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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:
Tenant nbr, name
Application description
subdivision Name
Property Use
Property zoning . . .
Application valuation
04-00000282
.503210
500 E FRONT ST
99-
Date
4/27/04
OL/-;28~
5fB L~VOhT
PA ROTERY
PUBLIC WORKS UTILITES
rOJJGD~
CENTRAL BUSINESS DISTRICT
o
Owner
Contractor
CITY OF PA PARKS DEPT
POBOX 1150
PORT ANGELES WA 98362
OWNER
Permit
Additional
Permit Fee
Issue Date
Expiration
desc
PUBLIC WORKS RES
$100.00 FOR BACK
795.00
4/26;04
10/23/04
WATER SERV
FLOW DEVICE
plan Check
valuation
Fee
.00
o
Date
Qty Unit charge Per Extension
BASE FEE 100.00
--------=~~~-----_:==~~~~~-~~---~~~-~~~-_:~~~=:_-----------------~~
permi t PLUMBING PERMIT
Additional
Permit Fee
Issue Date
Expiration
Qty
/ II VV/rn
-J
yl (\ lo~
11(v
1. 00
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 849.00 849.00 .00 .00
plan Check Total .00 .00 .00 .00
Grand Total 849.00 849.00 .00 .00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, ulilities, private and public improvemenls. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested wilhin 180 days from the last
inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinances governing this type of work will be complied wilh whether specified herein or not. The granting of a perm!1 does not
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the pelformance of
construction.
Signature of Conlractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T:\PLANNING\FORl\.1$\l 102.15 [11/]4/2003]
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CITY OF PORT ANGELES
0.. .,_
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST:
Date t.{ - 5" -0<[.
Time
7:00 ItWl Received by f)eql't'S E (phone, person)
Location of Work to be inspected ,5 I g E.. F rOVl...:-r-,
Name of person requesting inspection i)e<-tv(rs 6..
Address of person requesting inspection 4,(> y",-,J
,
Type of Inspection (circle appropriate one):
Sewer Foundation Framing Chimney Plumbing Final
Phone No.
Permit ~2-
Sewer Excav. Oth r t.Ut<...+€.. r
INSPECTION NOTES:
Inspected: Date t.f -L) -oc.{
Remarks:
Time Cj : 00 rrt"-1.. By b~Vl.V1. (5 E.
RESTORATION REQUIRED . . . . .. YES Y NO~'
I~
.~ e. Fn~V\.f ~
~
--s /g7 ~ 4x ~ t:lspt.......l-t c.vt ~
l~ IV
"8 ~,MQ.~e.( ""
~\c.~tC>v.) o.St,Q.~b\y
'f X-.. 'i
"AsPhalt 0 PCC 0 Other
Work Order # /t{7D5' -0z.1 \~ 6-!$l u> I
rt COMPLETE k~ Q.~~
o INCOMPLETE .\)j\~lA', ()O:- M\.;
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved OGravel
o Repaired by City
o Repaired by Permittee
o No Damage Found
,,.. ~_ u_ _ ..___ ,...._ ,.., __ _ _ _ _ _ _m.'