATERLINE 1 METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'5 SEPA:
PARKINGILIGHTlNG ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRlCAL - LIGHT DEPT. 417-4735 ELECTRlCAL
LIGHT DEPT
CONSTRUCTION R.W.I PWI CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW 1 ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
T:IPLANNINGIFORMSII102.15 [11/14/2003]
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use . . . .
Property zoning . . .
Application valuation
04-00000101 Date
.486634
1701 S 0 ST
06-30-01-5-5-0040-0000-
RES NEW SFR
11/17/04
RESIDENTAL SF 9000
RS9 RESDNTL SINGLE FAMILY
69610
Owner
Contractor
PAULSEN, SHAWN
1214 COLUMBIA ST
PORT ANGELES
(360) 452-5203
Structure Information
Construction Type
Occupancy Type
Other struct info
OWNER
WA 98362
NEW 1199 SF SFR W/ATT 524 SF
TYPE V NON-RATED
SINGLE FAM & CONGREGATES
TOTAL % LOT COVERAGE
CONSTRUCTION TYPE
NUMBER OF STORIES
EXISTING LOT COVERAGE
LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE
NUMBER OF UNITS
GARAGE
19.00
V-N
1. 00
1. 00
9007.00
1723.00
1723.00
1. 00
--
permi t . . . .
Additional desc
Permit Fee
Issue Date
Expiration Date
FIRE SPRINKLER RESID
.....::I
~
-
.00
11/17/04
5/17/05
Plan Check Fee
Valuation
.00
o
Special Notes and Comments
The site is located within the Madrona Woods Subdivision.
The residential structure may NOT be finaled until
infrastructure improvements for the subdivision are
installed and approved.
Building address sign shall not be less than 6" & not more
than 12" in height. Numbers colors must contrast with wall
color they are mounted on. (Ord. 14.36.050-E)
When roof gutters are installed, drains will located in dry
wells or piped to approved storm drain locations.
(f\
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Other Fees
SEWER SYSTEM DELV CHARGE
STATE SURCHARGE
PW WATER SYSTEM USE FEE
745.00
4.50
1025.00
~
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total .00 .00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 1774.50 1774.50 .00 .00
Grand Total 1774.50 1774.50 .00 .00
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 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.
(J /\1 j:: I 1- ;-
Signature of Cont~actor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T:\PLANNINGIFORMS\1102.15 [11114/2003]
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS 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 SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
I YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE/DOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN I
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
W fo- TER LINE (METER TO BLDG)
dAS LINE
BACK FLOW 1 WATER
AIRIsEAL
WALLS
CEILING I I
FRAMING
JOISTS 1 GIRDERS
SHEAR W ALLIHOLD DOWNS
WALLS 1 ROOF 1 CEILING
DRYWALL (INTERlOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL 1 FLOOR 1 CEILING I
MECHANICAL
HEAT PUMP
GAS LINE
WOOD STOVE 1 PELLET 1 CHIMNEY
HOOD 1 DUCTS
PW UTILITIES 1 SITE WORK (Engineering Division) SEPARATE PERMIT #'5:
WATERLINE 1 METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'5 SEPA:
PARKINGILIGHTING 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.I PWI CONSTRUCTION - R. W.
ENGINEERING 417-4807 PW 1 ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
T:\PLANNINGIFORMS\1102.15 [11/14/2003]
BUILDING PERMIT INSPECTION RECORD
CALL 4]7-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CO~SPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE/DOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN I
PLUMBING
UNDER FLOOR 1 SLAB
ROUGH-IN
'N A TER LINE (METER TO BLDG)
GAS LINE
BACK FLOW 1 WATER
AIR SEAL
WALLS
CEILING I
FRAMING
JOISTS 1 GIRDERS
SHEAR W ALLIHOLD DOWNS
WALLS / ROOF 1 CEILING
DR YW ALL (INTERlOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL 1 FLOOR 1 CEILING I
MECHANICAL
HEAT PUMP
GAS LINE
WOOD STOVE 1 PELLET 1 CHIMNEY
HOOD 1 DUCTS
PW UTILITIES 1 SITE WORK (Engineering Division) SEPARATE PERMIT #'5:
WATERLINE 1 METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'5 SEPA:
PARKINGILIGHTlNG ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRlCAL - LIGHT DEPT. 417-4735 ELECTRlCAL
LIGHT DEPT
CONSTRUCTION R.W.I PWI CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW 1 ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
T:IPLANNINGIFORMSI1102.15 [11/14/2003]
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BUILDING PERMIT - APPLICATION
-~./'-'
Fill out COMPLETELY and in INK. Your application and site plan MUST BE
COMPLETE to be accepted for review. Hyou have any questions, caD
(360) 417-4815
Applicant or Agent: /IOVSIIV(I. AiJ1"HOlliyt COi.!IVTY ()FC~UAm Phone: t!fSJ.. - 7 t"3 I ~7. V I
Owner: SHA-/;f)rV PkVJ..-s ~J i_Phone: '-!S'd - 5.~C '3
,
Address: /')../Y CO/"'u/l1I3;/1 ~y City: [>6R..f' !JrJG-U-f.$. Zip: Ig'3l A
Architect/Engineer: /"'I/V j) {)?,u,. A1?c It, .,ecrrs Phone: ~ '5 r/. - t'1 f t
Contractor If /r <2 C. State License #: Exp: Phone: ~ 5';; - 7(,:5 {
Address: (7oi <)OUTH '6" S7tCf:P:rr' City: Po/fq ./b1JGeL~/~ Zip: JS3{2,
PROJECf ADDRESS: I 7(;) J -$ 0 v"(f/ 'b # ~ 1 P-€ t"'r ;? ~ . ZONING: ~..s - ?
1/ It' /J_ _J
LEGAL DESCRIPTION: Lot: JJ;. 'I Block: 0 5<T12~~-r Subdivision: MASJ)K.,.uvlt WooD S
CLALLAM COUNfY PARCEL NUMBER: 0 t.3 OC) /5' ,:> .~ 00 Lj C
Credit Card Holder Name:
Billing Address: City:
Credit CardType VISA MC # Exp. ~ate:
TYPE OF WORK: SIZE/V ALUATION: ,
~ Residential KNew Constr. 0 Re-roof 0 Stove If. ?? SF: @ $ 'LJ'; !Ii /SF. = $
o Multi-family 0 Addition 0 Move )lr"Garage ,:J ;). t.; SF. @ $ 3 0 *~ /SF. = $
o Commercial 0 Remodel 0 Demolition 0 Deck SF. @ $ ./SF. = $
o Repair 0 Sign. , 0 Other TOTAL VALUATION $
BRIEF DESCRIPTION OF 11IEPROJECT: NEw l "51 "'f-J..'f,. 'F/PY1JJ..Y t<e5Fb'VV<!.-&. -
oAt. 5"TORy W)'1}f'hr'fA-C,ifEO ~-~ ~~~
COMMERCIALlRESIDENTIAL: Occupancy Group: Occupant LOad: " CoIistruCtion Type:
No. of Stories: -.L Lot Size: 90 C) / Existing Sq. Ft. e;J & Proposed Sq. Ft. /7:). :3 = TOTAL Sq.Ft. I 7;Z 3
Existing lot coverage -52- % '& PropOsed lot coverage -'..1-% = Total lot coverage If %
~r'" 3. '78' S....
c"
/ oJ I g ;,(s-
tf 6/0
,
PLANNING USE ONLY:
. APPROVALS:
PLAN:
BLDG:
DPWU:
ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other:
FIRE:
OTHER:_
BUILDING PERMIT APPLICATION SUBMI1TAL: The Building Division can provide you with information on the application and
plan submittal requirements if you have questions. "-
VALUATION 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 Building Division to comply with current fee schedules. Contact the Permit Coordinator at417-4815 for assistance.
PLAN CHECK FEE: IF a plan check fee is due it must be submitted at the time the building pennit application and construction plans are
submitted. All other permit fees are due at the time of permit issuance.
EXPIRATION OF PLAN REVIEW: Ifnopennitis issued within 180 days of the date of application, the application will expire. The
Building 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 Building 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 responsibility to determine w~at permits are required ,
T:\I;B~~)~B\BuiIdj~t~"
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JOB NO:
02030
CLIENT: FilE:
HOUSING AUTHROITY OF THE COUNTY OF CALLAM LOT4.DWG
2603 S, FRANCIS STREET DATE:
"'- PORT ANGELES, WA 98362 11-25-03...)
<J''''''~.
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CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
~21 EAST 5TH STREET. PORT ANGELES. WA 91n62
Application Number
pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use
Property Zoning , . ,
Application valuation
04-00000978 Date
,949514
1701 S 0 ST
06-30-01-5-5-0040-0000-
ELECTRICAL ONLY
1/21/05
RESIDENTAL SF 9000
RS9 RESDNTL SINGLE FAMILY
o
Owner
Contractor
PAULSEN, SHAWN
1214 COLUMBIA ST
PORT ANGELES
(360) 452-5203
WA 98362
ELECTRIC SERVICE
82 DRAPER RD
PORT ANGELES
(360) 452-6424
WA 98362
Permit
Additional desc
Sub Contractor
Permit Fee
Issue Date
Expiration Date
ELECTRICAL NEW RESIDENTIAL
NEW RESIDENCE
ELECTRIC SERVICE
96.40 Plan Check Fee
10/26/04 Valuation , ,
4/25/05
,00
o
Qty
1. 00
1. 00
Unit Charge Per
73,0000 ECH
23.4000 5C
EL-R-SQFT FIRST 1300
EL-R-SQFT ADDITIONAL 5QO
Extension
73.00
23.40
Fee summary Charged Paid Credited Due
----------------- ~--------- ---------- ---------- ----------
permi t Fee Total 96 ,40 96 .40 ,00 .00
Plan Check Total ,00 .00 ,00 .00
Grand Total 96,40 96 ,40 ,00 .00
~
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COMMENTS/ACTION NEEDED
ELECfRICAL PERMIT INSPE~f.lON RECORD
CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER.
INSULA TE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE
DATE
COMMENTS
NO
GENERAL COMMENTS:
PW-II02.1S (4196)
!f'PORT~
$.J,.O~~~
".
"-~
~
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use
Property Zoning , , .
Application valuation
04-00000290 Date
.145500
1701 S 0 ST
06-30-01-5-5-0040-0000-
ELECTRICAL ONLY
4/12/04
RESIDENTAL SF 9000
RS9 RESDNTL SINGLE FAMILY
o
Owner
Contractor
PAULSEN, SHAWN
1214 COLUMBIA ST
PORT ANGELES
(360) 452-5203
WA 98362
ELECTRIC SERVICE
82 DRAPER RD
PORT ANGELES
(360) 452-6424
WA 98362
permi t . . , .
Additional desc
Sub Contractor
Permit Fee
Issue Date
Expiration Date
ELECTRICAL TEMPORARY SERVICE
60A
ELECTRIC SERVICE
40.90 Plan Check Fee
4/12/04 Valuation
10/09/04
,00
o
,
~
"
Qty Unit Charge Per
1.00 40.9000 ECH EL-TEMP SRV - 0-60 SRV FDR
Extension
40,90
, .14
a
jI~
~
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 40,90 40.90 .00 .00
Plan Check Total ,00 .00 .00 .00
Grand Total 40.90 40.90 .00 .00
.
~
~
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 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 Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T:IPLANNlNG\FORMSllI02.15 [11114/2003]
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS, CALL 417-4735 FOR ELECTRICAL 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 LOCA nON,
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUND A T10N DRAINAGE/DOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN I
PLUMBING
~bER FLOOR 1 SLAB
~GH-IN
~A TER LINE (METER TO BLDG)
,~s LINE
i IIMK FLOW 1 WATER
Ad ~AL
V. lt1..LS
C Il'UNG I
FjI ~ING
JOISTS 1 GIRDERS
..sHEAR WALL/HOLD DOWNS
~;}LLS 1 ROOF 1 CEILING
~ 'IIf:YW ALL (INTERIOR BRACED PANEL ONL Y)
-LAR
IN~TION
?SLAB
W ~L 1 FLOOR 1 CEILING I
MECHANICAL
fiEA T PUMP
. "'~S LINE
~OD STOVE 1 PELLET 1 CHIMNEY
HfOD 1 DUCTS
P>>, UTILITIES 1 SITE WORK (Engineering Division) SEPARATE PERMIT #'5:
WATERLINE 1 METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT, SEPARATE PERMIT #'5 SEPA:
PARKING/LIGHTlN'::; ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 :Y/z~~i/ Ac:O ELECTRICAL
LIGHT DEPT
CONSTRUCTION R,W, 1 PWI , / CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW 1 ENGINEERING
FIRE 417-4653 FIRE DEPT,
PLANNING DEPT. 417-4750 PLANNING DEPT,
BUILDING 417-4815 BUILDING
T:\PLANNING\FORMSII 102,15 [11/1412003]
**
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FROM :
FAX NO. :
Aug.
05 2003 08: 03PM P2 .... ;~:A
I'Ok OFI'ICIAl. IJoo1'o..l
DoW'."
~,:
--,
--
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ELECTRICAL PERMIT APPLICATION
The E lectJtcaI PermIt AppUl:atJcm mUM b. fllled N com alat8lv.
P ,.... type or "pMlln Ink. "y DU """. .ny llIl_""". pi.... c.1I (3ID) .11-41.
F.. numb.r: lHII411-4111
4 ')'2. (.lj~ 'iFax:. 'i 6 'l- ~) '-j ?. Lj
Phon.: ~
PropOlty Owner.
Add""",: \1
. e CT
EI_IConlraalar. E.!" [..h-Lt.. k~" c..lo I~t.-. ~i_'.#:SJ: /32...... E1cp: "1
AddresS: . R"~ 0-~.- Vc< I lJ.., RJ Clly:~ f\L18.,J.-L~
INSTALLATION WIREP 8Y; Cl OWI\4ER ~ICA~ CONTRACTOR
Credit CarTI HoldSI' Name:
Zip: ~)
:"$ pRone:",,, 'I.'f
Zip: 7' g~ ~.
&rCHY-
~ . , Exp. Date:
On
PROJECT AllCHIESS: Iii I 5. CJ. oS T. / n 1/ /
/
2 WORK: Check ilIlhlt apply: 0 New
. esldentiaf Cl MultI-family . 0 CommitlCial
.
CnJdIf earTI Num"":
Zip:
VISA:
Billing AddNBB:
.5.
O. Sr; / /709
/
o Alteration/Addition
..:s. a. S r-..
.0 MobJIeHome
Sq.Ft.
o Remote Meter 0 Detached gEll'Bge'" cj Hol Tub .0 Swim Pool' 0 Septic Pump' ," 0 L-o\IlI VoIlege CI TeleccrT1.
Number of Circuits addtd or altered:
DESCRIPTION OF TH~ ELEC'TRIC,o,L PROJECT:
~~. t' "::.(-
.(Q&~
.EI~ Lft..... additions and or subtnlctiDnll
service Informatlan
o Overl\eed Service
oTempSlIIVlce
o Underground Service
VoltSge:
Phne: CJ 1 0 3
Service Size:
Feeder S~:
. 0 8_board
o Fumece
o Hoat Pump
o fen-WeU
KW
_KW
_TON_~R
KW
.
PAMC 14.05.060(8): For IndUlltrlel. com lII8<CIal. & residential projects larger than a duplex, a one. line drwwlng of the Electrical SenI
Fetder$. building slz e (sq. ft.). load calculations, and the ty pe & of conductolS and/or r8cew ey is required and sh8IJ accorn pany the
Electrical PlIIII1l1 application,
I hereby certify that I have read end examined this application and know that same to be true and correct, anc
authorizad to apply for this permit. I understand II is not the Clty's legal responsibility to determine whet perm
are requJr&d; It remains the applicants responsibility to determine what permits are required and to obtain SlJc.
OWn.r or lillC. ,om. slgniltur.:
('J 0./7) j
CJ:dVlAf,JAiCu.4R Pat.' ...('1 (.."
;?A~' 97 c2 ,~c1 Det.: ~ /1 (oy
PERMIT FEE: $ +'1;.90)(.3
Credll Card HoIder'a Slgn.ture'
PW.so1G17103
MAR 26 2004 13:32
HOUSING AUTH CLALLAM
3604577001
p.l
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2603 S. Francis Street
Port ~Ieles. WA 98362
If, " .,'
Housing ~uthority: of the
County o~ CI~lIarr":.::" t~.;.
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(360) 45~~.7631 . (360) 457-7001 Fax
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The hlonnallan _4ooh..d In 1he facsimile mes&aglIls IegIIIy ptIvIIeged and confidenllaJ Inlormallan
InlenCIed only for the use of the IndMdual or entlly to whom the fax 18 addressed. If the reader of this
messuge Is not the Intended reclplent, you .. notified that ..y dlssemlnallon, distrl>utlan or copy of this
teIecopy Is lIlrIdIy pmhIbIt8d. If you haw received this lelecopy In error, please Immediately noliIy 118 by
lllIepl10ne and l!Ilum the original mnngeto US at the addnI8s 8bove ~a the UnIt8d Slales PosIlI'SGrvk:e.
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MAR 26 2004 13:32
HOUSING AUTH CLALLAM
3604577001
p.2
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SHEET 1 OF 2
WII1Nr'.1 PR SCJRVBY1NG 4 MAPPING en
f 330 &AST FIRST ST.. SUITE JO
.PORT ANGELES. .WASHINGTON 98362
(380) 457-9600
FAX (380) 4:57-9558 .
SURVFYrJR'S CFRTJFTCATE
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