HomeMy WebLinkAbout2201 W 16th St - Engineering
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CrrY;OF PORT ANGELES
DEPARTMENT OF COMMUNlTYI:>EYELOPMENT ,.. BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number ," 04-00000496 Date'
pin ,number . . .' ,.,'. .41989-6
Property Address ,. 2201 W 16Tli"S'l' ,
ASSESSOR PARCEL NUMBER; 06-30-00-1-11'-7800''-0000'"
Application description . PUBLlC WORKS UTrLITES
Subdivision Name
property Use . . . .
Property ZOning . '. .
Appl1cationvaluation
Owner
Contractor
< '" "
-----------------~------
PILOT IN'l'ERNATrONAL
259,403 HWY 101
SEQlJIM WA 9838.2
(360) 457-7222
Permit' . . . .
Additional desc
Permit Fee
Issue Date
Expiration Date
PUBLIC woRKs RES WATER SBRV
, , ,
.' - '-' . , -, ',' ,
.~------------------------~----~.----~-----~-----------------------.-------~-
640.0~
6/04/0~
12/01/04
Plan Check Fee
Valuation . .
Qty Unit Charge ~l;'
1.00 640.0000 EA PW, W/M 1ft SERV 5/8" METER
.00
.00
.00
~
~
~
;
Fee summary " cparged Paid Credited Du$
-------------~--. -------~~- -..---.-.- ---------- ----------
Permit Fee,Total
Plan Check Total
Grand Total
.00
.00
.00
~
~'
Q)
~
~
Separate Permits are required for electrical work, SEPA;$h9re!ine, ESA, utilities, private and public improveme.f1!S.lt1is petmifb,!tCom~s
nutl and 'Void if work or constrlJctIon authorized IsnQtcorilll1e)'l~W!1J1iri 18!) da~~Jf construction or work issuspend,ed~r~bandonei:t
for a period of 189, days after the work as commenced; or If required Inspections have not been requested W,ithjn18(fdaysfTOm"the last
inspection.Jh~r.eby c~rtifythat I have read and exal1'linedthis application al1dJ~ll()w the same tobetrueand colTect.A1lprp"isions of
la, ws and 6~inanCeSgovem, big this type of wOrk,wiU be COmplied, with whether SP, ecl~,~ herein or no, t, ."The grantin9,'.f' ap~rmit,does not
presume to ive authority to violate or cancel the provisions of any state or locallsw regulating construction or e performance of
constructi'. '.
\
T;\PLANNING\FORMS\II02.IS [1111412003]
Signature of Owner (if owner is builder) .
Date
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BUILDING'PERMIiflNSPECTION RECORD
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CALL 417-4815 FORBUlLDlNGINSPECTIONS. CALL 417-4735 FOR, ELEcTRICAL INSPECTIONS.
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PLEASE PROVIDE A MINIMUM24 HOURNOTI~E. IT IS UNUWEUL.TO COVER,INSl!.L;tT~.ORCqNCEAL ANYJfOIU(JJ~FOR.E
INSPECTEDANDACCEPTED. POSTPEmnrIN A CONSP~ClJOll~ LOCATI<)N'i ..o' ...... .. ...... .............
KEEP PER;MIT CARD AND APPR.OVED PLANSATJOBSITE.
INSPECTION TYPE DATE .' ACCEPTED -- ", '. COMMENTS
. YES I NO" .
FOUNDATION: I.' ......
.
FOOTINGS
WALLS . ; '.<'
FOUNDATION .' DRAINAGEIOOWN SPOUTS .' / , '.' . '.
ELECTRICAL (LIGHT DlWf) SEPARATE PERMIT: # ... .. ...
ROUGH-IN . . >: J .......... I. I . .....
. \ .' . ..
PLUMBING '.' ....
UNDER FLOOR I SLAB
ROUGH-IN .'. .' .'
.. ..
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW I WATER ~ .' '.
-
. . .
AIR SEAL . .'
WALLS . I. ;' '.
CEILING I I J.
FRAMING ..
.
JOISTS I GIRDERS '.
SHEAR W ALUHOLDI>OWNS I;
WALLS I ROOF I CEILING . " ...-.
DRYWALL (INTERIOR BRACED PANEL ONLY) ..'
T.BAR '. '. .., - '. .:. '. ..... .
INSULATION .. . '. '.'-
.
SLAB .-
WALL! FLOOR! CEILING I.' '. '.' ..
. .
. - .,. '. . "."--
MECHANICAL '. . ,.' .
HEAT PUMP
GAS LINE .. . ,
.'
WOOD STOVE I PELLET I CIDMNEY ',.
HOOD I. DUCTS .... .' ,. -.., ..
P\V UTILITIES I SITE WORK (Engineering Division) SEPARATE pERMIT #'s: .
'.
WATERLINE I METER .' .
SEWER CONNECTION . . .. ;'
''',
SANITARY . .'
STORM . ,
- .,' .
PLANNING DEPT. SBP~TEPERMrr#'s' .... '.' .... SEPA:
PARKlNGILIGHTlNG ESA:., ."
,LAN,~SCAPING . .. .' .. .' I..' ::/ ~<?RELINE:'.."". ;;r. .
. . .. ..... I. ,,'. .... .'. , "
" .... i; .;;FJNAA INSPECJWI')IS ~gU,~RED,PItIOl\ TO OfClJ,~Nl-CXJ,y~I!::'" " "," '", ),', '"
,
'. -;c- REsIDENTIAL ',,, DATE..... YES .NO c- " <'~.";;'" '-;qA<;CE~~D.,., .~'-
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"' .... ;'<,:;.l.i;:-'.";,;,; .,' .,' ".. '''",,''.- 'i
ELECTRICAL.. LIGHT DEPT. 417-4735 ELECTRICAL '., ,{ "'1',,:,"4.' 1"/0
UGHTDEPT',' ' ./). ,
CONSTRUCTION R. W.I PWI .. . 'COli~Uc.nON ~ R. W. .- ....
i (;
ENGINEERING 417-4807 ,-'. -, PW I Q~!3~g .... . c.
~ .'., , 'f... ........\.,:..:'-J " \ <.," , )
FIRE '. ., 417-4653 FIRE DEPT.' ;."^
417-4750 I , ".f .' '. '. ;;
PLANNING DEPT. , PLANNING DEPT. , ,. .'
'. . BUILDING -',,"" " ., . .....
BUILDING 417-4815 , ,.
.
T:\PLANNING\FORMS\1102.1S (11/1412003)
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'I
BUILDING PERMIT - APPLICATION
FOR OFFICIAL USE ONLY:
DateRec,: '-{- /'" oS
Permit #: (:);5" - ~
Date Approved: 1
Date Issued:
Fill out COMPLETELY and in INK. Your application 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: L eel.- h f(66d.s Phone: avO i;'oq - D~o/~
.
Owner: O/Y/41 p/c. Land Oe l/e,/ Opme/LT Phone: 31;0 ~57 -7 Z:l 2-
Address: PO. 60)( '5'Cf'S City: ('a.,-/.shor, ,wA Zip: Cj %'3..24
Architect/Engineer: 7' ' Phone: S'oq ot::fl{ s Aae"l 'R.oP<Is
. . (onrfr?rch~Y7 (;..)~N"'A~:Z I L
ContractorWa.nf Achpl"'7 State License #: qer Z/J 3 Exp: (/.27 o(P Phone: 36 (;) tpf'/-39'1z.
Address: P O. ~o)(' 1~2S City: 5 ~~w ~ I /NA. Zip: q J' 3t! L.
PROJECT ADDRESS: 220 { W (& ~ sf fori .-41"17'efl's ZONING: Jf?..s 7'
LEGAL DESCRIPTION: Lot: -4 I Block: Subdivision: (;)1 Y J1-1 pi L Neic; ), 1- S.
CLALLAM COUNTY PARCEL NUMBER: 0 (p 3600 ( 0 7 8 () () 0 00 0
Credit Card Holder Name:
Billing Address:
Credit Card Type VISA
TYPE OF WORK:
VResidential 1B"'New Constr. 0 Re-roof
o Multi-family 0 Addition 0 Move
o Commercial 0 Remodel. 0 Demolition
o Repair 0 Sign
BRIEF DESCRIPTION OF THE PROJECT:
a. d (Ve-{ o.,o~.rt..:f a f
City:
Exp. Date:
MC
#
COMMERCIAL/RESIDENTIAL: Occupancy Group:
No. of Stories: 2. Lot Size: C( 0 ?.2 Existing Sq. Ft.
Total lot coverage .:2-'1
SIZEN ALUATION:
o Stove I q-zg SF. @$ 100, cJo /SF. = $ lq 7. YtJo. () 0
.
o Garage SF. @ $ /SF. = $
o Deck SF. @ $ /SF. = $
o Other TOTAL VALUATION $
S/,-ui/~ ..p~'1y r'<S ,-de.nC-e /0"7
3 ~ h ~rr\ C S w / 1-/,(' ~4t8/~
~
Occupant Load: Construction Type:
& Proposed Sq. Ft. 2.& $4 = TOTAL Sq. Ft. 2" scf
%
APPROVALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:_
PLANNING USE ONLY:
ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other:
J
BUILDING PERMIT APPLICATION SUBMITTAL: The Building Division can provide you with information on the application and
plan submittal requirements if you have questions.
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: Ifno 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 Rl 05.3.2
of the International BuildinglResidential Code, 2003). No application can be extended more than once.
I 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.
Applicant: ~a.-h ~ Date: LI!t/OS
T:\RVESS\BLDG- forms-brochures\2003-Buildingpermit. wpd
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CITY OR-PORT AN@ELES
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'PUBLIC WOR:.K,.~: - UTlliIT~S DNISION
321 EAST STH STREET; PORTANGE,LES, WA 98362
Application Number
Application pin number
property Address
ASSESSOR PARCEL NUMBER: ,
Application type description
Subdiyision Name
property Use . . . .
property Zoning . . .
Application valuation
RS~ RESDNTL SINGLE FAMILY
197800
Owner
. "'- , --~' -~., - -', - -", ' " ,"' -;.
-----------'------------,-"
-" , '
- - - - ~.... - -',- - - - - - - - - - _.- - - --
OLYMPIC.LAND DEVELOPMENT
259403 HWY 101
SEQUIM
(360)457-7222 \
Struct,ure Information 000
construction ~e
Occupancy Type
Other.struct info
WANT. ACrION CONSTRTJcTION
P. O. BOX:1.425
SEQUIM
(360) 681..,3992
000 1978SF 2 STORY SFR W/ATT,
TYPE V NON-RATEIf" .
SINGLE FAM & CC)NGREGATES
TOTAL %, LOT' COVERAGE
CONSTRUCTION TYPJ!) -
NUMBER OF STORIES, '
EXISTING LOT COVERAGE
LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE:
NUMBER OF UNITS"
INC.
INC,',
WA 98382
Permit . . . . .
Additional desc .
Permit pin number
Permit F'ee .'~
,Issue Date ,
Expiration Date
RIGHT OF WAY
Qty Unit Charge Per
1.00 50.0000 ECH
,. .~
, " , " '- - "-'" -
. - - - - - - - - - - - - - -'- - - - - - - -...- - - - - - -'- - - - - -- - - - -'- - - - - - - - - - --'-- - - - - - - -'- - - - - - - -'- -.- - -'-
Permit . . . . .
Additional desc.
E>ermit'pin number
Permit Fee
Issue Date
ExPiz;atfon Date
SANITARY
47480
110.00
4/20/05
10/17/05
Qty Unit Charge Per
1.00 110.0000 EA SAN
,~' -' . .., ,"
-------_._._------------------------------------------------------------------
Special Notes and Comments ,
Building address sign shall not be less than'6"'& 'notmq:t;e
thcin12" in height. Numbers colors must contrast,with wall
color they are mounted on. (Ord. 1.4.36. 050':'E),', ,
When roof gutters are installed, drains will, located in'dry
wells 'or piped to approved storm: drain ,locations '.' "
New ,subdivision outside the four'minute respbnse time,shall
be equipped with a residential sprinkler systemthaf is '
installed and maintained in accordance with Uniform Fire
Code (UFC) and National Fire 'Protection Assodkt1on(NFPA)
/ c .
standards.
Separate Permits ;are required for electri,cal work, SEPA, Shp-reli~~:ES", utilities, private and publiC Improvem,'
null and void if work or constructioh authorized is not commenced within 180 da9S; if construction ot Work "
for,aperiodQf:180::days;afterttiewPrk~as.rominenced,or~if" , I" ," ' nspectionshave:notbeenrequeste.
inspection. I hereby ~ertifythatl haSte read'and examined alion and know the same to be trUe arl, :.,.., ,
laws and,ordinances governing this type of work will be camp ,whet/:ler specifiedhereirior not. The',g,!cinJiri9. .
presume to give authority to ;violate or cancel the provisions.: o any state or local law regulatirigconstniCtidh of
construction. " , I\.) ',' '/' ' "
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PERMIT INSPECTION: RECORD
""'=';
CALL417-4807 FORUTILI'[Y INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE'I1'ISUftlLAWfC!LT() COVE'rR,
INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A,CONSPICUOUSLOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE A<;CEPTED COMMENTS '.
I ,
. YES NO .' "
PW UTILITIES (Engineering Division) ,
WATERLINE/ METER ~
SEWE~ CONNECTION ,
SANITARY.
STORM '..
.
SITE DRAINAGE'
.' ..
. SITE EROSION CONTROL
PARKING " .
SIDEWALK \
CURB & GUTTER , ,
,
DRIVEWAY APPROACH I
BACK-FLOW DEVICE. I I . i
:l
-
.
.. ....
". . ..
I
I I .
, ,
.
.
.
. . .
. .
. ,
.'
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, F'INAJ:INSP~CTIONS REQUJR;E.D PRIOR TO O<;CUP~9'JUSE .' ,\.
. H'~ltESIDENTIAL ' ..' . ". "IiATE · " ccVES -NO ";c-(:OMMERCIAL' i. ~'c~DATE .- .' ~-ACCEPiI'ED
,
.. \ YES ,<' .NO
, ,. .
CONSTRUcnONR.W./ PW/ CONSTRucnON- R.W., "
ENGINEERING 417-4807 P.W/ ENGINEERING '.'
..' ." ,
FIRE .' 417-4653, .. '.. , ,. . FlREDEt>;l'.-,
PLANNING DEPT. . 417-4750 PLANNING DEPT. .
, OUILOINQ .... . .
BUILDING 417-4815 .' , ,.,
~ ....
. '.'
T:\Policies\II02.15R [1105]
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1----
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Signature ofContr~ctor or AuthClrized Agent
\;GITY OF PORT ANGELES
PUBLICWORI<.S.... UTILITIES DIVISION.
~2IEAST5TH STREET,PORTANGELES,WA 98362\
1
Application Number . . .... 05-00000236
Application pin number 182956
I'
Special Notes .and Comments
'n1e proposal will result in as. f. residence in the RS-9
zone for total lot coverage of 29%. Lot coverage is good. No
land use issues are noted. -
ElectJ;ical load calculations.. artd elctrical pe:rmits are
required.
Connection fee of $222.00 required. . .
Sanitary sewer connection inspection isreq1.lired by
PUblic Works prior to backfill of ditch,
Construct driveway to City Standards.
No concrete with exposed aggJ;egateallowed in the City
road right of. way.
. .'
---------------------------------------~------------------------------------
Other. .Fees
SEWER SYSTEMDELV C~GE
STATE SURCHARGE
PW WATER SYSTEM. USE FEE
745.00
4.50
1025.00
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Pe:rmitFee Total 160.00 160.00 .00 -.00
Plan Check Total .00 .00 .00 .00
Other Fee Total 1774.50 1774..50 .00 .00
Grand Total 1934.50 1934..50 .00 .00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improv~meFlts,Jt1ispennij'bec()mes
null and void If work or construction authorized is not commenced within 180. days, ifqonstrticfion oryjorklss4S~~ri_ded '- ab~ndned
"- for aperiodof~18'O-days-after-the_worK ascommenc-ed,or if-requirediQspectlonschavEHlot-been-reques~edWithin-180' .. ._ :tast
inspection. I hereby certify that I have read and examined this application ard knowth~sanie to 1:1& true and ~rrElct;"~i ons9f
laws and ordinances goveming this type of work will be complied with whether specified h.ereln or not. Thegi"jlntingof aj>~rml .. . bes not
presume to give authority to violate or cancel the provisionj)of any state or localJaw'r~ulating construqtioti. or the perfqti1iarice of
construction. - - . .. . - .-
T:\Policies\1102.1SR [1105]
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PERMIT INSPECTION RECORD
CALL 417-4807 FOR UTILITY 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 LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO .
PW UTILITIES {Engineering Division) :.
WATERLINE / METER _._.
SEWER CONNECTION
SANITARY
STORM
SITE DRAINAGE ..'
,
.
SITE EROSION CONTROL
-
PARKING
SlDEW ALK
CURa & GUTTER
DRlVEW A Y APPROACH I
BACK-FLOW DEVICE I' I . -
.
.
I " I
...'
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE' YES ' NO . COMMERCIAL --DATE hACCEPTED
YES NO
CONStRUCTION R. W./ PW / il-IB-6S I<V CONSTRUCTION - R. W.
ENGINEERING 417-4807 PW / ENGINEERING
. .
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
T:\Policies\1102.15R [1105]
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CITY OF PORT ANGELES
PUBLIC WORKS - UTILITIES DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
0'5" -d,3 Y
.. I.,,: '"
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application type description
Subdivision Name
Property Use
Property Zoning .
Application valuation
05-00000236 Date
182956
2201 W 16TH ST
06-30-00-1-0-7800-0000-
RES NEW SFR
4/20/05
--rh
J-'?O / W } /fl-
RS9 RESDNTL SINGLE FAMILY
197800
OLYMPIC LAND DEVELOPMENT
259403 HWY 101
SEQUIM
(360) 457-7222
Structure Information 000
Construction Type
Occupancy Type
Other struct i~fo
INC.
WANT ACTION CONSTRUCTION INC.
P. O. BOX 1425
SEQUIM
(360) 681-3992
000 1978SF 2 STORY SFR W/ATT 528SF GARAGE
TYPE V NON-RATED
SINGLE FAM & CONGREGATES
TOTAL" % LOT COVERAGE
CONSTRUCTION TYPE
NUMBER OF STORIES
EXISTING LOT COVERAGE
LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE
NUMBER OF UNITS
WA 98382
~
Owner
Contractor
WA 98382
29.00
04-- 411 ~
vJl(Yl
V-N
2.00
1. 00
9052.00
2654.00
2654.00
1. 00
Permit . . . . .
Additional desc .
Permit pin number
Permi t Fee
Issue Date
Expiration Date
RIGHT OF WAY
47498
50.00
4/20/05
10/17/05
Plan Check Fee
Valuation
.00
197800
Qty Unit Charge Per ~x .
1.00 50.0000 ECH RIGHT OF WAY PERMIT 50.00
---------------------------------------------------------------- -----------
Permit SANITARY SEWER HOOK UP
Additional desc .
Permit pin number
pe rmi t Fee
Issue Date
Expiration Date
47480
110.00
4/20/05
10/17/05
plan Check Fee
Valuation
.00
197800
oK-..
i:YcJIt --D S.
"M ,;r..0 U //'ti 0
~~~ , /I 9/4~D
5#~
11)7~ (()~
I j/lf?
Qty Unit Charge Per ~xtens-'
1.00 110.0000 EA SAN SEWER HOOKUP ~~
------------------------------------~--------------------------- -------- -
Special Notes and Comments
Building address sign shall not be less than 6" & not more
than 12" in height. Numbers colors must contrast with wall
color they are mounted on. (Ord. 14.36.050-El
When roof gutters are installed, drains will located in dry
wells or piped to approved storm drain locations.
New subdivision outside the four minute response time shall
be equipped with a residential sprinkler system that is
installed and maintained in accordance with Uniform Fire
Code (UFCl and National Fire Protection Association (NFPA)
standards.
Separate'Perrtlits-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 (1105]
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CITY OF PORT ANGELES.
PUBLIC WORKS - UTILITIES DIVISION
321 EAST 5TH STREET, PORT ANGELES, W A 98362
Application Nwnber . . . . . 05-00000236
Application pin number 182956
Page
Date
2
4/20/05
special Notes and Comments
The proposal will result in a s.f. residence in the RS-9
zone for total lot coverage of 29%. Lot coverage is good. No
land use issues are noted.
Electrical load calculations and elctrical permits are
required.
Connection fee of $222.00 required.
Sanitary sewer connection inspection is required by
Public Works prior to back fill of ditch.
Construct driveway to City Standards.
No concrete with exposed aggregate allowed in the City
road right of way.
-----~~~~~-;~~~--~-~-~-~-~-~-~-~-~--:~=;;-:~~~~:~~-~~~;--~~--
----~-------------------------------~~-~~=~~_:=::~~-~:~-~~~---~----
Fee sununary Charged Paid Credited Due
----------------~ -~-------- ---------- ---------- ----------
Permit Fee Total 160.00 160.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 1774.50 1774.50 .00 .00
Grand Total 1934.50 1934 _ 50 .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
fora period of 180 days after the work as commenced, orif 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 tonstruction or the performance of
construction.
Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T:\Policies\1 102.15R [1/05]
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . INSPECTION REPORT. . . . . .
REQUEST:
Date J/~ /5-D5
. .
Time
Received by
RV'
(phone, person)
Location of Work to be inspected 2 2l'? I lJ I b,f h
Name of person requesting inspection A I( <::Ll./l
Address of person requesting inspection Phone No.
Type of Inspection (circle appropriate one}: Permit No. 05 -?'S' <:;
Sewer Foundation Framing Chimney Plumbing cB;V Sewer Excav. Other
INSPECTION NOTES:
Inspected: Date 1/ -/5 - 0 S-
Remarks: Wat/<..''-t.3 'Pa.il1.
iA)41 tol'5 '.pat'"
Time By
h(')f- t:..,..s fed/.ed
121/
u- (<;-oS
/1-=-19,-0:;-
16 l\,Z)uJ ~ "",sta.\\-e!
0(<-
RESTORATION REQUIRED . . . . .. YES
NO '>L
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
o Repaired by City
[] Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . INSPECTION REPORT. . .
REQUEST:
Date <;is - LI-oS
Time 9: ~ 11m Received by
(phone, person)
Location of Work to be inspected :J. :z 0 I uJ e;. s -/- I&, J-l. ST
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
Sewer Foundation Framing Chimney Plumbing Final
Phone No.
Permit No. OS -23(.;,
~er Exc0 Other
INSPECTION NOTES: ~
Inspected: Date 'is - 4 -0 <; Time 9./?.9 #/11 By ;
Remarks: COI1I.el'Jcf.cr /OC-I'l kJ (.,"11/1:... 5E0eL sf-<<. b - 9- I ~~I- J.- .if, S' iJut? Rrrn<-,
Hl e ~/'-U ,/J/'ol-e'-^+j c'.oet1.er2. - t2E:J <-u e -1-0 '1"Pilc.. - rn sip; /1",eJ '-I I 'Pile C. 0 ,J
.phe J1-o.oe. AfpoJ( 9~ EI'1"5/-otf'l-c"C. ~/WCO~N't" e>-f-jLe hC<<J-c I4~J ;2'
S,CJIA..Jr, o-f- U t'" ~u-d -e -
RESTORATION REQUIRED. . . . .. YES
NO X.
(iJ
~)
01 LU./Iotl."
()I--
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
o Repaired by City
[] Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
</POJIr""'q
/~<'(~
~
. --
""<~
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, W A 98362
o 1- - qqy
Application Number
pin number
property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property use.
Property zoning . . .
Application valuation
04-00000496 Date
.419856
2201 W 16TH ST
06-30-00-1-0-7800-0000-
PUBLIC WORKS UTILITES
6/04/04
z-- Z-O I /tV / if CA
RS9 RBSDNTL SINGLE FAMILY
o
Owner
Contractor
PILOT INTERNATIONAL
259403 HWY 101
SEQUIM WA 98382
(360) 457-7222
OWNER
Permit PUBLIC WORKS RES WATER SERV
Additional desc
Permit Fee 640.00 Plan Check Fee
Issue Date 6/04/04 Valuation
Expiration Date 12/01/04
.00
o
Qty Unit Charge Per
1.00 640.0000 EA PW W/M 1" SERV 5/8" METER
Extension
640.00
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 640.00 640.00 .00 .00
plan Check Total .00 .00 .00 .00
Grand Total 640.00 640.00 .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 ive authority to violate or cancel the provisions of any state or local law regulating construction or \he performance of
constructi n f!vt G ~ Of \
tr ctor or Authorized Agent Date Signature of Owner (if owner is builder) Date
T:\PLANNfNG\FORMS\1102.15 [11/14/2003]
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . INSPECTION REPORT. . . . . . .. . . .
REQUEST:
Date_ 7- ^ -0((
Time .?:UZJ f /Vl Received by (phone, person)
_ ~()/ /AJ/trn
Location of Work to be inspected /h r"- We-Sl c+ AI sf' ,?9.()7 HI /v'?ft-
Name of person requesting inspection w~ fer Oil/.
Address of person requesting inspection I J (1,- ! JJ
Type of Inspection (circle appropriate one):
Sewer Foundation Framing Chimney Plumbing Final
Phone No. 417,'-/f5<17
Permit No. 0 f'" 1-1 V
~ ().f!r:" 447
Sewer Excav. ~ [A.7. e.t
INSPECTION NOTES:
Inspected: Date Time
Remarks:
-d 0(\ I . w,,,l-e r ,<; e,F I/k-e JI/,d-a./ vv,t"-
By
5 tl-e..:-I C.,/'~S6/~
/
~ 4~4qv
4/t.j'''1 I RESTORATION REQUIRED.. ~.. YES V NO
,
-Z207W)1/1K> ;X~D! Ih~ 'ff/
{. ~ 'ZIt .:!.;, Z'2.S I J1
-- r 04/63 ~"Z----
J61~
1./'1/
ISf
1
~,. (Jilt-
\..:
-r'
~
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved OGravel
o Repaired by City
D Repaired by Permittee
D No Damage Found
~SPhalt 0 PCC 0 Other
Work Order # ) If 7c:J Y - 03 J
o COMPLETE
o INCOMPLETE
/[S < f frfff
(Continue on reverse side if necessary)
I J
1/ J 2-/0 CJ r F
STREET SUPERINTENDENT
(DATE)