HomeMy WebLinkAbout1521 O St - BuildingNAME OF PREMISES
SERVICE ADDRESS
LOCATION OF DEVICE.
ASSEMBLY V 1) I A/
Manufacturer
IS THIS AN APPROVED ASSEMBLY'? YES NO IS ASSEMBLY INSTALLED CORRECTLY' YES NO
DATE OF INSTALLATION UNKNOWN
Initial
Test
Repairs
Details
Final
Test
Initial
Test
Repairs
Final
Test
DOUBLE CHECK VALVE ASSEMBLY
CHECK VALVE 1 CHECK VALVE #2 RELIEF VALVE PVB/SVB
Leaked
Held at 7. Cpsi
Cleaned
Replaced
REDUCED PRESSURE PRINCIPLE ASSEMBLY
Held at psi
Backflow Assembly Test Report
City of Port Angeles
Public Works and Utilities Department
Water/Wastewater Collection Division
r .a
r/
f i14 1 /76 Trf
5G X 6.
Model Size Serial No
Leaked
Closed Tight
Held at t g C
Cleaned Cleaned
Replaced Replaced
Closed Tight
Held at
Did Not Open
Opened at psi
3 psi Buffer YES NO
Opened at psi
AIR GAP INSPECTION
REQUIRED MINIMUM SEPARATION YES NO
COMM ENTS
Ott S e C j e 7 S i 12 1 ii P
WHITE CUSTOMER COPY YELLOW PURVEYOR COPY PINK TESTER COPY
RP RPDA
DC at! DCDA
PVB Air Gap
SVB AVB
AIR INLET r
Did Not Open
Opened at psi
CHECK VALVE
Leaked Held at psi n
REPAIRS 1 1'
Cleaned
Replaced
TYPE OF HAZARD
7 Line Pressure I 3" psi
Held Backpressure
#2 Shutoff Held
Official Use Only
Asscm
Received
AIR INLET Opened at psi
CHECK VALVE Held at psi
BACK PRESSURE NO YES
4
YES [a''NO
YES 13- NO
Relief Valve Exercised YES NO
Date/Time Tester Signature Cert. Test Kit Passed Failed
/3( -r)ct1 15fr f x -51' A4 lP rvs'r; i
Application Number 08 00000403
Application pin number 680118
Property Address 1521 0 ST
ASSESSOR PARCEL NUMBER 06 30 99 1 0 8040 0000
Application type description PUBLIC WORKS UTILITES
Subdivision Name
Property Use
Property Zoning RS9 RESDNTL SINGLE FAMILY
Application valuation 0
Application desc
Install irragation water meter
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET PORT ANGELES, WA 98362
Owner Contractor
OSTERBERG KENT W /KARI L
1521 SO
PORT ANGELES WA 983631313
Permit
Additional desc
Permit pin number
Permit Fee
Issue Date
Expiration Date
PLUMBING PERMIT
OWNER
Date 4/03/08
124065
57 00 Plan Check Fee 00
4/03/08 Valuation 0
9/30/08
Qty Unit Charge Per Extension
BASE FEE 50 00
1 00 7 0000 ECH PL- EA LAWN BACKFLOW 7 00
Fee summary Charged Paid Credited Due
Permit Fee Total 57 00 57 00 00 00
Plan Check Total 00 00 00 00
Grand Total 57 00 57 00 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 has 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
V-3-6 e;.
Date
Print Name
T.Forms /Building Division/Building Permit (10 /01 /07).wpd
A“ei
Signature of.eontractor or Authorized Agent Signature of Owner (if owner is buildtr)
I MANUFACTURED HOMES
CALL 417 -4815 FOR BUILDING INSPECTIONS CALL 417 -4735 FOR ELECTRICAL INSPECTIONS.
CALL 417 -4807 FOR PUBLIC WORKS UTILITIES
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
FOUNDATION•
FOOTINGS
SHEAR WALLS WALLS
FOUNDATION DRAINAGE DOWN SPOUTS
PIERS
POST HOLES (POLE BLDGS.)
PLUMBING
UNDER FLOOR SLAB
ROUGH -IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS ROOF CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T -BAR
INSULATION
SLAB
WALL FLOOR CEILING
MECHANICAL
HEAT PUMP FURNACE DUCTS
GAS LINE
WOOD STOVE PELLET CHIMNEY
COMMERCIAL HOOD DUCTS
FOOTING SLAB
BLOCKING HOLD DOWNS
SKIRTING
PLANNING DEPT SEPARATE PERMIT H's
PARKING /LIGHTING
LANDSCAPING
RESIDENTIAL
ELECTRICAL LIGHT DEPT 417 -4735
CONSTRUCTION R.W PW/
ENGINEERING 417 -4807
FIRE 417 -4653 I
I PLANNING DEPT 417 -4750 I
BUILDING 417 -4815 I
T Forms /Building Division /Building Permit (10 /01 /07).wpd
BUILDING PERMIT INSPECTION RECORD
1
16;-7 -og 1RB
1'ES 1 NO
SEPA.
ESA.
I SHORELINE.
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
DATE YES NO COMMERCIAL
FINAL
FINAL
ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W
PW ENGINEERING
I FIRE DEPT
I PLANNING DEPT
I BUILDING
DATE ACCEPTED BY.
DATE ACCEPTED BY.
DATE ACCEPTED G
1 YES 1 NO I
0
OQ
0
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER
Application type description
Subdivision Name
Property Use
Property Zoning
Application valuation
Application qesc
Install irrigation water meter
Owner
OSTERBERG KENT W /KARI L
1521 SO
PORT ANGELES
WA 983631313
08 00000403
680118
1521 0 ST
06 30 99 1 0 8040 0000
PUBLIC WORKS UTILITES
RS9 RESDNTL SINGLE FAMILY
0
Contractor
OWNER
Permit PUBLIC WORKS RES WATER SERV
Additional desc 2ND METER FOR IRRIGATION
Permit pin number 124057
Permit Fee 770 00
Issue Date 4/03/08
Expiration Date 9/30/08
Qty Unit Charge Per
1 00
Fee summary Charged
770 0000 EA PW W/M 1
Permit Fee Total 770 00
Plan Check Total 00
Grand Total 770 00
T\Policies \1102.15R [1 /05]
CITY OF PORT ANGELES
PUBLIC WORKS UTILITIES DIVISION
321 EAST 5TH STREET PORT ANGELES, WA 98362
Paid
770 00
00
770 00
Plan Check
Valuation
SERV 5/8 METER
Fee 00
0
Credited Due
00
00
00
Date 4/03/08
Extension
770 00
00
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.
4-(5(c9P
Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is b 'Ider) Date
CALL 417 -4807 FOR UTILITY INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOURNOTICE. IT IS UNLAWFUL TO COVER,
INSULATE OR CO NCEAL 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 1 NO
PW UTILITIES (Engineering Division)
WATERLINE METER
SEWER CONNECTION
SANITARY
STORM
SITE DRAINAGE.
SITE EROSIONCONTROL
PARKING
SIDEWALK'
CURB GUTTER
DRIVEWAY _APPROACH
BACK -FLOW DEVICE
T•\Policies \1102.151. [1/051
RESIDENTIAL
.I
CONSTRUCTION RW .1 PW/
ENGINEERING. 417 -4807
FIRE 417 -4653 I
PLANNING DEPT 417 -4750 I
BUILDING 417 -4815
PERMIT INSPECTION RECORD
FINAL INSPECTIONS REQUIRED,PRIOR TO OCCUPANCY/USE
DATE YES NO COMMERCIAL DATE= :ACCEPTED
YES' NO'
CONSTRUCTION. kW
PW ENGINEERING
I FIRE DEPT
I PLANNING DEPT
BUILDING
I'
1',
Application Number 07 00001325 Date 11/20/07
Application pin number 185475
Property Address 1521 0 ST
ASSESSOR PARCEL NUMBER 06 30 99 1 0 8040 0000
Application type description ELECTRICAL ONLY
Subdivision Name
Property Use
Property Zoning RS9 RESDNTL SINGLE FAMILY
Application valuation 0
Owner Contractor
JORISSEN ROBERT /SHARON
1521 SO
PORT ANGELES WA 983631313
APS ELECTRIC
546 BENSON RD
PORT ANGELES
PORT ANGELES
(360) 452 6753
WA 98363
Permit ELECTRICAL ALTER RESIDENTIAL
Additional desc
Permit pin number 115311
Permit Fee 91 00 Plan Check Fee 00
Issue Date 11/20/07 Valuation 1
Expiration Date 5/18/08
Qty Unit Charge Per Extension
1 00 91 0000 ECH EL -R OR RM 201 600 ALT SRV FDR 91 00
Fee summary Charged Paid Credited Due
Permit Fee Total 91 00 91 00 00 00
Plan Check Total 00 00 00 00
Grand Total 91 00 91 00 00 00
INSPECTION ELECTRICAL
TYPE DATE RESULTS INSPECTOR
DITCH
SERVICE
FINAL
COMMENTS:
1llZ� 00- €P
AS
ROUGH IN
tfloicey
31,g(cP, 044
°10P
M7
Job wired by
Elcctrica contractor name License number Date Expires
1i 6 6tectr col Ga nhroci'vr
Pure 5 mailing dress n
City ?ifik Ctilkiacekatc zIP W A q3i6.3
Tctgcmc
P remises owner's
Address r inspection
5a►
City p 1
Phone number to schedule Inspection
O wner as defined by RCW 19.28.261•(1) Owner will occupy the structure for two
years 441er this electrical permit it finalized (2) Owner is required to lure an electrical
contractor if above said property is for saw, rent or lease.
After reading the above statement, I hereby certify that I am thc owner of thc above
named property or a licensed electrical contractor. I am making the electrical instal-
lation or alteration in compliance with the electrical laws. N.E.C. RCW Chapter
19.28, WAC, Chapter 296.46B, The City of Port Angeles Municipal Codc, and
Utility Specifications.
tSignatu of wner, cicctri t c�ttrac or or electrical administrator Expiration Date
T� 1 47 of card
�X te:
Electrical Load Additions and or subtractions
NO LOAD CHANGES
Baseboard KW
O Furnace KW L' I Overhead Service
O Heat Pump Ton LAR LI Temp Service
O Fan -Wall KW Underground Service
SAME DAY INSPECTION, CALL BEFORE 7:00 AM 360 -417 -4735
Inspection
Date
11 5/rs
RECEIVED
NOV 1 4 2007
Td Wtf6S `9 LIME bT
lectrical Contractor 0 Owner
AX number
Kari
o D
ROUGH -IN
Da c Appmved A
FINAL
3 W_
Approved By
("ION
5 4 rx
sl-eite
recif
O e
THERMOSTAT
Date Apprcv,XI By
DITCH
By
Area, Building or Equipment Inspected
ELECTRICAL WORK PERMIT APPLICATION
1/Installation descriptio
0 Commercial r esidential
0 New 1 ltered/Addition
pvLoAil.
a QO arm rp “r-O i C Q
0 Cash 0 Check
0 Credit Card Visa
Card
d'e 1`ectO 5 e. 1 &e
SERVICE
1076 7 .S-7sP
oat Approval By
FEEDER
Date
IS IA_
Mastercard
Voltage
Phase'1 0 3
Service Size:
Feeder Size:
Action Taken
A Pk, tzov I
Appr ved dy
Discover
lnapection fee
qj
Service Information
Electrical
Inspector
ESL9 ZSb 092 '0N Xl d 21O10d211NOD -d0I2110313 'S d '11 WONd
f/
/
.
CITY OF PORT ANGELES LIGHT DEPARTMENT
321 E. Fifth Street
Port Angeles, WA 98362
(206) 457-0411
PERMIT NO. .3 7~
//&3
DATE
Installed By:
,;2
/f}c/~
~.::r
ELECTRICAL PERMIT
'b q-
o READY FOR
INSPECTION
license Number:
~WILL CALL FOR
INSPECTION
Phone:
Site Address:
Owner/Business:
Phone:
Owner/Business Address:
Sq. Ft.
~ RESIDENTIAL
o COMMERCIAL
o BASEBOARD KW _
~ FURNACE KW --/-Q.-
o FAN/WALL KW _
~ HEAT PUMP KW ~
o SIGN
o IEMPORARY SERVICE
WPERMANENT SERVICE
~EW CONSTRUCTION
o REMODEL
o ADD/ALTER CIRCUITS
o SERVICE UPGRADE/REPAIR
o SPECIAL EQUIPMENT
(LIST BELOW)
o OVERHEAD SERVICE
BlJNDERGROU~ S.EBVICE
VOL-mGE: /0702~
E1SINGLE PHil E
o THREE PHASE
SERVICE SIZEdOV AMPS
Details/Description:
AJ~ ~.,p
.
W.S. No. SERVICE SIZE
CAPACITY:
o O.K. NOT O.K.
ACTION REQUIRED: 0 CHANGE TRANSFORMER
o INSTALL SERVICE POLE
DATE
ENGR.
o CHANGE SERVICE WIRE
o OTHER
o Ditch Inspection O.K.
~,jJ Rough-in/cover O.K.
Y f/! O.K. to connect service
1t"'lflJ Final O.K.
Installer:
.,$D.
Site Address:
.
Notify Port Angeles City Light by Street Address and Permit Number when ready for inspection. Work mus not be covered
before inspection and O.K. for covering has been given by the electrical inspector in writing on eitherthe Wiring Report
or on the Bu~ Permit. PHONE 457-0411, EXT. 224.
f(V\Nl NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT
, $
Electrical Inspector
WHITE - File by address
YELLOW - file by number
PINK - Top: Eng, Bottom, Customer
fe. 0 !!!2
Permit Fee /.
/ ~
GREEN - Top: Meter Dept., BOtlOm:\ ,jI
OLYMPICPRINTER$INC.
(/:PDIlT"""
....~'V~
"r-di .
.... ~--
"ti:'C~'
CITY OF PORT ANGELES
PUBLIC WORKS - UTILITIES DIVISION
321 EAST 5TH STREET, PORT ;,NGELES, W A 98362
08A03
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER;
Application type description
Subdivision Name
Property UEle
Property Zoning
Application valuation
08-00000403 Date
680118
1521 0 ST
06-30-99-1-0 8040-0000-
PUBLIC WORKS UTI LITES
4/03/08
Owner
Contractor
J D? / 3 6 11
rO~
5j W/m
RS9 RESDNTL SINGLE FAMILY
o
Application ~esc
Install irr,gation water meter
OSTEREERG KENT W/KARI L
1521 SO.
OWNER
PORT PJ'.JGELES
WA 983631313
Permit
Additional desc
Permit pin number
Permit Fee
Issue Date
Expiration Date
PUBLIC WORKS RES WATER SERV
2ND METER FOR IR~GATION
124057
770.00 Plan Check Fee
4/03/08 Valuation
9/30/08
.00
o
Qty
1. 00
Unit Charge Per
770.0000 EA PW W/M 1" SERV 5/8" METER
Extension
770.00
Fee summary Charged Paid Credited Due
------.----------- ---------- ---------- ---------- ----------
Permit Fee Total 770 .00 770 .00 .00 .00
plan Check Total .00 .00 .00 .00
Grand Total 770 .00 770 .00 .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:\Policies\1102.15R [IID5}
b "./le,
"
APPLICATION FOR WATER
City Water Division, Port Angeles, WA
Issued date: 'I ~ s-D8 Installed by & date: 'f7f;!n'l!
I
71'lFus Permit # 6e - '162
I
I hereby apply for water to be furnished in accordance with rates and rules of the City for the
following premises:
Applicant Name & Phone: Ken f 05-1eyb~~
Site Address: 152./ C s r Mailing Address: 152.i 6';;"-
Blk: Lot: Add: Parcel#:Cb50'1q(09.0'fDC<?cO
Svc ON I@ Meter #'5 C F 0/ I ?i'?1J.,)W/O #. -:)c) L/7f -,Jq J
11//_
Svc. Size , ~W ' . ~ RestoratIOn ReqUIred
Signature <-..- ~ ___ _ __ . __ Remarks -r 0, J I I _
~ rrq,j4T1c);..(. JU,<e'f"'t::..r-
,
w
/6'L
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10
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o
s
;:.
ELECTRICAL PERMIT
CITY OF PORT ANGELES
360- 417 -4735
Application Number , . 1 15- 00001575 Pate 12/17/15
Application pin number , . , 223650
Property Address 1521 0 ST
ASSESSOR PARCEL NUMBER; 06 -30 99 1 -0- 8040 Application type type description ELECTRICAL ONLY
Subdivision Name . . .
Property Use
Property Zoning . . , . , , . RS9 RESDNTL SINGLE FAMILY
Application valuation 0
- -- -----------------------
Application desc
Replace ducted heat pump system
Owner Contractor
KENT W AND KART L OSTERBERG DAVEIS HTG & COOLING SRVC iNC
1521 S 0 ST. PO BOX 913
PORT ANGELES WA 963631313 PORT ANGELES WA 98362
(360) 460 -2231 (360) 452-0939 -y
----------------------------------------------------------- --- -- - - - - --
Permit . . , . , , ELECTRICAL ALTER RESTDENTIAL
Additional desc . .
Permit Fee . , . . 56.00 Plan Check Fee 00
Issue Date . . 12/17/15 Valuation , . . . 0
Expiration Date , , 6/14/16
Qty unit charge Per Extension
1.00 56.0000 ECH 'EL- LVT- "THERMOSTAT 56.00
Fee Summary Charged Paid Credited Dud
Permit Fee Total 56.00 56.00 00 00
Plan Check Total Go ,00 00 .00
Grand 'Total 56.00 56.00 00 00
INSPECTION TYPE DATE:
DITCH
SERVICE
ROUGH -IN
FINAL
COMMENTS:
PERMIT WILL EXPIRE SLX (6) MONTHS FIZOM LAST INSPECTION
Signature of owner or Electrical Contractor X
GAEXCRANGE1BUILDING
RESULTS
REPORT SALES TAX
.on your excise tax form
to the City of Port Angeles
(Location Code 0502)
INSPECTOR:
Date:
12/15/2015 11:308M FAX
CITY OF PORT A -NG]EL S PER�11T AYFLICATIOIV
Building Divi sion /Clectlt•ical�Rspectiolns
321 East Fifth Street — P.O. Box 1150 / Port Angeles Washington, 98362
Ph: (360) 417 -4733 Fax: (360) .417 -4711
160001 /0002
"1
Each Swimming fool or Hot I ub I $ 110.00 5
I S -z)z"Total
Owner as defined by RCW.19.28.261: (1) Owner will occupy the structure for two years after this electrical permit is finalized. (2) Owner is requires I
to hire an electrical contractor if abo�e said property is for sale, rent or tease. Permit expires after six months of last inspectio►4_
After reading the above statement, t hereby rertify that I rim the owner of lhn ahovp nultued property cr a lir:erlBF:dtlleoincal contractor. I am Makin q
the alcoldcal installation or alteration in compliance Wft the: elcatnr.al laws, N.E.C., RGW. Chapter 19.28, WAC . Chapter-M-463, The City of Por 1.
Angeles Municipal Code, and Ulillly Specificalions and PANIC 14.06.060 regarding Electrical Pennit Applications.
Signature of owner, electrical contractor or electrical adminlstrator: ❑ cash ❑ Check
Credit Card 0
K oatcd: _, OTO1r2012
1 & 2 Single Family Dwelling
' Plan Review May Be Required,
kI ase Complete lectrioa) Plan Ravie
Inform tion Sheet
Job Address:
Ouildin g Square Fooi e' _.....,.. _...,_ _
IA. _....., .............. ..........
..1. ,.., ,.,..,
D ascriptionofabove P rf
{
�,�,, _
,,Qwner I rmation
Contractor Informatign
co,
N,'me. �w`t
Name tt
f uG
�1a }ling dress;,L�,g�
Mailing Ores
«L _.,.
S1r11o: (Q J, 7,ip.
City 11' , c
late. Zip
Phone '' RX._,.�:;
Phone ?
Face e-15 —z7`, /q
'
License 01 Exp.
- ke' 4 --f %
A0—M
Unit Char a
gt
Total (Qty Multiplied by Unit Ghaga {ej
Servicerreedar200Amp
$12.0.00
- - -,_ —•
$„ _�....... —. —_
Service /Feeder 201 -400 Amp.
5146.00
Servica)Feeder 401 -600 Amp
$ 205.00
_
Service[Feedor 601 -1000 Amp
$ 262 00
_ - --
5 _
Ser AcelFeeder over 1000 Amp.
$ 373.00
^
S
Branch Circuit WI Service Feeder
6 5.00
$�
Branch Omuil WI[) Service Feodet
!
S 6300
Each Additional Branch Circuit
S 6.00
S _
Branch Circuits 1.4
i
$ 75.00
S,
'ramp Servico! Feeder 200 Amp
$ 9300.
_T.__u
$,.,.._.....,..._...__._
Temp. Service /Feeder 201 -400 Amp.
S 110.0D
S—
Temp SnrvicG /Feeder40i -600 Amp.
$14900
_ ..... .............
S- - - -, —_
Temp, Service /Feeder 601 -1000 Amp .
S 168.00
_
$
Portal to Portal Hourly
Signal Circuit/ Limited Ennrgy • 1 & 2 Fancily Dwelling
$ 00.00
5 6400
$—T„_
klanufactuied Nome Connection 1
$120.00
$
Renewable Electrical Er45rgy - 5KVA Syalem or Less
$102.00
S
Thermostat
$ 56.00
Note. $5.00 for each additional T•S al
NEW CONSTRUCTION ONLY,
First 1300 Square F1.
1
120 OD
__.. , , ..
"w,,. ,_ ,,••,
Each Additional 500 Square Ft. or Portio{
of
S 40.00
5
Each Outbuilding or Detached Garage
;
S 74.00
^�
$
Each Swimming fool or Hot I ub I $ 110.00 5
I S -z)z"Total
Owner as defined by RCW.19.28.261: (1) Owner will occupy the structure for two years after this electrical permit is finalized. (2) Owner is requires I
to hire an electrical contractor if abo�e said property is for sale, rent or tease. Permit expires after six months of last inspectio►4_
After reading the above statement, t hereby rertify that I rim the owner of lhn ahovp nultued property cr a lir:erlBF:dtlleoincal contractor. I am Makin q
the alcoldcal installation or alteration in compliance Wft the: elcatnr.al laws, N.E.C., RGW. Chapter 19.28, WAC . Chapter-M-463, The City of Por 1.
Angeles Municipal Code, and Ulillly Specificalions and PANIC 14.06.060 regarding Electrical Pennit Applications.
Signature of owner, electrical contractor or electrical adminlstrator: ❑ cash ❑ Check
Credit Card 0
K oatcd: _, OTO1r2012