HomeMy WebLinkAbout801 E Front St Ste D - Building 't
City
CERTIFICATE
of :Pout Angeles Building D iv i s i on
This certificate is issuedpursuant to the requirements of Section 111 of the 2009 International Building
Code certifying that at theime of issuance this�structure was in compliance with the various ordinances of
the City regulating buddingrconstruction or use forithe following r�
b Business name: I d Ap pare l and S m oke Y
Business address '801 E. Front St, Suite D 0
Properly owner: 8 01 E. Front LLC
Property owner's address: PO Box 460, Carlsborg, WA 98324
Automatic fire spnkler system: Per IBC
Use occupancy classification: Business
Occupant lo ad: Per 2 009 IBC, Table 1004.1.1
Building permit numb X 1 1 11128 r
Type of construction: VB. r
s
,�'a ma l OptC� k
12 -19 -11
Sue R b P Zann z ng�Manager Date
h
-„,-.71 r101 4 ba
o Post on the premises in a conspicuous place. This certificate shall not be removed except by the Building Official.
I
T
,our a ti CERTIFICATE OF OCCUPANCY APPLICATION Permit#
e s: R f FEES
CITY OF. PORT ANGELES $50 Certificate Inspection
Attn: Permit Technician
NNW 321 E. Fifth St., Port Angeles, WA 98362 arking Business Improvement Area (PBIA)
(360) 417 -4815 fax (360) 417 4711 fee charged for Downtown locations
)fr 5
PLEASE PRINT IN INK
Check one: New business in P.A. Change of ownership only? Moving location from within P.A.? Zoning C., A
BUSINESS NAME t-'I VO C s' YP,\ CW 16 1- 11n11
Business address a t* `!mp, D i 1- Mailing address 7 11 C G Finn J R1>r-I'PareS„ vim
Phone number,(, -I( ?.2( Opening dateJOV, ,2oli Days hours of operation_ do, y barvt-
Business owner's name he )+f°i'll,M- efsa,VOY Dkprham Contact phone -Lo tif0C�22
Business owner's address V1r(\ pto Pc ¶'t );m, InAI 9e, 3 PO—
Brief description of business Pt' k Sit al t, t
Property owner's name t` 0 0 E ELC Contact phone
Property owner's address /contact f 6 Pio',t 23 Ss �il�tr`d u .W Pr 6 t83 33 2 ;32_
It
BUILDING DEPARTMENT P hone 417 -4815 Bldg approval by /I on f
Is the business a restaurant or bar that will seat 50 or more people? Yes No 7
Construction changes planned (moving walls, adding /enlarging windows or doors, roofing, siding, foundation work,
adding /altering stairways, ramps, bathrooms, electrical, heating /cooling /ventilation systems, etc).
Work planned:
FIRE DEPARTMENT phone 417 -4653 Fire approval byV. )D by e 1 1 1
Changes to a fire sprinkler system or fire alarm system? Yes No/
Work planned:
PBIA (Parking Business Improvement Area Downtown) phone 417 -4623
Square footage of business? I S n‹--) PBIA notified 1v on
Is business moving within the PBIA? Yes No.
CITY CLERK phone 417 -4634 City Clerk approval by a'1.4 Mail
Second -hand dealer /pawnbroker business? Yes No t
Will there be dancing at this business? Yes No,,
A City of Port Angeles Business License is required for:
Taxi, Peddlers; Second -Hand Dealer, Pawnbroker, Dance,
Hotel- Motel, Fireworks, Ambulance, and Tattoo Businesses.
Page 1 of 2
,I'i
COMMUNITY ECONOMIC DEVELOPMENT phone 417 -4750 CED approval by 1 f
Number of off street parking spaces available for employees and
customers? S
(A parking plan may be required.)
Signs? (wall- mounted, freestanding, projecting, awning, A- frame, etc
Signs planned:
lend WSrar6∎ o ex-n.i Vaicke. 00aCc en
\Ou■
PLEASE NOTE: NO flashing, intermittent, or chasing signs are permitted in the City of Port Angeles.
PWE approval by l :Si I V I'd I I
PUBLIC WORKS DEPARTMENT- ENGINEERING phone 417 4812 4b (4)m
Is site work planned (new or re- located sewer or water service,
excavation, grading or filling work in City right -of -way,
new driveway openings, site drainage, parking lots, downspouts,
irrigation system backflow devices, etc.). Yes No R
Work planned:
PUBLIC WORKS WASTEWATER phone 4174845 PWW approval by
Will waste, other than domestic household waste, be discharged into the sewer system? Yes No/
If yes, what will be discharged:
Call for Certificate of Occupancy inspections BEFORE opening business.
Building Department Inspection 417 -4815
Fire Department Inspection 417 -4653
Please sign up for utility services at the cashiers' counter.
hereby apply for a Certificate of Occupancy. I acknowledge that I have read this application and state that the
information 1 have supplied is correct to the best of my knowledge. Incorrec formation may result in revocation of
permit.
Datei CAM Print Name /rP VOr a /v) Si atur
T:1Forms1Building Division\Certificate of Occupancy Application (2010).doc
Page2of2
Clallam County Assessor Treasurer Property Details 61645 801 E FRONT LLC for Page 1 of 1
Clallam County Assessor Treasurer
Property Search Results 61645 801 E FRONT LLC for Year 2011 2012
Property
Account
Property ID: 61645 Legal Description: SMITH, NORMAN R
LOTS 10 -12 BL 38
2/3-1/3 INT
Geographic ID: 0630005138400000 Agent Code:
Type: Real
Tax Area: 0010 PA 121 PORT ST CNN H2 L VVMP Land Use Code 59
Open Space: N DFL N
Historic Property: N Remodel Property: N
Multi- Family Redevelopment: N
Township Section:
Range'
Location �a ^Ul
Address: 801 E FRONT ST Mapsco:
PORT ANGELES, WA 98362
Neighborhood: PA East Comm Map ID: 2
Neighborhood CD: 5005000
Owner
Name: 801 E FRONT LLC Owner ID: 22952
Mailing Address: PO BOX 2323 Ownership: 100.0000000000%
SILVERDALE, WA 98383 -2323
Exemptions:
Taxes and Assessment Details
Property Tax Information as of 10/06/2011
Amount Due if Paid on: NOTE: If you plan to submit payment on a future date, make sure you enter the date and
click RECALCULATE to obtain the correct total amount due.
Click on "Statement Details" to expand or collapse a tax statement.
First Half Second Half
Year Statement ID Base Amt. Base Amt. Penalty Interest Base Paid Amount Due
R Statement Details
2011 156067 $4830.42 $4830.33 $0.00 $0.00 $4830.42 $4830.33
I" Statement Details
2010 44344 $4806 69 $4806.70 $0.00 $0.00 $9613.39 $0.00
Values
Taxing Jurisdiction
Improvement Building
Sketch
Property image
Land
Roll Value History
Deed and Sales History
Payout Agreement
This year is not certified and ALL values will be represented. with "N /A
Website version: 9.0.32.2200 Database last updated on: 10/6/2011 3:47 AM 2011 True Automation, Inc. All Rights
Reserved. Privacy Notice
http: /websrv8.clallam. net propertyaccess /Property.aspx ?cid =0 &year =2011 &prop_id =61645 10/6/2011
OW- 4w f CERTIFICATE OF OCCUPANCYAPPLICATIOIV Permit Il i
FEES
CITY OF PORT ANGELES 50 Certificate Inspection
A ttn: Permit Technician
"MOW 321 E. Fifth St., Port Angeles, WA 98362 1 Parking Business Improvement Area (PBIA)
(360) 417 -4815 fax (360) 417 -4711 fee charged for Downtown locations
5" A e PLEASE PRINT IN INK
Check one: New business in P.A. ?tX Change of ownership only? Moving location from within P.A.? Zoning
1
BUSINESS NAME \--I \f O +cvC4YP,\ G�l/Z^1 SVYI(?'�''1�
Business address ?�.O I 2. 1-trCn al(fiej Mailing address 'i I f 6 Frd7ri i Jv -A-i- 1 tivr
Phone number (.r ?,2-L 1. Opening date JOV; i, Ac e Days hours of operations• balm bpi
Contact hone -GU I ZZ2 1
Business owner's name 11�1,rv�k �t >,��rn.0rt�''C�teNo�r n,��j�m p y
Business owner's address 5 V1113 fp pci s .'Am. Md4 90' 7L Pt2
Brief description of business S!it' k s V'n4 n i r
Property owner's name i0 li E JS'1 k Lt---C Contact phone
Property owner's address /contact 'Q .P�0,< 2323 r S IN/Pc- G 1S3 3 3.- 3Z 3
BUILDING DEPARTMENT phone 417 -4815 Bldg approval by on
Is the business a restaurant or bar that will seat 50 or more people? Yes No jZ
Construction changes planned (moving walls, adding /enlarging windows or doors, roofing, siding, foundation work,
adding /altering stairways, ramps, bathrooms, electrical, heating /cooling /ventilation systems, etc).
Work planned:
FIRE DEPARTMENT phone 417 -4653 Fire approval by on
Changes to a fire sprinkler system or fire alarm system? Yes No/
Work planned:
PBIA (Parking Business Improvement Area Downtown) phone 417 -4623
Square footage of business? 1 5_0'0 PB/A notified
Is business moving within the PBIA? Yes No..
CITY CLERK phone 417 -4634 City Clerk approval by on I a/1 i
r
Second -hand dealer /pawnbroker business? Yes No t
Will there be dancing at this business? Yes No/
A City of Port Angeles Business License is required for:
Taxi, Peddlers, Second -Hand Dealer, Pawnbroker, Dance,
Hotel- Motel, Fireworks, Ambulance, and Tattoo Businesses.
r Page 1 of 2
COMMUNITY ECONOMIC DEVELOPMENT phone 417 -4750 CED approval by on
i
Number of off- street parking spaces available for employees and
customers?
(A parking plan may be required.)
Signs? (wall- mounted, freestanding, projecting, awning, A- frame, etc
Signs planned:
CZ, 4 a 14 a eY' oacrl nn
PLEASE NOTE: NO flashing, intermittent, or chasing signs are permitted in the City of Port Angeles.
PWE approval by A 4 on JCS /3
PUBLIC WORKS DEPARTMENT- ENGINEERING phone 417 -4812 ND -e vIf_S
Is site work planned (new or re- located sewer or water service,
excavation, grading or fillirig, work in City right -of -way,
new driveway openings, site drainage, parking lots, downspouts,
irrigation system backflow devices, etc.). Yes No R
Work planned:
PUBLIC WORKS WASTEWATER phone 417 4845 PWW approval by on
Will waste, other than domestic household waste, be discharged into the sewer system? Yes Nogi
If yes, what will be discharged:
Call for Certificate of Occupancy inspections BEFORE opening business.
Building Department Inspection 417 -4815
Fire Department Inspection 417 -4653
Please sign up for utility services at the cashiers' counter.
hereby apply for a Certificate •of Occupancy. I acknowledge I have read this application and state that the
information I have supplied is correct to the best of my knowledge. Incorrec formation may result in revocation of
Print Name gVOr i /vj iv Si atur:
WWI/
T: \Forms \Building Division Certificate of Occupancy Application (2010).doc
Page 2 of 2
COMMUNITY ECONOMIC DEVELOPMENT phone 417 -4750 CED approval by on
Number of off street parking spaces available for employees and
customers?
(A parking plan may be required.)
Signs? (wall- mounted, freestanding, projecting, awning, A- frame, etc
Signs planned:
`pc \.a's\
tom e aC� ,Mvarc\Cnc) U PXXS\- ViTcAr(boaccl nn
PLEASE NOTE: NO flashing, intermittent, or chasing signs are permitted in the City of Port Angeles.
PWE approval by on
PUBLIC WORKS DEPARTMENT- ENGINEERING, phone 417 -4812
Is site work planned (new or re- located sewer or water service,
excavation, grading or filling, work in City right -of -way,
new driveway openings, site drainage, parking Tots, downspouts,
irrigation system backflow devices, etc.). Yes No ,F2'
Work planned:
PUBLIC WORKS WASTEWATER phone 417 4845 Pwwapproval by on
Will waste, other than domestic household waste, be discharged into the sewer system? Yes No;(21
If yes, what will be discharged:
Call for Certificate. of Occupancy inspections BEFORE opening business.
Building Department Inspection 417 -4815
Fire Department.lnspection 417 -4653
Please sign up for utility services at the cashiers' counter.
I hereby apply for a Certificate of Occupancy. I acknowledge that l have read this application and state that the
information I have supplied is correct to the best of my knowledge. Incorrec formation may result in revocation of
permit.
Date Print Name irg VCJ/ .0r) Si atur: AA -a-
T: IFormstBuilding DivisionlCertificate of Occupancy Application (2010).doc
Page2of2
co o ,:r A It CERTIFICATE OF OCCUPANCY APPLICATION Permit# I \7,f
s*., FEES
flic CITY OF PORT ANGELES $50 Certificate Inspection
Attn: Permit Technician
'WNW 321 E. Fifth St., Port Angeles, WA 98362 l Parking Business Improvement Area (PBIA)
(360)417-4815 fax (360) 417 -4711 fee charged for Downtown locations
5;\ V PLEASE PRINT IN INK
Check one: New business in P.A. ?Nl Change of ownership only? Moving location from within P.A.? Zoning CA
1
BUSINESS NAME vo C ina1/P,A CWY`1 SitrYwitinf
Business address ,A01 b 'Q71>{' 1 Wet* Mailing address 1 i G FOX t iY� 1 v im
Phone number, )--I( 2-( Opening date t OV j ,201 -1 _Days hours of operation:, Dail baW)- lcpv1
Business owner's name'(YlP.,VANn ter Y Dsy e (Yetla�r Doy ar�n _Contact phone -,C.0 ''1Ca&t2s, ZZ
2
Business owner's address 5 Vir 4• "0
Brief description of business SIC 1 1.,A St'l''• A A AL C,-._.
r
Property owner's name c 0 EY1i" LL_C Contact phone
Property owner's address /contact 2• 2 k 4r .c. W at d
NT phone 417 -4815 g approval by i4, /it on
BUILDING DEPARTME Bld a p
Is the business a restaurant or bar that will seat 50 or more people? Yes No 71
Construction changes planned (moving walls, adding /enlarging windows or doors, roofing, siding, foundation work,
adding /altering stairways, ramps, bathrooms, electrical, heating /cooling /ventilation systems, etc).
Work planned:
FIRE DEPARTMENT phone 417 -4653 Fire approval by_ z '4) on It -3 0 I t
Changes to a fire sprinkler system or fire alarm system? Yes No/
Work planned:
PBIA (Parking Business Improvement Area Downtown) phone 417 -4623
Square footage of business?
5 r)-0 PBIA notified on
Is business moving within the PBIA? Yes No.g
CITY CLERK phone 417 -4634 City Clerk approval by on
Second -hand dealer /pawnbroker business? Yes No .t
Will there be dancing at this business? Yes No,
A City of Port Angeles Business License is required for:. t
Taxi, Peddlers, Second -Hand Dealer, Pawnbroker, Dance,
Hotel- Motel, Fireworks, Ambulance, and Tattoo Businesses.
Page 1 of_
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CERTIFICATE
City of Port AngeleS: Building Division
This certificate is issu'dpur.suani 10 the requirements of Section 111 of the 2009International Building Code
certifying that at the t e;OliSSUanfrthefinmeturewas in compliance with the various ordinances of the City
regulating building cpns,CtiOne 'Ilse fo 0111000
Business name i ceptge-R. Bre:tylpF.
CPA
Business address e :WE. front St, 5:41ite:eP, r:
Property owner i:' 4 801 E. FrotiV140
Property owner s address: PO Box 460Ctirl$1594'= A 98324
Automatic fire sprinkler system. Per Ipp
cA 4
Use occupancy classification Busit;l0s
Occupant load.
Building permit numben
Type of construction.
12-21-10
Date
ra- Pr.
Post on the premises in a conspicuous place. This not be removed except by the Building Official.
Y\aA, c 1 st
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER
Application type description
Subdivision Name
Property Use
Property Zoning
Application valuation
Application desc
4 circuit remodel
Owner
801 E FRONT LLC
PO BOX 460
CARLSBORG
(360) 683 9033
Permit
Additional desc
Permit pin number
Permit Fee
Issue Date
Expiration Date
Qty
1 00
3 00
Unit Charge
73 5000
2 6000
Permit Fee Total
Plan Check Total
Grand Total
WA 98324
ELECTRICAL
178640
81 30
12/08/10
6/06/11
Per
ECH
ECH
Fee summary Charged
81 30
00
81 30
Signature of owner or Electrical Contractor X
ELECTRICAL PERMIT
CITY OF PORT ANGELES
360 417 -4735
10 00001433 Date 12/08/10
933854
801 E FRONT ST/CO 1)1•1 6 1 O b
06 30 00 5 1 3840 0000
ELECTRICAL ONLY
COMMERCIAL ARTERIAL
0
Contractor
NORTH PENINSULA ELECTRIC
761 FRESHWATER PARK RD
PORT ANGELES WA 98363
(360) 477 1764 CM: -W
ALTER COMMERCIAL 9, LTER COMMERCIAL J j
Plan Check Fee 00
Valuation
EL BRANCH CIRCUIT WO /FEEDER
EL ECH ADDNT BRANCH CIRCUIT
Paid Credited
81 30 00
00 00
81 30 00
INSPECTION TYPE DATE.
DITCH
SERVICE
ROUGH IN
FINAL
COMMENTS
PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION
RESULTS
lzlia fib a
Acv
0
Extension
73 50
7 80
Due
00
00
00
REPORT STATE SALES TAX
on your excise tax form
to the City of Port Angeles
(Location Code 0502)
INSPECTOR.
Date.
2010 -12 -07 16:50 NORTH PENINSULA ELEC
City of Port Angeles Permit Application
Building Division /Electrical Inspections
321 East Fifth Street P.O. Box 1150
Port Angeles Washington, 98362
Ph: (380) 417 -4735 Fax: (360) 417-4711
I,.
Date: U
1 2 Single Family Dwelling
Multi- Family Or Commercial'
LCommerc al Addition I Alteration Remodel Repair*
Plan Review May Be Req
Job Address.
Building Square Footage:
Description of above
Owner I f m
Name:
Mailing Addre
City Y'� State.) t,+ Zip
Phone: Fax:
License Exp.
Unit Charms
119.90
145.50
204.60
S 262 20
372.50
S 2.60
S 73 50
2.60
92.70
$110.30
148.10
$167 90
95.90
it 88 20
9590
$6390
S 63.90
119.90
102.30
S 110.30
5 35.20
5 73.50
110.30
56.00
Owner as defined by RCW.19.26.261 (1) Owner will occupy the structure Mr two years after this electrical permit is finalised. /2) Owner Is required to hire an electrical contractor If
above said property is for sale, rent or leave. Permit expires after six months of last Inspection.
After reading the above statement, I hereby certify that I am the owner of the above named property or a licensed electrical contractor. I em making the electrical Installation or
alteration in compliance with the electrical laws, N.E.C. RCW. Chapter 19.28, WAC. Chapter 298.468, The City of Port Angeles Municipal Code, and Utility Specifications.
Signature of owner. electrical contractor or electrical administrator Cash
x
wire Ple; a Complete Elecj<ical P n Re, eys Informabon Sheet F
Contractor I rmati n� r
Name 1\ >C) Y' 1F l 1� f .1
Mailing Addles L. r Y
2. City State:
Phone•--\l
License Exp. 10 r 4- CI Z
Total (Qty Multiplied by Unit CharoJ
Service/Feeder 200 Amp.
Service/Feeder 201 -400 Amp.
Service/Feeder 401 -600 Amp
Service/Feeder 601 1000 Amp
Service/Feeder over 1000 Amp
Branch Circuit W/ Service Feeder
Branch Circuit W/O Service Feeder
YO I Each Additional Branch Circuit
Temp. Service/Feeder 200 Amp.
Temp Service/Feeder 201-400 Amp
Temp. Service/Feeder 401-600 Amp.
Temp. Service/Feeder 601 -1000 Amp
Portal to Portal Hourly
Sign/Outline Lighting
Signal Circuit/ Limited Energy Commercial. Addiuonat 1500 5500
Signal Circuit/ Limited Energy 1 8 2 Famly Dwelling
Signal Circuit/ Limited Energy Multi-Family towelling
Manufactured Home Connection
Renewable Electrical Energy 5KVA System or Less
First 1300 Square Ft.
Each Additional 500 Square Ft. or Portion or
5 Each Outbuitinng or Detached Garage
S Each Swimming Pool or Hot Tub
S 1.' Thermostat
$51 Total
Check
la 1-1 t)
3609289409
360 417 4711
I E
L J
L.
ELECTRICAL
INSPECTIONS
Credit Card I C 1
P 1/1
PREPARED 10/29/10 8 21 01 INSPECTION TICKET PAGE 7
CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 10/29/10
ADDRESS 801 E FRONT ST D SUBDIV
TENANT NBR GEORGE R BRALY CPA
CONTRACTOR PHONE
OWNER 801 E FRONT LLC PHONE (360) 683 9033
PARCEL 06 30 00 5 1 3840 0000
APPL NUMBER 10 00001062 CO CHANGE OF OCCP /USE
PERMIT CO 00 CHANGE OF OCCUP /USE
REQUESTED INSP DESCRIPTION
TYP /SQ COMPLETED RESULT RESULTS /COMMENTS
CO99 01 10/29/10
JLL
BLDG C/O FINAL TIME 01 00
OVERRIDE TAKEN BY LPANGRLE DATE 10/28/10 TIME 16 51 08
October 28 2010 4 50 15 PM 1pangrle
MACK 360 460 1179
C OF 0 FINAL GEORGE R BRALY CPA
AFTERNOON
COMMENTS AND NOTES
RECEIVED
SEP 2 1 2010
0)Kr,i CERTIFICATE OF OCCUPANCY APPLICATION
.41 EL ES
CI
WITHIN P.A.? Zoning C
BUILDING DEPARTMENT phone 417 -4815
Is the business a restaurant or bar that will seat 50 or more people?
Work planned
FIRE DEPARTMENT phone 417 -4653
CITY OF PORT ANGELES
Attn. Permit Technician
321 E. Fifth St. Port Angeles, WA 98362
(360) 417 -4815 fax (360) 417 -4711
Changes to a fire sprinkler system or fire alarm system? Yes No
Work planned
PBIA (Parking Business improvement Area owntown) phone 417 -4623
J )i)
Square footage of business k l
Is business moving within the PBIA? Yes No
12 5.RK phone 417 -4634
Second -hand dealer /pavvnnbroker business? Yes ❑,�Noo
Will 1hc.� dancing at this business? Yes No LW
A City of Port Angeles Business License is required for
Taxi, Peddlers, Second -Hand Dealer Pawnbroker Dance,
Hotel Motel, Fireworks, Ambulance, and Tattoo Businesses.
Page 1 of 2
Permit# (9
FEES
FEES
Certificate Inspection
00 Parking Business Improvement Area (PBIA)
fee charged for Downtown locations
Suj }e P EASE PRINT IN INK
CHECK ONE. ,NEW BUSINESS IN P.A.? CHANGE OF OWNERSHIP ONLY? MOVING LOCATION FROM
BUSINESS NAMEt C� w rGt)K G t. kt l i r A C(6 Cc Y tC.1 g k
Business addre s W 1 r_ t' it.btJ 1 '1 Y/ �)k Maili g address 15 v ->I Li .O LS 16 di; Vkk_ Wit re Phone number (.IS (4i, 0 1 'LA Opening d e I -I v_ Da hours of op ration y 4 Y
Business owner's name C._ f P, C phone In 0 I 1
Business owner's address 0 l L 1' k- U t' k W A `r
Brief description of business AC U ki(Tio r, d-- Egli- (Al) q ji ti k
Bldg approval by
Yes No '(17
on
Construction changes planned (moving walls, adding /enlarging windows or doors roofing siding foundation work,
adding /altering stairways ramps, bathrooms electrical heating /cooling /ventilation systems, etc)
Property owner's name gl 6V *tV (0 t NA Contact phone ,y d ��3 q 5
Property owner's address /contact j) G Il O, I n
Il-0( `4�l u c �.7VU9 1x
Q I
,a
Fire approval by on
PBIA notified on
City Clerk approval by on
COMMUNITY ECONOMIC DEVELOPMENT phone 417 -4750
Number of off-streel parking spaces available for employees and
customers? 0
(A parking plan may be required.)
Signs? (wall- mounted, freestanding projecting awning A -frame etc
Signs planned:
PLEASE NOTE. NO flashing, intermittent, or chasing signs are permitted in the City of Port Angeles.
PUBLIC WORKS DEPARTMENT ENGINEERING phone 417 -4812
Is site work planned (new or re- located sewer or water service,
excavation, grading or filling work in City right -of -way
new driveway openings, site drainage, parking lots do spouts
irrigation system backflow devices, etc.) Yes No
Work planned
PUBLIC WORKS WASTEWATER phone 417 4845
Will waste other than domestic household waste be discharged into the sewer system? Yes No
If yes, what will be discharged
Please sign up for utility services at the cashiers' counter
.l hereby apply for a Certitccc.te of Occupancy 1- acknowledge that I have r this p lication and state that the
information I have supplied_, is to the best of my knowledge lncorrect :ir form ion may result in re.vonation_of
permit.
Datel I 1 10 Print Name „U,
h k.1 ti er (k
T \Fors \Building Division \Certificate of Occupancy Application (2010).doc
LMLI Signature...
I
Page 2 of 2
CED approval.by L.Z.1 on 9 /3e) if
PWE approval by on
PWW approval by
Call for Certificate of Occupancy inspections BEFORE opening business.
Building Department Inspection 417 -4815
Fire Department Inspection 417 -4653
on
RECEIVED j�
o er
SEP 2 1 2010
pther�?ti CERTIFICATE OF OCCUPANCY APPLICATION
0
FPCWIT ELES I
'N
Work planned
CITY OF PORT ANGELES
Attn. Permit Technician
321 E. Fifth St. Port Angeles, WA 98362
(360) 417 -4815 fax (360) 417 -4711
5u P EASE PRINT IN INK
CHECK ONE. 1NEW BUSINESS IN P.A.? CHANGE OF OW NERSHIP ONLY? MOVING LOCATION FROM
BUSINESS NAME!, G r�U1 G g A( r� �Lsi e Ptk c A (ii ICC g
I V_ 1" btJ 1 4 .1 1' Y(' k Maili g address
W
Business addre s n r( i �i_D l \(LuS 13 daC, In►A! j
Phone number (-)6 L1I 0 4 1 Opening d e JD Da hours of opl�ration (y ►A
Business owner's name v,
g 1 C l C p hone `Ttn 0 12.2-
Business owner's address 0 t Ms Y Pk wR
Brief description of business AC( vui k)( t) 4 1 C (A tidA
WITHIN P.A.? V Zoning C i5(
BUILDING DEPARTMENT phone 417 -4815
Is the business a restaurant or bar that will seat 50 or more people?
Construction changes planned (moving walls adding /enlarging windows or doors roofing siding foundation work,
adding /altering stairways, ramps bathrooms, electrical heating /cooling /ventilation systems, etc)
Property owner's name g'rPoj 6i .1 kt/') C 0 U' Contact phone y (a d .el 5
Property owner's address /contact l r
it
FIRE DEPARTMENT phone 417 4653
Changes to a fire sprinkler system or fire alarm system? Yes No
Work planned
PBIA (Parking Business Improvement Area E owntown) phone 417 -4623
v
Square footage of business i t? i PBIA notified on
Is business moving within the PBIA? Yes No I
CITY CLERK phone 417 -4634
Second -hand dealer /pawnbroker business? Yes ❑N o
Will there be dancing at this business? Yes No L�
A City of Port Angeles Business License is required for
Taxi, Peddlers, Second -Hand Dealer Pawnbroker Dance,
Hotel- Motel, Fireworks, Ambulance, and Tattoo Businesses.
Page 1 of 2
FEES
Certificate Inspection
Parking Business Improvement Area (PBIA)
fee charged for Downtown locations
Bldg approval by
Yes No I/
Fire approval by on
City Clerk approval by
Permit# V•O
on
on
COMMUNITY ECONOMIC DEVELOPMENT phone 417 -4750
Number of off-streel parking spaces available for employees and
customers? 0
(A parking plan may be required.)
Signs? (wall- mounted freestanding, projecting awning A- frame, etc
Signs planned:
PLEASE NOTE. NO flashing intermittent, or chasing signs are permitted in the City of Port Angeles.
PUBLIC WORKS DEPARTMENT ENGINEERING phone 417 -4812
Is site work planned (new or re- located sewer or water seryice,
excavation, grading or filling work in City right -of -way
new driveway openings site drainage, parking lots do spouts
irrigation system backflow devices etc.) Yes No
Work planned
PUBLIC WORKS WASTEWATER phone 417 -4845
CED approval by on
PWW approval by on
PWE approval by _5 V on q 3O LO
Nc9
Will waste other than domestic household waste, be discharged into the sewer system? Yes No qi
If yes, what will be discharged
Call for Certificate of Occupancy inspections BEFORE opening business.
Building Department Inspection 417 -4815
Fire Department. Inspection 4 -4653
I hereby apply for a Certificate of Occupancy I acknowledge that I have eland this A pplication and state that the
information I have supplied is correct to the best of my' knowledge. Incorrect it form ion may result in revocation- of
permit.
10 Print Name Sf/bt`Ui LI Signature
I
T \Forms \Building Division \Certificate of Occupancy Application (2010).doc
Please sign up for utility services at the cashiers' counter
Page 2 of 2
RECEIVED
SEP 2 1 2010 CIf TIFICATE OF OCCUPANCY APPLICATION
0 ppltTq
CI o y ELES
CHECK ONE.
BUSINESS NAM C rLOg G 6 r(
Business addre
Phone number
Business owner's name
Business owner's address 0
Work planned
CITY OF PORT ANGELES
Attn. Permit Technician
321 E. Fifth St. Port Angeles, WA 98362
(360) 417 -4815 fax (360) 417 -4711
NEW BUSINESS IN
Second -hand dealer /pawnbroker business? Yes ❑�N /o
Will there be dancing at this business? Yes No ICY
A City of Port Angeles Business License is required for
Taxi, Peddlers, Second -Hand Dealer Pawnbroker Dance,
Hotel Motel, Fireworks, Ambulance, and Tattoo Businesses.
Page 1 of 2
f `Atli 1/..1 Y.! 1/1_14
FIRE DEPARTMENT phone 417 -4653
Changes to a fire sprinkler system or fire alarm system? Yes No
Work planned
PBIA (Parking Business Improvement Area wntown) phone 417 4623
Square footage of business 1
1
Is business moving within the PBIA? Yes No I
CITY CLERK phone 417 -4634
Permit# LO 0 (92
FEES
Certificate Inspection
00 Parking Business Improvement Area (PBIA)
fee charged for Downtown locations
P EASE PRINT IN INK
P.A.. CHANGE OF OWNERSHIP ONLY MOVING LOCATION FROM
1 Y7 LJk Mailing address )c Li 0 j' (LS w� g 1
Opening d e (!O Dais hours of op ration 1. '►VA y
c, k C e Ckl phone I
ui4 ,1 k A 3(r
Brief description of business Ar l(t l G 6- I`ku l c A i►ni e" yJ
WITHIN P.A.? G Zoning C.
BUILDING DEPARTMENT phone 417 -4815
Is the business a restaurant or bar that will seat 50 or more people? Yes No V/
PBIA notified
Bldg approval bal...-
onj¢ -Z9 I 0
Construction changes planned (moving walls adding /enlarging windows or doors, roofing siding, foundation work,
adding /altering stairways, ramps, bathrooms, electrical heating /cooling /ventilation systems, etc)
Property owner's name i4 61 kW i it 0 6 1' O` Contact phone y (o d I b 5 S
Property owner's address /contact p Q 4� (tog D A L S (L 1 tt g 5 t l
Fire approval by ig,D V on t 2 10 —I Q
City Clerk approval by 1 H on C 1 10-1
COMMUNITY ECONOMIC DEVELOPMENT phone 417 -4750 CED approval by SR_ on 6 1 -3 0 10
Number of off-streel parking spaces available for employees and
customers? 0
(A parking plan may be required.)
Signs? (wall- mounted, freestanding projecting awning A -frame etc
Signs planned
1.1h o kl ((k6 \k‘
PLEASE NOTE. NO flashing intermittent, or chasing signs are permitted in the City of Port Angeles.
PUBLIC WORKS DEPARTMENT- ENGINEERING phone 417 -4812
Is site work planned (new or re- located sewer or water se ice
excavation, grading or filling, work in City right -of -way
new driveway openings site drainage parking lots do spouts,
irrigation system backflow devices etc) Yes No
Work planned
PUBLIC WORKS WASTEWATER phone 417 4845
Will waste other than domestic household waste be discharged into the sewer syste
If yes, what will be discharged
Call for Certificate of Occupancy inspections BEFORE opening business.
Building Department Inspection 417 -4815
Fire Department Inspection 417 -4653
Please sign up for utility services at the cashiers' counter 1
I hereby apply for a Certificate of Occupancy I acknowledge that I have i d this pplication and state that the
information I have supplied is correct to the best of my knowledge. Incorrect it form ion may result in revocation of
permit. r r y
Signature
Date_ /I P to Print Name �J /b�l�t 1\ $LI
I
T \Forms \Building Division \Certificate of Occupancy Application (2010) doc
Page 2 of 2
PWE approval by RV on -36
PWW approval by
Yes No
730
820
815
Bii