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13609452091 T -434 P001/002 F -300
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Number of pages
FAX TRANSMITTAL
'360 '5 -2091
3
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W A S H I N G T O N U S A
Department of Community Economic Development
321 E Fifth Street
Port Angeles WA 98362
Planning Division (360) 417 -4750
Building Division (360) 417 -4815
FAX (360) 417 -4711
TTY (360) 417 -4645
Website www cityofpa us
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Peldoi t BUILDING BGRMi,T 700 PR FEE
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Te a Date 4/23/09
Vi 9546
1 ra tion Dane 10 /2o•1os
Qty VAiv Charge -Per Extension
sage PEE 95 75
98 00
7 00 14 0000 THOU BL 2001 25K (•10 PER K)
oc4er Fees
Tee etwoary
Am= SthlCllARGE
spa
Charged Paid Credited Due
Pegmit Fee Total 193 75 193 75 00
Pion Cheek Total, 013 00 00
Ot= .EeC._ Rol. 4 ,50 .9 50 00
Grand Total 198. 25 198 25 00
13609452091
4 30
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T -434 P002/002 F -300
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Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilitibs, private and public improvements. This permit becomes null and
void if work or construction authorized rs not commenced within 180 days, if construction•orwork is suspended or abandoned fora period of 180 days
after the work has commenced, or ifreq Inspections have not been rcgvcated within t80 days•from the toot .napcction 1 hereby certify that 1 have
read and examined this application and know the same to be true and correct. All provisions of Taws and ordinances governing this type of work.will
be complied with whether specified herein or not. Pre granting of a permit does not presume to give authority .to violate or cancel the provisions ofany
state Or local law regulating construction or the performance of cons 4 cried.
g (q(CA
\Date I Print Name Signature of n E clOr or AuthorlYed Agent Signature of Owner.(if owner is builder)
T:Forms/Building Oivirbn/9r,nt„ z Pennil
PREPARED 5/05/09 8 25 24 INSPECTION TICKET PAGE 5
CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 5/05/09
ADDRESS 516 C ST
TENANT NBR MARTIN /AUDREEN WILLIAMS
CONTRACTOR HOME DEPOT AT HOME SRVCS
OWNER MARTIN /AUDREEN WILLIAMS
PARCEL 06 30 00 0 1 0886 0000
APPL NUMBER 09 00000365 RE ROOF
PERMIT BNOP 00 BUILDING PERMIT NO PR FEE
REQUESTED INSP DESCRIPTION
TYP /SQ COMPLETED RESULT RESULTS /COMMENTS
BL99 01 5/05/09
tit
SUBDIV
BLDG FINAL
May 4 2009 4 51 19 PM 1pangrle
AARON 360 620 7683
BLDG FINAL RE ROOF HOUSE
COMMENTS AND NOTES
PHONE (800) 381 5699
PHONE (360) 417 2096
FAX(TX)
1 1 DATE I.START T I RECEIVER
1 0011 MAY /04d 04 09PM1836087116919858747
TO ar6
Company
Fax: 360 -,$7 l 101
Number of pages. 2—
(Including transmittal page)
W A S H I N G T O N U S A.
FAX TRANSMITTAL
s
TRANSACTION REPORT
MAY /04/2009/MON 04 10 PM
JIO NGEL
Department of Community Economic Development
321 E. Fifth Street
Port Angeles, WA 98362
Planning Division (360) 417 -4750
Building Division. (360) 417 -4815
FAX. (360) 417 -4711
TTY (360) 417 -4645
Website www cityofpa.us
ICOM TIMEIPAGEI
1 0 00 25 2 1
FROM
Ltv1cL Pat ra r
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TYPE /NOTE ITILEI
OK SG3167611
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P 01 /01
Application. Number
Application pin number.
Property Address
AS PARCEL NUMBER'
Tenant Ilbr' Maine;
Application type description
Subdivision Name
Property Use
Property Zoning
Application'valuation
Application desc
TEAR OFF RE ROOF 'THE" HOUSE
Owner
MARTIN /AUDREEN WILLIAMS
516 C ST
PORT ANGELES WA 98363
(360) 4'17' 2096
Structure Information 000 000
Permit
Additional desc
Permit pin number
Permit Fee
Issue Date
Expiration Date
T.FormsBuilding DivisionBuile. Permit
CITY OF'PORT ANGELES
DEPARTMENT OF COMMUNITY k ECONOMIC DEVELOPMENT BUILDING' DIVISION
321 EAST 5TH °STREET PORT ANGELES WA 98362
09, 00000365 Date 4/23/09
,2 ,46425 4, y
06: C ST
0_6630 00 0 1 0 0000
MARTIN AUDREEN WILLIAMS
RE ,ROOF
RS7` RESDNTL SINGLE FAMILY
854'6
Contractor
HOME DEPOT AT HOME SRVCS
rv"
23420 68TH AVE' S
KENT
(80'0)" 381 5699
TEAR OFF RE ROOF HOUSE
BUILDING PERMIT NO PR FEE
TEAR OFF RE ROOF HOUSE
144758
193 75
4/23/09
10/20/09
P1'an Check Fee
Valuation
Qty Unit Charge Per
BASE FEE
7 00 14 0000 THOU BL -2001 25K (14 PER K)
Other Fees
Fee summary Charged Paid Credited
Permit Fee Total 193 75 193 75 00
Plan Check Total 00 00 00
Other Fee Total 4 50 4 50 00
Grand Total 198 25 198 25 00
WA 98032
STATE SURCHARGE 4 50
Due
00
00
00
00
0 0
8546
Extension
95 75
98 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 o 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. 1 hereby certify that 1 have
read grid 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 gran ofa permit does not presume to give authority to violate or cancel the provisions of any
state or local law regulat.ng construction or the performance of construction.
Dale Print Name S gnature r' t .ontractor or Authorized Ag, t ;nature of Owner (if owner ouilder)
BUILDING PERMIT INSPECTION RECORD c�
0
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
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
Stemwail
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 Hod Downs
Skirting
Electrical
Construction R W PW Engineering
Fire
Planning
Building
T.Forr i3uilding Di isicr'Bi.iiding Permit
Date Accepted By
417 -4735
417 -4831
417 -4653
417 -4750
417 -i815
PLANNING DEPT Separate Permit #s SEPA.
Parking Lighting 1 ESA.
Landscaping SHORELINE.
Comments
FINAL Date Accepted by
FINAL Date Accepted by
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE
Inspection Type Date Accepted By
5 -5 -0 L[_
04 -23 -2009 13 21
FROM -NW PERMIT
CITY OF PORT ANGELES
Attn: Building Permit Technician
321 E. Fifth St. Port Angeles, WA 98362
(360) 417 -4815 fax (360) 417 -4711
Applicant 1Q kUV'Q-Sk Q.Q-4/1/K.4
Property Owner A -k 1P t) tN t LLI PriktS
Property Owner's Address G U° S C
Contractor im.e: z) A--t` l
Contractor's Address fW 6915 Ave 5 i&+
V
License +4.01M D* Expires 2 11
13609452091
PROJECT ADDRESS 5 ((o '4 C S -4
Parcel Number O CD5OOW 1ogS(o WO
P pe Brief Descriotion: gResidential o Multi- family o Commercial
Check all that apply
I7 New Construction
ID Addition
o Remodel
Repair
Demolition
`fie -roof
o Heat System
a Other
Date 1' 23 1 O Print Name N A-1 DA- V-Pr ,v
T -894 P 002/002 F-195
BUILDING PERMIT APPLICATION Print in ink
For City Use Only
Date Received 4 On
Permit
Date Approved
Phone (.42O` 4S
Phone Scar -4lI- -20'I b
Phone SIX) 381 -.9099
9
Wfl 4&037--
1 I E -mail taa- cia. v1w'.Q,t/tn'u+, 60Vv\.-
Lot Zoninp
o Industrial
douse o garage o other }dear off re -roof o lay over one layer
o Heat pump o wood- buming stove o gas fireplace o pellet stove o other
Roar Areas Existina (sq. ft.) Ersposed (sa. ft.)
Basement per sq. ft.
1 Floor
2 Floor
3' Floor
Garage
Carport
Covered Porch
Deck
Shed
Other
TOTAL VALUATION 8 5 C
Total footprint of structures sq. ft. T Lot size sq. ft. Lot coverage
Site Coverage the amount of impervious surface on a parcel, including structures, paved driveways, sidewalks, patios,
and other impervious surfaces. (see PAMC 17.94 135 for exemptions) Site coverage
of bedrooms
of full baths
of half baths
Max. height of proposed structures ft. Occupancy group
Will a lawn sprinkler system be Installed? Occupant load
Will a fire sprinkler system be installed? Construction type
I have read and completed this application and know it to be true and correct. 1 em authorized to apply for this permit and understand
that it is my responsibility to deternine what permits are required, and to obtain permits prior to working on projects.
Signature (111 AA /1
7:Foms /building Division /Bldg PermlLdoc
U
Per phone. 15cida Gives` con+rac Y ferrniI o«ly
ct\t A coo i f he- 5 `J exTrYi+ c6 receipt 6acie --1-0 Isat ct
04 -23 -2009 13 21 FROM -NW PERMIT
Northwest Permit Inc.
1345 Gulf Road
Point Roberts IA/A.98281
360 945.2787•
360-945.2091.
CC:
To: Linda City of Port Angeles Fax 360 -417 -4711
Permit Services
From. Naida Khan Date: April 23, 2009
Re: Mechanical Permit Aps Pages: 2
0 Urgent 0 For Review
0.,
try
ags u'1
The contractor will be into pick up the permit on Monday, April 27
cess attached building permit application.
j'd t 't e r f T ri*, ►a!:
arge the permit fees to Visa card xp
CVC 411. The billing address for this cc is 1345 Gulf Rd,
oberts, WA 98281
Please send all receipts and a copy of the permit to.
Northwest Permit Inc.
1345 Gulf Rd
Pt. Roberts WA 98281
13609452091 T -894 P 001/002 F -195
Please Comment Please Reply 0 Please Recycle
If you have any questions or require additional information, please
contact me at 360- 945 -2787 or by email at nalda@nwpermit.com
GovN
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. CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT -BUILDING DMSION
321 EAST STH STREET, PORT ANGELES, W A 98362
Application Number
Pin number
.Property. Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use . . . .
Property Zoning. . .
Application valuation
Owner
04-00000928 Date 10/12/04
.948160
516 S C ST
06-30-00-0-1-0886-0000-
ELECTRICAL ONLY
RS7 RESDNTL SINGLE FAMILY
o
Contractor
REEVES HARRY L/P N
9225 220TH ST SW
EDMONDS WA 980204549
Permit . . . .
Additional desc
Permit Fee
Issue Date
~I Expiration Date
Fee sUllllllary
Permit Fee Total
Plan Check Total
Grand Total
OLYMPIC ELECTRIC
423p TUMWATER
PORT ANGELES
(360) 457-5303
WA 98363
ELECTRICAL ALTER RESIDENTIAL
ALTER 200A SVC.
.00 Plan Check Fee
10/12/04 Valuation
4/11/05
.00
o
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Charged
Credited
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.00
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Separate Permits are required for electrical work, SEP A"Shor~line,I;{iA, utilities, private and public improvements.. This pel11)lt bec9mes
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 180days after the work as commenced, or, if required Inspections. have not been requested wlthin180 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 goveming this type of work will be complied wltllWhether specified herein or not The granting of a permit does not
presume to give authority to violate orcaricel 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)
T:\PLANNING\FORMS\II02.IS [11/14120(3)
Date
"
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL IN~PECTIONS.
., i
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWPUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. . POST PERMIT IN A CONSPI<::uOUS LOCATI~N.
KEEP PERMIT CARD AND APPROVED PLANS AT JOBiSITE. ~ I
DATE ACCEPTED COMMENTS
I
['
INSPECTION TYPE
FOUNDATION: ."
FOOTINGS
WALLS
FOUNDATION DRAINAGEIDOWN SPOuts
"" ~-"',,;;'~':(( ,;--' '~"'.~-~;::;\;>~
BUILDING PERMIT INSPECTION RECORD
.
I
I NO
i .
YES
.
.
'.
(UGHT DEFT) SEPARATE PERMIT: #. .
J J-.:u--t:AP1 ) lH I
J 1- S-p fJ. ...~ ~ c..:...Il.--:.
l'A-~:" ~ - I Y
ELECTRICAL
ROUGH-IN
PLUMBING
UNDER FLooRI SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS UNE
BACK FLOW / WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS / GIRDERS
SHEAR W ALLlHOLD DOWNS '.
WALLS/ROOF/CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T-BAR .
INSULATION
SLAB
WALL / FLOOR/ CEILING
MECHANICAL
HEAT PUMP
GAS UNE
WOOD STOVE / PELLET I CHIMNEY
HooDJ DUCTS
(Engineering Division) SEPARATE PERMIT #'s:
PW UTILITIES / SITE WORK
WATERLINE / METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEI'ARATE PERMIT.#'s
PARKlNGlLIGHTlNG
LANDSCAPING
.
RESIDENTIAL
ELECTRICAL - UGHT DEPT.
417-4735
CONSTRUCTION R. W./ PW/
ENGINEERING
FIRE
PLANNING DEPT.
BUILDING
417-4807
417-4653
.
, 417-4750
417-481S
T:\PL~G\FORMS\II02.IS (1111412003)
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BSA:
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FINAL]NSPE(:J]QJIl~REQ1,JIRED PRIOR TOOCCytoANc,x{lJ!t'. i
. DA'FE . .~ NO COMMERCIAL ..J
.... . '.. .,y' . . "c'
.
7C. ....
DATE
. ACCEPTED
YES NO
1~a-.lJl./ l~~ i
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UGHTDEPT.!
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FIREDEPT.,:,~ "_ _ I
PLANNING DEPT. I
BUItDING" .1
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Appl1cation Number
P1n number
Property Address
ASSESSOR PARCEL NUMBER:
Appl1cat1on descript10n
Subdivision Name
Property Use
Property Zoning . . .
Applicat10n valuation
04-00000826 Date
.556988
516 S C ST
06-30-00-0-1-0886-0000-
MECHANICAL APPL. PERMIT
9/17/04
RS7 RESDNTL SINGLE FAMILY
3500
\:3(f/lIZE;I':?
4/~/o~
1//
~
Owner
Contractor
REEVES HARRY L/P N
9225 220TH ST SW
EDMONDS WA 980204549
MERIT MECHANICAL
P. O. BOX 2109
REDMOND
(425) 602-3245
WA 98073
Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
MECHANICAL PERMIT
FURNACE & HEAT PUMP
61.70 Plan Check Fee
9/17/04 Valuation
3/17/05
.00
o
Qty Unit Charge Per
Extension
47.00
14.70
BASE FEE
1.00 14.7000 ECH ME- INSTALL 100- FAU
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 61.70 61.70 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 61.70 61.70 .00 .00
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Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction orwork is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspection. I 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)
T IPLANNING\FORMSII 10215 [11114/2003]
..C. JvLJ .JI ~Jil No.2139 p. 1 DOl/DOl
Fill out COMPLETELY and in INK. Your application aDd site pllln MUST BE
COMPLETE' to be accepted for review. If YO"Q have an3' questions, call
PERMITS (360) 417-4815 FAX(360)417-471I
FOR OfFICIAL USE
Date Rec.: q - I '7 ~6 ~
l'CTInJril: 04 '-92 b
Date Approved'
Date Issued
Applicant o\!'1len: ~~ Or:- ~ \<~'Q Q "':l-' D Phon" @/pO- ./17- / of5L
tlw.a-,- . ~ _ - - - , .: _ ttn Phone 40Jt> l'o 7 ~ - I-<lM
Ad<h:~ss_ 5 \ I.c C:rt,% e. ti crty~ .~; -i.o . . . .~p ~-J06' - -/
Arcbitect/Engmeer: . .' _' . ~ :..' .Phone: ;r.) . .
('\1\ " . \\...~ - ~ \\ Mo.ll :'-7-J/'11...I'"C?.Cfi1 AI / ,.-c- ( ~5' . I --' i
Contrac~" ~-~ L \ S"'" ~~,,"~ Lie~_ 1Ji::1" ~~ ()~ :Phone, ~",?,tJ<}S
Address~(~ ~~(~ a \DC; Clty:~_(_c\ ~: Zip: 9f(()5",
PROJECT ADDRESS: 0\ lo ~()~~, ~~i.\::., . ZONING:
LEGAL DESCRIPTION: Lot: . . Block: SubdivislOn:
CLALLAM COUN1YP ARCEL NUMBER: ()~:s ()0CX-) / c~ 88 (00 c,) 0 c)
Credit Cord IIolder Name-:Y c,..~; c;. e.. ~ e.e, y <::~"> -.i!1;:; ~
Billing Address: q @ \ ~ PJ 0) C'I "-:lO ~.!.. ~~ 9ty: t:..:~ .~c\.. l..) _ c.; g Ql~
Credit enX'd TJ'pe VISA" ,Me _ #..:. Exp. Date:
TYPE OFWOR1(: SIZENALUATION:
~Residential 0 New Const!. 0 Rc-roof 0 Stove SF. @ $ ISF. "" 5:
o M'lllti-fa.mily CI Addition CI Move 0 Garage SF. @$ ISF. "" $
o COlDIIlercis.l CI Remodel. 0 Demolition. 0 Deck .l.l. . I SF. @ $ ISF. =:: $
CI Repair 0 Slgn .Jl('''othcr~ (/..l TOTAL VALUATION $ <.e)~. 00
BRIEF DESCRIPTION OF TEE PROJECT: ~'-~.0t\~ ~ ~6 Ou__~ \G L'- .!\...C\...(' 11 0\.... - \:-~ \. \)
'(\} t'J "->-~ \\ ~ \.. ~ \.. \'V'- ~ ~ . ~ -t--eY\ -\"G\.nL r" ~ _
COMMERCIALIRESIDENTIAL: Occupancy Group: Occupant Load' COnslru.ctioD Type:
No. of Stories: 1- Lot Size: EJOSting Sq. Ft J :~5C) & Proposed Sq. Ft. = TOTAL Sq. Ft.
Totl.llot coverage %
APPROVALS:
PLAN:
BLDG:
DPWU:
F.illE:
OTHER:_
PLANNING USE ONLY;
.. ......
ESAlWctlan.d(s): D Yos 0 No SEPA Checklist reqmred? 0 Yes 0 No Other:
BUILDING PERMIT APPLICATION SUBl\11TTAL: The Building Division can provide you with information on the application and
plan submrttal requirements if you have questions.
VALUATION OF CONSTRUCTION' In aU callOS, a valuation aIllClUnl mu.st be entered by the applicllJJt. T.his :figure will be revJc\l\'ed
and may be revised by the Building DivisIon to com;ply~tith current fee schedules, Contact the PeImit Coordinator at417 -4815 for assistance.
PLAN CHECK FEE' IF a plan check fee IS due. it must be :;ubnutted at the tlme the building pemut application and construction plans are
. _. '-submitted.-All.other-pe;lJ1ut.f~~ are due at the tlme of permit lSSU3Ilce.
EXPIRATION OF PLAN REVIE~;;-rfllO- prnriiOs'issuea withm'180'd.ll~'s Qfthe-Gatc.(Jf.applicatioll, the applic.~.~Qll:- ~ilt~!p_~e. Thc
Buildmg Official can eA'tcnd the time for action by the applicant up to 180 days upon written request by the applicant (see Section Ri(J5~3T"
of the International BuildinglR.esidcntial Code, 20(3). No apphcation can be extended more than once.
T. \RVESS\BLDG-foID1&',brochul'l:6\2003-Bulldingpeunit. wpd
I hereby certify that I have rBad and examinBd this application and know the same to be true and correct. I am authorized to appll for this permit and
understand that it is my responsibility ta determine what permits am required ,not th~9if and that I rrifiSiObl . such pem,its Wi t r; . n .
~: ~ Datc;Yf- /7-d/'
\ . J()Ltg~J::L-0 )
Recleved Time Sep, 16.
7:56AM
~ :;5G~ , -; oj." I I
~Q2
o 2/ .:,.
10/08/2004 14:20 FAX 3604523498
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OLYMPIC ELECTRIC
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ELECTRICAL PERMIT APPLICATION
FOR OI'FlCIA1. U~ ONLY
_.
I'lmU ."
0Id.~..
-.......
The E lec1rIcel Permit Application must be f1111K1 aut cornafetelv.
Pt.... t)'pe or ,..pl'fnt In Ink. It you haye Iny Que8tJorw, pi.... ull (350) ."~715
Fax- nurn ber: (380) ."'''''1 t
o..-...EIec. Contr._Agent 01 ymp icE 1 ec t r i c
Property Ownor.;t7rr" -/. i?71h/ iF" ;1 c' rr/ ('. <;
./ <r
Add....: -(/ ~ _ <( ,,"'-
e_ COnlroctor. Olympic Electric Co., Inc.
~ 4230 Tumwater
Co. , Inc. Phone: 457-5303 Fax: 452-3498
Phone: '1/ 7 - /P'5?1
CUI': f?;rf A~r/rJ Z1~: '/ y U2
License t: a... YM=H28501Exp. 3/31/03 Phone: 457-5303
CII\': Port Angeles 2l9: 98363
INSTALLATION WIRED BY:
o OWNER
lO ELECTRICA.L CONTRACTOR
Creditc.nlHoJdet-NIJJJM: Charles T. Burkhardt, Olympic Electric Co., Inc.
amlng Addrua:
Same
Credit c.nI Number.
City:
Exp. Data:
Zip:
\l7SA: X Me:
PROJECT ADllRE8S:
,;/;;::; j (: -' r
TYPE: OF WORJ(:
Check alllhat apply:
J?,r .-1- Ad/: 1
./
o New. 19'Al18ratloolAdditlon
ll3"'R'esldenU81 0 Multl-f8mily
o Commercial 0 Mobile Home
Sq.Ft.
2
OSlg ~
oq
"
.'
"
o Remole Meter 0 Detached garage 0 Hot Tub 0 Swim Pool 0 Septic Pump . 0 Low Voltage 0 Telecom.
Number 01 ClrcullB added or eltered:
DESCRIPTION OF THE ELECTRICAL PROJECT: I!/,:-!;/
.-:;;.~,.<) J I/V' /
r/ ".,~/'17/? /77,~r ~ r//7,'-
, /
E'ect- I ...... ......./tIon. and or .ubtrac:tJon.
Service Info.....-..
o Baaeboerd
Ofumac:e
o _Pump
D F....WalI
KW
KW
TON
-KW
LAR
~emead Servlca
o Tamp Service
D Underground Setvlce
Vollage: ;2. 'V/
Phase: i2'1 0 3
5."";",, Slz.: .2?:?~
Feeder Slze:__
PAMC 14,05.060(8): For induotrlBJ. commerciel. & resldenli8J projects larger than a duplex. a one - line drawing 01 the Electrical Setvica &
Feedenl. building size CSll. Il,).1oeC calculatJonB. end thBlype & olconductol'8 and/or ~ay Is required and shall eecompany Ihe
ElacIrIc8J Permit eppllc8tlon.
I hereby certify that I have read and examined this application and know Ihat same to be true and correct, and I ef
authorized to apply for this permit. I under:;tand it is not the CiIy's legal responsibility to determ hat permits
are requir&G; it remains the applicants responsibIlity to determine what permits are required and to obtain such.
CrodM Cord Holder'. SIg.........:
Dat.: /?Jh /?'t/
Do.., /0// /?/t/
PERMIT FEE: $ . 6h ~
Owner or EI.c. Cant. SiSftature:
PW-9018171tl3
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IElrE(c"fIF<<~CAl ~INISIPIEC"f~<O>1NI
W~ 1Rl~ NG flllElP<O>lPflr
417-4735
-
tZ...-4.U'A
$, C:.- "~
APPROVED NOT APPROVED
D """.".."....."..".. DITCH ................... D
D .............. ROUGH IN/COVER. . .. . .. . . . .. .. D
D .................. SERVICE .................. D
D .................... FINAL. . . . . . . . . . . . . . . . . . .. D
CORRECTIONS NEEDED:
@
NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
- DO NOT REMOVE -
OLYMPIC PRINTERS, INC. (380) 452-1381
....
. -
"
ELECTRICAL ~INISfPllECT!OINl
WIR!NG 1Rl1E~(QlIRT
417-4735
~
IN~Tfcl
DATE
IO-.z..o - 0<-(
o ICONTRACTOR
.
E,
ADDRESS
5/ S
APPROVED NOT APPROVED
o ................... DITCH ................... 0
o .............. ROUGH IN/COVER. . .. .. .. . .. ... 0
o .................. SERVICE .................. 41
o .................... FINAL. . . . . . . . . . . . . . . . . . .. 0
CORRECTIONS NEEDED:
Gel 1. IA-/iAA./ -...dz..uf .-<'1 'I/~f 1)).-\,
t~...f tI2 A~"'. Q~ ..
NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
- DO NOT REMOVE -
.__.9LYMPIC PRINTERS, INC. (360)452-1381