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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, W A 98362
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr, name
Application type description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
07-00001078 Date
570164
1121 E 4TH ST
06-30-00-5-4-0160-0000-
KELMIE BLAKE
MECHANICAL APPL. PERMIT
9/18/07
RS7 RESDNTL SINGLE FAMILY
2000
Owner
Contractor
KELMIE BLAKE
1121 E. 4TH ST.
PORT ANGELES
(360) 452-4367
WA 98362
EVERWARM
257151 HWY101
PORT ANGELES
(360) 452-3366
WA 98362
Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
MECHANICAL PERMIT
111203
50.00 Plan Check Fee
9/18/07 Valuation
3/16/08
.00
o
Qty Unit Charge Per
1.00 50.0000 ECH ME-WOOD BURNING APPL.
Extension
50.00
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 50.00 50.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 50.00 50.00 .00 .00
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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 orwork 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 ereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and or . ances JlPverning this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume t give autnority t iolate or c ncel the provisions of any state or local law regulating construction or the performance of
con ruc.
Signature of Owner (if owner is builder)
Date
T:\Policies\l102_15 building pennit inspection record05.wpd [1/4/2005]
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 4] 7-4735 FOR ELECTR]CAL INSPECTIONS.
CALL 417-4807 FOR PUBLIC WORKS UTILITIES 0
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULATE OR CONCEAL AN}' WORK EEFORE .:.J
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPJCUOUSLOCATION. ,
KEEP PERMIT CARD AND APPROVED PLANS AT .lOB SITE.
INSPECTION TYPE llATE ACCEI'TEll COMMENTS
I YES NO
FOUNI)A TlON:
FOOTINGS
SHEAR WALLS / WALLS
FOUNDA TJON DRAINAGE/ DOWN SPOUTS
PIERS
POST HOLES (POLE BLOGS.)
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
WATER LINE (METER TO BLOG)
GAS LINE FINAL DATE ACCEPTED BY:
BACK FLOW / WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS / GIRDERS
SHEAR W ALL/HOLD DOWNS
WALLS / ROOF / CEILING
DRYWALL (INTERJOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILING
MECHANICAL
ROUGH-IN
HEAT PUMY lFURNACE/DUCTS Elli&-I 0 /61/r51 DATE -:s LL-
GAS LINE ACCEPTED BY:
WOOD STOVE / PELLET / CHIMNEY J
MANUFACTURED HOMES
FOOTING / SLAB
BLOCKING & HOLO DOWNS
SKJRTING
PLANNING DEPT. SEPARATE PERMlT#'s SErA:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRJCAL - LIGHT DEPT. 417-4735 ELECTRJCAL
LIGHT DEPT
CONSTRUCTION R.W. / PW/ CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW I ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
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T:\Policies\1102 15 buiJdmg pemlll mspecllOn record05.wpd [1/4/2005]
"
BUILDING PERMIT - APPLICATION
Fill out COMPLETELY and in INK. Your application, prescriptive energy
form, plans, specs, and a 8 W' x 11 " site plan MUST BE COMPLETE to be
accepted for review. (360) 417-4815 FAX (360) 417-4711
FOR OFFICIAL USE ONLY:
Date Rec.: CJ-I3' / 07
Permit #: 0" ~ \ (\ :1<6
Date Approved: Cl-I <6 ~ D-,
Date Issued: I I
Residential projects: submit two sets of plans
Commercial projects: submit three sets of plans
Owner's Address
Phone
Phone 4r-L.---- 43~ r
Applicant
Owner
ContractorlEngineer
ContractorlEngineer's Address .......-D-
PROJECTADDRESS:~ll-\ t:& ~T-- ~t-...
LEGAL DESCRIPTION: Lot: Block: Subdivision:
CLALLAM COUNTY PARCEL NUMBER:
Expires
Phone
ZONING:
SIZEN ALUA TION
SF. @ $ /SF. == $
SF. @ $ /SF. == $
SF. @ $ /SF. == $
TOTAL VALUATION $ ...2 I e-co
~e WX rO', ~ lJlh\ a-.. V'e/
o Residential
o Multi-family
o Commercial
o Repair
TYPE OF WORK
o New Constr. 0 Re-roof J Stove
o Addition 0 Move 0 Garage
o Remodel 0 Demolition 0 Deck
o Sign 0 Other
BRIEF DESCRIPTION OF THE PROJECT:' Ffnll
\\1\
.
COMMERCIAL/RESIDENTIAL: Occupancy Group: Occupant Load: Construction Type:
Existing Structure(s) basement Sq. Ft. & Proposed Structure(s) basement Sq. Ft.
1st floor Sq. Ft. & 1st floor Sq. Ft.
2nd floor Sq. Ft. & 2nd floor Sq. Ft.
3'd floor Sq. Ft. & 3'd floor Sq. Ft.
Accessory Structures Sq. Ft. & Accessory Structures Sq. Ft.
Existing Structure(s) TOTAL Sq. Ft. & Proposed Structure(s) TOTAL Sq. Ft.
TOTAL of existing & proposed structures Sq. Ft.
Maximum Height of Proposed Structure(s) Ft.
LOT COVERAGE
Lot size Sq. Ft.
Existing Structure(s) Sq. Ft. Footprint
Proposed Structure(s) Sq. Ft. Footprint
TOTAL Structure(s) Sq. Ft. Footprint
Total Lot Coverage %
Are you planning to install a lawn sprinkler system?
(Divide Total Structure(s) Sq. Ft. Footprint by Lot Size Sq. Ft.)
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 at 417-4815
for assistance.
PLAN CHECK FEE: The plan check fee must be paid at the time the building permit application is submitted. All other permit fees are
due at the time of permit issuance.
EXPIRATION OF PLAN REVIEW: An application for a permit for any proposed work shall be deemed to have been abandoned 180
days after the date of filing unless such application has been pursued in good faith or a permit has been issued; except that the buildirig
official is authorized to grant one or more extensions oftime for additional periods not exceeding 180 days (90 days for commercial
projects) each. The extension shall be requested in writing and justifiable cause demonstrated. (IRC/IBC 2006 105.3.2)
I hereby certify that I have read and examined this application nd know the same to be tr e and correct. I am authorized to
apply for this permit and understand that it is my respo sibil" to deterfJ'tine permits re required, and that I must obtain
such penn/ts p~ /, (
Date '1. 0
T:\FORMS\BUILDING DIVISION\BldgPermitAppl.-2006 CODE - backup.wpd