HomeMy WebLinkAbout104 W 3rd Street (2) Address:
104 W 3rd Street
TI FICY ., NC
CiWQ Port Angeles B,uoldin- ,Dwis-on
This certificate is issue"ursuant to the requirements,of Section HL6f the 2Q. 2 International Building
Code certifying that at`ihe ttme of issuance this structure was to compliance wi the various ordinances
of the City regulating= uz,ldtrlg=constriictton or; use for the follcfwin"g;
Business name: �Laurelental Clinic
Business address 104- 3rd Streret �
v Business owner: AdaP. Cramer,,DDSdF
Business owners da,ress'r; 1502 Bishop RdF S11 , T �nwa etj 4 A 985a
Automatic fire spy nkl"t�ytem: s _ ` � }
Use &occupancy asstfication: Business,
Occupant load: 'Per_201.2 IBC, Table 1004 1:;1
Type of construction.
12/12/2014
Robet= ag' r'r Date
Post on the premises in a conspicuous place. his certi_�icaq shalt not be removed except by the Building Official.
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0
+ OS.pnRT,4SCF CERTIFICATE OF OCCUPANCY APPLICATION Permit# ! !
C?� RFs
FEES
CITY OF PORT ANGELES $50 Certificate/Inspection
Attn: Permit Technician
321 E. Fifth St., Port Angeles,WA 98362 $100 Parking Business Improvement Area (PBIA)
(360)4174815 fax (360)4174711 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
BUSINESS NAME A LO.VI*e1 T)etA,�"al a(i v►i c_ Ga ov "me i5 Dr.AJAt% Cr^&m&r, PLIC
Business address 00 w- 3 Sk iling address IS uZ is{oa (Lcl SCJ, 7p4t"WAfev WA 99 12-
Phone number '360- 457- 51q4 _Opening date 1 Days & hours of operation M -F S-S
Business owner's name Ad o-m P. 1'rc,i%w, 0 Contact phone 36v-
Business
6v-Business owner's address 15-0-L kD SW W►riA+er WA- 1s z—
Brief description of business DeA%+A lFA,,Q_
Property owner's nameSiwA 5"t hi ell 5 1 DA-4+a Q,n&hee Wllr C �ontact phone 31c o — 4 0 _33V
Property owner's address/contact 'fso 17 Mi- +oaL ei 2d , po 4 ,Q-wte u 414- 1131 Z
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 l
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: h 0 he-
FIRE DEPARTMENT phone 417-4653 Fire approval by on
Changes to a fire sprinkler system or fire alarm system? Yes ❑ No .
Work planned:
PBIA (Parking Business Improvement Area-Downtown) phone 417-4623
Square footage of business? PBIA notified on
Is business moving within the PBIA? Yes ❑ No%
CITY CLERK phone 417-4634
City Clerk approval by on
Second-hand dealer/pawnbroker business?Yes ❑ Nol
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.
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COMMUNITY& ECONOMIC DEVELOPMENT phone 417-4750 CED approval by on
Number of off-street parking spaces available for employees and
customers? /-g
(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.
PWE approval by on
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:
PUBLIC WORKS WASTEWATER phone 417-4845 PWW approval by on
Will waste, other than domestic household waste, be discharged into the sewer system? Yes ❑ No"X
If yes, what will be discharged:
Call for Certificate of Occupancy inspections BEFORE openin_g 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 -2--1 Print Name�F�-D n'l/3-S T IJ C L s ol� Signature L4rtA
T Worms\Building Division\Certificate of Occupancy Application(2010).doc
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