HomeMy WebLinkAbout322 W. Front Street Address:
322 W Front Street
CERTIF11-AT.E --O,F UC-C UPANCY
CitA'i Port Angeles - Buildin"i- 7DE'livision
.w " �"'." I 1 9
This certificate is issuedpursuant to the requirements ofSection III-of the 2'009 International Building
Code certifying that at the time af-.issuaqCe this structure was in compliance with the various ordinances
of the City regulatin tti-idingconstri4ciio� '6i--useforthef owing;*---
Business name,
Nauohty'Nur�e"�,Tattob�-�-""�"7"�"-'T-'
Business address:',.-.322-WjFrontf�treet
Business owneh; ��Kimberly D Conley
Business owners address: 643 Olym ic-H, ots-p-h'n1g�.'RdP6rt Angellps, WA 98363
Automatic fire sprinkler-system: N/A-11
Use & occupancy\ccla��itication: Busiin-e'ss'
j6 1 Od4l.rl,1 ----- -
Occupant load: Pee 2009 1 BC, Tab
Type of constructi6n,
12/10/2012
U'e� Mneiger Date
Post on the premises in a conspicuou I I i il t tshall not be removed except by the
Building Official.
CERTIRCATE OF OCCUPANCY APPLICATION Permit#
FEES
CITY OF PORT ANGELES Certificate Inspection
R Attn: Permit Technician $10
2 E. Fifth St., Port Angeles, WA 98362 01$100' Parking Business Improvement Area (PBIA)
AUG 2 9 201Z (3 0)417-4815 fax(360) 417-4711 fee charged for Downtown locations
CITY OF PORT ANGELES PLEASE PRINT IN INK
UILDING DIVISION A,
=Tuck'u e6wusiness in P.A.?>(Change of ownership only? 11 Moving location from within P.A.? El Zoning
BUSINESS NAME M J7 1
Business address -'-52�2—k Mailing address P,197EX2 e' !aI129, P717+ e144 V
Phone number:��-fN j-4k--7AC-7 —Openin8;d��te,Cf- J-1�?- _Days & hours of operation' Vdxfgk:�.� (qjP,2,f0-
Business owner's name 5--"V)eXW I--% _ek_A Contact phone 40P
PM I - A-74��
Business owner's address (44�, E)WA w\0 L I -Rc�, -Ptrr-b jbpWif�-
Brief description of business re+Nj1) Ds-+
Property owner's name Contact phone ;;560- 4do0- t 2-
Property owner's address/contact lot-,,ft 25 2-
BUILDING DEPARTMENT ph Bldg approval h4lz-���on
r
Is the business a restaurant o ple? Yes El No
Construction changes plannec windows or doors, roofing, siding, foundation work,
adding/altering stairways, ram /cooling/ventilation systems, etc).
Work planned:
FIRE DEPARTMENT phone Fire approval by_on
Changes to a fire sprinkler system or fire alarm system? Yes 11 No
Work planned:
,;mck.v / �"uv) dj'rT>d(JL L
ICT77 A 1-50 CAF 0 CU2,:A
PBIA (Parking Business Improvement Area -Downtown) phone 417-4623
Square footage of business? PB1Anotifi*eJ.!;An I I on "-?M 1-4
Is business moving within the PBIA? Yes XNo LEI
CITYCLERK phone 417-4634 City Clerk approval byz) on 0-2-fi- 12-
Second-hand dealer/pawn broker business? Yes 11 Nox &Asw55
Will there be dancing at this business?Yes El No7K
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 I of 2
VORV..j CERTIFICATE OF OCCUPANCY APPLICATION Permit#
FEES
CITY OF PORT ANGELES $050 Certificate /Inspection
D Attn: Permit Technician
R 2 E. Fifth St., Port Angeles, WA 98362 $100 Parking Business Improvement Area (PBIA)
AUG 2 9 202 (3 0)417-4815 fax (360)417-4711 fee charged for bowntown locations
CITy OF PORT PLEASE PRINT IN INK
3UILDING DIVISION r A,
ew usl s in P.A.?gchange of ownership only? 0 Moving location from within P.A.? [I Zoning %--V%
BUSINESS NAME MOWAIA)a I t-3 Ltr!Se,
Business address 22,� 11?.4 Frm+- Mailing addressP,19, -,r Pvr+Avin
Ope
Phone number ning d�atje - 1- 12- Days & hours �f operation'
Business owner's name T &n(Jej-A Contactphone -110� ,QA
Business owner's address DWAW\00- ADk )Z�?V I AA6rR.6)�,
Brief description of business::j]2_�-_�(�D __)-pV�MD " ',e
,DVVIOL)j� ,e
Property owner's name Contact phone ?%-_0— 4r1o0— t'16
Property owner's address/contact 106Ak V_.JRAA_nY1�0jj T-A, Pr q-9�a2s2_
BUILDING DEPARTMENT phone 417-4 815 Bldg approval bJ4_��� on_q41j"'
Is the business a restaurant or bar that will seat 50 or more people? Yes El No
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 DEPARTMENT phone 417-4653 Fire approval by on
Changes to a fire sprinkler system or fire alarm system? Yes 0 No�Z
Work planned:
svvickx d LY�S,�jj)ej
'A r,%. I
I I N4.10-AF J2 rWV,:::j
PBIA (Parking Business Improvement Area -Downtown) phone 417-4623
Square footage of business? PBIA notir1ej=&J_on
Is business moving within the PBIA? Yes X No El
CITYCLERK phone 417-4634 City Clerk approval bya Ff on
Second-hand dealer/pawnbroker business?Yes 0 NoX 'ei/Lskre*
Will there be dancing at this business?Yes El NoK IV)
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 I of 2
Aft
COMMUNITY& ECONOMIC DEVELOPMENT phone 417-4750 CED approval b
Number of off-street k' ces javail ble for employees and
7 parking spaces
customers?__ ;?— F ne CAn
(A parking plan may be required.)
Signs? (wall-mounted, freestanding, projecting, awning, A-frame, etc?)
Signs planned:
C1 t 965 Lt 14"L" V-)Ly-dCLO
PLEASE NOTE: NO flashing, intermittent, or chasing signs are permitted in the City of Port Angeles.
Oa -9 F
PINE approval by V V on 0.�V I
PUBLIC WORKS DEPARTMENT- ENGINEERING phone 4174812
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 0 NO%91
Workplanned: F1�40 �!D 6 T-,
hctoci razt be-L�Jl, pt
J
PUBLIC WORKS WASTEWATER phone 417-4845 F��approval by_on
Will waste, other than domestic household waste, be discharged into the sewer system? Yes D Nok
If yes, what will be discharged:
Call for Certificate of Occupancy inspections BEFORE openin-q business.
Building Department Inspection 417-4815
Fire Department Inspection 417-4653
Please sign up for utility servic es 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 IJ 2--Print NameK�,Moef(:�4 71)'CCA) Signaturze�"MZb
----------------------------S�
TAForms\Building DivisionTerfificate of Occupancy Application(2010).doc
Page 2 of 2
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Form 68
Lease/Rental Agreement @Copyright 2011
Rev. 12/11 Northwest Multiple Listing Service
Page I of 5 LEASE/ RENTAL AGREEMENT ALL RIGHTS RESERVED
This Agreement dated: Au Ust 1. 2012
is made and entered into between Danni L Breen 1
("Lessor"), 2
by and through
("Listing Firm") 3
and Kim Conley ("Tenant") 4
for the"Property"Commonly known as 322 West First Street
5
in Port Angeles OaHam County,Washington. 6
If this Agreement is for more than one (1)year, the legal/description of the Property is attached as Exhibit A. 7
I. SECURITY DEPOSIT. Lessor acknowledges receipt from Tenant of the sum of$_-&I* fY 0 0 Q-" 8
1
which is being deposited in a trust account in Sound Communitv BAnk Bank, 9
Sequim Branch, in Seq Itim , WA. Lessor or Listing 10
Firm will give written notice of any change in said depository. This cl�posit—is security for performance of 11
Tenanfs obligations pursuant to this Agreement, including but not limited to payment of rent, and to 12
indemnify Lessor for damages to and cleaning of the Property for which Tenant is responsible. 13
A written "Move In/Move Out Inspection Agreement" describing the condition and cleanliness of and any 14
damage to the Property and furnishings will be signed by Lessor or Listing Firm and Tenant upon 15
commencement of tenancy and a written copy given to Tenant. NO SECURITY DEPOSIT MAY BE 16
COLLECTED UNLESS THIS CHECKLIST IS COMPLETED. 17
Within fourteen (14) days after termination of tenancy and vacation of premises (or abandonment of 18
premises), Lessor will give Tenant a full and specific statement of the basis of retaining any of the deposit 19
and a refund of any portion due Tenant, addressed as Tenant directs or in the absence thereof, to Tenant's 20
last known address. If the deposit is insufficient to reimburse Lessor for such damages and cleanin Tenant 21
agrees to pay any deficiency on demand. 22
2. POSSESSION. Tenant's right to possession of the Property begins at the commencement of the term 23
indicated below. If, through no fault of Lessor or Listing Firm, Lessor cannot deliver possession of the 24
Property to Tenant on the date indicated below, Lessor shall not be liable to Tenant for damages. 25
3. TERM(Check one).
Q a. LEASE.This Agreement is for a term of commencing on 26
This Agreement shall end at midnight on 27
28
Tenant must vacate the Property and surrender possession on the last day of the term. If Tenant 29
holds over without the prior written consent of Lessor, Tenant shall be liable for rent and all other 30
damages sustained by Lessor because of such holdover. If Tenant vacates prior to the expiration of 31
the term, the security deposit shall be forfeited and Tenant sha be obligated for the ntal 32
payments for the remainder of the term,or until the Property has bee 11 re
n rerented whichever is less. 33
55 b. MONTH-TO-MONTH. This Agreement is for a month-to-month tenancy commencing on 34
August 1,2012
. Lessor or Tenant may terminate this Agreement only upon written notice 35
received by the other at least 20 days prior to the end of each monthly rental period. If any such 36
notice of termination is not received at least 20 days in advance, then it shall not be effective until 37
the end of the next following monthly rental period. 38
4. RENT.The rent is$ 400.00 per month, payable in advance and due on or before the 5d first day, 39
E3_day of each month commencing on the first month of the term. Each monthly rental period shall 40
Initials: Tenant: Date:1 21 UZ-- Date:
Tenant: ay-
Date: Lessor: Date:
Form 68
Lease/Rental Agreement @Copyright 2011
Northwest Multiple Listing Service
Rev. 12/11 LEASE/RENTAL AGREEMENT ALL RIGHTS RESERVED
Page 2 of 5 (Continued)
begin on the day rent is due. Rent shall be paid 0 to Listing Firm at the address shown below Ed to Lessor 41
at the address shown below. Lessor acknowledges receipt of $� 400.00 as the first atid-42
43
-5. UTILITIES.Tenant shall,PaY all utilities when due except: 5f water (d sewer C3 garbage 44
9 electricitv 45
6. OCCUPANCYISUBLETTING. The Property is rented as a Private residence only for the following named 46
persons:
47
Kim and Charles Con - 48
Tenant shall not assign this Agreement, sublet all or any portion of the Property, nor give accommodation to 49
any roomers or lodgers, without the prior written consent of Lessor or Listing Firm. 50
7. MAINTENANCE. Tenant will at all times maintain the Property, including any yard and lawn, in a neat and 51
clean condition and upon termination of this Agreement will leave the Property in as good condition as it is 52
now, reasonable wear and tear excepted.Tenant agrees not to make any alterations or improvements to the 53
Property without Lessors prior written approval. 54
8. INSPECTIONISALE. Lessor may enter the Property to inspect it or make alterations or repairs at 55
reasonable times and, except in emergencies, will give two days' notice to Tenant, If Lessor wishes to show 56
the Property to actual or prospective purchasers or tenants, only one day's notice shall be required. 57
9. RENT LATE CHARGEINSF CHECK. If any rent is not paid on or before the due date, Tenant agrees to pay 58
a late charge of 56 $ 2.00 for each day that the same is delinquent, including the day of 59
payment, up to a maximum of 10% of one month's rent, or Q . 60
Tenant agrees to pay a charge of$ 15.00 for each NSF check given by Tenant to Lessor. Lessor 61
shall have no obligation to redeposit any check returned NSF. 62
In addition to the foregoing, Lessor may elect to terminate this Agreement for nonpayment of rent. Lessor 63
shall notify Tenant of late rent and NSF check charges and the same must be paid within 5 days. 64
10. RULES. The attached Rules on page 5 are a part of this .Agreement and failure to abide by them will 65
constitute default under this Agreement. 66
11. ATTORNEYS' FEES. In the event it is necessary for either party to employ an attorney to enforce any terms 67
of this Agreement the prevailing party is entitled to reasonable attorneys'fees as provided for by law. In the 68
event of a trial,the amount shall be as fixed by the Court. 69
12. WAIVER OF SUBROGATION. Lessor and Tenant hereby release and waive for the duration of this 70
Agreement and any extension or renewal thereof their respective rights of recovery against each other for 71
any loss resulting from perils of fire and/or extended coverage as defined in fire insurance policies issued to 72
either Lessor or Tenant in effect at the time of the loss; provided that such waiver and release shall apply 73
only in the event such agreement does not prejudice the insurance afforded by such policies. 74
13. NONREFUNDABLE FEE. Tenant agrees to pay prior to occupancy, a nonrefundable fee of 75
$ 0.00 .This nonrefundable fee shall not be returned under any conditions. 76
14. PETS. No dogs, cats or other animals will be permitted on the Property without the prior written consent of 77
the Lessor or Listing Firm and without a fully executed Pet Agreement(NWMLS Form No.6813). 78
v-7
e
Initials: Tenant: Date: L Date: Z—
Tenant: Date: Lessor: Date:
Form 68 CCopyright 2011
'Lease/R�ntal Agreement Northwest Multiple Listing Service
Rev. 12111 LEASE I RENTAL AGREEMENT ALL RIGHTS RESERVED
Page 3 of 5 (Continued)
15. PERSONAL PROPERTY.Tenant agrees that all personal property kept in or on the Property is at the risk of 79
the Tenant. Tenant is specifically advised of the availability of and is encouraged to obtain insurance for 80
such personal property. 81
16. SMOKE DETECTOR.Tenant acknowledges and Lessor certifies that the Property is equipped with a smoke 82
detector(s) as required by RCW 43.44.110 and that the detector(s) has/have been tested and islare 83
operable. It is Tenanfs responsibility to maintain the smoke detector(s) as specified by the manufacturer, 84
including replacement of batteries, if required. In addition, if the Property is a multi-family building(more than 85
one unit), Lessor makes the following disclosures: 86
(a) The smoke detection device is El hard-wired A battery operated. 87
(b) The Building 0 does t6 does not have a fire sprinkler system. 88
(c) The Building LJ does Ed does not have a fire alarm system. 89
(d) 56 The building has a smoking policy, as follows: 90
No smoking inside
91
Q The building does not have a smoking policy 92
93
(e) El The building has an emergency notification plan for occupants, a copy of which is attached to this 94
Agreement. 95
E6 The building does not have an emergency notification plan for occupants. 96
(f) El The building has an emergency relocation plan for occupants, a copy of which is attached to this 97
Agreement. 98
Rj The building does not have an emergency relocation plan for occupants. 99
(9) El The building has an emergency evacuation plan for occupants, a copy of which is attached to this 100
Agreement.
The building does not have an emergency evacuation plan for o 101
ccupants. 102
Tenant hereby acknowledges receipt of a copy of the building's emergency evacuation routes. 103
17. AGENCY DISCLOSURE. If real estate broker are involved in this transaction, en at the signing of this 104
Agreement, Listing Broker represents 0 L or; L3 both Lessor and Tenant. enant's Broker represents 105
LI Lessor; E3 Tenant; Q both Lessor and enant; 13 neither Lessor nor Te nt. Tenant's Firm, Tenant's 106
Firm's Designated Broker, Tenant's Br er's Branch Manager (if any) a Tenant's Broker's Managing 107
Broker (if any) represent the same y that Tenants Broker repres, Is. Listing Firm, Listing Firm's 108
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Designated Broker, Listing B ker's rich Manager(if any), and Listin roker's Managing Broker(if any) 109
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represent the same party tha the isfing Broker represents. If Ten I's Broker and Lisfing Broker are 110
different persons affiliated with t same Firm, then bbothBrLessor nd Tenant confirm their consent to Ill
Jana er(if any) and IV ker f an re resentll
I d isting Broker re 3 0 r Y)r p ti 9 1
n i a e n ep esen n
Je consentto that pe Des nated Brok,
f ny) representing bol al aci ig
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Designated Broker, Branch Mana er(if any), and Managin Broker, any) representing both parties as dual 112
agents. If Tenant's Broker and isting Broker are the same pe on representing both parties then both 113
Lessor and Tenant confirm thei consent to that person and his r Designated Broker, Branch Manager(if 114
any), and Managing Broker(if ny) representing both parties as d al agents.All parties acknowledge receipt 115
aw of I -�t t.A
of the pamphlet entitled"The aw of/Real Estate Agency." 116
18. COMMISSION. Lessor agrees to pay isting Firm the sum of$ for negotiating this 117
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hasieh er
r
ton there-, List t Prop S_
Agreement. If Tenant enters into n agreement or option —T e th Propety during Tenant,s 118
to purchas r
occupancy or within six (6) mon s thereafter, Lessor agrees to pay Listin Firm a sales commission of 119
or % of the total selling priXce. L ndlord and Tenant consent to 120
r
Listing Firm and/or Tenant's Fi receiving compensation from more than one party. 121
19. LEAD-BASED PAINT. If the Property includes housing that was built before 1978, then the Addendum 122
entitled"Disclosure of Information on Lead-Based Paint and Lead-Based Paint Hazards"(NWMLS Form 22J 123
or equivalent), must be attached to this Agreement unless this lease/rental transaction is exempt from 124
applicable federal regulations.
125
Initials: Tenant:—41— Date: Lesso�r i�e:
Tenant: Date: Lessor: Date:
Lease/Rental Agreement Northwest Multiple Listing Service
Rev. 12/11 LEASE/RENTAL AGREEMENT ALL RIGHTS RESERVED
Page 4 of 5 (Continued)
20. MOLD DISCLOSURE. Tenant acknowledges receipt of the pamphlet entitled "A Brief Guide to Mold, 126
Moisture, and Your Home." 127
VAJ,]A (I 7v 2 1- 1 z- L 1z R-V�� 128
Tenant Date Lessor Date
129
Tenant Date Lessor Date
.10 *3 &7— SF' P—,jkAj6S L( 'AA A30
Y a'n-t, Present -Add Lessors Addr s .9
F X OJT q6 5(,, -5 7 F—
City, State,Zip City,State,Zip
4-Oe --Rql +-7+16 3 4, o q66 t 4-(. 2- 132
Home Phone Work Phone Lessor's Phone
ywc 133
Tenant's Employer Listing Firm
Tenant's Firm Listing Broker 134
1 135
Te n�roroker Listing Firm dress
27- Z- 136
Listing Firm's Phone No.
?STATE OF WASHING ON ))Ss. 137
138
COUNTY OF 139
1 certify that I know or have tisfacto evidence that 140
is the person who appeared befo me, and said person acknowledged that he/she/theyAt signed the instrument ana 141
acknowledged it to be his/her thei s free and voluntary act for the uses and purposes mentioned in the instrument. 142
Dated: 143
a ve
0�7
me
ir as fre
Signature: 144
Print Name: 145
Notary Public in and for the State of 146
Washington, Residing at: 147
My Appointment Expires: 148
(Use this space�for notary stamp/seal.) 149
STATE OF HINGTON 150
)ss- 151
COUNTYOF 152
1 certify th t I know or have satisfactory evidence that 153
v
re
is the person who a ared before me, and said person acknowledged that he/she/they/it signed the instrument and 154
acknowledgedittobe is/hertheir/its free and voluntary act for the uses and purposes mentioned in the instrument. 155
Dated: 156
Signature: 157
Print Name: 158
Notary Public in and for the State of 159
Washington, Residing at: 160
My Appointment Expires: 161
(Use this space for notary stamp/seal.) 162
Clallarn County Assessor&Treasurer- Property Details - 55970 DANNI LYNN BREEN... Page I of I
Clallam County Assessor& Treasurer
Property Search Results > 55970 DANNI LYNN BREEN for Year 2011 -2012
Property
Account
Property ID: 55970 Legal Description: LOT 6 BL 34
Geographic ID: 0630000034200000 Agent Code:
Type: Real
Tax Area: 0010-PA 121 PORT ST CNTY H2 L WMP Land Use Code 62
Open Space: N DFL N
Historic Property: N Remodel Property: N
Multi-Family Redevelopment: N
Township: Section:
Range:
Location
Address: 322 W FIRST ST Mapsco:
PORT ANGELES,WA
Neighborhood: PA East Comm MapID: 2
Neighborhood CD: 5005000
Owner
Name: DANNI LYNN BREEN Owner ID: 15305
Mailing Address: 664 E RUNNION RD %Ownership: 100.0000000000%
SEQUIM,WA 98382-7551
Exemptions:
Taxes and Assessment Details
Values
Taxing Jurisdiction
t/Building
Property image
Land
iistory
rbi��ales History
Payout Agreement
Website version:9.0.32.2200 Database last updated on:8/29/2012 3:51 2012 True Automation, Inc.All Rights
AM Reserved. Privacy Notice
http://websr-v8.clallam.net/propertyaccess/Property.aspx?cid=O&year--2011&propjd=55970 8/29/2012
Heather Catuzo
From: Janessa Hurd
Sent: Thursday, August 30, 2012 8:17 AM
To: Heather Catuzo
Subject: RE: Certificate of Occupancy Naughty Nurse Tattoo
A business license has been turned in. So I'm good.
-Janessa
From: Heather Catuzo
Sent: Wednesday, August 29, 2012 2:37 PIVI
To: Janessa Hurd; Ken Dubuc; Roger Vess; Sue Roberds; Edith Parker; Rick Hostetler
Subject: Certificate of Occupancy Naughty Nurse Tattoo
Please see the following and provide comments by September 7, 2012.
GAEXCHANGE\Building Routings\CO Naughty Nurse Tattoo,pd
Thank you,
Heather Catuzo
Building Permit Technician
City of Port Angeles--Building Division
321 East 5th Street
Port Angeles, WA 98362
(360)417-4817
hcatuzo@citvofpa.us
Heather Catuzo
From: Roger Vess
Sent: Thursday, August 30, 2012 7:49 AM
To: Heather Catuzo
Subject: RE: Certificate of Occupancy Naughty Nurse Tattoo
Engineering has no comments.
Roger
From: Heather Catuzo
Sent: Wednesday, August 29, 2012 2:37 PM
To: Janessa Hurd; Ken Dubuc; Roger Vess; Sue Roberds; Edith Parker; Rick Hostetler
Subject: Certificate of Occupancy Naughty Nurse Tattoo
Please see the following and provide comments by September 7, 2012.
G:\EXCHANGE\Building Routings\CO Naughty Nurse Tattoo.pd
Thank you,
Heather Catuzo
Building Permit Technician
City of Port Angeles--Building Division
321 East 5th Street
Port Angeles, WA 98362
(360)417-4817
hcatuzo@citvofpa.us
1'2:27
COMMUNITY& ECONOMIC DEVELOPMENT phone 417-4750 CED approval by on
Number of off-street parki g sPacekavail0le for employees and
customers? K
z.e,
(A parking plan may be required.)
Signs? (wall-mounted, freestanding, projecting, awning, A-frame, etc?)
Signs planned:
L a65 L� +4C4-LA�IA W v-)wldCLk�
PLEASE NOTE: NO flashing, intermittent,or chasing signs are permitted in the City of Port Angeles.
PUBLIC WORKS DEPARTMENT- ENGINEERING phone 417-4812 PWE approval by on
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 10 N01V
Work planned._ b [)1i IdAjA& [`b f-(�40 elD�6c
yay)a t-oua uc-tiA� e(� 1 +0 ,�
I
PUBLIC WORKS WASTEWATER phone 417-4845 PWW approval by_on
Will waste, other than domestic household waste, be discharged into the sewer system? Yes L-1 No
If yes, what will be discharged:
Call for Certificate of OccupancV inspections BEFORE openinq 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.
D'CO-Y116 Signature
Date 2--Print Name 7,�;A
TAFormsTuilding Division\Certificate of Occupancy Application(2010).doc
Page 2 of 2
Prepared 11/27/12,11:47:45 Application Inquiry-(BPN200IO01) Page
Program HTDFTAL Screen detail for Program: BP BPN200I, Inspection history
User ID PBARTHOL Application 12-00001123
------------------------------------------------------------------------------------------------------------------------------------
Property Information
Address: 322 W 1ST ST
PORT ANGELES, WA 98362
Location ID: 89512
Owner name: BREEN, DANNI LYNN
ASSESSOR PARCEL NUMBER: 06-30-00-0-0-3420-0000-
ALTERNATE ID: 063000003420
Zoning: CA COMMERCIAL ARTERIAL
Subdivision:
Application information
Application desc: CERTIFICATE OF OCCUPANCY
Application status: PLAN REVIEW
Status Date: 8/29/2012
Application type; CO- CHANGE OF OCCP/USE
Application date: 8/29/2012
Tenant name/number: NAUGHTY NURSE TATTOO
Valuation: 0
Square footage: 0
Public building: NO
Reviewed by:
Pin number: 048459
Entered by: PERMITS
Contractor Information
Contractor Name: OWNER
Contractor Number:
Type:
Status:
Contractor Requirements Doc Number Exp Date
------------------------------ --------------- ----------
STATE LICENSE
BOND
LIABILITY INSURANCE
Outstanding Inspections
Insp Schedule Confirmation Permit Pmt
Type ID Date Number Description Seq Min Max
--------------- ------ ---------- ------------ --------------- --- ----- -----
No outstanding inspections exist
Work Description
Code Description Quantity
------ ------------------------- --------
CO Information
CO Issue
Str/seq Date Status Description
------- ---------- ------ --------------------
Str/Seq Permit/Seq Inspection type Insp Seq Inspector Schedule date Results Results date
Confirmation Nbr
000 000 CO 00 BLDG C/O FINAL 0001 JLL 11/15/2012 AP 11/16/2012
386078
CERTIFICATE OF OCCUPANCY APPLICATION Permit#
FEES
CITY OF PORT ANGELES
R ED Attn: Permit Technician U$1 5 0 Certificate Inspection
2 E. Fifth St., Port Angeles, WA 98362 Parking Business Improvement Area (PBIA)
AUG 2 9 ?017 (1 0)417-4815 fax (360)417-4711 fee charged for Oowntown locations
CITY 01'PORI PLEASE PRINT IN INY
UILD(NIG D 'M "_1
e ii, in P.A.?gChange of ownership only? Moving location from within P,A.? D Zoninq CA
BUSINESS NAME K)(Lurlk 0-
Business address _5 Ma iling add ress P, '-1[2,:;,9, EbrlAtAr4 ejv<,�,t)
Phone n umber`�W6-FY�I- Openin date Days & hours�f operation' \(ax 'ec)j W3k, 2,
Business owner's name 5_X�.�O�X Nv)I 6LA Contact phone 4G4�-PA I - 4-74-�r,—
Business owner's address CC-, JA Wqb��)
,
Brief description of business-aUiACV -- t,1AQ-Q a4A
6 ',�,V\1001 t �->��C J f_
-NAili vy iLay_v-� Contact phone
Pro erty owner's name 4ryoo— t'll'c"2
Property owner's address/contact ��-JRAA_Y\YVCTI 7E-J- 1.0 Pt Ct�, aF-,2-
BUILDING DEPARTMENT phone 417-4815 by_on
Is the business a restaurant or bar that will seat 50 or more people? Yes D No X
Construction changes planned (moving walls, adding/enlarging windows or doors, roofing, siding,,foundation worDk, ,
adding/altering stairways, ramps, bathrooms, electrical, heating/cooling/ventilation systems, etc).
Work planned:
FIREDEPARTMENT phone 417-4653 Fire approval by_agj��_on
Changes to a fire sprinkler system or fire alarm system? Yes N o
Work planned:
,�Vylok_o
T.7 ce— &i4jj
PBIA (Parking Business Improvement Area-Downtown) phone 417-4623
Square footage of business? on
Is business moving within the PBIA? Yes No El
X
CITYCLERK phone 417-4634
City Clerk approval by-on
Second-hand dealer/pawn broker business?Yes :1 No�Kh
Will there be dancing at this business?Yes 7 NoX.
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 I of 2
COMMUNITY& ECONOMIC DEVELOPMENT phone 417-4750 CED approval by_on
Number of off-street parki g spac,ek vail7bl for employees and
e/. A, Tr
customers? e 7re f�
(A parking plan may be required.)
Signs? (wall-mounted, freestanding, projecting, awning, A-frame, etc?)
Signs planned:
61465 U+41fyuI4 M LCLYIUMAJ
J
..— '�AJLALU�W
PLEASE NOTE: NO flashing, intermittent,or chasing signs are permitted in the City of Port Angeles.
PUBLIC WORKS DEPARTMENT-ENGINEERING phone 417-4812 PWE approval by_on
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 0 N01Y
Work planned: LA C4-zAe�c
C1 rtx�
PWWapprovalby
PUBLIC WORKS WASTEWATER phone 417-4845 _on
Will waste, other than domestic household waste, be discharged into the sewer system? Yes D Nok
If yes, what will be discharged:
Call for Certificate of OccupancV inspections BEFORE openin-q business.
Building Department Inspection 417-4815
Fire Department Inspection 417-4653
Please sign up for utility services at the cashiers' counter.
hereby apply for a Certificate of Occupancy. I acknowledge that I have read this application and state that the
information / have supplied is correct to the best of my knowledge. Incorrect information may result in revocation of
permit.
toc
Date..7' —Print Name. KLvn, -4 tc COA)A Signatu7re
T
TAForms\Building Division\Certificale of Occupancy Application(201 0).doc I
Page 2 of 2
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