HomeMy WebLinkAbout1212 E. 6th Street Address:
1212E 6th street
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THE
For City Use
CITY OF RT NGELES Al /�Z/
Permit# /
WASH I N G T o N , U . S . Date Received: /p -/S-!�
321 E 5th Street , Date Approved
Port Angeles,WA 9836
P:360-417-4817 F:360-417-4711
Email:permits0cityofpa.us BUILDING PERMIT 1APPLICATION
Project Address: G@S N Se�-
cUSe?,4 e (i y g/4Phone: (.� C-( `� `� — 3 G
Prima Contact: G W d CotvS' u ail: k sse k ? Aoo, GOk,
Name / we / Phone / r� D ^
Property Mailing Address Email 5
Owner
City State Zip
ILE c(
Name--SoSe (*( (<Q h pb,4 Phone r~ Cc_I r
W 0 S r i k ca t 36C-,1?'�-�G:.^ 7 _L4 7 _3 8 2 l
Contractor
Address
Email r
Information city 5� �v Stat )
Contractors License# 0- L M Exp.Date:
Legal Description: Zoning: Tax Parcel # Project V lue: (materials and labor)
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Residential Commercial ❑ ! Industrial ❑ Public ❑
Permit Demolition ire 11 Repair ElReroof( tear off/lay over) El
Classification For the fWowvirtE. fill out both p,�es of permit application:
(check New Con stiction 13Exterior,.Remodel K Addition Elm
Tenant I proveent ❑
appropriate) Mechanical ❑ Plumbing ❑r Other C]
Fire Sprinkler Sy em? Irrigat+pn System? Proposed Bathyooms Propo "d Bedrooms
Yes [3 No Yes � No i'°
Project Description A)eQ,) AL4&
Is project in a Flood Zone: Yes ❑ Nop' Flood Zone Type:
If in a Flood Zone, what is the value of the structure before proposed improvement? $
I have read and completed the application and know it 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 to
obtain permits prior to work. I understand that plan review fees are not refundable after review has
occurred. I understand that I will forfeit review fees if I withdraw the application before the permit is
issued. I understand that if the permit is not picked up/issued within 18o days of submittal,the application
will be considered abandoned and the fees will be forfeited.
o
o
l t iy
Date Print Name ganature
Residential Structures
For Office Use
Area Description(SQ FT) Existing Proposed $$value
Basement
First Floor G n
Second Floor 0 ('
Covered Deck/Porch/Entry
Deck(over 30"or i"d floor)
Garage 10 / 7 0 / 7
Carport �d I
Other(describe) V!�
Area Totals
Commercial Structures
r Office Use
Area Descriptions(SQ FT) Existing Proposed $$Value
Existing Structure— s /
Proposed Addition
Tenant Improvement?
Other work(describe)
Site Area Totals /11
Lot/Site Covera a Calculations
Lot Size(sq ft) Lot Coverage(sq ft) %Lot Cove age(Total lot coverage_lot size)
Site toverage(S t of all impervious) _ %of Sate Coverage(total site coverage_lot size)
- E L. 37
Mechanical Fixtures
Indicate how rnan of each type of fixture to be installed or relocated as part of this project.
Air Handler Size: # Haz/Non-Haz Piping Outlets:
Appliance Exhaust Fan # Heater(Suspe , oor,Recessed wall) #
Boiler/Compressor Size: # _ eating/Cooling appliance #
re air/alteration
Evaporative Cooler(attached,not Pellet Stove/Wood--burning/Gas #
portable) Fireplace/Gas Stove/Gas'Co`nk,$tove/Misc.
Fuel Gas Piping #of Outlets: Ventilation Fan,single duct #
Furnace/H a ump/ Size: # Ventilation System #
Force r Unit
Plumbing Fixtures
Indicate how many of each type of fixture to be installed or relocated
Plumbing Tra # Fuel gas #of Outlets:
Water Heater # edical gas piping #of Outlets:
Water Line # Plumbing Vent piping-----_ #
Sewer Line # Industrial waste pretreatment
interceptor Grease Trap) Size
Other(describe):
T:\BUILDING\APPLICATION FORMS\Current BP Application\Building Permit 4-17-13.docx
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10175 FT.
94"x-1