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Home My WebLink About1215 W Hwy 101 #15 - Buillding d•°"' CITY OF PORT ANGELES 'j PUBLIC WORKS - ELECTRICAL DIVISION 321 EAST STH STREET. PORT ANGELES.WA 98362 Application Number 04-00001011 Date 12/22/04 Pin number . . . . . . .631130 Property Address . . . . . . 1215 W HWY 101 #IS ASSESSOR PARCEL NUMBER: 03-63-00-8-8-7147-7000- Application description . . . RES MANUFACTURED HOME Subdivision Name . . . . . . Property Use . . . . . . . . Property Zoning . . . . . . . UNKNOWN Application valuation . . . . 4000 Owner Contractor ------------------------ ------------------------ INGWERSEN, RON OWNER 1215 W HIGHWAY 101 # 15 PORT ANGELES WA 983639401 (457) 1553 ----- ------ Structure Information 840 SF Construction Type . . . . . TYPE V NON-RATED Occupancy Type . . . . . . SINGLE FAM & CONGREGATES Other struct info TOTAL % LOT COVERAGE 1.00 1.00 EXISTING LOT COVERAGE LOT SIZE 3595.00 \ PROPOSED LOT COVERAGE 840.00 TOTAL LOT COVERAGE 840.00 NUMBER OF UNITS 1.00 _____ __ --------------------------------------- v� Permit . . ELECTRICAL NEW RESIDENTIAL - Additional desc MOBILE / FEEDER Sub Contractor SHAMP ELECTRICAL CONTRACTING 00 Permit Fee . . . . 78.70 Plan Check Fee . Issue Date 12/22/04 Valuation . . . . 0 / Expiration Date . . 6/21/05 Qty Unit Charge Per Extension ` 1.00 78.7000 ECH EL-MANF HOME SERVICE & FEEDER 78.70 �\ ----------------- Special Notes and Comments The proposal will result in the placement of a single wide manufactured home in the RTP on a lot that is 3595 sq.ft. in area. Setbacks are good. No land use issues are noted. Electrical load calculations and elctrical permits are required. --------------------- Other Fees STATE SURCHARGE 4.50 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- Permit Fee Total 78.70 78.70 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 83.20 83.20 .00 .00 COMMENTS/ACTION NEEDED ELECTRICAL PERMIT INSPECTION RECORD CALL 417A735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A NUND"24 HOUR NOTICE. ITIS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE -T DATE ACCEPTED COhMENTS YES NO DITCH SERVICE FINAL Lr. GENERAL COMMENTS: PW-1102.15141961 P A ORT NGELES W A S H I N G T O N, U. S. A. PUBLIC WORKS & UTILITIES DEPARTMENT November 15, 2004 Mr. Ron Ingwersen 1215 Highway 101 Port Angeles,WA 98363 SUBJECT: Meter pole replacement -Welcome Inn Trailer Park Dear Mr. Ingwersen: The estimated cost for labor and material to replace the meter pole and service wire for Lot #15 is $793.00. The installation will be scheduled for approximately three to four weeks after receipt of the estimated amount of$793.00. If the actual cost of installation is less than the paid amount,you will be refunded the difference. If the cost is more,there will be no further billing. Please have area for installation free of any debris that might interfere with the truck and crew. If you have any questions or concerns,please do not hesitate to contact me at 360-417-4708. Sincerely yours, s. Gail McLain Electrical Engineering Specialist cc:James Harper,Electrical Engineering Manager Roger Vess,permitting File 321 EAST FIFTH STREET • P. O. BOX 1 150 • PORT ANGELES, WA 98362-0217 PHONE: 360-417-4805 0 FAX: 360-417-4542 0 TTY: 360-417-4645 E-MAIL: publicworks@cityofpa.us CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT -BUILDING DIVISION v 321 EAST 5TH STREET, PORT ANGELES,WA 98362 Application Number . . . . . 04-00000699 Date 8/09/04 Pin number . . . . . . .232347 Property Address . . . . . . 1215 #15 W HWY 101 ASSESSOR PARCEL NUMBER: 03-63-00-8-8-7147-7000- Application description DEMOLITIONr G N4Subdivision Name . . . . . . 4 � 1 f Property Use . . . . . . . . Property Zoning . . . . . . . UNKNOWN Application valuation . . . . 4000 Owner Contractor ------------------------ ------------------------ CHARLES R/BONNIE L SCHLOSSER GAGNON BUSHELLING 1215 W HIGHWAY 101 # 15 292 BISHOP RD PORT ANGELES WA 983639401 PORT ANGELES WA 98362 (360) 928-2640 ------ Structure Information DEMO MANUFACTURED HOME ----- Construction Type . . . . . TYPE V NON-RATED Occupancy Type . . . . . . SINGLE FAM & CONGREGATES ---------------------------------------------------------------------------- Permit . . . . . . DEMOLITION Additional desc . . DEMO MANUFACTURED HOME Permit Fee . . . . 47.00 Plan Check Fee' . .00 Issue Date . . . . 8/09/04 Valuation . . . . 0 Expiration Date . . 2/06/05 \�_) Qty Unit Charge Per Extension BASE FEE 47.00 ----------------------- ------------ ---------------------- 1 Other Fees . . . . . . . . . STATE SURCHARGE 4.50 Fee summary Charged Paid Credited Due Permit Fee Total 47.00 47.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 51.50 51.50 .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 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 conu ion. 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. ITIS UNLAWFUL TO COYER,INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INA CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE. INSPECTION TYPE DATE ACCEPTED COMMENTS YES NO FOUNDATION: FOOTINGS WALLS FOUNDATION DRAINAGE/DOWN SPOUTS ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT:# ROUGH-IN PLUMBING UNDERFLOOR/SLAB ROUGH-IN WATER LINE(METER TO BLDG) GAS LINE BACK FLOW/WATER AIR SEAL WALLS CEILING FRAMING JOISTS/ GIRDERS SHEAR WALL/HOLD DOWNS WALLS/ROOF/CEILING DRYWALL(INTERIOR BRACED PANEL ONLY) T-BAR INSULATION SLAB WALL/FLOOR/CEILING MECHANICAL HEAT PUMP GAS LINE WOOD STOVE/PELLET/CHIMNEY HOOD/ DUCTS PW UTILITIES/ SITE WORK (Engineering Division) SEPARATE PERMIT#'s: WATERLINE/METER SEWER CONNECTION SANITARY STORM 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 417-4807 PW/ENGINEERING FIRE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 BUILDING T:\PLANNING\FORMS\1102.15[11/14/2003] CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT -BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES,WA 98362 Application Number . . 04-00000700 Pin number • .327100 Date 8/09/04 Property Address . . . . 1215 #15A W HWY 101 ASSESSOR PARCEL NUMBER: 03-63-00-8-8-7248-4000- Application description .. DEMOLITION Subdivision P1 Subdivision Name f' Property Use . Property Zoning _ . UNKNOWN / 7 Application valuation . . . . 4000 / Owner Contractor ------------------------ HOPPER JIM L GAGNON BUSHELLING 521 N LEES CREEK RD 292 BISHOP RD PORT ANGELES WA 98362 PORT ANGELES WA 98362 ------ Structure Information DEMO (360) 928-2640 Construction Type MANUFACTURED HOME ----- � TYPE V NON-RATED Occupancy Type SINGLE FAM & CONGREGATES ----------------------------------------- Permit . . . . . . DEMOLITION Additional desc . . DEMO MANFACTURED HOME Permit Fee . . . . 47.00 Plan Check Fee . Issue Date . . 8/09/04 .00 • 2/06/05 Expiration Date . Valuation 0 Qty Unit Charge Per Extension n ---------------BASE-FEE---- 47.00 -------------------------- Other Fees STATE SURCHARGE 4.50----- fl Fee- ------ summary Charged Paid Credited Due --- ------- ---------- ---------- Permit Fee Total47.00 47.00 .00 .00 4 ---------- Plan Check Total .00 .00 Other Fee Total .00 .00 4.50 .50 Grand Total 51.50 51.50 .00 .00 .00 .00 Finspection. mits are required forelectrical work,SEPA,Shoreline,ESA,utilities,private and public improvements. This permit becomes if work or construction authorized is not commenced within 180 days,if construction or work is suspended or abandoned f 180 days after the work as commenced,or if required inspections have not been requested within 180 days from the last I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of nances governing this type of work will be compliedwith 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 constru 10 . Signature of Contractor or Authorized Agent Date Signature of Owner(if owner is builder) Date T:APLANNING\FORMS\1102.15[11/14/2003] BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS.CALL 417-4735 FOR ELECTRICAL INSPECTIONS. IS UNLAWFUL To COVER,INSULATE OR CONCEAL ANYWORK BEFORE PLEASE PROVIDE A MIINSPECTED AND ACCEPTEDNIMUM 24 HOURNOTICE. . POST PERMIT IN A CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE. COMMENTS INSPECTION TYPE DATEESY CEPTED NO FOUNDATION: FOOTINGS WALLS FOUNDATION DRAINAGE/DOWN SPOUTS ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT:# ROUGH-IN PLUMBING UNDERFLOOR/SLAB ROUGH-IN WATER LINE(METER TO BLDG) GAS LINE BACK FLOW/WATER AIR SEAL WALLS CEILING FRAMING JOISTS I GIRDERS SHEAR WALL/HOLD DOWNS WALLS/ROOF/CEILING DRYWALL(INTERIOR BRACED PANEL ONLY) T-BAR INSULATION SLAB W ALL/FLOOR/CEILING MECHANICAL HEAT PUMP GAS LINE WOOD STOVE/PELLET/CHIMNEY HOOD/ DUCTS PW UTILITIES/ SITE WORK (Engineering Division) SEPARATE PERMIT#'s: WATERLINE/METER SEWER CONNECTION SANITARY STORM SEPA: PLANNING DEPT. SEPARATE PERMIT#'s ESA: PARKING/LIGHTING SHORELINE: LANDSCAPING FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY /USE ACCEPTED DATE YES NO COMMERCIAL DATE RESIDENTIAL YES NO ELECTRICAL ELECTRICAL-LIGHT DEPT. 417-4735 LIGHT DEPT CONSTRUCTION-R.W. CONSTRUCTION R.W./PW/ PW/ENGINEERING ENGINEERING 417-4807 FIRE DEPT. 417-4653 FIRE PLANNING DEPT. PLANNING DEPT. 417-4750 BUILDING BUILDING 4174815 T:\PLANNING\FORMS\1102.15[11/14/2003) CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT -BUILDING DIVISION Lv 321 EAST STH STREET, PORT ANGELES,WA 98362 Application Number . . . . . 04-00001011 Date 11/22/04 Pin number . . . . . . .631130 Property Address . . . . . . 1215 W HWY 101 #15 ASSESSOR PARCEL NUMBER: 03-63-00-8-8-7147-7000- Application description . . . RES MANUFACTURED HOME Subdivision Name . . . . . . L ' C--/ Property Use . . . . • • ,tel/D Property Zoning . UNKNOWN Application valuation . . . . 4000 Owner Contractor - ------------------------ ----------------------- INGWERSEN, RON OWNER 1215 W HIGHWAY 101 # 15 PORT ANGELES WA 983639401 (457) 1553 ----- ------ Structure Information 840 SF Construction Type . . . . . TYPE V NON-RATED Occupancy Type . . . . . . SINGLE FAM & CONGREGATES Other struct info . . . . . TOTAL % LOT COVERAGE 1.00 EXISTING LOT COVERAGE 1.00 LOT SIZE 3595.00 PROPOSED LOT COVERAGE 840.00 TOTAL LOT COVERAGE 840.00 NUMBER OF UNITS 1.00 ---------------- ----- ------------------ ----- _Permit . . . BL MANUFACTURED HOME Additional desc . . 1972 VANTAGE ID#4440 Permit Fee . . . . 230.00 Plan Check Fee .00 11/22/04 Valuation . . . . 4000 �i Issue Date \ Expiration Date . . 5/22/05 Qty Unit Charge Per Extension BASE FEE 230.00 ---------------------------------------------------------------- Special Notes and Comments The proposal will result in the placement of a single wide manufactured home in the RTP on a lot that is 3595 sq.ft. in . area. Setbacks are good. No land use issues are noted. Electrical load calculations and elctrical permits are required. ------------------------------------------------------------- Other Fees . . . . . . . . . STATE SURCHARGE 4.50 Fee summary Charged Paid Credited Due Cj ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 230.00 230.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 234.50 234.50 .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 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 ord' es y'erning this type of work will be complied with whether specified herein or not. The granting of a permit does not presume a au grity to violate or cancel the provisions of any state or local law regulating construction or the performance of constru 961641. Signature of C tdactor or Authorized Agent Date Signature of Owner(if owner is builder) Date T:\PLANNING O \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. ITIS UNLAWFUL TO COVER,INSULATE OR CONCEAL ANY WORKBEFORE INSPECTED AND ACCEPTED. POST PERMIT INA CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE. INSPECTION TYPE DATE ACCEPTED COMMENTS YES NO FOUNDATION: FOOTINGS ♦ (� /` / �F WALLS FOUNDATION DRAINAGE/DOWN SPOUTS ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT:# ROUGH-IN PLUMBING UNDER FLOOR/SLAB ROUGH-IN WATER LINE(METER TO BLDG) GAS LINE BACK FLOW/WATER AIR SEAL WALLS CEILING FRAMING JOISTS/ GIRDERS SHEAR WALL/HOLD DOWNS WALLS/ROOF/CEILING DRYWALL(INTERIOR BRACED PANEL ONLY) T-BAR INSULATION SLAB WALL/FLOOR/CEILING MECHANICAL HEAT PUMP GAS LINE WOOD STOVE/PELLET/CHIMNEY HOOD/ DUCTS PW UTILITIES/ SITE WORK (Engineering Division) SEPARATE PERMIT#'s: WATERLINE/METER SEWER CONNECTION SANITARY STORM 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 417-4807 PW/ENGINEERING FIRE 4174653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 BUILDING T:\PLANNING\FORMS\1102.15[11/14/2003] 1A PREPARED 11/22/04, 13:53:35 INSPECTION TICKET PAGE 4 CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 11/22/04 ---------------------------------------------------------------- ------ ADDRESS . : 1215 W HWY 101 415 SUBDIV: CONTRACTOR : PHONE : OWNER INGWERSEN, RON PHONE : (457) 1553 PARCEL 03-63-00-8-8-7147-7000- APPL NUMBER: 04-00001011 RES MANUFACTURED HOME PERMIT: BLM 00 BL MANUFACTURED HOME REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ------------------- --------------------------------`----- ------------- B L 9 9 01 4��'/2-'2/�,44 j L �i ��li , RON 457-1553 ` COMMENTS AND NOTES � ------------------------ ------------- ----------------------- ------------- N.1 oh Tq,l C� F0-R OFF IC11AL SSE 00NI-i` BUILDING PERMIT - APPLICATION Date Rec.:It> 1 Permit#: U �� Fill out COMPLETELY and in INK.Your application and site plan MUST Date Approved: t COMPLETE to be accepted for review. If you have any questions,call S` PERMITS (360)417-4815 FAK(360)417-4711 Date Issued: Applicant or Agent: �6 /WoG( Phone: "IS 7— Owner: Owner: (�� E Phone: Address: lQ?/.7 KLVU l8/ City: 7.b� Zip: Architect/Engineer: Phone: Contractor U, tate License#: Exp: Phone: Address: City: Zip: PROJECT ADDRESS: /21-5- icy, /9/ l /S ZONING: LEGAL DESCRIPTION: Lot: Block: Subdivision: CLALLAM COUNTY PARCEL NUMBER: Credit Card Holder Name: Billing Address: City: Credit Card Type VISA MC—# Exp.Date: TYPE OF WORK: SIZENALUATION: ❑ Residential ❑ New Constr. ❑ Re-roof ❑ Stove SF. @$ /SF.=$ ❑ Multi-family ❑ Addition ❑ Move ❑ Garage SF. @$ /SF. =$ 5/6i9c-' ❑ Commercial ❑ Remodel ❑ Demolition ❑ Deck SF. @$ /SF._$ ❑ Repair ❑ Sign .U-Other ry�I'OTAL VALUATION $ BRIEF DESCRIPTION OF THE PROJECT: ge&Cye— — �—"T7F- �&CVW U-72- COMMERCIAL/RESIDENTIAL: Occupancy Group: Occupant Load: Construction Type: No. of Stories:_ Lot Size: Existing Sq.Ft. &Proposed Sq.Ft. =TOTAL Sq.Ft. Total lot coverage % APPROVALS: PLANNING USE ONLY: PLAN: BLDG: DPWU: ESA/Wetland(s): ❑Yes ❑No SEPA Checklist required? ❑ Yes ❑ No Other: FIRE' OTHER: 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 maybe 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 RI 05.3.2 of the International Building/Residential Code,2003). No application can be extended more than once. 1 hereby certify that 1 have read and examined this application and know the same to be true tl torr t. l,am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required,not the City's, a tha ust j Iain such permits prior to work. T:\RVESS\BLDG-forms-brochures\2003-Buildingpermit.wpd Applicant: Date: 12/17/2004 14:34 FAX d 001/002 e ELECTRICALWORKPERNUTAPPLICATION �e p -Request Inspection `l7 Electrical Contractor O Owner w.or ❑ Annual Permit ❑ Alarm ❑ Carnival ❑ Commercial ❑ Residential ❑ Residential MAinL ❑ Signs ❑ Thermostat ❑ Telecom. Installation description Job wired by 'f�Electrical Contractor O Owner Electrical convector name License number �SF�T11P y-�ICAL / pnk, T2A -ml& W P haser's mailing address t ?sow 3L�5 3 U�IiF Cistate ZIP Telephone number FAX number o-457 - 1(o GI c Prowner's name Muomo I k1tJ Address of Inspectlo 125 Uel- �ht�a.t� lel I,�•r!r F � �� cl ❑ Cash ❑ Check# I hereby certify Thar I am the owner of the above named properry or a licensed electrical contractor(or the fm's authorized agent) and am making the electrical Credit Card Visa MasterCard Discover installation or alteration in compliance with the electrical law,Chapter 19.28 RCW, Card# (]M pi u Sign re or owner, tlectrice atrattor or electrical administrator Expiration Date V/ Ot CBrd $nspection fre7o WALLS V CEQ,II�'G THERMOSTAT SERNWEf Insulation Only Insulation Only Due A,pry ,J By np� Dae Appro.ea By Dem Aprm.m By DITCH a FEEDER Cover Cover Doc App a,ed By Due nppm•ed By Dem Apprered By De,e Approved By Electrical Load Additions and or subtractions Service Information O NO LOAD CHANGES ❑ Baseboard _KW Voltage ❑ Furnace —KW O Overhead Service Phase D 1 ❑ 3 O Haat Pump _Ton _ LAR ❑ Temp Service Service Size: ❑ Fan-Wall _KW 0 Underground 5ervlce Feeder Size: Inspection Arca,Building or Equipment Int Inspected Electrical Date SP Action Taken Inspector /J�� /�) AW /�7 14 d WIRING REPORT 417-4735 DATE PERMIT 0 INSPECTOR OVPERICCJNTRACTOR S*/t ADDRESS 1,2 C5' APPROVED NOT APPROVED ❑ . . . . . . . . . . . . . . . . . . . DITCH . . . . . . . . . . . . . . . . . . . ❑ ❑ . . . . . . . . . . . . . . ROUGH IN/COVER . . . . . . . . . . . . . . ❑ ❑ . . . . . . . . . . . . . . . . . . SERVICE . . . . . . . . . . . . . . . . . . 1 ❑ . . . . . . . . . . . . . . . . .o. . FINAL . . . . . . . . . . . . . . . . . . . . ❑ CORRECTIONS NEEDED: NOTIFY INSPECTOR WHEN CORRECTIONS ARE COMPLETED WITHIN 15 DAYS - DO NOT REMOVE - OLYMPIC PRINTERS.INC.(380)452.1381