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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET PORT ANGELES WA 98362
Application Number 09 00000912 Date 9/04/09
Application pin number 127648
Property Address 504 H ST
ASSESSOR PARCEL NUMBER 06 30 00 0 1 2705 0000
Application type description RE ROOF
Subdivision Name
Property Use
Property Zoning RS7 RESDNTL SINGLE FAMILY
Application valuation 3000
Application desc
RE ROOF WITH COMP
Owner Contractor
OFFICER JR ELDON E
1011 MADRONA ST
PORT ANGELES
WA 983632326
OWNER
Permit BUILDING PERMIT NO PR FEE
Additional desc INSTALL COMP ROOFING
Permit pin number 152991
Permit Fee 109 75 Plan Check Fee 00
Issue Date 9/04/09 Valuation 3000
Expiration Date 3/03/10
Qty Unit Charge Per Extension
BASE FEE 95 75
1 00 14 0000 THOU BL -2001 25K (14 PER K) 14 00
Other Fees STATE SURCHARGE 4 50
Fee summary Charged Paid Credited Due
Permit Fee Total 109 75 109 75 00 00
Plan Check Total 00 00 00 00
Other Fee Total 4 50 4 50 00 00
Grand Total 114 25 114 25 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 re ting. construction or the performance construction.
s Yo f d��r
Date Print Name /Signature of Contractor or Authorized Agent
T:FormsBuilding DivisionBuilding Permit
\CA
CI
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Signature of Owner (if owner is builder)
IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED
POST PERMIT IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE.
Inspection Type
FOUNDATION
Footings
Stemwall
Foundation Drainage Downspouts
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 Under Floor
Shear Wall Hold Downs
Walls Roof Ceiling
Drywall (Interior Braced Panel Only)
T -Bar
INSULATION
Slab
Wall Floor Ceiling
MECHANICAL.
Heat Pump Furnace FAU Ducts
Rough -In
Gas Line
Wood Stove Pellet Chimney
Commercial Hood Ducts
MANUFACTURED HOMES
Footing Slab
Blocking Hold Downs
Skirting
T.Forms /Building Division /Building Permit
BUILDING PERMIT INSPECTION RECORD
PLEASE PROVIDE A MINIMUM 24 -HOUR NOTICE FOR INSPECTIONS
Building Inspections 417 4815 Electrical Inspections 417 4735
Public Works Utilities 417 4831 Backflow Prevention Inspections 417 4886
Inspection Type
Date Accepted By
PLANNING DEPT Separate Permit #s SEPA.
Parking Lighting 1 ESA.
Landscaping 1 SHORELINE.
Comments
FINAL Date Accepted by
FINAL Date Accepted by
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE
Date Accepted By
Electrical 417 -4735
Construction R.W PW Engineering 417 -4831
Fire 417 -4653 1
Planning 417 -4750 I II
Building 417 -4815 l t,'(D (13JL q iq_ lO
I
Applicant 6a
Property Owner r4
Property Owner's Address T n 1
Contractor /a/~�'
Contractor's Address
License Expires
PROJECT ADDRESS
Parcel Number
Proiect Type Brief Description.
Check all that apply
New Construction
Addition
Remodel
D,molition
c e-roof
Heat System
Other
Floor Areas Existing (sq. ft.) Proposed (sq. ft.)
Basement
1St Floor
2 Floor
3 Floor
Garage
Carport
Covered Porch
Deck
Shed
Other
Date 7' rint Name
BUILDING PERMIT APPLICATION Print in ink
CITY OF PORT ANGELES
Attn. Building Permit Techhician
321 E. Fifth St. Port Angeles WA 98362
(360) 417 -4815 fax (360) 417 -4711
ll X
Total footprint of structures
Site Coverage the amount of imp
and other impervious surfaces. (see
Max. height of proposed structures
Will a lawn sprinkler system be ins led?
Will a fire sprinkler system be i ailed?
22 cC
7
ous surf
Occupancy group
Occupant load
onstruction ty
Lot
House garage other tear off re -roof lay over one layer
Heat pump wood burning stove gas fireplace pellet stove other
iResidential Multi- family .o Commercial' Industrial
sq ft T Lot size
on a parcel including structures
7 94 135 for exemptions)
Phone
Phone
E -mail
per sq ft.
C f r laleki S
TOTAL VALUATION
I have read and completed this application and know it to be true and correct. I am authorized to apply for this permit and understand
that it is my responsibility to determine what permits are required, and to obtain permits prior to wo ing on projects.
.Signature
T Forms /Building Division /Bldg Permit.doc
For City Usg O
Date Received
Permit C7 /7 4
22
Phone
Zoning
of bedrooms
f full baths
of If baths
56
3, coo
sq ft. Lot coverage
aved driv gays sidewalks patios
Site coverage