Loading...
HomeMy WebLinkAbout612 S Lincoln St - Buildingk (2/4/2011) Linda Pangrle Re Soda machine backflow protection inspection Pa e 1 From Ron Becker To: Linda Pangrle Date: 2/4/2011 10 02 AM Subject: Re Soda machine backflow protection inspection Linda I completed the test on the soda machine, and it passed. I will get the report to you when I get a chance to make it to City Hall. Ron Ronald D Becker rbecker @cityofpa.us Linda Pangrle 1/13/2011 10:55 AM Hi Ron, Did the owners of Shirley's Cafe ever call you for a soda machine backflow protection inspection? They got permit #10 -620 on 06- 15-10 to install a backflow device on their soda machine. I'm trying to final this permit, and need to know whether or not you inspected and approved the work. Please let me know Thanks, Linda (1/18/2011) Linda Pangrle Re Soda machine backflow protection inspection Page 1 I From Ron Becker To: Linda Pangrle Date: 1/18/2011 8 47 AM Subject: Re Soda machine backflow protection inspection Linda I inspected, tested and passed the backflow on the soda dispenser at Shirley's Cafe on 12 20 -10 Ron Linda Pangrle 1/13/2011 10 55 AM Hi Ron, Did the owners of Shirley's Cafe ever call you for a soda machine backflow protection inspection? They got permit #10 -620 on 06- 15-10 to install a backflow device on their soda machine. I'm trying to final this permit, and need to know whether or not you inspected and approved the work. Please let me know Thanks, Linda C \Oixa-t,', 11-2: 6 C E RTI;CAT`E OF T CCU PAN CY n This certificate is issueipqiisOnuolhe requirements of Section 111 of the nternational Building Code certifiiing that at the tiffie4atplance was in compliance with the ious ordinances of the City regulating building c ;nslianction4r4.1se V" l b Business address r 6, S L i ncoln St. Property owner William andDiane:.H;orton Property owners address. 137 Fairway) Automatic fire sprinklerAystem. Per IBC Use occupancy classa;lcation. Business Occupant load. Building permit number Type of construction. 98382: 12 -21 -10 Date Post on the premises in a conspicuous place. Thi certifieafe s all not be removed except by the Building Official. 5 pORT4 hE Backflow Assembly Test Report City of Port Angeles Public Works and Utilities Department l �J Water/Wastewater Collection Division NAME OF PREMISES. S/ C. C C 4 r C SERVICE ADDRESS (n A L /A/ C /it/c/ 5 //e r ,C` 7 LOCATION OF DEVICE. /A/ /0 FL HE",/1/ 1% E/1 /A//J 5 WiN //V( P /e ASSEMBLY 1/1 //1 I S D �7 //9.. v GG 4 0fts Aso Manufacturer Model Size Serial No IS THIS AN APPROVED ASSEMBLY? YES C9'NO IS ASSEMBLY INSTALLED CORRECTLY' YES ErNO DATE OF INSTALLATION N ?G UNKNOWN❑ Initial Test Repairs Details COMMENTS DOUBLE CHECK VALVE ASSEMBLY CHECK VALVE #1 Leaked Held at W psi Cleaned Replaced REDUCED PRESSURE PRINCIPLE ASSEMBLY I DateTime Tester Initial 1 ?G Y� E Test j Eckel el Repairs Final Test Q /e CHECK VALVE #2 Leaked Closed Tight Held at psi Cleaned Cleaned Replaced Replaced Final Closed Tight EL Test Held at C� (psi Held at psi AIR GAP INSPECTION REQUIRED MINIMUM SEPARATION YES NO /5-te C er R P ii 1.1L/V e 7 xrE!' f 0Pi95T Signature RELIEF VALVE Did Not Open Opened at 54 2 3 psi ButTer YES NO WHITE CUSTOMER COPY YELLOW PURVEYOR COPY PINK TESTER COPY RP 0.■ RPDA DC DCDA PVB Air Gap SVB AVB Did Not Open Opened at psi CHECK VALVE Leaked Held at psi REPAIRS Cleaned Replaced AIR INLET Opened at psi 5 �yL CHECK VALVE Held at psi Opened at ?psi BACK PRESSURE NO YES TYPE OF HAZARD 5 SPA P/- 5 Y 7 E'/i /Cf4' Line Pressure' .5 psi Held Backpressure YES C"NO #2 Shutoff Held YES 1!Y NO Relief Valve Exercised YES LtYNO Cert. Test Kit Passed Failed '9C (v /tit II v g 6 t.. SCR 1�vti, l 1 `f- /tl 1 n u c> 1 Official Use Only A.sem.# (1 Received PVB/SVB AIR INLET FIRE DEPARTMENT phone 417 -4653 CITY CLERK phone 417 -4634 CERTIFICATE OF OCCUPANCY APPLICATION CITY OF PORT ANGELES Attn Permit Technician 321 E. Fifth St. Port Angeles WA 98362 (360) 417 -4815 fax (360) 417 -4711 Is business moving within the PBIA? Yes No Second -hand dealer /pawnbroker business? Yes No X, Will there be dancing at this business? Yes No X A City of Port Angeles Business License is required for Taxi, Peddlers, Second -Hand Dealer Pawnbroker Dance Hotel- Motel, Fireworks, Ambulance, and Tattoo Businesses. Page 1 of 2 Changes to a fire sprinkler system or fire alarm system? Yes No Work planned FEES Certificate Inspection 00 Parking Business Improvement Area (PBIA) fee charged for Downtown locations PLEASE PRINT IN INK Check one. New business in P.A. Change of ownership only Moving location from within P.A.? Zoning CSI BUSINESS NAM6O V/ t /it" 5 /1 Business addressLo 17 0.11 ref Mailing address S 11-7-)1fP Phone numbe t-/5 7 seo Opening date (-1 -11 Days hours of operation/( 2P/31 ,1, Business owner's name ne3 0- v- (S'bLr i r J11Gc ttlJ J Contact phoned 2g-1.1'7q Business owner's address 7{ (i .(�2. WA"- Prigp.(.2 �iA c 2 Brief description of business r Sh7J an 1 (S■e,a (`rlct,c_k rock) Property owner's named 1( -010,17C, Y/z)--) Contact phone Property owner's address /contact BUILDING DEPARTMENT phone 417 -4815 Bldg approval by on Is the business a restaurant or bar that will seat 50 or more people? Yes No 2( Construction changes planned (moving walls adding /enlarging windows or doors roofing siding foundation work, adding /altering stairways, ramps bathrooms electrical heating /cooling /ventilation systems etc) Work planned Fire approval by on PBIA (Parking Business Improvement Area Downtown) phone 417 -4623 Square footage of business? /164 PBIA notified on City Clerk approval by on Permit I Li (01-t 11 COMMUNITY ECONOMIC DEVELOPMENT phone 417 -4750 Number of off- street parking spaces available for employees and customers? n (A parking plan may be required.) Signs? (wall- mounted, freestanding projecting awning A= frame etc Signs planned PUBLIC WORKS DEPARTMENT ENGINEERING phone 417 4812 Is site work planned (new or re- located sewer or water service excavation grading or filling work in City right -of -way new driveway openings site drainage parking lots, downspouts irrigation system backflow devices, etc.) Yes No Work planned PUBLIC WORKS WASTEWATER phone 417 -4845 TForms\Building Division\Certificate of Occupancy Application (2010).doc Page 2 of 2 CED approval by on PLEASE NOTE. NO flashing, intermittent, or chasing signs are permitted in the City of Port Angeles PWE approval by i. V on /7- /6 /Uo ,Cv Zvi f -e r C PWW approval by on Will waste other than domestic household waste be discharged into the sewer system? Yes No fk If yes what will be discharged Call for Certificate of Occupancy inspections BEFORE opening business. Building Department Inspection 417 -4815 Fire Department Inspection 417 -4653 Please sign up for utility services at the cashiers' counter I hereby apply for a Certificate of Occupancy I acknowledge that I have read this application and state that the information I have supplied is correct to the best of my knowledge Incorrect information may result in revocation of permit. Date(Z-r6 -I d Print Namcctte h l a ex )C Signature pORTq CERTIFICATE OF OCCUPANCY APPLICATION Permit# 10` H 64 PLEASE PRINT IN INK Check one New business in P.A. Change of ownership only Moving location from within P.A.? Zoning CS t BUSINESS NAME ?h t (61.5 /'e Business address t 0. h(y/,r) Mailing address 5 /17'2? f Phone numbere) L/S 7 /(o c1.0 Opening date Days hours of operationa 24 Business owner's name .)*ni€3 t t (S t i f� MO( t ft Contact phone _Og 'z U Business owner's address 74r, S 0 lae,1 Iu cbd ir190.(.2 ,I1 M c 2 Brief description of business kaSI71.ipan (She,-.% f r©w Property owner's name, I' lap c, tV1 6Y1 Property owner's address /contact BUILDING DEPARTMENT phone 417 -4815 FIRE DEPARTMENT phone 417 4653 Square footage of business? Is business moving within the PBIA? Yes No CITY CLERK phone 417 -4634 CITY OF PORT ANGELES Attn Permit Technician 321 E. Fifth St. Port Angeles WA 98362 (360) 417 -4815 fax (360) 417 -4711 Second -hand dealer /pawnbroker business? Yes No SN. Will there be dancing at this business? Yes No A City of Port Angeles Business License is required for Taxi, Peddlers, Second -Hand Dealer Pawnbroker Dance Hotel Motel, Fireworks, Ambulance and Tattoo Businesses. FEES Certificate Inspection 00 Parking Business Improvement Area (PBIA) fee charged for Downtown locations Contact phone Bldg approval b on /a 6 0 Is the business a restaurant or bar that will seat 50 or more people? Yes No C? Pact 6 Construction changes planned (moving walls adding /enlarging windows or doors roofing siding foundation work, adding /altering stairways ramps bathrooms electrical heating /cooling /ventilation systems etc) Work planned Changes to a fire sprinkler system or fire alarm system? Yes No Work planned PBIA (Parking Business Improvement Area Downtown) phone 417 4623 Page 1 of 2 Fire approval by 14.DD on 12=11 1 Q PBIA notified City Clerk approval by 1r1-t on 12 --2_O S COMMUNITY ECONOMIC DEVELOPMENT phone 417 -4750 CED approval by S on 12.-2 G to Number of off- street parking spaces available for employees and customers? (A parking plan may be required.) Signs? (wall- mounted freestanding, projecting, awning A` -frame etc Signs planned PLEASE NOTE: NO flashing, intermittent, or chasing signs are permitted in the City of Port Angeles PUBLIC WORKS DEPARTMENT ENGINEERING phone 417 -4812 Is site work planned (new or re- located sewer or water service, excavation grading or filling work in City right -of -way new driveway openings, site drainage parking lots downspouts irrigation system backflow devices etc) Yes No,,l Work planned PWE approval by j on 1 7.--11" I phone 417 -4845 PWWa b y on PUBLIC WORKS WASTEWATER p N. Will waste, other than domestic household waste be discharged into the sewer sysfii Yes Nol If yes what will be discharged T\Forms\Building Division\Certificate of Occupancy Application (2010).doc Page 2 of 2 Call for Certificate of Occupancy inspections BEFORE opening business. Building Department Inspection 417 -4815 Fire Department Inspection 417 -4653 Please sign up for utility services at the cashiers' counter 1 hereby apply for a Certificate of Occupancy acknowledge that I have read this application and state that the information I have supplied is correct to the best of my knowledge Incorrect information may result in revocation of permit. 1 c Date(Z t(e r v e J Print Nam(IK f*'1 Ca Q 1CU k./ Signature L Q kJ) CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 Application Number 10 00000620 Date 6/15/10 Application pin number 891980 Property Address 612 S LINCOLN ST ASSESSOR PARCEL NUMBER 06 30 00 0 1 6600 0000 Tenant nbr name WILLIAM AND DIANE HORTON Application type description PLUMBING REPAIR Subdivision Name Property Use Property Zoning COMMUNITY SHOPPING DISTR Application valuation 600 Application desc INSTALL A BACKFLOW PREV DEVICE ON A SODA MACHINE Owner Contractor WILLIAM AND DIANE HORTON TRUST ANGELES PLUMBING INC 137 FAIRWAY PL PO BOX 1151 SEQUIM WA 98382 PORT ANGELES (360) 452 8525 Permit PLUMBING PERMIT Additional desc SODA MACHINE BACKFLOW DEV Permit pin number 167734 Permit Fee 57 00 Plan Check Fee 00 Issue Date 6/15/10 Valuation 0 Expiration Date 12/12/10 Qty Unit Charge Per Extension BASE FEE 50 00 1 00 7 0000 EA PL- BACKFLOW PROTECTION <OR =2 7 00 Fee summary Charged Paid Credited Due WA 98362 Permit Fee Total 57 00 57 00 00 00 Plan Check Total 00 00 00 00 Grand Total 57 00 57 00 00 00 20 40 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after the work has commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. 29(P/t/& Date Print Name T:Forms/Building Division/Building Permit Signature of Contractor ororized Agent Signature of Owner (if owner is builder) IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED POST PERMIT IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Inspection Type FOUNDATION Footings Stemwall Foundation Drainage Downspouts Piers Post Holes (Pole Bldgs.) PLUMBING Under Floor Slab Rough -1n Water Line (Meter to Bldg) Gas Line Back Flow Water AIR SEAL. Walls Ceiling FRAMING Joists Girders Under Floor Shear Wall Hold Downs Walls Roof Ceiling Drywall (Interior Braced Panel Only) T -Bar INSULATION Slab Wall Floor Ceiling MECHANICAL. Heat Pump Furnace FAU Ducts Rough -In Gas Line Wood Stove Pellet Chimney Commercial Hood Ducts MANUFACTURED HOMES Footing Slab Blocking Hold Downs Skirting PLANNING DEPT Separate Permit #s Parking Lighting Landscaping Electrical 417 -4735 Construction R.W PW Engineering 417 -4831 Fire 417 -4653 Planning 417 -4750 Building 417 -4815 T Forms /Building Division /Building Permit BUILDING PERMIT INSPECTION RECORD PLEASE PROVIDE A MINIMUM 24 -HOUR NOTICE FOR INSPECTIONS Building Inspections 417 4815 Electrical Inspections 417 4735 Public Works Utilities 417 4831 Backflow Prevention Inspections 417 4886 Inspection Type Date Accepted By Comments FINAL Date Accepted by SEPA. ESA. SHORELINE. FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE rya 0 :2)&1 c- K-Floc ZO Q� FINAL Date Acce by W h v Bex Date Accepted By V J 5 3 v L.- 06/15/2010 11 28 3604528583 ANGELESPLUMBING PAGE 02/02 Applicant or Agent ANGELES PLUMBING. INC Property Owner William Uj ana Horton Trust Property Owners Address 137 Fairway F1. Sequim, WA 98382 Contractor /Engineer ANGELES PLUMBING. INC. Contractor /Engineer's Address P o BOX 1151, Port Angeles, License ANGELPIO77KP PROJECT ADDRESS Parcel Number project Noe BrWpescrimfion_ Check all that appy o New Construction o Addition Remodel o Repair o Re -roof a Demolition Heat System VOther BUILDING PERMIT APPLICATION Print in ink CITY OF PORT ANGELES Attn: Building Permit Technician 321 E. Fifth St. Port Angeles WA 98362 (360) 417 -4815 fax (360) 417 -4711 SHIRLEY'S CAFE 612 S Lincoln Residential Poor Areas Edina lso. R.) wed !sa. ftJ Basement 1 Floor 2 Floor 3 Floor Garage Carport Covered Porch Deck Shed Other Total footprint of structures sq. ft. Lot size o Commercial Phone Phone 165f0 Lot Phone WA 98362 Expires Heat pump o wood burning stove o gas fireplace o pellet stove o other Install hackflow device on non machine For City Use Only Date Received (o 15 I O Permit ALS) G 2D Date Approved o IkiIti famfly 452 -8525 452 -8525 5-1572012 Zoning 1ersq ft. sq. ft. Lot coverage Industrial TOTAL VALUATION 600.00 Max. height of proposed structures ft. Occupancy group of bedrooms WII a lawn sprinkler system be installed? Occupant load of full baths Will a fire sprinkler system be installed? Construction type of half baths I have read and completed this application and know it to be true and coned. f am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required, and to obtain permits prior to working on Projects. Date la //5 Print Name DALE BRUNTZ Signature T Forms/Building Division /Bldg PermitAppl. -2006 Code_doc Application Number 07 00001179 Date 10/23/07 Application pin number 889322 Property Address 612 S LINCOLN ST ASSESSOR PARCEL NUMBER 06 30 00 0 1 6600 0000 Tenant nbr name SHIRLEY S CAFE Application type description SIGNS Subdivision Name Property Use Property Zoning COMMUNITY SHOPPING DISTR Application valuation 2300 Owner Contractor WILLIAM /DIANE HORTON TRUST 194 HART RD PORT ANGELES WA 98363 CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 Qty Unit Charge Per 1 00 115 0000 PER S SIGN FREE OR PROJ 25+ JACKSON S SIGNS GRAPHICS 472 MOUNT PLEASENT RD PORT ANGELES WA 98362 (360) 457 3703 Permit SIGN Additional desc 64 TOTAL SF 2 SIDED SIGN Permit pin number 113084 Permit Fee 115 00 Plan Check Fee 00 Issue Date 10/23/07 Valuation 2300 Expiration Date 4/20/08 Special Notes and Comments October 12 2007 12 39 30 PM sroberds The proposal is to replace an existing sign with the same size face but different display No land use issues are noted Fee summary T.Forms /Building Division/Building Permit (10 /0I /07).wpd Charged Paid Credited Due Permit Fee Total 115 00 115 00 00 00 Plan Check Total 00 00 00 00 Grand Total 115 00 115 00 00 00 Extension 115 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 has commenced, or if required inspections have not been requested within 180 days from the last inspection I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. M-aV 07 S rity 611-1.61 I¢ Date Print Nam# Signature of Contractdt or'Authorized AgWnt Signature of Owner (if owner is builder) INSPECTION TYPE DATE 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) GAS LINE BACK FLOW WATER AIR SEAL WALLS CEILING FRAMING JOISTS GIRDERS SHEAR WALL/HOLD DOWNS WALLS ROOF I CEILING DRYWALL (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 SEPARATE PERMIT N's PARKING /LIGHTING LANDSCAPING RESIDENTIAL ELECTRICAL LIGHT DEPT 417 -4735 CONSTRUCTION R.W PW/ ENGINEERING 417 -4807 FIRE 417 -4653 PLANNING DEPT 417 -4750 BUILDING 417 4815 T Forms /Building Division /Building Permit (10 /01 /07).wpd BUILDING PERMIT INSPECTION RECORD 0 CALL 417 -4815 FOR BUILDING INSPECTIONS. CALL 417 -4735 FOR ELECTRICAL INSPECTIONS. CALL 417 -4807 FOR PUBLIC WORKS UTILITIES 1 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. YES NO ACCEPTED COMMENTS I FINAL DATE ACCEPTED BY. I I FINAL SEPA. ESA. SHORELINE. FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL ELECTRICAL LIGHT DEPT CONSTRUCTION R.W PW ENGINEERING I FIRE DEPT I PLANNING DEPT I BUILDING DATE ACCEPTED BY. DATE ACCEPTED YES I NO V l i I i l/_ I I� ^i/ III /I (/U Jt poRr gq {C lliMAS Applicant or Agent ----c LS" Phone g� /4 f Owner/, g1 4P 4 Phone L/ ___C .3 g Owner's Address 2 p f n.) Ste• 620/ 2 Contractor /Engineer 4 c.I&SD).J ,.S.',- ',lc State License 4.17),�,%c ss GUS a- Expires] _24 --I-0o' Contractor/Engineer's Address !'1 /2i 1 PL. A el- L-- Phone -S' 7- .3 70...? PROJECT ADDRESS t s 4 x I LA-) LEGAL DESCRIPTION Lot: Block: CLALLAM COUNTY PARCEL NUMBER. Residential Multi family Commercial Repair TYPE OF WORK New Constr Addition Remodel JSign BRIEF DESCRIPTION OF THE PROJECT <m Existing Structure(s) basement 1St floor 2' floor 3'd floor Accessory Structures Existing Structure(s) TOTAL LOT COVERAGE Lot size Sq Ft. Existing Structure(s) Sq Ft. Footprint Proposed Structure(s) Sq. Ft. Footprint TOTAL Structure(s) Sq. Ft. Footprint Total Lot Coverage BUILDING PERMIT APPLICATION Fill out COMPLETELY and in INK. Your application, prescriptive energy form, plans, specs, and a 8'/:" x 11" site plan MUST BE COMPLETE to be accepted for review (360) 417 -4815 FAX (360) 417 -4711 Residential projects: submit two sets of plans Commercial projects. submit three sets of plans Re -roof Stove Move Garage Demolition Deck Other `7 COMMERCIAL/RESIDENTIAL. O cupancy Group. ,Occupant Load. Subdivision. SF SF SF TOTAL VALUATION ZONING _72f SIZE/VALUATION Sq Ft. Proposed Structure(s) basement Sq. Ft. 1' floor Sq. Ft. 2 floor Sq. Ft. 3r floor Sq. Ft. Accessory Structures Sq. Ft. Proposed Structure(s) TOTAL TOTAL of existing proposed structures Maximum Height of Proposed Structure(s) Are you planning to install a lawn sprinkler system? (Divide Total Structure(s) Sq. Ft. Footprint by Lot Size Sq. Ft.), FOR OFFICIAL USE ONLY Date Rec. 1 0 l o 07 t (Permit it 0`7- It ate Approved Date Issued: /SF /SF /SF /19J)U I s, j Constructfi Type: X 7 2 Sq. Ft. Sq Ft. Sq. Ft. Sq Ft. Sq. Ft. Sq Ft. Sq. Ft. Ft. 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. The plan check fee must be paid at the time the building permit application is submitted. All other permit fees are due at the time of permit issuance. EXPIRATION OF PLAN REVIEW An application for a permit for any proposed work shall be deemed to have been abandoned 180 days after the date of filing unless such application has been pursued in good faith or a permit has been issued, except that the building official is authorized to grant one or more extensions of time for additional periods not exceeding 180 days (90 days for commercial projects) each. The extension shall be requested in writing and justifiable cause demonstrated. (IRC /IBC 2006 105.3.2) 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, and that I must obtain such permits prior to work. Date Applicant l lli T• \FORMS \BUILDING DIVISION \BldgPermitAppl: 2006 CODE backup wp Mai emain Il?a.au.412 L(G 6 uld 4 111 2 5 SMtaiag IVVLUI.a 6 uldcle..IaS Approval Date 0 SMa.JOS levaii.aa4G 6uldde.1 }lac, ema*51 W+ N6 ----1 6 u ldd r?ldl a6 eu6le I��.aW 9 X Z Z CITY OF PORT ANGELES Construction Plans The Issuance of this permit based upon these plans, specifi- cations and other data shall not prevent the building official from thereafter requiring the correction of errors in said plan specifications and other data, or from preventing building operations being carried on thereunder when in violation of all codes and ordinances of this jurisdiction. (SECTION 303(c) Uri orm wilding Code. By 5 u6i5 ig X44y CE RTIFIcATEFoCcu PANCY City of Port Angele Building Division This certificate is issued;JurSuant;,tolhe requirements of Section 110 of the 2004International Building Code r certifying that at the tnne4ofiSsUance:lbis .Structure was in compliance with the various ordinances of the City regulating building cOnskUCtion`Oi use f(*.th'efolliiWing I ..L, Business name The Movie House (c)initier.'"te$tSide V:entikrerOup LLC) Business address 4.71,2 's 'Lincoln St Oteveri :4 11-10yt Property owner William antrtjapa .H.Ort00304 s:t k ,-r-, v Property owner s addrO 137 Fairway ,41equinl AA.tA8'.38 ft? 1. Automatic fire sprinkle!! system. Per IE3G ft. Use occupancy clasgification. Merterrtile, Occupant load. Building permit number Type of construction. M "fire& 4 r' .er 06-17-10 Manager Date Post on the premises in a conspicuous place. This certificate shall not be removed except by the Building Official. 6 TN") Print in ink BUSINESS NAME 110P 6z 00P LL(_ hRA- I I4ri 1Niov iG 1-1-0 1 BUSINESS ADDRESS .ko 1,2 S o -Tut- L /_.uGbL.t! ,Peary 4,06,5:.133 t4J/- 4t3L2 Zoning rSb Business mailing address StAmAiz Phone 36o =417 PC. t Opening date 2 i ao b Days hours of operation 0,4.,11A4 s ,,gq i b,4rvf 04.16.4.4401 Washington State Tax I D If known list the name of the previous business at this location 'R 1,_0 (_cc /u Brief description of proposed business i'bt ov, i5 2G_.v A t_ d— FLi..TAt L. I Business owner's name Sl vu Phone 4 1 t' 7 —o6 t G I Business owner's home address jolao �6�3 -t A V S i O,� c :S 1.314- a ?G� (36.)- PLEASE NOTE 2F3`t A Business License is also required for the following businesses Taxi, Peddlers Second -hand dealer Pawnbroker Dance Hotel Motel Fireworks Ambulance Tattoo shop Contact the City Clerk at 417 -4634 for additional information. ACTION New business Transfer of business location from a PBIA location Transfer of business location from a non -PBIA location Change of ownership Remodel Temporary business Change of use For City use only' Department Building Fire PBIA Planning City Clerk Public Works Call for Certificate of Occupancy inspections before Opening business. Building Department Inspection 417 -4815 Fire Department Inspection 417 -4653 Please provide a minimum 24 -hour notice for inspections I hereby apply for a Certificate of Occupancy I acknowledge that I have read this application and state that the information I have supplied is, correct to the best of my knowledge Date C /a /10 Print Name STEYlziil /4 Signature �J )4 ne Par ve dpte Vt f1 �13 11r4 1 5R it Ili). �O 6 1 O IRV( 3thhn T:Forms /Building Division /Certificate of Occupancy Application CERTIFICATE OF OCCUPANCY APPLICATION CITY OF PORT ANGELES Attn Building Permit Technician 321 E. Fifth St. Port Angeles WA 98362 (360) 417 -4815 fax (360) 417 -4711 WILL THERE BE ANY OF THE FOLLOWING? Electrical changes New or relocated signs Ti,,,o ret-novy.Ld Twe Construction changes 1 sKihnool only Mechanical changes (ventilation, heating, cooling, etc.) Plumbing changes Fire sprinkler system changes Fire alarm system changes New or relocated sewer or water service Excavation or filling of lots Work done in the City right -of -way New driveway openings Grading site drainage (parking lots, downspouts, etc.) Landscape irrigation system (backflow devices) Is this a home occupation? Is this a second -hand dealer or pawnbroker business? Is there off street parking for this business? Is the street in front of this business paved? Is there a sidewalk in front of this business? Is there a curb gutter in.front of this business? Rejected Initials date $50 ►I Certificate Inspection •0 00 Parking Business Improvement Area (PBIA) fee charged for downtown locations FEES NOV YES/ s/ Comments Conditions Type of construction Occupant Load Automatic fire sprinkler system required no Permit IF YES CONTACT Electrical Dept. at 417 -4735 Building Div at 417 -4815 Public Works at 417 -4807 Water Dept. at 417 -4886 Planning Div at 417 -4750 City Clerk at 417 -4634 How many spaces? Q Please sign up for utility services at the cashier counter yes 10 -551 Clallam County Assessor Treasurer Property Details 57272 WILLIAM AND DIAN Page 3 of 5 SD 121 GEN GENERAL HOSP2GEN GENERAL WSMETPARK WILLIAM SHORE MET PK DIST Total Tax Rate Improvement Building Improvement #1 CONV Other State Code. 59 Exterior Wall 11 Concrete Block Foundation. Heating /Cooling: 3 Floor/Wall Roof Covering: Type ASPHALT CP -PATIO MA OTH Sketch No sketches available for this property Property Image N/A N/A N/A N/A Description ASPHALT CARPORT PATIO Main OTHER N/A N/A N/A N/A N/A N/A N/A N/A N/A Taxes w /Current Exemptions. N/A Taxes w/o Exemptions. N/A Class CD 01 01 01 01 7000 0 sqft Value N/A 3 Concrete Perimeter 5 Built Up Hotmop Sub Class CD 03 03 03 Year Built 1946 1946 1946 1946 Area 7500 0 362.0 7000 0 00 http. /vpn.clallam. net: 8084 propertyaccess /Property.aspx ?cid =0 &year= 2010 &prop_id =57272 6/2/2010 Clallam County Assessor Treasurer Property Details 57272 WILLIAM AND DIAN Page 1 of 5 Clallam County Assessor Treasurer Property Search Results 57272 WILLIAM AND DIANE HORTON TRUST for Year 2010 2011 Property Account Property ID 57272 Geographic ID 0630000166000000 Agent Code Type Real Tax Area: 0010 PA 121 PORT ST CNTY H2 L Land Use Code 59 Open Space: N DFL N Historic Property N Remodel Property N Multi- Family Redevelopment: N Township Section Range Location Address. 612 S LINCOLN ST Mapsco PORT ANGELES WA 4‘ Neighborhood: Cycle 5 Comm Map ID Neighborhood CD 20953140 Owner Name WILLIAM AND DIANE HORTON TRUST Owner ID 31294 Mailing Address. 137 FAIRWAY PL Ownership 100 0000000000% SEQUIM WA 98382 Taxes and Assessment Due Property Tax Information as of 06/02/2010 Amount Due if Paid on M. Legal Description Exemptions. LOTS 1 2 BL 166 TPA S5' OF E 6TH ST ABTG First Half Second Half Year Statement ID Taxing Jurisdiction Base Due Base Due Penalty Interest Base 2010 40276 ST SCH STATE SCHOOL $668 78 $668 79 $0 00 $0 00 $6€ 2010 40276 CC -GEN COUNTY_ $355 91 $355 90 $0 00 $0 00 $3E 2010 40276 PORT PORT $50 02 $50 02 $0 00 $0 00 $E 2010 40276 PORT ANG PORT ANGELES $824 03 $824 04 $0 00 $0 00 $82 2010 40276 SD #121 SCHOOL DISTRICT #121 $866 26 $866.26 $0 00 $0 00 $8€ 2010 40276 NTH OLY LIB NORTH OLYMPIC LIBRARY $103 42 $103 42 $0 00 $0 00 $1C 2010 40276 HOSP #2 HOSPITAL #2 $146 00 $146 00 $0 00 $0 00 $14 2010 40276 WSMET PK DIST WILLIAM SHORE MET PARK DIST $46 46 $46 45 $0 00 $0 00 $4 2010 40276 CITY_STORMWATER CITY STORMWATER $120 44 $120 43 $0 00 $0 00 $12 2010 40276 WEED_CONTROL WEED CONTROL $0 82 $0 81 $0 00 $0 00 9 2010 40276 TOTAL. $3182.14 $3182.12 $0.00 $0.00 $31€ 2009 572722008 ST SCH STATE SCHOOL $780 49 $780 49 $0 00 $0 00 $15€ 2009 572722008 CC -GEN COUNTY $394 99 $395 00 $0 00 $0 00 $7E 2009 572722008 PORT PORT $55 95 $55 95 $0 00 $0 00 $11 2009 572722008 PORT ANG PORT ANGELES $866 40 $866 38 $0 00 $0 00 $17' 2009 572722008 SD #121 SCHOOL DISTRICT #121 $965.21 $965.21 $0 00 $0 00 $19: 2009 572722008 NTH OLY LIB NORTH OLYMPIC LIBRARY $114 77 $114 77 $0 00 $0 00 $22 http. /vpn.clallam. net. 8084 propertyaccess /Property.aspx ?cid =0 &year= 2010 &prop_id =57272 6/2/2010 ~his Cfjftiji.c~tlon issued p'ur~uant to the re~uir:m~nts of Sect~o ~ 09 of the Uni(orrrJf13u~lamg-\ode certi!Y.mg tha~att~~ time ofls~uance thl~ s~uc~u~e was In coinplJflnce wlth the varIOus ordmances of the City, reg/{latmg Buddmg .1,: ,". ~ construction or Use. For the following: '. \ Use ClassificatIOn BUSIneSS Building Penrut No.: _ Business Name' Block Buster VIdeo I . i I Group B . \ T~ofconstructlOn. V-N th' . u~Zon~' CSID Owner of Business Eastslde Venture DBA Address' 1612 114 Ave. S.E.SUIte #21OfBellevue, W A. 98004 \ . .. ,.. I BUIlding Address. 612 South Lmcoln Street Port Angeles, WiA. 98362 17 2003 CERTIFICgk-rE~O~F1~e~ CUPANCY ~"'~ City of Port Angeles Building Division ous place. . uilding Official. / . $k>c..k b u..sfer- ROUTING SLIP f pORi-41\< ~O~Q~~ "? \~ Certificate of Occupancy Q~~,~ .... -=..11 ,c).$47.00 Certificate/Inspection Fee =- ~ ~(IC wo~;f.~ DATE 3'-<)-03 New Business .. . .. ............... ....... ( X ) Address of Proposed Business Transfer of Business location. . . . . . . . . . . . . . ( ) (P/.1. S. Li'n co/" POI-t A:1eAe.~ W3b'd- Change of Ownership . . . . . . . . . . . . . . . . . . . . . . ( )( ) Applicant lASfsidC Vc-(l.du:e dbA l31l>LKIoL1<.i'>J' New BUilding ................ . . . . . . . . . . . . . ( ) Address /(.." J- IlL/ lU Ave. S.E. Sfe. ';"/0 Remodel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ( ) 8e_11 C/1I vi C-, LuA qyo!J 1- Temporary Business ... . . . . . . . . . . . . . . . . . . . . ( ) Phone: business /.fdS.io./~7-/9tj';)' home ^/J.':::-I./g J. t..,}3< Change of Use . . . . . . . . . . .. . ...... . ( ) Brief descriptIon of proposed business: /../,de-D /(01-10._1 S fore.- fA.) (. -!-/I.- -SD ;116 Ke. t~,/ legal Description: lot i <r1J..- Block J (,11.., Subdivision 'TPA , Current Use of Property: 1V\ Zoning Classification of Property: WILL THERE BE ANY OF THE FOLLOWING? YES NO THE FOllOWING Will BE REQUIRED: Construction changes .... . ~- PERMITS BUSINESS LICENSE Electncal changes ..... . ~- 1) BUilding 1) TaxI Mechanical (heating, cooling, stoves) J... 2) Plumbing 2) Peddlers Plumbing changes . - ----r 3) Electncal 3) 2nd Hand Dealer New or relocated signs X == 4) Mechanical 4) Pawn Broker New septic tanks _--L 5) Sewer 5) Dance New sewer service ..... . -~ 6) Sidewalk Installation 6) Hotel - Motel Admission charged to patrons -~ 7) Dnveway Installation 7) Fireworks Is this a home occupation? X 8) Curb Installation 8) Ambulance -- Excavation of filling of lots _-L 9) Sidewalk obstruction 9) Tattoo shop Work done In City nght-of-way _ -.lL 10) Water meter Installation 10) Other Is there suffiCient off-street parking? X 11 ) Fire -- New dnveway openings -~ 12) Occupancy A grading plan for site drainage -~ 13) Sign (parking lots, downspouts, etc) -- 14) Shoreline Are the eXisting streets paved? . . ~- 15) Home occupation Are there eXisting Sidewalks? . . .. . ....l.- _ 16) Conditional use Is there curb and gutter? .. ~- 17) Other Other -- I hereby apply for a Certificate of Occupancy and acknowl- 5'- f, 03 edge that I have read this application and state that the Date: Information I have supplied is correct to the best of my 0~1 O. (!~A-- knowledge. Signed: ~ REJECTED Comments / Conditions rfb Building Section s/1 ~~ Public Works Department Se Planning Department I J KOO Fire Department sjQ!03 Bu. City Clerk P.B.I.A. ~;City ofPor,t Angel~s Building :Division. : This c~ ifi~a#~nJ~~l{~1l!!!rsuant to the requirements of Sectio 109 of the Uni(orrrJBf!~!iJi'}g F{!,~~:c~rtify/~g tha/. fl~ the ~ime ofis~.fUl~C.~_thi~ s ;uc~u~e was m c~mflUl~'~l! 'l}'!!~the ,van:>us ordl[laTJces of the q'!J! legulllt'1J~ "B1utldmg I " '_ ~'_~', ,"constructIOn or ~e. Eor the foUowmg: . ' U" C"",,fi~ti"o Day f~ ,i..i.fif, "'~it N. '-,- Bo""", N"';, Kids Kampus . Group B-3 . Type of Construction. V-N. ' " Use Zone: ' a ',: ' ' "I Owner of Business. V a1 GaI'laGci,., Address 1010 Bast Front. Port Arigeles. 'w A, 98362 BUIlding Address: 612 SOU\' ~i~toln Street ' . ;"" portAng~~es. :wl. 98362 ous place. uilding Official. o - o O( Tl 6 ?t 'lii ~ CITY OF PORT ANGELES PUBLIC WORKS - ELECTRICAL DIVISION 121 EAST 5TH STREET. PORT ANGELES. WA 98162 Application Number Property Address ASSESSOR PARCEL NUMBER: Tenant nbr, name Application description Subdivision Name Property Zoning . . . Application valuation 03-00000525 Date 612 S LINCOLN ST 06-30-00-0-1-6600-0000- BLOCK BUSTER 6/29/03 SIGNS 1500 Owner Contractor 8436 LTD. CRAZY MIKES VIDEO LYNNWOOD WA 98036 ADVERTISING SALES & MORE 1327 E. 1ST STR~?T PORT ANGELES PORT ANGELES WA 98362 (360) 452-7785 Permit Additional desc Sub Contractor Permit Fee Issue Date Expiration Date ELECTRICAL SIGN PERMITS ANGELES ELECTRIC 85.70 Plan Check Fee 6/29/03 Valuation 12/26/03 .00 1500 Qty 1. 00 3.00 Unit Charge Per 35.3000 ECH EL-COMM-1ST SIGN 16.8000 ECH EL-COMM-ADD SIGN Extension 35.30 50.40 ~ "- ~ Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 85.70 85.70 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 85.70 85.70 .00 .00 ~ ~ ~ ~ CA '1 , COMMENTS! ACTION NEEDED ELECTRICAL PERMIT INSPECfION RECORD CALL 417-4735 FOR ELECTRICAL INSPECTIONS PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE COMMENTS NO GENERAL COMMENTS: PW -11 02 IS [4196] CERTIF ~~ .'T,;5,t~Q;F':::10~rUPANCY ~,_<\,\ ~\~'<\ ~\"~'\td~:;~~~~~>:\i;-'''t,:~\,~,~',:~,:-(1''\';; ~~~f~ ,f~:port Ang~'I~$i~:\Build,!ft,g,pi~ision ," \\"'~'~;'-,> ' <>:~~:~\\ \,' <'\ ":c~" Thzs certificate is issue ursuant to the requirement~' 'Of Sectzonl].O'oj the 1/i61nternatzonal Building Code certifYing that a fJ,,'t(me,o.tassuance this structure was in compliance wi$h the varzous ordinances of the City regulatzn l!'iidi~~:~o~~tr~c(iRh. 'or. u~eJor the fQll()~ing,. \ , ',' ~:~::~~2~'\~ ",:,~,~:t~;:\;~' '~\~"~\ \ ~,~} \\~ >'~~ \ Business name: ,,' S~ir,leY!s CafEf:~,,''1<<f~\ "\\ '\ \..\'''~;J{';~:0'~,~\',\. '~r ~* <1~:"'1 ~,- Business address~1';<~Q1'2'\'~;' Lincol~.'9tr :;;\ l!! ".," _.-;:;t\li. "\.' Owner ,ofbusine,sr ;:~~~ '~y Cargile I~~\:) Owner s address'l h,,:.:,., ' Front S1. ~~..~,~ Automatic fire spr~n~!~~.,~~st~m: Per:.;;:IB ' Us~ ~ occupa~cy ~a~f/Y4fatlOn: BUlldmg permzt nUn:lfey,.'\~{'4\"" ", Type of construction" Occupant load: 09/26/07 Date ,.~. ~(\'\ cd \e! ~. - ~ \2-\/-0, VJ --. \ ,.. " :s S c:--- 5 ~ c ~I C~-fe :::tf: 0 (-, I () If ROUTING SLIP ~o-Xl\e.. l/h tUlje... OY\~ ~ Certificate of Occupancy ~ $50.00 Certificate/Inspection Fee 5 h \ r l e )5 DATE 09 -2.Y-07 Address of Proposed Business I::::" Re.c.e., ve P\,l" i'he.re. ~\2... S. L,'()to\h 983(02- Applicant Sh'rl~ Co..r,glle :}nc-. Address 30cD E Fyont- Si- #2- P.A. .wA q8362- , Phone: business '3bO-4~'1. t65bhome Y~2.-I2.~( Brief descnptlon of proposed business: Re..s-ku ~V\t legal Description: lot Current Use of Property: Zoning Classification of Property: Block Will THERE BE ANY OF THE FOllOWING? Construction changes Electrical changes Mechanical (heating, cooling, stoves) Plumbing changes New or relocated signs New septic tanks New sewer service AdmiSSion charged to patrons ,... Is thiS a home occupalion? Excavation of filling of lots Work done In City right-of-way Is there suffiCient off-street parking? New driveway openings A grading plan for site drainage (parking lots, downspouts, etc) Are the eXisting streets paved? Are there eXisting sidewalks? Is there curb and gutter? Other YES NY -\7 -- -~ -~ _--L V -==~ --V ----v -~ ~~ - ---v- ~-== ---v - ----v- - I hereby apply for a Certificate of Occupancy and acknowl- edge that I have read thiS application and state that the information I have supplied IS correct to the best of my knowledge REJECTED Building Section Public Works Department Planning Department Fire Department City Clerk P.B.IA New Business. . . . . . . . . . . . . . . . . . . . . . . . . . . . Transfer of Business location . . . .. ... Change of Ownership ..................... New BUilding ....... .................... Remodel . . . . . . .. ....................... Temporary Business. . . . . . . . . . . . . . . . . . . . . . . Change of Use . . . . . . . . . . . . . . . . . . . . . . . . . . . ~o D CL-1JfCl n.+ lo~ Subdivision THE FOllOWING Will BE REQUIRED: BUSINESS LICENSE 1) TaxI 2) Peddlers 3) 2nd Hand Dealer 4) Pawn Broker 5) Dance 6) Hotel - Motel 7) Fireworks 8) Ambulance 9) Tattoo shop 10) Other PERMITS 1) Building 2) Plumbing 3) Electrical 4) Mechanical 5) Sewer 6) Sidewalk Installation 7) Driveway Installalion 8) Curb installation 9) Sidewalk obstruction 10) Water meter Installation 11) Fire 12 13) 14) 15) 16) 17) Occupancy OP~tl~ Sign .- t-'-' Shoreline 'S I 'II b d..o Home occupalion I' II w, e he Conditional use b~ 11(2.1.'107 Other b:~Otl..y\vZ.:30rm " Date: Signed' Comments / Conditions When you are almost ready to open your business, please call for Certificate of Occupancy mspectlOns Call 417-4815 for a BuIldmg Dept Inspect. Call 417-4653 for a Fire Dept, InspectIOn Please proVide a mmimum 24 hour notice ) A ) ) ) ) C'h' ..) \rey~ ("Sn '- cr\ \;,. ;\~~-r.fJ,;~~ .(;~:t ...~~.... -'\*4[f:~~~:" , > DlJ'i\k~~ :tt or-IIOY. ~-~ .- , ROUTiNG SLIP ~o \ne. C \ 1 t..., 1je.. on~ C)r-- Certificate of Occupancy /../ $50.00 Certificate/Inspection Fee ,..- "., DATE 0 "'i - 2. q - 07 Address of Proposed Business I:::" _, '. I II E \'\:dl. i he~'f 1{)(, (\7. ~). Lill(oh" ,:3(,2.. Applicant ~_,I\1\' I.... (c", \' ;; IE. :r ne . / ..... Address A,; (" r F,~ fl hi" ;:.t ~ 2- F, F\. . ItJ A ! ?'5~,2 Phone: bUSiness __;:,r q I), .' I {/:::6home 'If;; 2.' 12-::", Brief description of proposed bUSiness: r< 12-: :.. ~~. u \ t\ i ,t (. legal Descnptlon: lot Current Use of Property: Zoning Classification of Property: Block Will THERE BE ANY OF THE FOllOWING? Construction changes Electrical changes . . . , Mechanical (heating, cooling, stoves) Plumbing changes New or relocated signs New septic tanks New sewer service Admission charged to patrons Is this a home occupation? Excavation of filling of lots Work done In City right-of-way Is there sufficient off-street parking? New driveway openings A grading plan for site drainage . (parking lots, downspouts, etc ) Are the eXisting streets paved? Are there eXisting sidewalks? Is there curb and gutter? Other YES NO,/ V - -z,T -~ -~ -~ -~ vI" -~ -iT - ----r V - ----:-;- V / ~~ - -:;r -:;- v ~- V v' ----:;- - \ ' v -- I hereby apply for a Certificate of Occupancy and acknowl- edge that I have read this application and state that the information I have supplied IS correct to the best of my knowledge. APPROVED REJECTED '1 ~d~r; l h( '/7-/ "-' f BUilding Section Public Works Department Planning Department Fire Department City Clerk P.B.I.A. New Business. . . . . . . . . . . . . . . . . . . . . . . . . . . . Transfer of Business location . . . . . . . . . . . . . . . Change of Ownership .................. New Building ... . . . . . . . . . . . . . . . . . . . . Remodel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Temporary Business. . . . . . . . . . . . . . . . . . . . . . . Change of Use . . . . . . . . . . . . . . . . . .. ....... ;,.~o ..J. -'" ell.' "'r)( 1\ r I SubdiVIsion C4 THE FOllOWING Will BE REQUIRED: v PERMITS 1) BUilding 2) Plumbing 3) Electrical 4) Mechanical 5) Sewer 6) Sidewalk Installation 7) Driveway installation 8) Curb Installation 9) Sidewalk obstruction 10) Water meter Installation 11) Fire 12) Occupancy ,- _ ( ~ ~"'~!g~_ ~c1 (). t;;.. 14) Shoreline 15) Home occupation 16) Conditional use 17) Other , . , ~ . '2 , ,,(, " , ,'- .::- . .iI'(lI~ I >"'\ ( ";:....' " If._H <c K J BUSINESS LICENSE 1) TaXI 2) Peddlers 3) 2nd Hand Dealer 4) Pawn Broker 5) Dance 6) Hotel - Motel 7) Fireworks 8) Ambulance 9) Tattoo shop 10) Other _ I I) ; .,1\\ L", OGI1t' " 1..-, \1/21.\107 Date: /- , c1 ~, , " '4 Signed' ." ! f , ',(~ t l~ t/"_ "'__.... fj~! Comments / Conditions ((pOAT "11' !-o~Q~<<, c~w L. -=....:w =- ~ ~LICWO"':+"c;, ( ) ( ~ ( Y"/) ( ) ( ) ( ) ( ) I 0(; (~ Sh' ) c~ ::ft O{ 110'" \r ey 5 e. D {'.(~ vle.Ss;. - a. . ROUTING SLIP l\\o.-me. c,,\r1 iU1je. OY\~ ~VOAT "Ii\! ",,10 ~ 0 ~'.4ttt~<<, y" Certificate of Occupancy CJ~~,~ "- """"-'" '=- , $50.00 Certificate/Inspection Fee ~ -'>u!3LICWO'Y''f-.'<> DATE 0 OJ -2.LI-07 .,. New Business. . . . . . . . . . . . . . . . . . ( ) .... . . . Address of Proposed Business It::" Receive flb.i.tne.b"\!ivc Transfer of Business location . . . . . . . . . . . . . . . ( ~ 0\7- S. L' i"\l.o\h 983hz.. Change of Ownership .. . . ........ . ..... . . ( Applicant SY\IV"II!!A.J Cara; Ie. +y\G. New Building ......... ..... .. . ..... . .. ( ) J ..J Address '36(1') {;;. f;rnn+ $;- ;3::t:2.. Remodel . . . . . . ... . . . . .... . . . . ..... .... ( ) P.A. wA QS3lo2.. Temporary Business. . . . . . . . . . . . . . . . . . . . . . . ( ) I Phone: business '3bO-45;# IbS6home t../~2.- 12.3'7 Change of Use . . . . . . . . . . . . . . . . . . . . . . . . . . . ( ) Brief description of proposed business: Re. s-hA.u ~"nT ~o oct-lira V\t 100.& legal Description: lot Block SubdiVISion Current Use of Property: .. Zoning Classification of Property: Will THERE BE ANY OF THE FOllOWING? YES N:Y THE FOllOWING Will BE REQUIRED: Construction changes - ----v" PERMITS BUSINESS LICENSE Electrical changes -- 1) BUilding 1) TaxI Mechanical (heating, cooling, stoves) _ ---1L- 2) Plumbing 2) Peddlers Plumbing changes _ 1/ 3) Electrical 3) 2nd Hand Dealer New or relocated signs -~ 4) Mechanical 4) Pawn Broker New septic tanks _L- 5) Sewer 5) Dance New sewer service -~ 6) Sidewalk Installation 6) Hotel - Motel Admission charged to patrons . V 7) Driveway Installation 7) Fireworks Is this a home occupation? - V 8) Curb Installation 8) Ambulance Excavation ot tilling ot lots -V 9) SIdewalk obstruction 9) Tattoo shop Work done In City rlght-ot.way --v; 10) Water meter Installation 10) Other Is there sufficient off-street parking? V .. 11) Fire New driveway openings V 12) Occupancy t; c.e -V- A grading plan tor site drainage \T- ~) 'SI9~_ ~ (J.. (parking lots, downspouts, etc ) 14) Shoreline ,..... , w; l\ he done Are the eXisting streets paved? ---v - 15) Home occupation .J\5n .. ~ \T- Are there eXisting sidewalks? 16) Conditional use b~ 11(2.1.\101 Is there curb and gutter? -V- 17) Other -- b: sCl t\,VVI ~ z: 3t> r m Other -- t d I)""j'. II 1./o..H' to ~ . J I hereby apply for a Certificate of Occupancy and acknowl- 9-~/-~1 edge that I have read this application and state that the Date: ~.. Information I have; supplied IS correct to the best of my ~L( ~\~ knowledge. Signed: / ) -) v APPROVED REJECTED Comments / Conditions Building Section Public Works Department \,' ',;'.\.." Planning Department I~ Fire Departmenl (<en D _ City Clerk P.B.IA 5 hh"'le )5 Ca.-fe.. DATE 0 <1 -2-l./ -07 Address of Proposed Business I:::::' ReeL, ve fl)..,,-t. i'her'e. 0\2. s~ L"l')t.oh'\ 93302- Applicant srll'r 1:1 Ca.y:!; \e !l"\c.. Address 36<0 ~ FlronT $, .#2- p. A. . wA qg3b2- , Phone: business '3bO-Y~(; Ib5bhome t./~2--12.-37 Brief description of proposed business: Re.skv \'7A.V'\T legal Description: lot Current Use of Property' Zoning Classification of Property. Block -# Oc-/loy- New Business. ...... .... ....... Transfer of Business location . . . . . . . . Change of Ownership . . . . .. ....... . New BUilding ....... .............. Remodel . . . . . . . . . . . . . . . . . . . .. .... Temporary Business. . .. ............ Change of Use .. ........................ !So 0 cLv pCHd- looA Subdivision WILL THERE BE ANY OF THE FOLLOWING? Construction changes Electncal changes Mechanical (heating, cooling, stoves) Plum~lng changes . New or relocated signs New septic tanks New sewer service AdmiSSion charged to patrons Is this a home occupation? Excavation ot tilling ot lots Work done In City nght-ot-way Is there suffiCient off-street parking? New dnveway openings . A grading plan tor site drainage (parking lots, downspouts, etc) . Are the eXlsling streets paved? Are there eXisting Sidewalks? Is there curb and gutter? Other YES N~ THE FOllOWING Will BE REQUIRED: -V PERMITS BUSINESS LICENSE -- 1) BUilding 1) TaXI _ -1L- 2) Plumbing 2) Peddlers _L- 3) Electncal 3) 2nd Hand Dealer _-L 4) Mechanical 4) Pawn Broker -~ 5) Sewer 5) Dance -~ 6) Sidewalk Installation 6) Hotel - Motel -IT 7) Dnveway Installalion 7) Fireworks -iT 8) Curb Installation 8) Ambulance -~ 9) Sidewalk obstruction 9) Tattoo shop -L~ 10) Water meter Installation 10) Other 11) Fire -IT 12) Occupancy f6..ce ~== ~3) Slg~- \X 14) Shoreline 5\~n w; I \ be.- done ( 15) Home occupation \7- 16) Conditional use bj 1I/z....q07 ----vr - 17) Other -- b::s6 t.LVV\- Z :3" r m -- '( >- ROUTING SLIP l~ O--\I)'\~ cAl) ll() j'e. OY\~ ~ Certificate of Occupancy ~ $50.00 Certificate/Inspection Fee I hereby apply for a Certificate of Occupancy and acknowl- edge that I have read this application and state that the Date' Information I have supplied is correct to the best of my knowledge. Signed: APPROVED REJECTED &- q-~~-{)7 Building Section Public Works Department Planning Department Fire Department City Clerk P.B.I.A. Comments / Conditions When you are almost ready to open your bUSiness, please call for CertIficate of Occupancy inspectIOns' Call 417-4815 for a BUlldIng Dept Inspect Call 417-4653 for a Fire Dept InspectIOn Please provide a minimum 24 hour notice ) ~ ) ) ) ) CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number pin number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Use Property zoning . . . Application valuation 04-00000392 Date .440352 612 S LINCOLN ST 06-30-00-0-1-6600-0000- RE-ROOF 5/10/04 COMMUNITY SHOPPING DISTR 18300 Owner Contractor HORTON TRUST, WILLIAM/DIANE 194 HART RD PORT ANGELES WA 98363 EMERALD ROOFING 114 MT PLEASENT CREST PORT ANGELES WA 98362 (360) 452-8173 Permit Additional desc Permit Fee Issue Date Expiration Date BUILDING PERMIT TEAR OFF, TORCH 330.75 5/10/04 11/06/04 - NO PR FEE DOWN Plan Check Valuation Fee .00 18300 Other Fees STATE SURCHARGE 4.50 ~,. - y 11 Y' "' ; .. -> ( -- ..,. "- .::s \\ ~ -- ~ Qty Unit Charge Per Extension 92.75 238.00 BASE FEE 17.00 14.0000 THOU BL-2001-25K (14 PER K) ------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 330.75 330.75 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 335.25 335.25 .00 .00 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after the work 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. ../) -.---;:;' //; -------..--/------ L / .~.-;? ~.. =-sfg."rr&ture of Contractor or Authorized Agent / sjfof1/ qafe Signature of Owner (if owner is builder) Date T:\PLANNING\FORMS\I 102.15 [1111412003] 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 UNLA WFUL TO COVER, INSULA TE 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/DOWN SPOUTS ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # ROUGH-IN I PLUMBING UNDER FLOOR / SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW / WATER AIR SEAL WALLS CEILING I FRAMING JOISTS / GIRDERS SHEAR WALL/HOLD DOWNS WALLS 1 ROOF / CEILING DRYWALL (INTERJOR BRACED PANEL ONLY) T-BAR INSULATION SLAB WALL / FLOOR / CEILING MECHANICAL HEA T PUMP GAS LINE WOOD STOVE 1 PELLET / CHIMNEY HOOD / DUCTS PW UTILITIES 1 SITE WORK (Engineering Division) SEPARATE PERMIT #'5: WATERLINE / METER SEWER CONNECTION SANITARY STORM PLANNING DEPT. SEPARATE PERMIT #'5 SEPA: PARKINGILlGHTING ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRICAL - LIGHT DEPT. 4 I 7-4735 ELECTRJCAL LIGHT DEPT CONSTRUCTION R.W. / PW/ CONSTRUCTION - R.W. ENGINEERING 417-4807 PW 1 ENGINEERJNG FIRE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 V:::: - Q -0 if. .J.k - BUILDING T:\PLANNINGIFORMS\I 102.15 [11/14/2003] OJ >-3 'tI :>''''00:>' 0'" t< >< ~ ",:>,~oo H:O '" '" "':OZZO >-301 '" ....... t< 001 >-3:0 ><'" Ul H 01:0:001 :>' a 0 .., Zt< :>'Ul 0:0 H ~. OUl ''It'l >-3 0 Ii! OJ 0 '" ti 01' :0. 0 0:00 :0 :0'" Ot'l'tl >-3....... ;;::0 a ",c:o oo~tI:lO'\ ~.;: t<t'lo ,t::.O'\O:3:1--' t'lUl 1 1 :ot'lN Qa >-3 >-3 OJ ow..,::o 01"" t'lt'lC: aoQ;J:>!W t<- OOH al Zt< 01 g; a a Ot< UlH aa>-3 H N ~ H WI :o:oZ :0 IZi \.DoC:OO W t'lHG) NI UlOO "" UlZ 1--'~t'Ijt"" C:Ul'tl :0 1 - HZ en ~"'~ 01'" Z a 1 O'\::E:GJW :OaH >-3 1 H oat< .., 0 1 t< 1 "laH OJ 1 :00 I ~~ ::1 , 0101 , UlUliZi a....... t< , c:oo , 0 0 , t<:o ~ H 1 >-3H'tI Z , Ul"':<l 0 Q .......>-3 01 0 1 OH'<I H ;;:: "l , OOttl HZ ;;:: Z , ~Zttl ZUl 01 Ul'" Z :>' 01 "'01 >-3 t< 1 Z 010 Ul , >-3 0>-3 , Ul >-3H ~ , 00 , :oZ 0 1 , ,-<>-3 Z , ~~ 0 , "''''Ul >-3 , 55:ii 01:>: 01 , Ult'l Ul ZZO >-3 t'lt'lH t< <: t< H 01 W :0 '" t< a >< "" en N , OJ H -.J W 0'" :>':>' >-3Q 0101 '" ....... a N ....... a ""'" CITY OF PORT ANGELES e~' DEP~TME~ OF COMM~TY DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application N~mber ..... 03-00000106 Date 2/28/03 Property Address ...... 612 S LINCOLN ST ASSESSOR PARCEL NUMBER: 0630000166000000 Application description . . HOOD/DUCT SUPPRESSION SYSTEM ~roperty Zoning ....... Application valuation .... 2000 Owner Contractor 8436 LTD. LISENBURy FIRE PROTECTION LYNNWOOD WA 98036 PORT ANGELES WA 98362 (360) 683-5132 .......................... Structure Information ......................... Construction Type ..... TYPE V NON-RATED Occupancy Type ...... ASSEMBLY <300 W/O STAGE Permit ...... HOOD & DUCT SUPP SYSTEM Additional desc . . Permit Fee .... 40.00 Plan Check Fee . . .00 Issue Date .... 2/28/03 Valuation .... 0 Ex131rmtlo~ Date . . 8/27/03 Qty Unit Charge Per Extension 1.00 25.0000 ECH HOOD/DUCT INSPECTION/TESTING 25.00 1.00 15.0000 ECH HOOD/DUCT PL~ R~"~IEW 15.00 Fee surm~ary Charged Paid Credited Due Permit Fee Total 40.00 40.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 40.00 40.00 .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 pedod of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. [ 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/~ ~ ' ' .... Co~tractor or Authorize(J/Agent ' Date S~gnature of Signature of Owner (if owner is builder) Date 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 JOB SITE INSPECTION TYPE I DATE [ YEsACCEPTEDI NO COMMENTS FOUNDATION: FOOTINGS WALLS FOUNDATION DRA1NAGE ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # PLUMBING UNDER FLOOR / SLAB ROUGH-/N WATER LINE GAS LINE BACK FLOW / WATER AIR SEAL FRAMING JOISTS / GIRDERS SHEAK WALL WALLS ! ROOF / CEILING DRYWALL T-BAR INSULATION MECHANICAL HEAT PUMP WOOD STOVE / PELLET / CHIMNEY HOOD/ DUCTS PW UTILITIES / SITE WORK (Enginecdng Division) SEPAKATE PERMIT #'s: WATEKLINE / METER SEWER CONNECTION SANITARY STOKM FIRE 417-4653 FIRE DEPT. f~-J/c~(~ ,~.~ PLANNING DEPT. 417-4750 PLANNING DEPT. BULOING 417~4,~s BUILDING FOR OFFICIAL USE ONLY:  Date Rec.: , BUILDING PERMIT - APPLICATION Permit#: ~ Date Approved: Date Issued: The Building Permit Application must be fllled out completely. Please type or print in ink. If you have any questions, please call 417-4815 ApplicantorAgent: /? ?~/,~/~. ~ /. -~f'( e~ ,~o ~ ~ ~o~ Phone: ~ ~ Owner: ~ ~ ~V~ ~' Phone: ~,f~-~ ~ ~ Address: ~ ~V ff~-/v~' ~ City: .~ /: ~~ Zip: ~ ~chitecVEngineer: ~c2 ..~? ~/ Phone: Contractor ~-~,r-~ d._ ~,- /~?r~, License g: Exp: Phone: Address: City: Zip:. PROJECT ~D~SS: ~/2 ~ ~f//~(~/.// .f' W tuNING: LEGAL DESC~PTION: Lot: Block: ,. Subdivision: CL~L~ COUNTY P~CEL N~BER~ :2 ~. - '~5'~edit Card Holder Name: Billing Addr~s: City:. Credit Card g: Exp. Date: VISA MC T~E OF WO~: SI~N~UATION: m Residential ~ New Consm ~ Re-roof ~ Wood-stove SF. ~ $. /SF. =$ D Multi-f~ly ~ Ad&fion ~ Move ~ Garage SF. ~ $. /SF. = $ ~ Comercial m Remodel ~ Demolition ~ Deck SF. ~ $ /SF. = $ ~ Repair ~ Sign ~ O ~ TOTAL V~UATION $~oO~ COMMERCI~SIDENTI~: Occupancy Group: Occupant Load: CondUction T~e: No. of Stories: ~ Lot Size: % Lot Coverage: % Existed Lot Coverage: /sq. fi. + Proposed Lot Coverage: /sq. fl. = TOTAL LOT COVE~GE: ]sq. fi. PLYING USE ONLY: ~PROV~S: PL~ Notes: BLDG. DPW FI~ ES~etland(s): ~ Yes u No SEPA Checklist required? ~ Yes ~ No O~er: OTHER BUILDING PE~IT ~PLICATION S~MITT~: Your application and site plan must be filled out completely to be accepted for review. The Bulldog Division can provide you with more detailed ~omtion on ~e application and pl~ sub~al requirements. Yo~ co~leted application, site plan (for additions) and building conduction pI~s are to ~ subdued to the Building Division. V~UATION OF CONSTRUCTION: In all eases, a valuation amount must be entered by the applic~t. T~s fig~e will be reviewed and ~y be revised by the Building Division to comply M~ cu~ent fee schedules. Contact ~e Pe~t Coordinator at 41%4815 for assistance. PL~ CHECK FEE: Your pl~ check fee is due at ~e t~e the building pe~t application and conduction plans are submiRed. All other pemt fees are due at the t~e of print issuer. EXPIATION OF PL~ ~VIEW: If no pe~t is issued wi~in 180 days of the date of application, t~s application will expire. ~e Building Official c~ extend the t~e for acOon by the applicant up to 180 days upon ~en request by ~e applicant (see Section 107.4 of the Unifo~ Building Code, c~ent edition). No application can be extended more than once. I hereby cert~ that [have read and examined this application and know the same to be true and correct, and I am authorized to apply for this pe~it. 1 understand it is not the Ci~'s legal responsibili~ to determine what permits are required,- it remains the applicant's responsibili~ to determine what permits are required and to obtain su~ T:~ORM S~PPS~ uildin~e~it ~ PORT ANGELES FIRE DEPARTMENT HOOD & DUCT FIRE SUPPRESSION SYSTEM PLAN REVIEW Project Name: Gordy's Restaurant Address: 612 S Lincoln H/D Installer: Existing Telephone: 683-5132 Systemlnstaller: Lisenbury Telephone: 452-1143 Permit #02-06 We have checked this plan and find that it conforms to the requirements of our ordinance. Additionally: 1. A hood and duct plan or diagram in conformance with NFPA/496 shall be submitted to the Fire Department. 2. If plans have not previously been submitted to an insurance rating organization, i.e., Washington Surveying and Rating Bureau, Factory Mutual, this Department strongly recommends such submittal to seek the most favorable insurance rate from the carrier. 3. A fire suppression system diagram in conformance with U.L., Inc. 4. Before final acceptance of the system, an inspection will be conducted by the Port Angeles Fire Department to ensure system comply with NFPA #96, UMC Chapter 20, UFC Article 10. [] Building Department Reviewed by [] Fire Department Date FP- 12 Page 1 of I PORT ANGELES FIRE DEPARTMENT HOOD & DUCT FIRE SUPPRESSION SYSTEM PLAN REVIEW Project Name: Gordy's Restaurant Address: 612 S Lincoln H/Dlnstaller: Existing Telephone: 683-5132 Systemlnstaller: Lisenbury Telephone: 452-1143 Permit #02-06 We have checked this plan and find that it conforms to the requirements of our ordinance. Additionally: 1. A hood and duct plan or diagram in conformance with NFPA #96 shall be submitted to the Fire Department. 2. If plans have not previously been submitted to an insurance rating organization, i.e., Washington Surveying and Rating Bureau, Factory Mutual, this Department strongly recommends such submittal to seek the most favorable insurance rate from the carrier. 3. A fire suppression system diagram in conformance with U.L., Inc. 4. Before final acceptance of the system, an inspection will be conducted by the Port Angeles Fire Department to ensure system comply with NFPA #96, UMC Chapter 20, UFC Article 10. [] Building Department Reviewed by ~Q ~¢-'.'.. ~ [] Fire Department Date ~' ~ c~ - t2~-a FP- 12 Page 1 of 1 ROUTING SLIP .~ Certificat® of Occupancy 't $47.00 Certificate/Inspection Fee DATE -~'- ~' O .~ New Business ............................ Address of Proposed Business Transfer of Business Location ................ ~:,/,.~. .~ ~.,,~ ¢OJ~) I~,'t /b¢1~5 ~,1~'~. Change ofOwnership ...................... Applicant c~/5'f~,,d~; I,/z.,~,'¥~,'~ ~-Yb_~ ~14)~:,~._loq&YJ' New Building ............................. Address /~/ ~ /1¥/~ /~u~. ~ St~ jL/c Remodel ................................. /.~ Ilo v~ ¢, L~l L/~C~) 7~ Temporary Business ....................... Phone: business z/a-~-~/~-I'l'~q~"'home ,/=zs--*,/,~-~a:t¢' Change of Use ............................ Brief description of proposed business: L~./'~/~-,p /~)¢,~ /~-/ .~;fC;~., .!.~.~-//t.. ~(,i,l~ /~ Legal Description: Lot i tlr ¢~ Block /('~[, Subdivision 'TF~ Current Use of Property: ,c~ Zoning Classification of Property: WILL THERE BE ANY OF THE FOLLOWING? YES NO THE FOLLOWING WILL BE REQUIRED: Construction changes .......................... ~ PERMITS BUSINESS LICENSE Electrical changes ............................. ~ 1) Building 1) Taxi Mechanical (heating. cooling, stoves) .. ~ 2) PlumPing 2) Peddlers Plumbing changes .......................... ~- 3) Electrical 3) 2nd Hand Dealer New or relocated signs .................... ~ 4) Mechanical 4) Pawn Broker New septic tanks ................................ X 5) Sewer 5) Dance New sewer service .............................. ~ 6) Sidewalk installation 6) Hotel - Motel Admission charged to patrons .................... )~ 7) Driveway installation 7) Fireworks Is this a home occupation? ....................... ,~ 8) Curb installation 8) Ambulance Excavation of filling of lots ...................... X 9) Sidewalk obstruction 9) Tattoo shop Work done in City right-of-way ................... ~ 10) Water meter installation 10) Other Is there sufficient off-street parking? ~ 11) Fire New driveway openings .......................... 'X 12) Occupancy A grading plan for site drainage .................... ~ 13) Sign (parking lots. downspouts, etc.) ................. 14) Shoreline Are the existing streets paved? .................. X 15) Home occupation Are there existing sidewalks? ..................... ,1( 16) Conditional use Is there curb and gutter? ....................... ~ 17) Other Other ...................................... I hereby apply for a Certificate of Occupancy and acknowl- edge that I have read this application and state that the Date: information I have supplied is correct to the best of my knowledge. Signed: Building Section Public Works Department Planning Department Fire Department City Clerk EB.I.A. CERTIFI( PANCY City of Port An Building Division This pursuant to the 109 of the Un. Code certifying that at the time of issuance tn c vith the various ordinances of the City regulatin, construction or use. For the following: Use Classification: Building Permit No.: Business Name- Block Bm C~oup: B ~ Type of Construction V-N os~ Zone: ow,,e, of Business: Eastsid~. Venture DBA ^ddress: 1612 114t~ Ave. S.E.Suitc WA. 98004 BuildingAddress: 612 South Lincoln Street 98362 2003 place. Shall not be Jilding Official. CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Applicatioa~ Number ..... 03-00000577 Date 6/13/03 Property Address ...... 612 S LINCOLN ST ASSESSOR PARCEL NUMBER: 06=30~00-0-1-6600_0000_ Tenant nbr, name ...... BLOCK BUSTER Application description . . . COMM REMODEL S~bdivision Name ...... Property Zoning ....... ADplication valuation .... 45000 Owner, Contractor 8436 LTD. THE BAG LADY C~AZy MIKES VIDEO 6402 S TACOMA WAY L~NNWOOD WA 98036 TACOMA WA 98409 (253} 770-8606 ...... Structure Information NEW FASCIA ..... Construction Type ..... TYPE V NON-RATED Occupancy Type ...... BUSINEaS:OFF/PRO/MED/REST Other struct info ..... NUMBER OF UNITS 1.00 Permit ...... BUILDING PERMIT - CO~9~ERCIAL Additional desc . . Permit Fee .... 616.75 Plan Check Fee . . 400.89 Issue Date .... 6/13/03 Valuation .... 45000 Expiration Date . . 12/10/03 Qty Unit Charge Per Extension BASE FEE 414.75 20.00 10.1000 THOU BL-25,001-50K (10.10 PER K) 202.00 Other Fees ......... STATE SURCF~%RGE 4.50 Fee summary Charged Paid Credited Due Permit Fee Total 616.75 616.75 .00 .00 Pi~ Check Total 400.89 400.89 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 1022.14 1022.14 .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. Ali 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 previsions of any state or local law regulating construction or the performance of constructioJ~-'7 Signature of Gontractor or Aufhorized Agent Date Signature of Owner (if owner is builder) Date T:\PLANNING\FORMS\ 1102.15 [4/2002] FOP. OFFICIAL USE ONLY: BUILDING PERMIT - APPLICATION Permit#: Fill out COMPLETELY and in INK. Your application and site plan MUST BE Date Approve: COMPLETE to be accepted for review. If you have any questions, call Date Issued: (360) 417-4815 ApplicantorAgent:~A5~SlO~ [/~ POc~ ¢:C~,~ ehone:Z},~S~3~g/ Address:/~o ~[ ]/~/~H S ~ S~t~e- ~/~Ci~: ~//~{fl Oe ~chitecffEngineer: ~ eL 0 Pd ~ 0 fig L~ g~ra~ Phone: Con.actor ~ ~ <'W< State License ~:~A ~gA~ '6~xp:jO -~0 PRO~CT~D~SS:~ /~. GouCH K / ~60L ~ ZONING: LEGAL DESerTION: Lot: / 7 ~ Block: / ~ ~ Subdivision: rfp Credit Card Holder Name: Billing Address: City:_ Credit CardType ~SA__MC __ ~ Exp. Date: T~E OF WO~: SIZE~UATION: o Residential ~ New Consm o Re-roof u Stove SF. ~ $ /SF. = $ ~ Multi-fa~ly = Addition ~ Move ~ Garage SF. ~ $ /SF. ~ Co~ercial ~' Remodel U Demolition ~ Deck SF. ~ $ /SF. = $ ~ R~air ~ Sign Q O~er TOTAL VALUATION BmEFDESC~PTIONOFTHEPRO~CT: ~ ~(vU4 ~ !)~ ff&~ COMMERCI~SIDENTI~: Occupancy Group: Occupant Load: Cons~ction T~e: No. of Stories: Lot Size: Existing Sq. Ft. & Proposed Sq. Ft. = TOTAL Sq. Ft. ExistM~ lot coverase ~ % & Proposed lot coveraie ~% ~ Total lot coverage % APPROVES: PL~: PL~NG USE ONLY: BLDG: DPt: FI~: ES~Wetland(s): ~ Yes ~ No SEPA Checklist requked? D Yes ~ No Other: aT.R: BUILDING PERMIT APPLICATION SUBMITTAL: The Building Division can provide you with information on the application and plan submii~al requirements if you have questions. VALUATION OF CONSTRUCTION: In all eases, 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 ttme 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 107.4 of the Uniform Building Code, current edition). 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. -' ' ' ' 5--/5-- T:WORM SkA?PS\Buildingpermit wpd Applicant: ' ~7~'- ~'~~'fl Date: premier En~in~in~, Inc. prepared by: P.O. Box ~ 165 ~/oadinviB¢, WA 95072 Structural Calculations for: ~kbuster Video - Remodel Si~¢ Addr~s: 612 $. Lincoln poti Aage'~es, WA pr~p~ed for: SconzoWlalls~Om Atch~te~ Data: j~¢ 10, 2003 CITY OF PORT ANGELES -- pb~'~, specff,cabons and other da~, et from 06,12/2803 13:51 4258839867 PREMIER ENGINEERING PAGE 83 C onsulti~g Engineers ( becked by I P.O. Box 2168 · Woodmville, WA 98072 (425) 867-1597 Description ~ ~.,,~,,:--,,,~ Consulting Engineers P.O. Box 2168 · Woodinville, WA 98072 (425) 867-1597 4258839867 PREHIER ENGINEERING PAGE 05 P,O. Box 2168 · Woodinville, WA 98072 (425) 86%1597 Description 2000 10: 5i 42SF]~B906, PREI,,,IlER ENGINEERTNG PAGE P,O, Box 2168 · Woodinville, WA 98072 (425)867-1597 ~)~- -(~¢3)~ :~/, ~r~ ~ ~ ~,5''~ ¢.5" " ~/12,,2~3 ~3:51 4258839~7 PREHIER ENGINEERING PAGE C onsult~ Checked by Date P,O, BOx 2168 · Woodinville, WA 98072 [425) 867-1597 Descriplion ~g~ ~ E T, yxy hE. 'Z. ~ L~' "~,~, 1~:51 42588~9887 PREMIER EMGIMEERIMG PAGE 88 Box 2168 · Woodinville. ~A 98072 ~3B:"12/201~3 13: 5~. ~2588390B? PF, E~,'IIER EHG~HE£RIH~ PA~E 13:~1 Consulting En~ineeis P~O. Box 2168 - Woodinville, WA 98072 (425) 867-1597 Description CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS ........... INSPECTION REPORT ........... REQUEST:~ / , ~_.~[_~ Date ~1. IL~ !,~-~ ~ Time )C~'. I ~.'~.~ Received by (phone, person) Location of Work to be inspected '~C~q.~ ~"'~g,~JcT~.~ ~[~. ~ /-.4~..~-~!a.J. Name of person requesting inspection Address of person requesting inspection Phone No. Type of Inspection (circle appropriate one): Permit No. Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other ~ INSPECTION NOTES:f Inspected: Date ~ .0~[~m[J0~ Time '~ By Remarks: - ~ r-~ ~ RESTORATION REQUIRED ...... YES. NO SURFACE RESTORATION: SURFACE TYPE: [] Unimproved []Gravel ~-IAsphalt ~--~PCC ~]Other [] Repaired by City Work Order # El Repaired by Permittee L-~ COMPLETE []No Damage Found [] INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) t( pORT ~ S4.0~~~ Ra !L ~ ~ ~~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, W A 98362 Application Number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Zoning . . . Application val~ation 03-00000560 Date 6/09/03 612 S LINCOLN ST 06-30-00-0-1-6600-0000- ELECTRICAL ONLY @ o Owner Contractor 8436 LTD. CRAZY MIKES VIDEO LYNNWOOD WA 98036 OLYMPIC ELECTRIC 4230 TUMWATER PORT ANGELES (360) 457-5303 WA 98363 Permit Additional desc Sub Contractor Permit Fee Issue Date Expiration Date ELECTRICAL ALTER COMMERCIAL OLYMPIC ELECTRIC 69.80 Plan Check Fee 6/09/03 Valuation 12/06/03 .00 o Qty 1. 00 2.00 Unit Charge Per 59.4000 ECH EL-COMM ALT <5 CIRCUITS 5.2000 ECH EL-COMM ALT-ADDTNL CIRCUITS Extension 59.40 10.40 ~ ~ ~~ Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 69.80 69.80 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 69.80 69.80 .00 .00 ~ ~ )~ ~ ~0J 1 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 construction. Signature of Owner (if owner is bUilder) Date Signature of Contractor or Authorized Agent Date T IPLANNlNGIFORMSII102 15 [4/2002] . BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING 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 I NO FOUNDATION: FOOTINGS WALLS FOUNDATION DRAINAGE , (LIGHT DEPT) SEPARATE PERMIT # ELECTRICAL ROUGH-IN I 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 I I MECHANICAL HEAT PUMP WOOD STOVE / PELLET / CHIMNEY HOOD / DUCTS PW UTILITIES / SITE WORK (Engmeermg DIVISIon) SEPARATE PERMIT #'5. WATERLINE / METER SEWER CONNECTION SANITARY STORM PLANNING DEPT SEPARATE PERMIT #'5 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 ~h l(1h AU) 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 [4/2002] ~ ~ORT ~ S~O~~~ r..,a "-~ -==- ~~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DNISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number Property Address ASSESSOR PARCEL NUMBER: Tenant nbr, name Application description Property Zoning . . . Application valuation "' 03-00000525 612 S LINCOLN ST 0630000166000000 BLOCK BUSTER Date 6/03/03 SIGNS 1500 Owner Contractor 8436 LTD. CRAZY MIKES VIDEO LYNNWOOD WA 98036 ADVERTISING SALES & MORE 1327 E. 1ST STREET PORT ANGELES PORT ANGELES WA 98362 (360) 452-7785 Permit Additional desc Permit Fee Issue Date Expiration Date SIGN 315.00 6/03/03 11/30/03 Plan Check Fee Valuation .00 1500 Qty 2.00 1.00 1.00 Unit Charge Per 85.0000 PER 30.0000 PER 115.0000 PER S- SIGN WALL 25 SF+ S- SIGN LES THAN 25 SF S- SIGN FREE OR PROJ 25+ Extension 170.00 30.00 115.00 ~. Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 315.00 315.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 315.00 315.00 .00 .00 - ? ~ ~ ..... ::s () ~ --- :os ~. 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 a 'to violate or cancel the provisions of any state or local law regulating construction or the performance of construction', c:.. Signature of Contractor or Authorized Agent G ,'1 . 0',1 Date Signature of Owner (If owner is builder) Date ~n :~ T \PLANNING\FORMS\1102 15 [4/2002] BUILDING PERMIT INSPECTION RECORD ,- '. , CALL417-4815 FOR BUILDING 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 FOUNDATION: FOOTINGS WALLS FOUNDATION DRAINAGE ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT # ROUGH-IN 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 (Engmeenng 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 h .JAu.I-a '2, 1.\1 BUILDING T \PLANNING\FORMS\I 102 15 [4/2002] C> CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . . REQUEST: Date 07 (?-1 /0 ') Time I 0 ~ I S- f I I / Received by '- ~t....e--'-"--' €~ person) 1;>~ckbvsL Location of Work to be inspected Name of person requesting inspection Address of person requesting inspection Type of Inspection (circle appropriate one): Sewer Foundation Framing Chimney 0/~ YJ1 , oJ< .e s CJ. I-vVl Co / I/) I/}//,"f/er Plumbing Final Phone NOotf6(1J CJ /13 Permit No. S 'J-.5 Sewer Excav. Other c 5/5 n J.w / e . INSPECTION N~ Inspected: Date b ~ Remarks: Time ?wt By -J I-- w RESTORATION REQUIRED . . . . .. YES NO SURFACE RESTORATION: SURFACE TYPE: 0 Unimproved OGravel o Asphalt OPCC 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) ~TRFFT ~IIPFRINTFNnFNT IDA TEl PREPARED 7/24/03, 11 12.44 CITY OF PORT ANGELES ADDRESS TENANT, NBR CONTRACTOR OWNER PARCEL APPL NUMBER INSPECTION TICKET INSPECTOR JAMES L LIERLY SUBDIV 612 S LINCOLN ST BLOCK BUSTER ADVERTISING SALES & MORE 8436 LTD 06-30-00-0-1-6600-0000- 03-00000525 SIGNS PERMIT: SIGN 00 SIGN REQUESTED INSP TYP/SQ COMPLETED RESULT DESCRIPTION RESULTS/COMMENTS PHONE PHONE (360) 452-7785 PAGE DATE 1 7/24/03 BL6 01 7/24/03 JLL BUILDING POST/COLUMN FTG ---------------------~--------- COMMENTS AND NOTES -------------------------------------- eJ\t:'U~ w / 5\ Oc l0l&-\lL. ~~ {F- I oL/ trz-\A--~ J ~tf~ \~ , tb /-~ t'UK I)/< I'IClAL lJ~~ UNL Y Date Rec.. 5"-2'2-0 Penmt #: .s-zS- BUILDING PERMIT - APPLICATION . Fill out COMPLETELY aud in INK. Your application and site pJan MUST BE COMPLETE to be accepted for review. If you have any questions, call (360) 417-4815 Date Approved. Date Issued' Applicant or Agent: P. S ~"'\ Owner: g<r'1~ l-"""'~.. Address: (?-". q, 0.>' 2 ~o I? City: .2. "-Irl ~ ~.::> c:> ArchitectlEngmeer: A--~ ~ g ~ ~ J 'kJ IE F f'J-a<2- s.. \ Cs~ So Phone: Contractor ~ S"" S \ Q. ,..j ~ State License #: O;J h~ Exp: Address: \ '3.?-1.. <f!;. ~'-~~., Clty: (l~a...-.., AJc.e (....:.s, PROJECT ADDRESS: (~) 2- g-r~ J.....,,J ~~ LEGAL DESCRIPTION: Lot: \.~:2. Block: \ lc b Subdivision: CLALLAM COUNTY PARCEL NUMBER: 0 bO.O 00 0 \ '-lc, 0 0 S \G-~ s.. Phone: ~J.. - ,., fr~ Phone: ZlP: ~ 8"-c>":> b 4~2-1'~~ Phone: Zip: q ?3b2- ZONING: Credit Cal"d Holder Name: Billing Address:. Credit CardType VISA TYPE OF WORK: o Residential 0 :-.Iew Constr 0 Re.roof o Multi-family 0 Addition 0 Move o CommercIal 0 Remodel 0 Demolition o RepaIr )(( Sign BRIEF DESCRIPTION OF THE PROJECT: r o~ ~~,~ ~ ,. City: MC # Exp. Date: SIZENALUATION: \ ,I.t."~ SF. @$ ISf. = $ '30 SF. @ $ ISF. = $ SF.@$ ISF.=$ TOTAL VALUATION $ t S; CiO. O~ au l ~. toic.. r-....An ClQ ~ l Q.~S: ~\G~ o Stove o Garage o Deck o Other ~ ~~'-- "3. ~cP-S'-Z~....s~. .,.)Q, COMMERCIALfRESIDENTIAL: Occupancy Group: Occupant Load: No. of Stories: _ Lot Size; Existing Sq. Ft. & Proposed Sq. Ft. Existing lot coverage _ % & Proposed lot coverage _% '" Total lot coverage Constructlon Type: = TOTAL Sq .Ft. % ESA.'Wetland(s): 0 Ye~No APPROV: PLANti- BLDG: DPWU: FIRE: OTIIER:_ BUILDING PERMIT APPLICATION SUBMITTAI_: The Building Divislon can provide you with mfomlation on the application and plan submittal requirements if you have questions. V ALVA nON OF CONSTRUCTION: In aU cases, a valuation amount must be entered by the applicant. This figure WIll be revlewed 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. An other pennit fees are due at the time of pemut 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 wntten request by the applicant (see Section 107.4 of the Uxuform Building Code, current edition). No applicabon can be extended more than once. I hereby certify that I have read and examined thiS application and know the S8me to be true and correct. ram authIJrized to apply for this permit and understand that it i3 my responSibility to determine what permits are required .not the City'S, a I must obtain such permits prior to work T.\FORMS\APPS\Bulldmgpermil \\-pd Applicant: l......-- J_ Date: S'. 2. 2... 03 ~ SIGNS PENINSULA'S FINEST ~~C-otb-... \?. ~~(S ....)~-r<!:L 1327 E. FIRST ST. PORT ANGELES, WA. 98362 PHONE (360) 452-7785 FAX (360) 452-8029 . S". ..22.. 03 u\ O<3c Q..\~ ~ ~p. p~-z ~C~i..C-<;;: / \) 1-,,,,,~ b 1 ?-. C:> '7 v.. ~ c+-. ~ I?'1 b '2...- :u.-t, B-7~ ~'l. Poruc' (\.JQ. ~c....e~ ~ 4.. "\ ~ "" "2.- . () ~<OeLcS:;-, V 0 f'2--...z SL~ L~U,~G- A ~ \ ES..J ~ t.J I L-'- I A~M k DC-/l}-c'C.t)r-J , /? aaeo':C-1~'l t3.J~7 p.t;l()u~ 6"'----0' 4 ,~ x. ~ . t::)? I '1 SQ~F,. ~_.~_ ~\.C...J ~.!r~ D~ f+ ~ \a..J ~-r L :;).J ~ S""7 p(...J- .! CB-':= e ~ l <6.~ Q G ~d/2...<.&~ c:..cS -?~ <= ~<.)J~ ~6 (2.:!:;~C....) · N G:.- -ru. ~ --r VI I ~ ,w I L.k-- I ' oP '3-I~ >LB'- ~C:>.- F-7 " --(" <? \C-Z a <? c...J ,""'1lA ,...J ""'7 l..~ ~ _ ....--r < .:;) '"" ~ /.-.0 ~.I C;-o sa . p-r J..,~l'~ ~'-'--o......> c. a ~ E. ~<-'L -71-t<(' ~~ )~ "'" .~. C""\- \ L..'- eue.. . t.... ;-L . _I .......... - urUUUflllD Hi~! lilil! uiill~ ! 111 I ~ I ~ .s ,I 11 II Ii " n..; III ~ ~ ~ ; i . ! ~ f i I ~ ~ t ~ - ACII1IltIr A. RlII~~6P1W1!i1l-/\lIdItlDlG'R3"W!~LlUltSCI QlIN2/C1 4,. A. A~ A. A.. .. 4,. -- 1)0 -4 = en ~ '" rn m -.t ,~ [? @ !fSEJ ~ :S ,8 ,~ ~ ~ - o z ~ I ~ . ~ C! - lZl 1lI f!i l ~ fJJ & ~-p r ~d..s.s ~ J1 i r~ ~ ~ '" 0-1: -- 'l"'P.~-"""'-- ..b... __'__ ~.-. ~ ,......,...___~ ~ ~ ...." II ',............1 illI1([l@I;{IDOO~U~IiI - - ~ - rnumlftCL16d Dtrecfllf's Cone wi 30" fnte:mr1ill t!lum!ru:ted ~O:C6W4V l.e1Mr S9t 19'- II(le IIeIIlRI1lle IlRIwMg lJA4lMll11- I t i 3~ ~ _=---=1 --------t---- , , ---- ........~\. " / ' \ 4 -,. ~ ;&C).F'T, 1:;" ,,! ~ , \00 j\ o ~ ~ SOUTH LINCOLN ELEVATION ~' ;\' y~ liIcde: 11&" -= )' - D" DtlllEr's Cml Spu:1fk.1IiJRs: COLOR SP~CJFJCA1l0NS: rarlca.18d alllri:un CD:m l. be conlltlldlld usllI, tublilu 1l1.~:Jm JJanlDJ 'fI/ 81umlllllm kill" Tile ab1mt to bI fdlr~ us)Jg 11m T)\Ie 3 alImJ!rum IIIdruslon wi a 3116" cw.a P*illlnd8 ... Fact gnlphbs lD be 3M ~1 fiil1 ~ to 2nd su/f;;l:t It lac8 - srI' COLOR SDEDlllI.1ktind ~ 5 it dtnllilU" piece .r lil;'__ IlI'lrn1ll111l. All ClmplJlllIIlB 'Ie hat'a llllllllhall. e,umllfnh. Reftrer.oo IaInICItIoo dllMlaJlll C1481W\ 1hru EfOl cll1lSlruc1oo & color spllCfflcal:JlJ3. Milunl lu~tD ~liscIil, c:::=-~ ~ --==-===a:a . 4Vrt..J6~D.n Jlbct "IWJ . '" i5211ltJe ttg o 1VJ-1705 Vl>1I:>vr.xlfJV ~ -;::::::I ~- ...."..-~ ...........--~~ ------.-..- Kieffer .-:.;,,--....-~.~ _:!.W.E~ Ii~b!l ~.....______.. co. ~- 13n_.......IlI--.III. _..., _~:IlI~5r.a1l M1I211_..-o .......r......_ aJ/T_~_ __ on., ""'I.lJllld,...II_lR IIIInIMI:: ~ ...' I--"'!! ~. .11: ~:B:q c@.. ~ '- J ~ -' I- ~ FUIUI:fIDl "REUnra r ~ Jd. .a'1 ____ ..., ---- .... -- ..., - ~ " J r ( G ;:I g ~ ..co. . . ... ~ I . 1 ~ I .. 1e ~ I "' ~ -i ~ "" E .. ~ ~ - i i. " " 'I 'I "' " 5<3~~~~~~ 1mB ~ a ~ a: l r~ " u - - I. i ] r= r,,_ f~i Ii' I Ii ! ,11111(1 Q Ii I" I' II i Ii r t r II ~ L '. !i ~- ~~ -"" -', -- 112 ~ ...... - .... 1M'" I Inlllll. : =~ ~ ~ I · ~~ili bE : m:I!1 t g~16A I~~'- ~ : ~~~.. . ~ :: -- . T1 Ii::,. W' !'!'I i . , , ~... .. . "," . ~ . '" .- \. '" I . I'j .: ~' . , .' II.J-' "t': I~ ,fl... ., , . . .'. I l",~,..:, I ~ '., ',". ' I I ,/ I f ~ ", ,i-, I \ . 1 ~~ i ' ::.t_'! " I~ . 1 ' I f:P , . )C . ,- ~ o ~ '\'.' ~ ~~ 1.'.6 '. , >;': ~ R i.,\ ~ tt ; . . . !'1;11;~I~1 ~ ~ ... I~ Jl S <= GI ... '" III i ~ " . .,..--- ~ O'1l::l..:l..:ln8AJ3..:l.:l3!)~ ~v =ll 8002 . ~2 . ^~J , I f . II JQ ~I -....,. r.. 1=::=:= ==i' ~!!, II~ II "'Ii'~' lIt III I ~ ,,'OJ (I if ill;'S Ijl q: III II mt II Iii j!!llt i~ iiS H' I! lir. 'I : ~irl( I ! II! 'i CQ 4 I it! ~" { i i rr-aJ--1 ,"' I I \ - C ~ 48168 A&VIItON ..... ~,. I I !lRJ!. I' I ~I ,.( ~ L.:~. : :~-::=II'.I i J ~ JIll 11 ~/~'.4 R)CI 'N-.! . ~~ O"'l'H ~nIi/..n ~ ..nT)l ~ ~ X =i! I ~ . ~ ~ '" 2 '~I III 0;; UI "' n . WHktol'['!: j:'~~';:l:::"J,HW . c~~ J:_(2..~~_'7_ 6- POo..J r:a Q 4-'-" I ~~ (? ~ 2c.:.... 2- '2- x ;) 2 ). ~. ;:''7 -=- g-1>9.o,+- (1 -;: J~t)(:1'-I- 'Jl,.t-':).' ~~ -:... '+ . 2. 'f ~.., K ,. 2D' .- ~ '~' ~ D. "-(- .>c- 't-Q Q 6 f::> 0 ..pc!!!> ~st ~I X- Li-" >< ,. - ~z.. -::... =- IJ, 2 . "2 ~ ~ ~ 19 .. , " ~ ~.. '2-~ ./1.' - - ~ ___...... .._- -... '~_-;,a - - ~ b 04. -~ V.2...'f ,-~q.4 -: ~ '/" ~ .><::. (\ + J I + Y~~G..,c W I _ -,..., .. - ..... /2.. - '" "l~ ~ (\-1' r;.~ 9:7.. '~o . ~ c::::::::: _ ~ 'f, ,-+ IL:L \ \ -+ t P. .6, -:l8' ~ I .I - 6f :: ?f ,J> 4 c..; --:5) <..~.., ~ ~,t I ' , 4-'~ ~3 ~3 <;: ~c:n ,o~ ~ 00 V I\.....U S p - ?-b t 2-Z >L '3.2- - 8- '1 a, - J..{ - 2.0' P~H M ~ \ b -, ~o ~x z \<oi ~o >Lo rb q1 c::; G, fLo ~. '+0 f~ '1 ::. ~ \ 0:::' 0 LO => c::> ~" 2. c #.A 2- c:;) 4-0 I ~~~ ...\ ~\.oc'" ~\)S1 'tl't ~ ~ FI Fr.TRtGAL 5f'i:GJAc;.....TlOHS ~ t'4b1U/C.t'lIKD F1...... esr;1!lJ3 La:ps C9 ASJJ-1MCKb ~ to A5&462al-~4 B<IIk&t ~.-...,., to :2iJ ...... GhWlt lIVHIl'.& WB.1.OtI 1lL~-' -"IT~~ ..,..-~ f.IlIF= -- . - '- If'lT...~ ~~Raft5tcr tu!i @ US1BJ COlOR SPECFICAlIONS I < fl>b: J~..lrnth..1l' ~....., .....,.a..w.~ ""....n 9~..L '~ 4'- 4114" l- t- (CoUll1O"w~) ~61f~r~ j!l.,........... _'__.1.1 W:i P't'lON ELEVAlDN CABINET CClN51RUCTION tAMPING GAaltfET SPl:CAFIC.ATIONS o..'r. t 1; IP ..... -z'te:,t-....tI5I1l:Ji.......... ~ ~~....~ - - n.....,. - ~ -~- """" - -- __ \l: PQI' _ -.........~ ""'" 'S:..1'.. 'Y. ~r -c;;." II>..~-- ... ""'- bs.l1f!iIJ~ Ji=___ ~............. ...-....... GABIET a<l:JC...6 sa;no~ I .q.t~... -...- -==-~ .::~ ....- ~ --=- I . Ri~ ...-",.~ Fer tu' Sf: :2' lbrfldlB"U IQ' J5oK.. """" 4"~111!1 f'l1O" " 2f1 ....1lI tft.41r"'~IIIlIJ"y.iG -.J To> Top P!:6: 3 ::c ..... I\! (.IJ N gj W ...... J:Il,:._ I"\J N !.jJ 3 SIDE T, " ~)'_"",",,- - ~-- ~.....wl~~..-~ ~~ -4-L-::J N./.zntbU .......pW&.... tJofdJ 51........." t!!!!l!lL.. ^ H q """T] ~ "- ~ """T] """T] D r o G) :;0 '""'"' ;;;;;;;, lJ.l'II. Tnc hind ..- slefwlJ Ila!t.hPlale, ,r.._. o?K~"-54aI 2_ ...~T.. ""'If.l" ........,:&11 ...- -:I> InlarnaJ 1'6:;,1;,.. V..lal1 c.tU "S;;8 jV.4" _ PIat.eJ .5f..aI.h .Ja" a ~.. .. ti .I-roJd>..1aW !;telcol Glt:;11 ~ (In' !o_1l'1."") :!ireal.. 31 == '-at' ""\I -..] (j] 4' X 8' Internally Illuminated Pylon Sign 32 SQ. Fr. Kieffer A144 x 8D ~=~-===-~~-=.:~ .-..m....-....:...__.ou. Ie "ilia.. KfUl=l=='@1A a CO..JN c.. :an....,1Io1l ...!.,......... IlIItI 'ilK: pert I8-UIS 'M: lIfI'liZl-lm "1J 1\1 '- U) -Dn DIF INTERIOR ILLUMINATED PYLON 5TJiltVAAD F)ooBRIC.ATION FOR Btoc..KBUSTER VIDEO "TORN TICKET" PYLON ~ 112' ~ I'-CO~ ~ c.ROS&!!liIiti'IIaIt .&It 2, IV ~t ~A ~ lIP> 2' i6l&, if F7l --=:; . . ,. ........zz- :2 !)TRlJCillfiAL ~ ARE UL N'PRCVED HREH'>'t5 GalfAMHe H.1. Bofo.U..AS"IS:. HIRIN!\ soc:t:elS .. .5fMIVTURAl. lWCIJW\RE ~B VIew ri=;%, a, fOl ~!t <00> "'-'-E g I ~ I 4.......... -+- :::.J ill f4 V.2" lC .2ln Hall) .. ~ ... 1*maI 5tc!lel1'p& ~ ~ To Top PlrAo. ~ -u== il .1", HaW. Plate Odorl " cw,. .9a'o'I JlI:r ~t Plate SGaI5. "" or 1'-6" (ITEM -t44X80) ~ Lalcdo A GoNGt n_ {V7' 5tsd Pklbe' Sools. I VA" c J~ STAAT PT. 1-4<.6", t ~1 ~q$d fidqB DetalI GIC. 'nM1 5t.aIs. If.3'' ... T- (I)" <<Z' II 2" 51cIl :I PIoccs. ....." 1tnI Far lI.2"xl v.r HsM Ifd 80Ia 4~ Internal Plate Detail & c;tt';lI 3flI6& w.." steel PII2taI 6ulIoJ. I \1.2" .. "....,. 1I1IIf>" lM1 fa" lIT x ;r ~ ttJ Pl4 ~ ... "" I aco___ I ~-I- ~ ltiIIR -.m...... ~ T I - .......... U! CllIlrDIER l\! ~ VIdoJo ' ~ LOOAlDI tu ~(If'1oul; I I'll _..... I'll 0011 l.{j 1lUr..... 3 P. FIljon ::=01'_1 i3 .... ......-.:t....... (Tl - -- .. .......... " --..a .......1111_. --............. ...., --...-. g ................ ......, .-. r........... __ "- -.. ~ g 1.lllllm~ I ~ 11._8~ ~ ~ ~I' .. ~ ::i ()1 \J ~ W \.0, ,,) I':. \,' () ,'.' ~-" j " '<.. ~.., J,:J ""'~~ J \ -fl.\~ , \ '? 1"..1> .'f', 1 \-)~.l \-,:>.... J " ,.- ~ " "i 1 /' 1\',"\ (J'r \ ,,:/r ~"' . , '\ \..1 \;'l T I j . J d'l , j ! t-""- 'it ,f ..J. ( i 1 T" \ I I'. I l 1 I . J , I f . \ I ,~ I I , I ! i I I I J i I ( I ' I r: !' , i Ii I I ,,' -b ;l t ., _. - f I ;; 1/1 ,~! II t ! ~ i I ~ I . ~ I It " J, L..l.,_ ~,I ,,' ")1 i l I., 'II " 'h 11 'I' \ \,~~ ,........ ! , ~I, tt.H ~t~ q ()' I l ~ \ " . ~V, !.:c;.((.... ~ .i-~\ :'e~,,,...~ ..~~_-_. ~{,~~~.."c: _ ("" . )5.;~ ,;;;0 'J ,'- ~..-<' I. "-I: ~ o~ -n.l,l ~' 'I P\..~-r'.."i.r . ~:.ilO\)~' d ,,j I , l '3 \ v: ~l I v' t.J I I :' ~ co......\("'a..li"l(. . I' , ,~. I ""'::' < (. r;:;'. . (. - r -- l, n G r L V) 4 \i I I I I I I I: I I' V) I I - V))C I 0 E~ \ ~ I I t. I ! b ~ , I ; , I I ~,L I I 1 , '-~--- ~ -- -- ....-- ~_.....- - - 6 "'fl.t p l) '-~ C ,-4..J7 ~2.. I g-l' r~(2on.,- ca 0 c..! a po ~O'7l.t s: \. D~....\ t:) <..\."-.1:' V} i ~-L -:..,,~ ll~ P :~ ! ~ ~ . \I:) ~ :.., V :,t i ~ , .0\ 1- ~ I 1 P )'... I~ - \~ 19 ;~ iL f'';)\5 t'"""i?O\"::) I,J D I"'\) i I I -9- 11/11/2002 13:35 3604528498 q 7..tJg.l$n JLS GROUP INC PAGE 02 ,.> NT' MA Tl!0IA.L9 TGSTING LAllonA TOnY 717 S. PoaUodV. Port ^nooloo. WA 00.:)02 (Joo) <4$2.0401 FlU( (360) 482.0400 , 09M~~~~~~~IQnim8T 8,?aC'MG~:r~~,N8~IJil:Ak &1'PST RE!SULTB FOIlM r'G' "1"11 p,o/.ot .~JJJ~"..),.~.ldomPI.(' ,....,.. 'at '''"1,- ltan.ltllu~ - . , Pc r:" Ar'lI}€le5 I. MQlor141 Typo: )( Concrolo 0 MOrtll( 0 Grout alant: C\~ 0 ~ Numbor or Spoclmon8: a I 02 ~3 a 4 2. a 6 Prol~C1: C c, r '" I?.C) 1 0... L I bf"'C'o'I'"'."-1 . 3. TostlnO Soquonco AOQU8stod (days after C48tlng): BIWNG INFOR~MTION o Srandard A )sf. Srandard B a Srandard C 0 Other (sPGClf) H no open lab .aoounl Of atJCIw pro/eat 10, mUlt 00 through . 7.28,28. Hold 7.28.28 28.28 , ' Bullnll... M.nllOe, fl..... a u-b Account /I 4. 08tO Cast: J-' - I - 00< 5. Cast By:....@ul p(i,~+~ )it ProJect Account 10 -.P A. FA 0 ~ 0 S 6. MatoMI Supptlad by: A r" qQ., Ies ea....<.. vI'. ~_ flori't;d.o:s ProJOd Manager P...A.L 1. Contractor. H~t..-h J ~ ell.:.?/' ~Y-Qv(;t o Pro-paid (reqll'l'e(f If not 01\ eeoount . _ rll"'R08) , B. Date Rec'd In Lab: " ~ .;i! .... 0 .;l 9. Rec'd by: ,gf , MA lERlAL $PECIFICA nONS , TEMPERATtlRf; AIR CONTENT Sl.UMP UNIT-WEIG1ofl' . DESIGN .5 ~~ao.)( ACTUAl -- oS 1. S:.;; - -- Required Compressive Srrength; tt:fo<.:JO osl@ ~e Days Additional ReqlJirements: , COMPONENTS/MISCEUANEOUS Cement Type: I... ~ 1 No. of Sacks/C.Y.; b '/,:; Load Size; q C.Y. , Admix Af'!lounUBrandfType; 4 'IR D2S /-\ , c::; A. / 'it) Admix AmolJnt/Brand/Type: "11 16"") c..(~ y...."O"...! + - , .M___'..__...._.._ ~_ Coarse Aggregate: 1770 /b5 3/4'" Ane Aggregate: I S' q.ll. "noS Weather: s: \..)f" ~ 1..0/ I Lf!>-\ I '^'"" AJr Temp~ 4~ R}markS/Locatlon of Concrete Placement e. t e.'ve'\+("~r '-'- JC"\ \ \ :; ir"'. -~ +r\.)C' k .Lc!".: ~-':~.d .--F,' c:.. kt~.+ ~ '1P(~I,Q. +....vc,'~ it 37 r"'~o~e.r " Specimen Control #: 18 TEST RESULTS (TO BE FIllED OUT BY NTI PERSONNel ONLY) Speclmon Spodmlln Te3t @ Tl!lsted Date Bl"eak Total IJItIt load - T~ OIlY! By Tested CAp Typo ~d /l.ra.a PSI A '~/;< 7 (:!; p- 11-<<3 '08/000 :;)d.4i7 -38~o a / ~8 t 1- ;1'1 c ~ ;)!3 11-""9 --~ 0 E "meIU$ abollt breaks; ~~/~~/L~~L ~~:~b .:lbId45284'38 NTI JLS GROUP INC PAGE 03 T....... _ NORT=~~R~;;~~RIES. INC. t;f:J ~nollan CcIcIrltMIlM . Mlr.r1$ r..b NT I 7'f7 8lllITll PEABODT. POIlT AAW. WAHIilTOIllilll3ft. ~llllI4lH481 TDU. AlEE (llOOllllOI.~ F~ DOlII "204401 PROJECT Co.o/" y-\(.:\ ; II... L\ t,.-'r" ~~~ ~ JOB CONSTRUCTION REPORT # DATE \ 1- '-Q~ CONTRACTOR CUENT lNSPEC7l0N ORDERED BY WEATHER S' '--' ^ -"\ ....../ ; c..c... I """",, C)r, <::" I' +.,~ I ~~+~r ,\ tl.".e.. ~. I e..d "-"-' : ~..h 00,. INSPECTOR ARRIllED: I ~ 0 0 DEPARTED: "!:.t;, d,.P\-' SIv\l'\'1:) 0('" 4-k,('... ."~ ','", ...., ~,-^ .II...-:.r-- .r' r..' I~v" ~- k 4..v'\-,~ \<, 1\'~Jq(-/ ~"\ '$ f;2.~-h~ I \.A.....' c.- .=$ I C.,':)(' ,=_y" r.~.-\< ~ "::.'-.:'() ('), ...:.'(' of ~2.(--t2".. .\~ \~...(-t,..~, ':'~1"'"'; /-l....~, ;,;;. ~. 'r~ I. .' " 'I" _ ~: . I 0\. +;,;~Ir \..\--..., ,', - ~~~l k ,:I,-y" c:,. \ \' ^~A .:?" ~~. s -+!,:) (".,.J.dl I' r-. 0"\ c.. to .;:) Ic..r CI (" r:5. ",d 11) -r- rQ.,.. ~~ I=-? t~+ , n_ _ _ __ ~_ I <:"' ,. '.. 'ir""' ,J~Jr, .\- of..... .,,"".... (-.. . ~ <" ,2. ...~:?'_ '\ ,l\" . REINSPECTlON REQUIRED 0 YES 0 NO /303 FEE R~CEIPT NUMBER CITY OF PORT ANGELES DEPARTMENT OF LIGHT APPLICATION AND ELECTRICAL PERMIT A TOTAL FEE '. 16~ ELECTRICAL PERM!T ONLY NO OCCUPANCY OR USE ESTABLISHED UND~R THIS PERMIT Site Address t /2.. Y. (1,<- Co 1"./ rj") CORRECT ADDRESS IS RESPONSIBILITY OF APPLICANT PERMITS WITH WRONG ADDRESSES ARE CANCELLED Owner ~ a.c fJ To ~ \) 1J U I Installation By () C </ /Y} jJ / L Owner's Address Installers Address Day Phone Installers Phone ApplicaUon is hereby made for Permit to install Electrical Equipment as follows: e~(VJ-{)/ f ~11A-a'1 uhtt.'/vi A ~uflf 'f..[C-f+' CONT. Lie. NO. TIMETO COMPLETE NO. STORIES LEGAL OCCUPANCY ~ It:... [ [c. 7/l-1 L- ~ ktfTltl"( t;c" rh--- " / Wiring Method CI..eJ-. A-btllAJ S . NUMBER AMP 120V 240V NUMBER AMP 120V. , 240V USE OF CIRCUIT PER 100A FEE USE OF CIRCUIT PER 100R FEE CIRCUITS CIR 10 30 CIRCUITS CIR 10 30 LIGHT SIGN . .. LIGHT 50 VOLTS OR LESS I CONVaNIENCE MOTOR CONVeNIENCE I MOTOR APPlI.AlNCE , /~ ,. . MOTOR , DI~HWASHER ~~ ---- FIRE ALARMS . DISPOSAL j , ./" BURGLAR ALARM , RANGe \\ Lf ./ MISC. OVEN q () / WATE~ HEATER IV // LAUNORY F u DRYER' REINSTALLATION'lIGHT FIXTURE # FURN~CE SUB TOTAL FEE GAS-tJIL FURNACE ENERGY FEE ELECTRIC BASIC FEE ELECTRIC HEAT TOTAL FEE ELECTRIC HEAT SIZE OF SERVICE SWITCH OR CIRCUIT BREAKER A.C. UNIT AMP PHASE FEEDER SIZE OF SERVICE ENTRANCE CONDUCTORS SERVICE AW.G. I SUB-TOTAL u SIZE OF GROUND SIZE OF ENTRANCE SWITCH , I certifY'that the work to be performed under this permit will be done by the installer and in conformance with the N.E.C. ~/ JI/f.k Electrical Code. Date A~plication made ,19 '7// ( By )C CONTRACTOR OR OWNER (OR AUTHORIZED AGENT) Pe~mission is hereby given to do the above described work, acqording to the conditions hereon andlac~ordjng to the approve'! plans andl specifi~ations pertaining thereto, subject to compliance with the Ordinances of th 9ityof Port AngeJes. . ; f", !' i I {:;- D eTO FIC LIGHT ~, . !, WARNING 1/! ( / f J. ~c. APPA ED ' . Notify Department of City Light by Street Address and Permit Number when ready for inspection. Work must not be covered or current turned on before inspection and O.K. for covering or service has been given by Inspector in Writing on Permit Placard. A.. Permits Phone: 457.0411 Ext. 158. PERMIT PLACARD MUST BE KEPT POSTED ON THE WORK - SEE OYER _ . Date Permit Issued " WHITE - Original CANARY. Duplicate PINK. Triplicate WHITE CARD. Inspector's Report QLYMPIC;PRINTERS, INC. REPORT OF INSPECTOR DATEOFV1$IT MADE BY REMARKS . .. , . 1l1, '\1 f\I\-Y O.K. FOR COVERING \ u-., IV......'~,.~_ BICE _. . z Cl a:: <t :!; !!! J: I- Z W l- . I- o Z o c . 6-18-203 10,21AH FROH ANGELES ELECTRIC INC 360 d52 9265 P-ol " - ~_u' . ....\~ - Co'" 't'''~0''- "U"",; .,f"J &~ 'V<SJ T11(~ Elccrtic;:l! F'ellnil J\pplic;:!li,m !D..USl be: Ullcd ou1 comDJetelv_ n~1< "'1l1V"~(": !)olrl""..d: ...1 .. ~ e type or reprinJ in Ink. If )'QIJ h3V~ any qlJe~1Jons. plc<lse call (360, 417-4735 11= 1"'z, \.~ F.u: numher: (360) 411--4711 ) .. REQUEST INSPECTION 0 OIVrlPI 01 A N(;F:LES----ELECTR 1 (' 1 Nt' ~Lt)(j(,fuS 17 "- \H 0'( tl S, "L;t"\c"l"":' Phon,e:452 '4764 Fax: 4'l7-'47r.'i Ptopr=l1y'Ow 1: Add,.s", ~ ld-. City: PA. . ANGELF.1460I\S license If: E xp: Phone: -.. * Eleclrical Conlraclor: ANGELES "LEeTH I C I NC. Add,.ss: 524 EAST FIEST Zip 9~{~.? Phone: d:E).?_Q?~4 Cily: PORT ANGELES, WlI Zip: 98362 INSTAlU,TION WIRED BY: CI OWNER x}t:LECTRIC/,lCON1RACTOR Credit Card Holder Name: ,.",1 <:;;mp"'nn Billing Address: City: ~ Zip: VISA:_MC:4- Credit Card Number: <? Exp. Dale: PROJECT ADDRESS: (", \ a, SOQ,\1- w~L"If\ TYPE OF WORK: Check alllhal apply: lJ New [J Allaraliofl/Additiofl o Residental 0 Multi-family o Commercial . 0 Mobile Home Sq_FL L\-- S I (;,.J\) S o Remote Meter o Detached garage o Hot Tub 0 Swim Pool DESCRIPTION OF THE ELECTRICAL PROJECT: H- I '-'-- Y .-SI.-S~ o Septic Pump 0 Low Vollage 0 T elecom_ ~ Sign >-"- 35. 30 I ->,~ Ib- eo '4'l"l He -8b 0.--)..;1 I '<J ,?,-o a.J.ol ,,+J ~> ~ Service Information .$ ~:7 Q Numbl:lr of Circuils added or altered: , .$85:10 Electrical Heal Load Additions I !.d,.N 1- 3 A.::>DlTlo~AL 35'.30 T. (jlo. 80 x"?) o Baseboard o Furnace o Heal Pump [] Fan-Wall _KW _KW _KW _KW o Overhead Service o Temp Service o Underground Service Vollage: Phase: 0 j . Service Size: Feeder Size: 03 PAMC 14.05.06Q{S): F~r induslriaJ, commercial, & residenHaJ projecls larger lhan a dupleX:. a one - line drawing or the Electrical Service 8. Feed!:'rs, building size (sq. ft), load calc"Jlations, and the type &. of conductors and/or raceway Is required and shall accompany the Electrical Permit application. ! hereby certify that I have read and examined this application and kno hat same to be true and correct, and I am outlJ penn it, I understand it is not (he City's legal responsibility to determine what permits ore required; il remains the appilcanls responsibility to determine what permits are required and to obtain such. (;/[,:/43 IJ I - 0 Ie- As ; ~ ~ -tdL . ' C"," C.., ".,"'" ':'"..~ jt~~N I- Do" . ~i; Owner or Eh,c. ConI. SIgnature: . ~ Dale: .J?t"l'J': . . . - 'W-9019 ~,c cO____ ?~ /0.3 ';:0-.:;.=.-.......... lu...;"'~....,.'-I I T ....I.J~.1 _!H."cL.~'::' 'f.i ~ ~/1) . "",'O'U_ I'.., I I . ELECTRICAL PERMIT APPLICATION FOR.~\I5I.~Y """_. -~ r.e ApPR......a; -- TIIo ElllC~ Po,"," AA>lIc:a.on mum b8 nll8Cl out_. JlnE #- Sr:;O P'--l'WPIl or rwpr1nt In Ink. n JUU ...." en, qUlllSllon, p..... caU (S8G. 41747'35 ..... .umber: 13801.,104711 Phone: 457-5303 Fo.: 452-3498 '1~<;; Lf~ .>00 7 OiMltIrCll"EIac.COI'IInll:lIlrAgeIll: Olympic Electric Co., Inc. Pl"I*IYo-r. 1fp?/~1/( t"tnrNt- U/,~ Alllhu: / ~ ~I I ;y-nr -"0/( ~ Jk Z-/O E1__~~ Olympic Electric Co., Inc. ~: 4230 Tumwater PharW: el1)': 13~//(I/,1iV LIcense I: OL YMPEC28~: Port Angeles, WA 3131/03 Zip: PhMIl: 457-5303 Zip: 98363 INSTAI.U\TICPj WIRED ey: 0 OWNER CrwdII Card He"" Ne_: Charles T. CI1y: ..ill ELECTRlCIlL CONTRACTOR Burkhardt, Olympic Electric Billing Adli, 'Iv.: CIedh Carrl Number: PRO.IECT 1lDORISS: Same ~/l 5' LI/I tP//! Co., Inc. City: Exp. oare- ZIp: """.. X ._. ......"...-.......- 13lbcK8v5'W TYPE OF WORK: o R8s1demllI Check lIlllhat apply. 0 New o Multi-family J!l Commercial ~~eratlOnlAddltlon o Mobile Home Sq. Ft o Septic Pump 0 low VoltBge 0 Telecom. 0 Blgr o RemQIe Meter o Dela!:hed geruge 0 Hot Tub 0 Swim Pool y? (?) Number of Circuha Bdded or 1II18nod: tJ~IPT1ON OF THE eLE~ PAO.IECT: t'/,p/ ,/I( f S'9"~ / . OI?M1 / (die.; I .M C /""~ 1/'/1' ?.,/~ ~h<<t'fJD:; 59.'10 -t-~~D)(2J I Semee InIonnBtton Valla;.; /1p/Z-I(O PI1a...: 0 1 ' JZf 3 Service Size; ?'PDA F_r Size: Illnb Ic6I Hat Load Additions _KW -KW _KW _KW o Overhead Servk;G o Temp Service o Undervround &rvlce PAM<: 14.05.060(8): For indull!llaJ, comrMrclal. & _nbaJ proJ8Cl9latger than a duplex, a Me . line -/'Ill 01 trl8 Elecn1cal SeMes & F-.... bollldlr1g .tu (oq. Ill. 108(1 _IaDona, and trl81ype 6 01 c:o<1duc1DrS an<IIor ra:eway 15 .-qul..a llI'Ir:Ilhall """",,"pany \he E1ectJ1ca1 P8l1'll1t llppOc..tIon. Illsrsby cefffly that I have read Bnd e.ramfnec1 thfs BppNcat/on snd know thBt same 10 be rrue sncJ corrBCt, ana , an authorlz!ld to appty for this pennlt. I untSBf8tana It is not the cays Ieg8J r&spot16/bi1try to de ne What permits are requiooj It remains /he sppfic8nts 1YI$pO('I$ibJllty to cist9rmfne what permits are r8quirBd and to obtain such. Credit CIIrd HoIder'1I SJ"nalurII: Owner or 1!1~. Con1. 8lgnllture: PW,go1e c.( IJto > ~(.:...- ob tt'<7 i'E> ()Jb.- C ~ TO lEI - {C,o J\( ?/1/03 JI~Jala JldNX10 t/y/o~ , . Ollie: aa.: o 1:II_....~rd OFurT11111:8 o HelifPump OF_Wall \(0 ~ \?~\r)' \ ~~(;I(J' ' S6tCZSt09C XYd 9Z:9T COOZ/SO/90 CITY OF PORT ANGELES PERIVIIT APPLICATION Building Division /Electrical Inspections 321 East Fifth Street— P.O. Box 1150 / Port Angeles Washington, 98362 Ph: (360) 417.4735 Fax: (360) 417 -4711 Date: -N-2d15° — Multi-Family or Commercial* " Plan Review a Be Re uire , Please Complete Electrical Plan Review of rm�7tiara Sheet Job Address: Buflding Square Footage: Description of above 'X r f- r' Owner Information Name: R i ie Mailing Address: 16"L-1 5 f' 6 City: ft 56 /ky— State: 0A- Zip; '7 36,2 Phone; Fax: License 4 / Exp, Item unit Charge Service /Feeder 200 Amp. $ 132.00 Service /Feeder 201.400 Amp. $160.00 ServicelFeeder 401.600 Amp $ 225,00 Service /Feeder 601.1000 Amp. $ 288.00 Service /Feeder over 1000 Amp, $ 410.00 Branch Circuit Wl Service Feeder $ 5.00 Branch Circuit W/O Service Feeder $ 74.00 Each Additional Branch Circuit $ 5,00 Branch Circuits 1.4 $ 66.00 Temp, Service/ Feeder 200 Amp, $ 102.00 Temp. Service /Feeder 201.400 Amp, $ 121.00 Temp, Service/Feeder 401 -600 Amp. $164.00 Temp, Servfce/Feeder601 -1GOO Amp , $ 185.00 Portal to Portal Hourly $ 96.00 Sign /Outline Lighting $ 68.00 Signal Circuit/ Limited Energy – Multi - Family $ 64.00 Signal Circultl Limited Energy 1 First 1500 sf – Commercial $ 96.00 Note: $5.00 for each additional 1500 sf Renewable Electrical Energy - 5KVA System or Less $ 113.00 Thermostat $ 56.00 Note: $5.00 foreach additional T-Stat Contractor Inform tion Name: 54=- A-C- r`�=C. , C. Mailing Address :. 0.5 rte_ 5, 2.. ;ra f + e City: K V- – State: Zip: r Phone: 75.3 8 Y2 —goax: License # 1 Exp, 9( Total (Qty Nfultioiied by Unit Charge? $ $ $ $ $ $ $ Total Owner as defined by RCW,19,28,261: (1) Owner will occupy the structure for two years after this electrical permit Is finalized, (2) Owner is required to hire an electrical contractor if above said property is for sale, rent or lease, Permit expires after six months of last inspection, After reading the above statement, I hereby certify, that I am the owner of the above named property or a licensed electrical contractor. I am making the electrical installation or alteration in compliance with the electrical laws, N.E.C., ROW, Chapter 19.28, WAC, Chapter 295 -468, The City of Port Angeles Municipal Code, and utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications. Signature of owner, electrical contractor or electrical administrator: C7 Cash M;-eheck Q Crefl Card # _ x Dated: I �t _ ELECTRICAL PERMIT CITY OF PORT ANGELES 360- 417 -4735 Application Number . . . . . 15- 0000004$ Date 1 /15/15 Application pin number . . . 153233 Property Address , . . . . . 621 S LINCOLN ST ASSESSOR PARCEL NUMBER: 06-30-00-0-2- 0100 -0000- Application type description ELECTRICAL ONLY Subdivision Name , . . . . Property Use Property Zoning . , . . , , . COMMUNITY SHOPPING DISTR Application valuation , , . 0 Application desc Exit light for existing door Owner Contractor SECOND REARING ASSOC SEA TAC ELECTRIC INC PO BOX 260765 7056 S 220TH ST ENCINO CA 914260765 KENT WA 98032 (253) 972 -5553 Permit . , , , , . ELECTRICAL ALTER COMMERCIAL Additional desc . , Permit Fee 74.00 Plan Check Yee 00 Issue pate 1/15/15 Valuation , . , , 0 Expiraticn pate 7/14/7.5 Qty Unit Charge Per 1100 74.0000 ECH E Fee summary Charged Permit Fee Total 74,00 Plan Check Total DO Grand Total 74.00 Extension L -COMM BRANCH CIR WO/ S/F 74.00 Paid Credited Due 79.00 00 00 .00 .00 .00 74.00 .00 00 REPORT SALES TAX on your excise fax form to the City of Port Angeles (Location Code 0502) INSPECTION TYPE DATE: RESULTS: INSPECTOR: DITCH SERVICE ROUGH -IN FINAL ' b COMMENTS: PERMIT WILL EXPIRE SIX (6) MONTI4S FROM LAST INSPECTION Signature of owner or Electrical Contractor X Date: G:IEXCHANGEa BUILDING i �c W MAR -27 -2014 07:39 FROM:13013S ELECTRIC 3604525943 CITY QF ,PoRT ANuius PERMIT APPLICATION" TO: 4174711 Building IDivision /Clectrical Inspections 321 East Filth Street — P.O. Sox 1150 / Port Angeles Washington, 98362 MAR 2 8 2M Pb; (360) 417 -4735 'Fax, (360) 417. 4711 EUCYRICAL Date; I I I I !-;f- _ Multi - Family or Commercial' NSPECTCq S Plan Revi w May fie Requi d, please Complete Electrical P an Review In f ation Sheet Job Addrws, dab Building Square Footage: Descrsplion of above F. 1/1 Owner InfornUdion ?_p(Q_ -7 1 Contractor I folrmatl Name: Mailing Address; Maill Ad revs: Ciry:.... 5ka e:Zip: City: F. State; ZI &4 Phone: Pais: phpne: Fa>6 Mle License # f Exp_ �icerse 4 l Exp. Item Unit Charge gty Tota! ftxty lNulti>,Iied by Unit Char t_e1 Service /Feeder 200 Amp, $132,00 5 $ervlWFeWor 201.400 Amp. $160.00 $ ServlWFeedor401 -600 Amp $ 225.00 $� ServICJFeeder 604 -1000 Amp. $ 288,00 $ Service/Feeder over 1000 Arno, $ 410.00 $� Branch Circuit WI Service Feeder $ 5,00 �._ ........ $ Branch Branch Circuit W10 Service Feeder • $ 74,00 $ Each Additional Branch Circuit $ 5.00 $�`d�r Branch Clrcuits 14 $ 96.00 $ 5& Temp. Service/ Feeder 200 Amp. $102,00 $� Temp. ServlcdFeader 201 -400 Amp. $121.00 $ Temp, Service/FeWer 401 -600 Amp, $164.00 $ Temp, Service /Feeder 601 -1000 Amp , $1 86.00 $ Portal to Portal Hourly $ 98.00 $ SignlOutline Lighting $ 88.00 _ $ Signal Circuilf Umited Energy - Mufti-Family $ 64.00 $ Signal ClrcuIV Umited Energy 1 First 1500 sf - Commercial $ 96,00 _ _ $�. Note, $5.00 for each additional 1500 sf Renewable Electrical Energy - 5KVA System or Less $113,00 $ Thermostat $ 56,00 $ Note: $5.00 for oath addltloral T -5tat $� Total Owner as defined by RCW.19,28.261: (1) (owner will occupy the structure for two years after this electrical permit is finalized. (2) Owner is required to hire an electrical contractor if above said property is for sale, rent or lease. Permit expires after six months of last inspection. After reading the above statement, t hereby certify that I am the owner of the above named property or a licensed electrical contractor, I am maklnrg the electrical installation or alteration in compliance with the electrical laws, N.E.C., RCW. Chapter 19.28, WAC. Chapter 296 -469, The City of Port Angeles Municipal Code, and Utility Specifications and PAM 14.05.050 regarding Electrical Permit Applications_ Signature of owner, electrical contractor or electrical administrator: 0 Caeh L7 Check (� i 0 credit Card 1r tJatest: T 0914112012 QA .ELECTRICAL PERMIT CITY OF PORT ANGELES 360 -417 -4735 Application Number . , . . . 14- 00040384 Date 3/28/14 Application pin number , , . 484992 INSPECTOR: Property Address . . . 612 S LINCOLN ST ASSESSOR PARCEL NUMBER; 06-30-00-0-1- 6600 -0000- SERVICE Applicatton type description ELECTRICAL ONLY Subdivision Name . . . . , ROUGH -IN Property Use Property Zoning , . . , , , , COMMUNITY SHOPPING DISTR Application valuation . . . . 0 COMMENTS: Application desc Exterior lights Owner Contractor --------------- --- - - -- -- JAKES/SHIRLEY MACKROW LLC ------------------------ BOB'S ELECTRIC INC 612 S LINCOLN ST 2293 DEER PARK RD, PORT AYGRLES WA 98362 PORT ANGELES WA 98362 (36D) 808 -0937 _________ -------------------------------------- ^)360) 457 -6BB7 _ Permit . . . . . . ELECTRICAL ALTER COMMERCIAL Additional desc 1 -4 CIRCUITS Permit Fee 86.00 Plan Check Fee 00 Issue Date . . . , 3/28/14 Valuation 0. Expiration Date 9/24/14 Qty Unit Charge Per Extension BASE FEE 86.00 Fee summary Charged Paid Credited Due Permit Fee Total 66.00 86.00 .00 ,00 P1.an Chock Total .00 .00 .00 .00 Grand Total 86.40 86.00 .00 .00 REPORT SALES TAX on your excise tax form to the City of Part Angeles (Location Code 0502) INSPECTION TYPE DATE: RESULTS: INSPECTOR: DITCH SERVICE ROUGH -IN .'' FINAL COMMENTS: PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION Signature of owner or Electrical Contractor X Date: G:IEXCHANGEIBUILDING t A . . .* Ft* - 360-417-4735 Application Number . . . . 1 15-00000074 Date 2/02/15 Application pin number. . . . 293510 Property Address . . . , 612 S LINCOLN ST ASSESSOR PARCEL NUMBER: 06-30-00-0-1-6600-0000- REPORT SALES TAX Application type description ELECTRICAL ONLY on your excise tax form Subdivision Name . . . . Property Use . � . � . . . to the City of Port Angeles Property Zoning , . . . COMMUNITY SHOPPING DISTR (Location Code 0502) Application valuation 0 Application desc Sub panel and circuits Owner Contractor JAMES/SHIRLEY MACKROW LLC BOB'S ELECTRIC INC 612 S LINCOLN ST 2293 DEER PARK RD. PORT ANGELES WA 98.362 PORT ANGELES WA 98362 (360) 808-0937 (360) 457-6887 Permit ELECTRICAL ALTER COMMERCIAL Additional desc . . Permit Fee 172.00 Plan Check Fee .00 Issue Date 2/02/15 Valuation 0 Expiration Date 8/01/15 Qty Unit Charge Per Extension 8.00 5.0000 ECH EL -BRANCH CIRCUIT W/FEEDER 40.00 1.00 132,0000 ECH EL -COM 0-200 SRV FEEDER 132.00 Fee surnmary Charged Paid Credited Due Permit Fee Total 172.00 172.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 172.00 172,00 .00 .00 INSPECTION TYPE DATE: RESULTS: INSPECTOR: DITCH SERVICE ROUGH -IN FINAL COMMENTS: 51 PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION Signature of owner or Electrical Contractor Date: G:\EXCHANGE\BUILDING oil V-�b-�b15 Ub: 4b rKUM: bUbb ELtC I K1C 56b45iJyy43 ` G f P. 1/1 u„r CITY OF PORT ANCELES ,PEauvuT APPLICATION Building Division/Electrical inspections 321.East'rilth Street —P.O. Box 1150 /Port Angeles Washington, 98362 Ph:. (360) 4.17-4735 Fax: (360) 4.17-4711 Cate:, ,,�� - 1 _ Multi -Family or Commercial” Plan Review May Be R tliretl4ae Coltriplete Elet thcal Plan Review Information Sheet Job Address: Building Square Frxr e: Description of above Owner Info on Contra or Informatl tt Namo: ^'� Name: .. aN ds City: State: Addross: MA res Siete: 2+•p City: Stoic AAA Tip: Pho ax. -..., Phone, ex License 0 / Exp. License IN tarp. Item unit CharneTotal Mui Ii� Mgjt Charge Service/Feeder 200 Amp. $132.00 / $. Service/Feeder 201400 Amp, $160.00 Service/Feeder 401.600 Amp $ 225.00 Service/Feeder 601-1000 Amp. $ 288.00 ServicelFeeder over 1000 Amp, $ 410.00 Branch Circuit Wl Service Feeder $ 5.00 $ Branch Circuit W/O Service Feeder $ 74,00 Each Additional Branch Circuit $ 5,00„ ` Branch Circuits 1-4 $ 86,00 _� $ Temp, Service/ Feeder 200 Amp, $102.00 Temp. Service/Feeder 201-400 Amp. $121A0 Temp. Service/Fooder 401-600 Amp. $164.00 $ Temp. Service/Feeder 601-1000 Amp . $185.00 $ Portal to Portal Hourly 96.00 Sign/Outline Lighting $ 88.00 Signal Circuitl Limited Energy - Multi -Family $ 64,00 $ Signal Circuit/ Limited Energy I First 1500 sf - Commercial 96.00 Note: $5.00 for each additional 1500 sf Renewable Electrical Energy - 5KVA System or Less $113.00 Thermostat $ 56.00 Note: $5.00 for each additional T-Stat $ "Dotal 2 - Owner as defined by RCW_19.28.261: (1) Owner will occupy the structure for two years after this electrical perrgit°I finalized. (2) Owner is required to hire an electrical contractor if above said property is for sale, rent or lease. Permit expires after six months of last inspection. After reading the above statement, I hereby certify that I em the owner of the above named property or a licensed electrical contractor. I am making the electrical installation or alteration in compliance with the electrical laws, N.E.C,, RCW. Chapter 19.28, WAC. Chapter 29646B, The City of Port Angelos Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications, Signature of owner, electrical contractor or electrical administrator: ❑ cash 0 check K f� Credit Cud $ a� peg �_ ELECTRICAL PERMIT CITY OF PORT ANGELES 360-417-4735 Application Number . . . . . 16-00000596 Date 4/27/16 Application pin number 526320 Property Address 612 S LINCOLN ST ASSESSOR PARCEL NUMBER: 06 -30 -00 -0 -1 -6600 -0000 - Application type description ELECTRICAL ONLY Subdivision Name . . . Property Use Property Zoning . . . . COMMUNITY SHOPPING DISTR Application valuation . . . , 0 Application desc ry Circuits Owner Contractor RESULTS: JAMES/SHIRLEY MACKROW LLC KIRSCH ELECTRIC INC, . . . ................... 612 S LINCOLN ST P. O. BOX 3396 PORT ANGELES WA 98362 SEQUIM WA 98382 (360) 808-0937 (360) 683-6819 ----------- Permit . . . , , I ELECTRICAL ALTER COMMERCIAL Additional desc 1.4 CIRCUITS Permit Fee 86.00 Plan Check Fee 0(1 Issue Date 4/27/16 Valuation 0 Expiration Date 10/24/1-6 Qty Ufit Charge Per Extension BASE FEE 86.00 Fee summary Charged Paid Credited Due Permit Fee Total 86.00 86.00 .00 Plan Check Total- .00 .00 .00 .00 Grand Total 86,00 86.00 .00 00 REPORT SALES TAX on your excise tax form to the City of Port Angeles (Location Code 0502) INSPECTION TYPE DITCH DATE: RESULTS: INSPECTOR: SERVICE . . . ................... ROUGH -IN FINAL COMMENTS: PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION Signature of owner or Electrical ContractorDate:- G:\EXCHANGE\BUILDING CITY OF Palirir A,NGE1.'W3.'r—ERmjrf' A.lrlri..JCA'1'1'0N BuRding DivisionfEleCtriCA TUSPOCODos 321 East Ffftb Street — P-6. Dox 1150 / Part Angeiewi Washftiig,00, 9830 Ph. (360) 417-4735 Fax. (360) 417-4711 60 Date, _2,WaWi "iftelling Plan Review May Be _Rqquired, Please Oomptq tElectrical Plan Review El Job Address; L-1 vl- n Building Square Footage-, Description of above - - Contrayorinfomatio Ownerr, rmation � I , 11 Z� A �e" Nam 4. 0; A Mwllai[ Address: L', Y� M mg Adder" % %a je city; .S e: �— Zip:$tie:-\UA-- Zip: P 6 ex. Phone° V Item Un _hMe 10--tw-Lqv Multip bar c4mg) Service/Feeder 200 Amp. $120,00 servicefFeeder 201400 AMP. $146.00 Ser4ce/Feedar 401-600 AMP $205.00 8ervioe/Feeder 601-1000 Amp, $282.00 Service/Feeder over 1000 Arnp. $373,00 Branch Circuit W/ Service Feeder $ 5.00 Branch Circuit W10 Service Feeder S 63.00 $------------ 171 C,)C) Each Additional Branch Circuit $ 5.00 $ CZ� Branch Circuits 1-4 $ 75,00 Temp- $arVic& Feeder 200 Amp, $ 93.00 Temp. SeMcaiFoeder 201-400 Amp. $110.00 $— Temp, $arvice/Feoder,MOO, Amp. $149.00 Temp. SeMOWFeederffil-110,00 Amp $168-00 Aortal to Portal Hourly $ 96.00 Signal Circuit/ Limited Fnergy - I & 2 Family Owelllng $ (14-00 Manufactured Horme.Connection $120-00 Renewable Electrical Energy - 5KVA System or Laos $102.00 Thermostat 56,00 $ Note, $6.00 for each additional T-Stat MORVOPNONLY: AMA Square Ft, $120.00 Each Additional 500 Square Ft. or Portion of S 40-00 Each Outbuilding or Detached Garage $ 74.00 Each Sm4mmin8 Pool or Hot Tub $110,00 $ 'otal Owner as defined by RCW.1 9.28.261: (1) Owner Wil occupy the sftcttire for two years after this electrical permit I , Phalized, (2) Owner is required to hire an electrical contractor N above said property is for sale, rent or lease. Permit expires after six months ofvslt Inspection. After reading the above statement, lhereby certify that I am the owner of the above named property or a licensed electrical contractor. I am making the electrical installation or alteration in compliance with the electrical laws. KEG., RCW. Chapter 19.28, WAC. Chapter 296-46B, The City of Port Angeles Municipal Code, and Utility SpecifleMons and PAIVIG 14.05.050 regarding Electrical Permit Applications. Signature of owner, electrical contractor or electrical administrator: 0 CUh Cl ChKk Cfedkc..d# 01101012