HomeMy WebLinkAbout721 I St - BuildingPREPARED 2/13/07 9 14 36 INSPECTION TICKET PAGE 10
CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 2/13/07
ADDRESS 721 I ST SUBDIV
CONTRACTOR JUDSON ENTERPRISES PHONE (916) 631 9300
OWNER LUNDGREN KRIS L /PEGGY L PHONE
PARCEL 06 30 00 0 2 4660 0000
APPL NUMBER 06 00001324 SIDING
PERMIT BNOP 00 BUILDING PERMIT NO PR PEE
REQUESTED INSP DESCRIPTION
TYP /SQ COMPLETED RESULT RESULTS /COMMENTS
BLDS 01 2/09/07 JLL BUILDING SIDING
2/09/07 DA 09/28/2006 11 18 AM NWEST
02/09/2007 09 20 AM PERMITS
PEGGY 452 5259
02/09/2007 04 33 PM JLIERLY
caulk gaps at windows /j11
BL99 01 2/13/07 A BUILDING FINAL TIME 09 00
02/12/2007 04 38 PM PERMITS
Y Peggy 452 5259
COMMENTS AND NOTES
PREPARED 2/09/07 9 52 21 INSPECTION TICKET
CITY OF PORT ANGELES
ADDRESS
CONTRACTOR
OWNER
PARCEL
APPL NUMBER
PERMIT BNOP 00 BUILDING PERMIT
REQUESTED INSP
TYP /SQ COMPLETED RESULT
BLDS 01 2/09/07
721 I ST
JUDSON ENTERPRISES
LUNDGREN KRIS L /PEGGY L
06 30 00 0 2 4660 0000
06 00001324 SIDING
NO PR FEE
DESCRIPTION
RESULTS /COMMENTS
INSPECTOR JAMES L LIERLY
BUILDING SIDING
09/28/2006 11 18 AM NWEST
02/09/2007 09 20 AM PERMITS
PEGGY 452 5259
COMMENTS AND NOTES
SUBDIV
PHONE (916) 631 9300
PHONE
PAGE 8
DATE 2/09/07
12er_4,1i
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER
Application type description
Subdivision Name
Property Use
Property Zoning
Application valuation
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET PORT ANGELES, WA 98362
06 00001324
078452
721 I ST
06 30 00 0 2 4660 0000
SIDING
RS7 RESDNTL SINGLE FAMILY
14062
Owner Contractor
Fee summary Charged Paid Credited Due
T•1Policies \1 102_15 building permit inspection record05 wpd [1/4/2005]
Date 12/18/06
LUNDGREN KRIS L /PEGGY L JUDSON ENTERPRISES
1007 E CRAIG AVE PO BOX 276977 SACRAMENTO
PORT ANGELES WA 98362 SACRAMENTO CA 958206205
(916) 631 9300
Permit BUILDING PERMIT NO PR FEE
Additional desc INSTALL VYNIL SIDING
Permit pin number 92254
Permit Fee 277 75 Plan Check Fee 00
Issue Date 12/18/06 Valuation 14062
Expiration Date 6/16/07
Qty Unit Charge Per Extension
BASE FEE 95 75
13 00 14 0000 THOU BL -2001 25K (14 PER K) 182 00
Other Fees STATE SURCHARGE 4 50
Permit Fee Total 277 75 277 75 00 00
Plan Check Total 00 00 00 00
Other Fee Total 4 50 4 50 00 00
Grand Total 282 25 282 25 00 00
Separate Permits are required forelectrical 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
fora period of 180 days after the work as commenced or if required inspections have not been requested within 180 days from the last
inspecti n. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws ndd 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.
f
Sig'nature of Contractor or Autl&zed Agent Date Signature of Owner (if owner is builder) Date
BUILDING PERMIT INSPECTION RECORD
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
YES I NO
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)
SHOWER PAN
I MEDICAL GAS LINE
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS GIRDERS
SHEAR WALL /HOLD DOWNS
WALLS ROOF CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T -BAR
INSULATION
I SLAB
WALL FLOOR CEILING
MECHANICAL
HEAT PUMP /FURNACE /DUCTS
GAS LINE
WOOD STOVE PELLET CHIMNEY
COMMERCIAL HOOD DUCTS
MANUFACTURED HOMES
FOOTING SLAB
BLOCKING HOLD DOWNS
SKIRTING
PLANNING DEPT SEPARATE PERMIT #'s
PARKING /LIGHTING
LANDSCAPING
RESIDENTIAL
ELECTRICAL LIGHT DEPT
1 1 1
I 1 1
I I I
1 1
CONSTRUCTION R.W PW/
ENGINEERING 417 -4807
FIRE 417 -4653 I I I
PLANNING DEPT 417 -4750 1 2 {�r 71
BUILDING 417 -4815 1 :4-' 1-
T \Policies \1102_15 building permit inspection record05.wpd [1/4/2005]
FINA
FINAL
SEPA.
ESA.
SHORELINE.
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
DATE YES NO COMMERCIAL DATE I ACCEPTED
I YES I NO
417 -4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W
PW ENGINEERING
TIRE DEPT
I PLANNING DEPT
1 BUILDING
COMMENTS
DATE ACCEPTED BY,
DATE ACCEPTED BY,
1 1
I I I I
I I 1
Applicant or Agent: `//a
Owner
O eIdI/ ZGr
Address: 7.2 S. S
Architect /Engineer
Contractor yS.9if.e 5 State License
Address: g 4 7 S /2 City 412-
PROJECT ADDRESS `7
LEGAL DESCRIPTION Lot: Block:
CLALLAM COUNTY PARCEL NUMBER.
TYPE OF WORK.
Residential New Constr
Multi family Addition
Commercial Remodel
Repair Sign
BRIEF DESCRIPTION OF TH
COMMERCIAL/RESIDENTIAL. Occupancy Group
No. of Stones. Lot Size: Existing Sq. Ft.
Total lot coverage
PLANNING USE ONLY
BUILDING PERMIT APPLICATION
Fill out COMPLETELY and in INK. Your application and site plan MUST BE
COMPLETE to be accepted for review If you have any questions, call
PERMITS (360) 417 -4815 FAX(360)417 -4711
Re -roof Stove
Move Garage
Demolition Deck
Other
ROJECT /y
ESA/Wetland(s) Yes No SEPA Checklist required? Yes No Other
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. 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 If no 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
RI05.3.2 of the International Building/Residential Code, 2003). No application can be extended more than once.
1 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 it is my responsibility to determine what permits are required ,not the City's, and that I
must obtain such permits prior to work.
T•\FORMS\BldgPermitform.wpd Applicant: �s�s�l Z Date: ..Z7G'G /7 D
City
Occupant Load.
Proposed Sq Ft.
FOR OFFICIAL USE ONLY
Date Rec.
Permit
Date Approved:
Date issued:
Phone: 7 ,'o -4•<4" 7 2
Phone: 3>�6 4 .S-z 9
Zip 913 �3
Subdivision.
Phone:
Exp
Phone:
Zip 93 1
ZONING VS
SIZE/VALUATION
SF /SF 2—
SF /SF
SF /SF
T,pTAL VALUATION
Construction Type:
TOTAL Sq. Ft.
APPROVALS
PLAN
BLDG
DPWU
FIRE.
OTHER.
8647.South 212th Street
KeRe WA 98031
(800) 528 -9543 (253) 872 -3440
BUYER(S) NAME
BUSINESS PHONE
ADDRESS l l 'T csr
INSTALLATION ADDRESS
(if different)
Buyer(s) offer to contract with K Designers (Seller), to furnish and install all materials necessary according to the following specifications:
f £P R A Pr L 77 1 X
l/ x4`7 JA i--{ e t t 1 T!1 r I s
t,roA r.�_) L 1 c 074' rii0 Ll, ��t r �,1 L c'Thiw c9 ir
L? t Go poi 1 A) PCB,_ j "WM
r mss. ;A I, C7}{) iC. 49S0L17 k Lf u c-1204 7 481
C i4 1 t f 2 ,t Y vii t cm'
A'T u A r} DP .411 1 Lk" Fri 7 72_
c 4.aNJA,/D Lv' .Aff P)f J 7 y--_
1_ 61_1 ft 29 (Lf Pk-L. 3 rOIC) p Pno rn"iv o t9''mer fr40..#
DESIGNERS
HOME REMODELING LEADER
SALES AGREEMENT
DATE CF,/ 47
Kk J 4 FEE I L i a) HOME PHONE
CELL EMAIL ADDRESS
F'' F o b L a tmrrna, 7- Limglb'`"I M /V
(L14 -L IB' Vie. (.0i A^10AA) PP /�r/}W9T4. -L /M1e7
Li N 4.f t.A i F roe citrtrefel, c
Approximate Starting Date crr— Approximate Completion Date.
Buyer( understand that this is only an stimated date.
IWAI
WA License #KDESI* *03305
CITY 7 4D l STATE 1_;-.04-- ZIPS S�'�j
CITY
ALL WORK TO BE COMPLETED TO BUYER'S 100% SATISFACTION
METHOD' OF,PAYMENT
STATE ZIP
•Phone#
Balance due on.conipletion
-Date.
Date
Balance due on.cothpletion
Ct;_
Y� Iti r)62-,z Contract Price
D% State Tax
h Total Contract Price
Cash Transactions. (Payment on Completion)
O.Ca"sh: Funds available, from Account#
Deposit Balance due on completion
Buyer(s) do jointly and severally' PROMISE TO PAY O■'COMPL of improvements,. to Seiler:'(Make.check payable to K- Designers and give to. job
foreman.) The undersigned are hereby authorizing Seiler to verify and review my /our credit ;record_ with an independent credit reporting agency and release
them.,froni all .liability incurred from inadvertentomissiomor errors.
Credit Card. Visa Mastercard .Discover AMEX
:Account Exp.:Date
Signature SSN
Signature SSN
Finance Transaction. (The credit to nd conditions are provided' on a separate. document.
Method of financing: Secured Unsecured Other Deposit
XISTING SIDING
D WOOD
0 STUCCO
SHAKES
BENNINGTON
4_, :#SQ'S OTHER
'13F1'ORIZONTAL TYPE. FINAL TOUCH
BENNINGTON
#SQ'S OTHER
VERTICAL (INDICATE LOCATION ON DRAWING)
#SQ'S
,d'GUTSIDE CORNER POSTS QTY Lt
#SQ'S
FLUTED CORNER POSTS QTY COLOR:
(INDICATE LOCATION ON DRAWING),
INSIDE CORNER POSTS QTY COLOR:
(RECOMMENDATION SHOULD MATCH SIDING COLOR)
A-X (STANDARD)(WINDOWS DOORS ONLY) COLOR:
REMOVE EXISTING WINDOWS DOOR TRIM
rJ JUMP CASINGS (IF LESS THAN 3/4
WIDE J- CHANNEL QTY WINDOWS COLOR
QTY DOORS
GABLE VENTS QTY r TYPE. f CTAGON
(INDICATE LOCATION ON DRAWING) SQUARE
0 RECTANGLE
EXTRA LABOR
0 REMOVE RESET FENCE POSTS (WOOD ONLY)
INSTALL SIDING ABOVE PATIO COVER
0 REMOVE REINSTALL STORM WINDOWS
0 REMOVE REINSTALL WINDOW AWNINGS
REMOVE REINSTALL WINDOW SECURITY BARS
REMOVE REINSTALL STORM /SECURITY DOORS
0 REMOVE REINSTALL EXISTING SHUTTERS
MOVE OBSTACLES AWAY FROM HOUSE
DRY -ROT REPAIR SIDING ONLY
*NOTE. (WE CAN NOT REPAIR ROOF OVERHANGS
OR RAFTER TAILS)
LIST WORK NOT AUTHORIZED
MASONITE ,a'OTHER TEAR -OFF
CJ LP /L11 #SQ'S
0 CINDER BLOCK
GIVE BRIEF DESCRIPTION OF ADDITIONAL WORK TO BE PERFORMED
SANDALWOOD
WHITE
COLOR: 0 SANDSTONE
0 SANDALWOOD
WHITE
COLOR: SANDSTONE
0 SANDALWOOD
0 WHITE
COLOR: 0 SANDSTONE
SANDALWOOD
WHITE
*WHITE ONLY*
0 SANDSTONE
SANDALWOOD
0 WHITE
0 SANDSTONE
SANDALWOOD
0 WHITE
0 SANDSTONE
0 SANDALWOOD
0 WHITE
ROUND
HALF -ROUND
APPROXIMATE SQ/FT
LOCATION FRONT
BACK
SHAKES
LP
0 OTHER
0 PEARL
EVERGLADE
0 MIST BLUE
PEARL
0 EVERGLADE
MIST BLUE
0 PEARL
EVERGLADE
0 MIST BLUE
0 PEARL
0 EVERGLADE
0 MIST BLUE
0 PEARL
0 EVERGLADE
0 MIST BLUE
PEARL
0 EVERGLADE
0 MIST BLUE
0 PEARL
QTY POSTS
YES R &R PATIO COVER
NO
QTY
QTY
QTY
QTY
QTY (IF NOT CHECKED OLD SHUTTERS
WILL BE HAULED TO THE DUMP)
WOOD PILE 0 MISC
REFRIGERATOR
STOVE
#STORIES
01 0
1 1/2 3
SIDING Colors indicated are the only colors authorized Adherence will prevent job delays or cancellations.
For Bennington product color* write in O marked other
fORIMONTAL TYPE. FINAL TOUCH COLOR: SANDSTONE MIST BLUE ROSEWOOD
0 MAIZE
OTHER
ROSEWOOD
MAIZE
OTHER
ROSEWOOD
0 MAIZE
0 OTHER
ROSEWOOD
MAIZE
,i2r6tHER 6
0 ROSEWOOD
MAIZE
OTHER
ROSEWOOD
MAIZE 110TH ER /77.4/
0 ROSEWOOD
MAIZE
EVERGLADE OTHER
COLOR: E ONLY
YES REQUIRES PROD. DEPT.
0 NO INSPECTION
OR LINEAL FT
0 LEFT SIDE (FROM STREET)
RIGHT SIDE (FROM STREET)
erjot t OrtiolB Cliet4 0 W 1t11
cidr
EAVES AND OVERHANGS
0 SOFFIT 0 *SOFFIT ONLY LINEAL FT WIDTH (INCHES)
COLOR. 0 SANDSTONE 0 WHITE 0 PEARL 0 ROSEWOOD
0 SANDALWOOD 0 MIST BLUE 0 EVERGLADE MAIZE
*NOTE. SOFFIT ONLY MAY STILL REQUIRE FURRING AND AN 'L WRAP
0 FASCIA FASCIA ONLY LINEAL FT WIDTH (INCHES)
COLOR: 0 SANDSTONE 0 PEARL BROWN 0 DOVER GRAY
0 SANDALWOOD 0 EVERGLADE 0 GRECIAN GREEN CANYONS CLAY
0 WHITE 0 ROSEWOOD 0 RED 0 WICKER
0 MIST BLUE 0 MAIZE 0 CHARCOAL 0 ALMOND
INSTALL NEW FASCIA BOARD LINEAL FT WIDTH (INCHES)
OPEN RAFTER TAILS YES 0 NO LINEAL FT
CUT BACK EXISTING RAFTER TAILS 0 YES 0 NO LINEAL FT
0 EXISTING GUTTER LINEAL FT
0 PORCH CEILING (WxL) 1 X 2. X 3. X
(PORCH CEILING MATERIAL RUNS PERPENDICULAR TO HOUSE. ANYTHING OVER 12' REQUIRES DOUBLE J)
WRAPS 2 INDOWS #SINGLES f-11 #DOUBLES #TRIPLES
8 -ENTRY DOORS #DOORS COLOR c c 7
0 GARAGE DOORS #SINGLES #DOUBLES COLOR
0 POST WRAP QTY COLOR
0 BEAM WRAP LINEAL FT COLOR
0 BELLY BAND/WATER TABLE LINEAL FT COLOR
0 FREEZE BOARD LINEAL FT COLOR
0 OTHER DESCRIPTION
TRIM COIL COLOR SELECTION: SANDSTONE WHITE PEARL ROSEWOOD BROWN RED DOVER GRAY WICKER SANDALWOOD
(INDICATE COLOR IN SPACE PROVIDED) MIST BLUE EVERGLADE MAIZE GRECIAN GREEN CHARCOAL CANYON CLAY ALMOND
pSIGN WORK
v #'SLANT DESIGN #SQ'S
(INDICATE LOCATION ON DRAWING)
0 FAN DESIGN #SQ'S
(INDICATE LOCATION ON DRAWING)
ACCENT PANELS #SQ'S AKES_ SQ'S
(OUTSIDE/INSIDE CORNER POSTS AND J- CHANNEL
REQUIRE SIDING COLOR COMPONENTS)
DESIGN ACCESSORIES
0 SHUTTERS QTY (PAIRS)
(INDICATE LOCATION ON DRAWING)
*COLOR: WHITE 0 BLACK 0 DK. GREEN 0 RUSTIC RED
BROWN DK.GRAY 0 DK. BLUE WINE/BURGUNDY
�u f *PER YOUR SHUTTER RING SAMPLE NOT AVAILABLE IN
ANY OTHER COLORS.
BRASS LAMPS QTY (INDICATE LOCATION ON DRAWING)
0 MOTION SENSOR LAMPS QTY (INDICATE LOCATION ON DRAWING)
INCLUDES SURFACE MOUNTING AND ATTACHMENT TO EXISTING ELECTRICAL OUTLETS ONLY
WE DO NOT PERFORM ELECTRICAL WORK.
0 BRASS MAILBOX BRASS MAIL SLOT BRASS DOOR KNOCKER 0 EAGLE BRASS 0 EAGLE -BLACK
BRASS KICK PLATE 0 BRASS HOUSE #'S 0 BRASS DOORBELL FLAG KIT
0 PAINT COLOR QTY COLOR QTY
DOOR OPTIONS
0 GARAGE DOORS (ATTACH SPECIFICATIONS SHEET)
0 ENTRY DOORS (ATTACH SPECIFICATIONS SHEET)
0 STORM DOORS (ATTACH SPECIFICATIONS SHEET)
GUTTERS
0 EXISTING GUTTERS 0 REMOVE HAUL AWAY
0 OPEN RAFTER TAILS LINEAL FT
0 EXISTING FASCIA BOARD LINEAL FT
0 INSTALL 5' O.G. GUTTER LINEAL FT.
INSTALL 5 1/2' FASCIA GUTTER LINEAL FT
(CALIFORNIA ONLY)
INSTALL NEW DOWN SPOUTS 0 ONF STfRV nTV
Colors indicated are the only colors authorized Adherence will prevent job delays or
cancellations. For Bennington product color write in 0 marked other
COLOR. 0 SANDSTONE
0 SANDALWOOD
0 WHITE
COLOR. 0 SANDSTONE
0 SANDALWOOD
0 WHITE
COLOR: 0 WHITE
0 PRAIRIE WHEAT
J -TAN
QTY
QTY
QTY
0 MIST BLUE
PEARL
0 EVERGLADE
MIST BLUE
PEARL
0 EVERGLADE
0 CLAY
KHAKI
0 GRAY
0 OTHER
0 INSTALL NEW FASCIA BOARD LINEAL FT
REMOVE REINSTALL NEW FASCIA BOARD LINEAL FT
COLOR:
COLOR.
I T\AIC CT/ %DV n
4 X
COLOR
0 ROSEWOOD
MAIZE
0 OTHER
0 ROSEWOOD
0 MAIZE
0 OTHER
0 HERITAGE GRAY
SLAT
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INTRODUCING... AMERICA'S DREAM!
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Design
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
BUILDING PERMIT ISSUED: 8/02/2002 PERMIT NO: 13605
OWNER/APPLICANT PROPERTY LOCATION
721 I ST S
PEGGY LUNDGREN
721 S. I STREET Lot: Sl/2 118,12'
Port Angeles, WA 98363 Block: 246 [] Long Legal
360/452-5259 Subdivision: TPA
T: S: Parcel No: 063000024660000
CONTRACTOR ARCHITECT
FERRELLGAS N/A
704 MARINE DR
Port Angeles, WA 98362 , 98360-0000
360/457-1151 360/000-0000
PROJECT INFO
Project Value: $1,000.00 SFD Units: 0 Commercial: 0
Project Type: PROPANE STOVE SFD SQ FT: 0 Industrial: 0
Occupancy Type: RESIDENTIAL Garage: 0
Occupancy Group: MFD Units: 0
Construction Type: MFD SQ FT: 0
Zoning Use:
PROJECT NOTES
INSTALL FREESTANDING PROPANE STOVE
RECEIPT#9495
FEES ASSESSMENT
Building Permit: $0.00 Misc Fee 1: PROPANE STOVE $35.00
Plan Check: $0.00 Misc Fee 2: $0.00
State Surcharge: $0.00 Misc Fee 3: $0.00 .~'1,,~
House Moving: $0.00
Manufactured Home: $0.00
Sign: $0.00 TOTAL FEE: $35.00
Plumbing: $0.00 AMOUNT PAID: $35.00
Mechanical: $0.00
BALANCE DUE: $0.00
Radon: $0.00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any state or local law regulating c, enstruction or the performance of
construction.
/
Signature of Contractor or Authorized Agent Date SignatL~C~f ~'wne~(if (~ner is builder) Date
T:\PLANNING\FORMS\I 102.15 [4/2002]
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. ITIS UNLAWFUL TO COVER,
INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT ./OB SITE
INSPECTION TYPE I DATE ACCEPTED COMMENTS
YES I NO
FOUNDATION:
FOOTiNGS
WALLS
FOUNDATION DRAiNAGE
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
WATER LINE
GAS LINE
BACK FLOW / WATER
AIR SEAL
WALLS
CEILiNG
FRAMING
JOISTS / GIRDERS
SHEAR WALL
WALLS / ROOF / CEILING
DRYWALL
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILiNG
MECHANICAL
HEAT PUMP
WOOD STOVE / PELLET / CHIMNEy
HOOD / DUCTS
PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT #'$:
WATEKLiNE / METER
SEWER CONNECTION
SANITARY
STOP. aM
PLANNING DEPT. SEPARATE PERMIT #'s SEPA:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL ~ LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W. / PW/ CONSTRUCTION - R.W.
ENGiNEERING 4l 7 4807 PW / ENGiNEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNiNG DEPT.
BUILDiNG 417-4815 C~ ~ L {~-~'~'~1 ]~.-,~-~- BUILDING
T:\PLANNING\FORMS\1102.15 I4/2002]
o~ ~44,e FOR OFFICIAL USE ONLY:
BUILDING PERMIT - APPLICATION ?ermit#:
Date Approved:
Date Issued:
The Building Permit .,Ipplication must be filled out completely.
Please type or print in ink. If you have any questions, please call 417-4815
Applicant or Agent: Phone:
~chitect/Engineer: Phone:
Contractor ~FF~/'<' License ~: Exp: Phone:
Ad.ess: City: Zip:
PROJECT ~D~SS: .~ ~ ~ ZONING:
LEG~ DESC~PTION: Lot: Block: Subdivision:
CL~L~ CO~TY P~CEL ~MBER: Credit Card Holder Name:
Billing Address: CiW:
Credit Card g: Exp. Date: ~SA MC
~E OF WO~: S~UATION:
D Residential ~ New Consff. ~ Re-roof ~ Wood-stove SF. ~ $. /SF. =~.
~ Multi-fa~ly ~ Addi~on ~ Move ~ Garage SF. ~ $. /SF. = $
~ Co~ercial ~ Remodel ~ Demolition ~ Deck SF. ~ $_ /SF. = ~
~ R~air ~ Si~ ~ TOTAL VALUATION $
BmEFDESC~PTIONOFT~PROJECT: ~ee ~c~ ~
COMMERCI~SIDENTI~: Occup~cy Group: Occupant Load: __ Com~c~on T~e:.
No. of Stories: __ Lot S~e: % Lot Coverage: %
Exist~g Lot Coverage: /sq. ff. + Proposed Lot Covcrage: /sq. ~. = TOTAL LOT COVE~GE: /sq. ~.
PLANING USE ONLY: ~PROV~S: PL~
Notes: BLDG.
DPW
ES~etI~d(s): ~ Yes D No SEPA Chec~ist requffed? ~ Yes ~ No O~er: O~ER
BUILDING PE~IT APPLICATION S~MITT~: Your application and site plan must be fiHed out compl~ely to be accepted for
review. ~e Bmlffing Division c~ provide you wiffi more detailed ~o~tion on ~e application and pl~ sub~l req~emen~. Your
completed application, site pl~ (for additions) and building cons~ction plato ~e to be subdued to ~c Building Division.
V~UATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by ~e applic~t. ~s fi~e will be reviewed
~d ~y be revised by ~e Building Division to co~ly wi~ c~ent fee schedules. Con,ct ~e Pe~t Coord~tor at 417-4815 for assistance.
PL~ CHECK FEE: Yo~ pl~ check fee is due at ~e ~me ~e building pc~t application ~d core,etlon plato ~e subdued. All other
pe~t fees are due at ~e ~e ofpe~t issuance.
EXP~ON OF PL~ ~VIEW: If no pe~t is issued wi~ 180 days of~e ~te of applicaton, ~is application will expire. ~e
Bulldog Official can extend ~e ~me for action by ~e applicant up to 180 days upon ~en request by ~e applicant (see Section 107.4 of
· e U~fo~ Building Code, c~ent e~tion). No application can be extended more than once.
I hereby cert~ that I have read and examined this application and ~ow the same to be t~e and correct, and I am authorized to apply for
this pe~it. 1 understand it is not the CiF's legal responsibili~ to dete~ine what permits are required; it remai~ the applicant's
responsibili~ to determine what permits are required and to obtain such.
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
........... INSPECTION REPORT ...........
REQUEST:
Date ~- 7 7 '-~---- Time Received by (phone, person)
Location of Work to be inspected'-'~-~ // ~-~ ~
Name of person requesting inspection
Address of person requesting inspection Phone No. ~-~--~
Type of Inspection (circle appropriate one): Permit No. /~.~ ~'~ ~
Sewer Foundation Plumbing~ Sewer Excav. Other
Framing Chimney ~'z~5~ ~/"t~/
INSPECTION NOTES:~:~ '~ ~ ,~,.~
Inspected: Date ~'--~-~ Time ,.By
Remarks:
RESTORATION REQUIRED ...... YES NO.
SURFACE RESTORATION:
SURFACE TYPE: [] Unimproved []Gravel ~]Asphalt []PCC []Other
I~! Repaired by City Work Order #
[--1 Repaired by Permittee [] COMPLETE
[] No Damage Found [] INCOMPLETE
(Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE)
<I~T~
(i
'l4l.C~
CITY OF PORT ANGELES
DEP ARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
Application pin number
property Address
ASSESSOR PARCEL NUMBER:
Application type description
Subdivision Name
property Use
property Zoning . . .
Application valuation
05-00000726 Date
065252
721 S I ST
06_30_00_0_2_4660-0000-
RES REMODEL
8/17/05
RS7 RESDNTL SINGLE FAMILY
800
Contractor
owner
------------------------
------------------------
OWNER
LUNDGREN KRIS L/PEGGY L
1007 E CRAIG AVE
PORT ANGELES WA 98362
----------------------------------------------------------------------------
Permit . . . . .
Additional desc .
permit pin number
permit Fee
Issue Date
Expiration Date
BUILDING PERMIT -RESIDENTIAL
58156
56.15
8/17/05
2/13/06
Plan Check Fee
valuation
22.46
800
Qty Unit Charge Per
Extension
47.00
9.15
BASE FEE
3.00 3.0500 HND BL-501-2K (3.05 PER C)
;:;
/,(~1---
c
/~/ ..-.. --
(d-/
( C/____
----------------------------------------------------------------------------
special Notes and Comments
The Fire Department has reviewed the project application and
has no comments
08/12/2005 09:44 AM SROBERDS -- The proposal is to cover
an existing porch in the RS-7 zone for total lot coverage
of 26%. No land use issues are noted.
Electrical load calculations and elctrical permits are
required.
MAINTAIN CLEARANCES FROM SERVICE WIRES, meter must be
accessible.
08/10/2005 08:35 AM GMCLAIN ----------------------------
Public Works Utility Engineering has no r~quirements for
this plan review.
----------------------------------------------------------------------------
Other Fees
STATE SURCHARGE
4.50
. . . . . . . . .
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 56.15 56.15 .00 .00
plan Check Total 22.46 22.46 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 83.11 83.11 .00 .00
-J
l'J
~
~~
~ ~
?:.
\\
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 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._ /7/ d
~ (~../!#I- 7f-/7-0C;-
Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T:\Policies\ 1102_15 building permit inspection record05.wpd [1/4/2005]
BUILDING PERMIT INSPECTION RECORD
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
YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDA TION DRAINAGE 1 DOWN SPOUTS
PIERS
POST HOLES (POLE BLDGS.)
PLUMBING
UNDER FLOOR 1 SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW 1 WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS 1 GIRDERS
SHEAR W ALLIHOLD DOWNS
WALLS 1 ROOF 1 CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL 1 FLOOR 1 CEILING
MECHANICAL
HEAT PUMP 1 FURNACE 1 DUCTS
GAS LINE
WOOD STOVE 1 PELLET 1 CHIMNEY
COMMERCIAL HOOD 1 DUCTS
MANUFACTURED HOMES
FOOTING 1 SLAB
BLOCKING & HOLD DOWNS
SKIRTING
PLANNING DEPT. SEPARATE PERMIT #'s SEPA:
P ARKING/LlGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W.I PWI CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW 1 ENGINEERING
FIRE 4 I 7-4653 FIRE DEPT.
PLANNING DEPT. 4 I 7-4750 PLANNING DEPT.
BUILDING 417-4815 1:)-/2/(15 <fi( BUILDING
T:\Policiesl) 102_15 buiJdmg peront mspectlOn record05. wpd [1/4/2005J
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application type description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
05-00000347 Date
948822
721 S I ST
06-30-00-0-2-4660-0000-
RE-ROOF
5/10/05
RS7 RESDNTL SINGLE FAMILY
2020
Owner
Contractor
LUNDGREN KRIS L/PEGGY L
1007 E CRAIG AVE
PORT ANGELES WA 98362
OWNER
Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
BUILDING PERMIT - NO PR FEE
TEAR-OFF, FELT, COMP
48736
106.75 Plan Check Fee
5/10/05 Valuation
11/06/05
.00
2020
Qty Unit Charge Per
Extension
92.75
14.00
BASE FEE
1.00 14.0000 THOU BL-2001-25K (14 PER K)
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ---------- -.J
permi t Fee Total 106.75 106.75 .00 .00
Plan Check Total .00 .00 .00 .00 y
Grand Total 106.75 106.75 .00 .00
~
\-i
~
\;(l
:-'f
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
constr~tion.
/
--,-~/
-:5- U-CS
./
Date
Signature of Owner (if owner is builder)
Date
T:\Policies\1102_15 building pennit inspection record05.wpd [1I4/2005J
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
CALL 417-4807 FOR PUBLlC WORKS UTILlTIES
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 LOCA nON.
KEEP PERMlT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
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
DR YW ALL (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
MANUFACTURED HOMES
FOOTING / SLAB
BLOCKING & HOLD DOWNS
SKIRTING
PLANNING DEPT. SEP ARA TE PERMIT #' s SEPA:
PARKIN G/LIG IITIN G ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W. / PW/ CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW / ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 ~/t?1t/5 \fit,. BUILDING
T:\Policies\1102_15 building pennit inspectIon record05.\vpd [1/4/20051
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BUILDING PERMIT - APPLICATION
Fill out COMPLETELY and in INK. Your applicatior. and site plan MUST B
COMPLETE to be accepted for review. If you have any questions, call
PERMITS (360) 417-4815 FAX(360)417-4711
Applicant or Agent TC>v\. AhA. '-)~
Owner: Kl' ') (< .,~ ?e'\'\1 . LV4\.~~f'O\
Address: 72 \ j... >t"re.er City:
Phone:
3(0 775- 0720
45)~ 5;>5'1
Zip: c:t ~36 2-
Architect/El1.gine~r: . \
contractor~'~ ~~:!\-Iv ""
Address:-1- U <> \ 0 ~ 2
PROJECT ADDRESS: 7.2 \
Phone:
Fo,+-An~~k c:,
__J
Phone:
~""'I r -,UI
tate License #: HUP.l. I\t\ ~<...~ Exp:
City: ]=bIt AV\-C5 ks
St\
Phone:
.J:
Zip:
ZONING:
Qq,3G1.
LEGAL DESCRIPTION: Lot Block:
CLALLAM COUNTY PARCEL NU1\1BER:
Subdivision:
Credit Card Holder Name:
Billing Address:
Credit Card Type VISA MC #
Ti'PE OF WORK: SIZEN ALUATION:
)( Residential 0 New Constr. 0 Re-roof 0 Stove ..tOO SF. @ $ 4.. GO/SF. = $
o Multi-family 0 Addition 0 Move 0 Garage SF. @ $ /SF. = $
o Commercial 0 Remodel 0 Demolition 0 Deck ~ SF. @ $ /SF. = $
o Repair 0 Sign tt. Othe{ CDJer ~ TOTAL V ALUATlPN IL
BRIEF DESC~TION OF THE PRO.JJfFT: 11.)( \ b ' ol2.:..k. I -to be. c..:::-vere.6-. ........' tn
..\n"'''''~\Nt.>:-K... cu,~ p,\t~t\.,~e k. -rl b 'O(A'i~
COMMERCIAL/RESIDENTIAL: Occupancy Group: Occupant Load:
No. of Stories: Lot Size: Gf1 e,'7 Existing Sq. Ft. J~S ( & Proposed Sq. Ft.
Total lot coverage 2S.5" %
City:
Exp. Date:
t:goo, CO
~W.LV
~_/'1~~
Construction Type:
jUO = TOTAl Sq. Ft.-I1~1
ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other:
APPRO V ALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:_
PLANNING USE ONLY:
VALUATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applicant. Tills 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: IF a plan check fee is due it mustbesubmitted at the time the building permit application and construction plans are
submitted. All other permit fees are due at the time of penuit issuance.
EXPIRATION OF PLAN REVIEW: If no 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 R1 05.3.2
ofllie International Building/Residential Code, 2003). No application can be extended more than once.
j hereby certify that I have read and examined this application and know the same to be true and correct. j am authorized to apply for this permit and
understand that it is my responsibility to determin.. e what permits arerr. ed ,not the City's, and that I must obtain such permits prior to work.
---,-- a_~-os
T:\Policies\BL-l102_13.wpd Applicant: ~ Date: ()
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
03-00001194 Date 12/17/03
721 S I ST
06-30-00-0-2-4660-0000-
ELECTRICAL ONLY
@)
."
RS7 RESDNTL SINGLE FAMILY
o
Owner
Contractor
LUNDGREN KRIS L/PEGGY L
1007 E CRAIG AVE
PORT ANGELES WA 98362
OLYMPIC ELECTRIC
4230 TUMWATER
PORT ANGELES
(360) 457-5303
WA 98363
Permit . . . .
Additional desc
Sub Contractor
Permit Fee
Issue Date
Expiration Date
ELECTRICAL NEW RESIDENTIAL
200 A PANEL + 100 A SUB @GAR.
OLYMPIC ELECTRIC
99.00 Plan Check Fee
12/17/03 Valuation
6/15/04
.00
o
~,
t\)
-
Qty
1. 00
1.00
Unit Charge Per
76.3000 ECH EL-RM-0-200 1ST SRV FEEDER
22.7000 ECH EL-RM-0-200 ADD SRV FEEDER
Extension
76.30
22.70
U'
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 99.00 99.00 .00 .00
Plan.Check Total .00 .00 .00 .00
Grand Total 99.00 99.00 .00 .00
~
\-)
...
....
~
,...,,..... ;~.::."",--_........t
~''''- -. -
Separat'e Perm'its are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null anavoid 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 authonty 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 \PLANNING\FORMS\1102.15 [11/14/2003]
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
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 LOCA TrON.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
'"".
I INSPECTION TYPE DATE ACCEPTED COMMENTS
..,r'~~~
,.- .. YES NO
~f]. . \
FOUNDA ION:" " .f 4
FOOTINGS~""--"", .
.. ...
WALLS
FOUNDATION DRAINAGE/DOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN I
PLUMBING
UNDER FLOOR 1 SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW 1 WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS 1 GIRDERS
SHEAR W ALLiHOLD DOWNS
WALLS 1 ROOF 1 CEILING
DR YW ALL (INTERJOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL 1 FLOOR 1 CEILING I
MECHANICAL
HEAT PUMP
GAS LINE
WOOD STOVE 1 PELLET 1 CHIMNEY
HOOD 1 DUCTS
PW UTILITIES 1 SITE WORK (Engmeenng DIvIsIOn) SEPARATE PERMIT #'s'
WATERLINE 1 METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT SEP ARA TE PERMIT #'5 SEPA:
PARKING/LIGHTlNG ESA.
LANDSCAPING SHORELINE
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRJCAL - LIGHT DEPT. 4 I 7-4735 1;J~!o5 Ad) ELECTRJCAL
LIGHT DEPT
CONSTRUCTION R W. 1 PWI , , CONSTRUCTION - R.W
ENGINEERING 417-4807 PW 1 ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT
BUILDING 417-4815 BUILDING
T'\PLANNING\FORMS\1102 15 [11/14/2003]
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ELECTRICAL PERMIT APPLICATION
JQt. OIFlClAl. USE 0IlI'Ll'
-
.......;
....-
--
7hp E IacfrlcBI P&rmlt AppJit;;&tttm mu.t tN ftllMt our 00". aOtarv.
po ....type CIiIr I'1IIprtn' In InIL tfyou hD~ any Qu..IIons, pl__ C1111 (3eO)..U.....73!1
F.... l'Iume.t; (3180) .,7-4711
Ownar at Elec. Con~.C1D, Agent DIy m pic E 1 e c t r i c
P"'Perly ~et; C.h",'s Lu...dg~<'V
Add....: 72/ SilL" S,
EI_Coftnclor. Olympic Electric Co" Inc.
~ 4230 Tumwater
Co. , Inc. Phone: 457-5303 Far.
Phone:
Diy: f'A
Ll""""" /I: QYM=EC285:l1Exp: 3/31/03
Dry. Port Angeles
452-3498
'f 5::Z--52r;1
ZJp: Cf83i, 3
Pilon": 457-5303
ZIp; 98363
INSTALLATIONWIRe.C IlY:
DOWNER
I'll ELECTRICAL COIIITRACTOR
Ct'8dItCantHolderName: Charles T. Burkhardt, Olympic Electric Co., Inc.
BIII'nv Addra..: Same
Cnrdlt Cant Number.
City:
ZIp:
V7SA:~ Me:
Exp.O..",:
PROJECT ADDREIIS;
72.1 5
"I." 5,
'TYPE OF WORK'
Check Jill \hat applY: 0 New
}(Resldentlal
o Multi-family
o Commercial
)( A1lBrallonlAddltlon
o Mobile Home Sq. Fl
o RemolD Meter 0 08l8ched garage 0 Hol Tub 0 Swim Pool 0 Septic Pump . 0 Low Voltage 0 Telecom. 0 SIg
Numt-- at Clrculbl lidded '" 8_:
DESCRIPTION OF ll1E EL.ECTRI~ PROJECT: ~ we.. ;l..0()" _ P IHv.E L-
Sl(bF",~1 l~ ~3a.~
I~
~C">(se. 1'1Mu.l! 100,0.
-
f;.KOtrlcal' ~D" Addition. and or aubtnlctlon.
8e",lce Information
o B8sebDartl
OF""""""
o Hal Pllmp
o F.....Wall
_KW
_KW
ll:lN LA~
-JC;W-
)l(OwmtIBIld S"",ice
o Temp S""",,,,,
o Und8tgcDUnQ 6..Nlce
VDl1age:
Phase::l<fl (:1 3
Sel'\l4c:e SJze; ;J... c-o
Feeder Slze:---Lco
.
PAMC 14.05JllIO(B): FDf'indlltiD1al, comll19n::i8l, & tesl08oli8l p<Ojecm 18rger lI'l8n . dllE>lelo:. a DI1e _ 111'I& d<awing at the Elec:rrical Serv;a, &
F9ElCl8Ill.lluilclIng 8128 ("'I. n.), Ioaa calcuI81lans, lII'Id the ty p& & Dr condudDnlllf'dlDl' "",away Isl'9qlJlred entl .",,'leeeDlT1 pany the
Electr1caJ Pennlt 8pp1lcet1on.
I hereby certify that. I heWl read end ellaminer! rhle applfca(;on and know th81 same /0 be true and co;roct. end I el
8UthcH1zed 10 apply for this permit. I IJndemand it i /he CIty's legal responsibIlity to determine what POfrTllts
are requirf1tl; it ramains the applicants responsibility to determIne wflat permits are required and /0 obte/n such.
V~/)3Y
PW-llCll1f7/1l3
Crad/t C.rd Hollier'. 811_'
Os.,,, )2.-/(,,"03
I~ -1/"'03
00..: ....
~
- ..99,,00
0......,. 0If ElOc. ConL SlgrI_ftJntl
PERMIT FEE: $ 7&..30 + ~7.. 7'"
kl~ q4~1
t2L- C~__
ZO~
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ELECTRICAL PERMIT APPLICATION
. 1)0
0,"
FOR OFFICIAL USE ONLY
DalclRec:
Pamil#;
Dl.leApproved:
The Electrical Permit Application must be filled out comoletelv.
Please type or reprint In Ink. If you have any questions, please call (360) 417-
4735
Fax number: (360) 417-4711
77(Pc::'
REQUEST INSPECTION 0
Owner or Elec. Contractor Agent: i!U1tA75 ~/ J.IL 5 0",",
Property Owner:Ve't,lJ'I-' \::'("; S L'-',,"<or... r---
Address: f'J~ IS. ~ s+
Electrical Contractor: C; / -e t..-/ r c:.... ~ 0 'Y\ ~ '
Address: 1'.0, ~cry \ '-\ "'I \
Phone.
Fax:
License #:
Phone:3UJ- </5,;)-5 ;J..S-9
uJ-I'\~ Zip: S 1>-.5 <0 ~
Exp: Phone' "/::;--7- ? /;; ()
uJ A-~ Zip: <1'2;"31.02--
city:7c,\ 'A-\I\~~\-e."
INSTALLATION WIRED BY:
DOWNER
City: f'. 'A-
)(ElECTRICAl CONTRACTOR
Credit Card Holder Name:
Billing Address'
City:
Zip:
Credit Card Number'
Exp. Date:
VISA:...-- MC,---
PROJECT ADDRESS'
'7 J-I .5
:z: :sT.
TYPE OF WORK:
Check all that apply: 0 New
o Alteration/Addition
o Residential 0 Multi-family
o Commercial 0 Mobile Home
Sq. Ft
Remote Meter 0 Detached garage 0 Hot Tub 0 Swim Pool 0 Septic Pump
o Low Voltage 0 Telecom. 0 Sign
Number of Circuits added or altered:
DESCRIPTION OF THE ELECTRICAL PROJECT:
,'11511'/'// -+ 171."f-.er art tiel""-'
Electrical Heat Load Additions
PERMIT FEE: t-1~ ..?---O :7/95lJ7 Service Information
o Baseboard
o Fumace
o Heat Pump
o Fan-Wall
_KW
_KW
_TON
_KW
LRA
o Overhead Service
o Temp Service
o Underground Service
Voltage:
Phase: 0 1 0 3
Service Size:
Feeder Size:
I hereby certify that I have read and examined this application and know that same to be true and correct, and I am
authorized to apply for this permit. I understand it is not the City's legal responsibility to determine what permits
are required; it remains the applicants responsibility to determine what permits are required and to obtain such.
Credit Card Holder's Signature:
Date:
Own.er or Elec. Cant. Signature:
C:/ELECT~ICALPERMITAPPLlCATION Af~'r.f~b e,tt.d kYv;S
;::M- C Q. p- 7-D 'Z- P(lfel~ . ~ftfl:" M~ m-
1'b k ~+I~ ~.
Date: /
1H-/14. ~11't'>, 4Ito L.
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