HomeMy WebLinkAbout2622 A & B Orchard Ave - Building
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'" Fon OFF1ClAL USE ONLY
BU!LDING PERMIT - APPLICATION I 'Date Rec, - -
I ~Penntl #' / I
Fill out COMPLETELY and in INK. Your application and site plan MUST BE ~' IDate ApP,oved'
COMPLETE to be accepted for revie",. If you have any questions, caU I '~
PERlVUTS (360) 417-4815 F..AX(360)417-4711 ,ate Issued
Phone:
LEG.AL DESCRIPTION: Lot:
CLALLAM COUNTY PARCEL NUMBER:
Block:
07D5>-
000
TYfE OF WORK:
IYtesidential ~ew Constr. D Re-roof D Stove
o Multi-family D Addition 0 MoveD Garage
o Commercial D Remodel 0 Demolition 0 De
o Repair D Sign 0 Other
BRIEF DESCRIPTION OF THE PROJECT:
SlZE/VALUATION:
SF. @$ 7.1. I~ /SF. = $
SF. @ $ ISF. = $
SF. @ $ /SF. = $
PI TOTAL VALUATION $
- -eX
.~ I CL> . qq LJ
,
& Proposed Sq. Ft.
PLANNING USE ONLY:
-055 ~ex-- ~\\rY\ U~\
Cv-v Y'I e,V r.
APPROVALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:_
ESAlWetland(s): DYe, No SEPA Checldist required? 0 Yes 0 No Other:
VALUATION 0 CONSTRUCTION: In aU cases, a valuation amount must be entered by the applicant.
This figure will e reviewed and may be revised by the Building Division to comply with current fee schedules. Contact the Permit
Coordinator a 17 -4815 for assistance.
PLAN C K FEE: IF a plan check fee is due it must be submitted at the time the building permit application and construction plans are
submitted. All other permit fees are due at the time of permit issuance.
EXPIRATION OF PLAN REVIEW: Ifno permit is 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
Rl 05.3.2 of the International Bui1dingfResidential Code, 2003). 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 ills my responsibility to determine what permits are required ,not the City's, and that I
must obtain such permits prior to work.
- J<..~
T:\FORMS\BJdgPerrnitform.wpd Applicant: ~
Date: q J.;;a/ab
,
,PREPARED 5/03/07,16:41:59 D/I'.\I
CITY OF PORT ANGELES '\~V\
Cro\\~vt;r
; APPLICATION NUMBER: 06-00001076 2622 ORCHARD AVE A
FEE DESCRIPTION AMOUNT DUE
MILW DRIVE ASSESSMENT
MECHANICAL PERMIT
BUILDING PERMIT - RESIDENTIAL
PLUMBING PERMIT
SANITARY SEWER HOOK UP
PUBLIC WORKS RES WATER SERV
SEWER SYSTEM DELV CHARGE
STATE SURCHARGE
PW WATER SYSTEM USE FEE
TOTAL DUE
960.00
215.40
2235.45
320.00
134.00
700.00
3480.00
12.00
4800.00
12856.85
PAYMENTS DUE RECEIPT
PROGRAM BP820L
Please present this receipt to the cashier with full payment.