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Home My WebLink About601 E Park Avenue Address: 601 E Park Avenue PREPARED 1/27/17, 8:58:47 INSPECTION TICKET PAGE 4 CITY OF PORT ANGELES INSPECTOR: JAMES LIERLY DATE 1/27/17 ------------------------------------------------------------------------------------------------ ADDRESS . : 601 E PARK AVE SUBDIV: CONTRACTOR A DEPENDABLE CONTRACTOR PHONE (360) 452-8770 OWNER SCOTT L AND FRANCES A JAMISON PHONE (360) 460-4359 PARCEL 06-30-10-4-3-0300-0000- APPL NUMBER: 16-00001194 RES ADDITION ------------------------------------------------------------------------------------------------ PERMIT: BPR 00 BUILDING PERMIT - RESIDENTIAL REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ------------------------------------------------------------------------------------------------ BL1 01 9/22/16 JLL BLDG FOUNDATION FOOTING 9/23/16 AP September 22, 2016 8:26:39 AM jlierly. Gene 808-3181 September 23, 2016 8:52:15 AM jlierly. BL99 01 1/27/17 BLDG FINAL JA.0 January 27, 2017 8:51:18 AM jlierly. Exterior deck frame and final/ gene 808-3181 --------------------- --------- COMMENTS AND NOTES -------------------------------------- CITY OF PORT ANGELES vi;a� DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT- BUILDING DIVI 321 EAST 5TH STREET, PORT ANGELES, WA 9836ft W'"U' .91� C . A Application Number . . . . . 1G-00001194 Date 8/24/16 Application pin number . . . 501912 Property Address . . . . . . 601 E PARK AVE REPORT SALES TAX ASSESSOR PARCEL NUMBER: 06-30-10-4-3-0300-0000- Application type description RES ADDITION on your state excise tax fonn Subdivision Name. . . . . . . to the City of Port Angeles Property Use Property Zoning . . . . . . . RS7 RESDNTL SINGLE FAMILY (Location Code 0502) Application valuation . . . . 22000 ----------------------------------------------------------------------- Application desc 240sq ft deck addition ---------------------------------------------------------------------------- Owner Contractor �j ------------------------ ------------------------ SCOTT L AND FRANCES A JAMISON A DEPENDABLE CONTRACTOR 601 E PARK AVE P. 0. BOX 1574 PORT ANGELES WA 983626756 PORT ANGELES WA 98362 (360) 460-4359 (360) 452-8770 .0ther-struct-info-.-.-.-.-.--HARD-SURFACE-AREA ---------- ------ ---- - - - - - ---- ------- ----------------------------- Permit . . . . . . BUILDING PERMIT -RESIDENTIAL Additional desc . . DECK ADDITION/DOOR Permit Fee . . . . 375.75 Plan Check Fee 244.24 Issue Date . . . . 8/24/16 Valuation . . . . 22000 Expiration Date 2/20/17 Qty Unit Charge Per Extension BASE FEE 95.75 20.00 14.0000 THOU BL-2001-25K (14 PER K) 280.00 -------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE SURCHARGE 4.50 - -----------------------------------------7----------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 375.75 375.75 .00 .00 Plan Check Total 244.24 244.24 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 624.49 624.49 .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 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 k will be Comy)iedwitt-i whether specified herein or not. The granting of a permit does 0, not presume to give authority to violate or c -el the provis, ns of ny state or local law regulating construction or the performance of construction. Date Print Name Signature of Contractor or Authorized Agent�, Signature of Owner(if owner is builder) T:Forms[Building Division/Building Permit BUILDING PERMIT INSPECTION RECORD Pft-ASEPROVIDEA MINIMUM 24-HOUR NOTICE FOR INSPECTIONS— Building Ins'pections 417-4815 Electrical Inspections 417-4735 .,Public WorAs Utilities 417-4831 Backflow Prevention Inspections 417-4886 IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INCONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Inspection Type Date Accepted By Comments FOUNDATION: Footings Sternwall Foundation Drainage/Downspouts Piers Post Holes(Pole Bldgs.) �;LUMBING: Under Floor/Slab Rough-in Water Line(Meter to Bldg) Gas Line Back Flow/Wate 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 ISkirting PLANNING DEPT. Separate Permit#s SEPA: Parking/Lighting ESA: Landscaping ]SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY1 USE Inspection Type Date Accepted By Electrical 417-4735 Construction - R.W. PW /Engineering 417-4831 Fire 417-4653 Planning 417-4750 Building 417-4815 THE For City Use. CITY OF 0-E 11 >R -- � P- -A- Permit# W A S H I N G T 0 N, U . S. Date Received: 321 E 51h Street Date Approved Port Angeles,WA 9836 P:360-417-4817 F:360-417-4711 Email:permitsOcityofpa.us BUILDING PERMIT APPLICATION Project Address: �6 Phone: 3 PrimaryContact: (f> 6J6 Email: Name Phone 'S C--Cl—I -rI24A� Property Mailing Address Email Owner &, 0 -F— City C:> /1, State zip Name/4_ Phone -7 _ _ 7 6 _A)D,4 'Contractor Addresp Email ERtfJ64- 13 f, Pex), cc,,q Information City PO a-,r' 04�J 6,&e f::�s State �\).4 zip i�E 34e,2— Contractor License# 0"S P(fA- 1-," 7 7 d- b M Exp.Date: _? , /q . t 7 Legal Description: Zoning: Tax Parcel# Project Value: (materials and labor) 12 -3 04 0,-14-3- 0 5e 6 $ Residential Dt Commercial Industrial Public Permit Demolition El Fire b Repair D Reroof(tear off/lay over) El Classification For the following,fill out both pages of permit application: (check New Construction 1:1 Exterior Remodel 11 Addition 11 1 Tenant Improvement appropriate) Mechanical 11 Plumbing El Other E9 Fire Sprinkler System Proposed Tirrigation System Proposed or Proposed Bathro roposed Bedrooms or Existing? Yes 0 No 19 1 Existing? Yes 13 No 0 rl�� -Itf�r— In addition to standard hard copy submittals please send a PDF copy of all Stormwater plans and Engineering to ww,w.stormwater@cityofpa.us Project Description g7 Al-0 q 7--it r) 12, 6. C- &64-R Is project in a Flood Zone: Yes 0 NoEl 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 i8o days of submittal,the application will be considered abandoned and the fees will be forfeited. Date Print Name Residential Structures Existing Proposed Construction For Office Use Area Descriptions(SQ FT) Floor area. Floor area $Value new area Basement First Floor Second Floor Covered Deck/Porch/Entry nd Deck(over 30"or 2 floor) Garage, Carport Other(describe) Area Totals Commercial Structures Area Descriptions(SQ FT) Existing Proposed Construction For Office Use Floor area Floor area $Value new area Existing Structure(s) Proposed Addition Tenant Improvement? Other work(describe) Site Area Totals Lot/Site Coverage Calculations Lot Size(sq ft) Lot Coverage(sq ft)foot print of %Lot Coverage(Total lot cov lot size) Max Bldg Height I all structures P-�j sq ft "07 Site Coverage ksq Ft of all impervious) %of Site Coverage(total site cov-- lot size) Mechanical Fixtures Indicate how many 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 d d FI -,-Kec,,,essed wall) # B6iler/Compressor- Sizef # Heat" o 'ing ao0liance pair/alterati6n Evaporative Cooler(attached,not # Pellet Stove/Wood-burning/Gas # portable) Fireplace/Gas Stove/Gas Cook Stove/Misc. Fuel Gas Piping #of Outlets: Ventilation Fan,single duct # Furnace/Heat Pump/ ize: # Ventilation System # Forced Air Uni 4-1- Plumbing Fixtures Indicate how many of each type of fixtu e to be installed or relocated Plumbing Traps # Water # Plumbing Vent piping # -Mf-d-ical gas piping #of Outlets: Water Line Fuel gas piping #of Outlets: Sewer Line # Industrial waste pretreatment interceptor(Grease Trap) Size Other(describe): T:\Forms\2015 CED Form Updates\Building&Permitting\BP\Building Permit 2015041S.docx Jl ate Ll I r.J--L,I LEI--7-—-—-— ---------- ozo 08 5.1 5 54 Park Ave Address: 601 E park Avenue PREPARED 3/09/16, 9:26:05 INSPECTION TICKET PAGE is CITY OF PORT ANGELES INSPECTOR: JAMES LIERLY DATE 3/09/16 ------------------------------------------------------------------------------------------------- ADDRESS 601 E PARK AVE SUBDIV: CONTRACTOR ALL WEATHER HTG & COOLING INC PHONE (360) 452-9813 OWNER SCOTT L AND FRANCES A JAMISON PHONE (360) 460-4359 PARCEL 06-30-10-4-3-0300-0000- APPL NUMBER: 16-00000299 RES MECHANICAL PERMIT ------------------------------------------------------------------------------------------------ PERMIT: ME 00 MECHANICAL PERMIT - REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ------------------------------------------------------------------------------------------------ ME99 01 3/09/16 J MECHANICAL FINAL March 8, 2016 11:10:39 AM pbarthol. llll� DHP ----- ------------- ------- --------- COMMENTS AND NOTES -------------------------------------- CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT- BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number . . . . . 16-00000299 Date 3/01/16 Application pin number . . . 363882 Property Address . . . . . . 601 E PARK AVE ASSESSOR PARCEL NUMBER: 06-30-10-4-3-0300-0000- REPORT SALES TAX Application type description RES MECHANICAL PERMIT Subdivision Name . . . . . . on your state excise tax form Property Use . . . . . . . . Property Zoning . . . . . . . RS7 RESDNTL SINGLE FAMILY to the City of Port Angeles Application valuation . . . . 9140 (Location Code 0502) ----------------------------------------------------------------------------- Application desc 2 ductless heat pump.systems ---------------------------------------------------------------------------- Owner Contractor ------------------------- ------------------------ SCOTT L AND FRANCES A JAMISON ALL WEATHER.HTG & COOLING INC 601 E PARK AVE 302 KEMP ST PORT ANGELES WA 983626756 PORT ANGELES WA 98362 (360) 460-43S9 (360) 452-9813 -------------------------------- -------------------------------------------- Permit . . . . . . MECHANICAL PERMIT Additional desc . . 'ZJ Permit Fee . . . . 79.60 Plan Check Fee .00 issue Date . . . . 3/01/16 Valuation . . . . 0 Expiration Date 8/28�16 Qty Unit Charge Per Extension BASE FEE 50.00 2.00 14.8000 EA ME-FURN/HP/FAU < OR = 5 TON 29.60 — ---------------------------------------------------------------------------- <1 Special Notes and Comments d Per Washington State Code 51-51-315, installation of Carbon Monoxide detector(s) is required if you are installing or replacing a fuel burning appliance (wood, pellet, gas)and must be in place prior to the final inspection of this permit. They are required to be place directly outside of each sleeping area and at least one on.each floor of the house. — -----------------m----------------------------- ----------------------------- Fee summary Charged Paid Credited Due --- ------- ------- ---- -------- --- Permit Fee Total 79.60 79.60 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 79.60 79.60 .00 .00 tj— Separate Permits are required for electrical work,SEPA,Shoreline,ESA,utilities,private and public improvements. This permit becomes -_.pull 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. Date Print Name Signat Cre jof onlor or Authorized Agent Signature of Owner(if owner is builder) T:Forms/Building Division/Building Permft 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 IT IS UNLAWFUL TO COVER,INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INCONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Inspection Type Date Accepted By Comments FOUNDATION: Footings Sternwall Foundation Drainage/Downspouts 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/Under Floor A Shear Wall/Hold Downs Walls/Roof/C iling 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 SEPA: Parking/Lighting ESA: Landscaping SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY1 USE Inspection Type Date Accepted By Electrical 417-4735 Construction - R.W. PW /Engineering 417-4831 Fire 417-4653 Planning 417-4750 Building 417-4815 03/01/2016 00:41 13604525177 ALL WEATHER HEATING PAGE 01/01 THE For City Use Ca-ry OF Permit# W A S FF I N G T 0 N. U. S. Date Received: 321 E 5�h Street Date Approved Port Angeles,WA 9836 P.,360-417-4817 F:360-417-4711 Email:permi sAdgUQ1&U$ BUILDING PERMIT APPLICATION Qc.601 East Park Avenue Project Addre Scott Jamison kLPhone:360-461-2296 Prima,a Contact: I Email: Name Scott& Fran Jamison Phone 360-461-2296 Property MailingAddre-"601 East Park Avenue Emad Owner c"y Port Angeles State WA 98362 114,mne All Weather Heating & Cooling, Inc. Phone 360-452-9813 Contractor Address 302 Kemp Street FMad billing@allweatherhc.com Infon,t,aidon C'ty Port Angeles Sta-t-e WA -�"P 98362 tc--�'—1�1t'"r,--U,,C'"-'n a e#A,L L W E H C 15�OK U Exp.Date!9/16 Legal Description: Zoning: Tax pa�,rcej# Project Value: (materiah and labor) s9140.28 Residential N Commercial 0 — Industrial Public Permit Demolition El Fire- Repair 11 Reroof(tear off/lay over) Classification EQXJLh2-f!21I 0-Mda g.h I I o u t h nth n a crC§j2LpgMjJAP11UCatjQU: (check New Construction 0 Exterior Remodel 0 Addition 0 Tenant Improvement appropriate) Mechanical W Plumbing 11 Other 0 Fire Sprinkler System Proposed—I Irrigation System Proposed or Proposed Bathroo—m$ Proposed Bedroorns -or-Existing? Yes C3 No C3 Existing? Yes 13 No 0 1 In addition to standard hard copy-,-atbmittals please send a PDF copy ofall Stormwater plans and Engineering to gayrwzto i &als�o�a-us Project Description QnsftN(2)ductless heat pump syshmn kmWI(2)ductles's heat pump syshms Is project in a Flood Zone: Yes C3 No13 Flood Zone Type: If in a,Flood Zone, what is the value of the structure before proposed improvement? $ 1 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 ray 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 apphcation before the permit is issued. I understand that if the permit is not picked up/issued within j.8o days of submittal,the application will be considered abandoned and the fees will beforfeited. Date 2Mlf6 Print Name Karen McKeown Siann.alture Address: 601 E Park Avenue PREPARED 2/09/16, 10:55:37 INSPECTION TICKET PAGE 3 CITY OF PORT ANGELES INSPECTOR: JAMES LIERLY DATE 2/09/16 ------------------------------------------------------------------------------------------------ ADDRESS . : 601 E PARK AVE SU13DIV: CONTRACTOR EVERWARM HEARTH AND HOME INC PHONE (360) 452-3366 OWNER SCOTT L AND FRANCES A JAMISON PHONE (360) 460-4359 PARCEL 06-30-10-4-3-0300-0000- APPL NUMBER: 16-00000167 RES MECHANICAL PERMIT ------------------------------------------------------------------------------------------------ PERMIT: ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ------------------------------------------------------------------------------------------------ ME99 01 2/09/16 jTLL MECHANICAL FINAL February 9, 2016 9:13:02 AM jlierly. fran 461-2296 wood stove insert ------- --------------- ------------ COMMENTS AND NOTES -------------------------------------- CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY& ECONOMIC DEVELOPMENT- BUILDING DIVISION CIF ) 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number . . . . . 16-00000167 Date 2/04/16 Application pin number . . . 099643 -- Property Address . . . . . . 601 E PARK AVE ASSESSOR PARCEL NUMBER: 06-30-10-4-3-0300-0000- REPORT SALES TAX Application type description RES MECHANICAL PERMIT on your state excise tax form Subdivision Name . . . . . . Property Use . . . . . . . . to the City of Port Angeles Property Zoning . . . . . . . RS7 RESDNTL SINGLE FAMILY Application valuation . . . . 4521 (Location Code 0502) ---------------------------------------------------------------------------- - Application desc wood burning stove insert ---------------------------------------------------------------------------- Owner Contractor ---------------------- ------------------------ SCOTT L AND FRANCES A JAMISON EVERWARM HEARTH AND HOME INC 601 E PARK AVE 257151 HIGHWAY 101 PORT ANGELES WA 983626756 PORT ANGELES WA 98362 (360) 460-4359 - (360) 452-3366 ----------------------------------------------------------------------------- Permit . . . . . . MECHANICAL PERMIT Additional desc WOOD STOVE INSERT Permit Fee . . . . 60.65 Plan Check Fee .00 Issue Date . . . . 2/04/16 Valuation . . . . 0 Expiration Date . . 8/02/16 4 Qty Unit Charge Per Extension BASE FEE 50.00 1.00 10.6500 EA ME-STOVE/FIREPLACE/MISC. APP. 10.65 ---------------------------------------------------------------------------- Special Notes and Comments Per Washington State Code 51-51-315, installation of Carbon Monoxide detector(s) is required if you are installing or replacing a fuel burning appliance (wood, pellet, gas)and must be in place prior to the final inspection of this permit. They are required to be place directly outside of each sleeping area and at least one on each floor of the house. ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- --------7- ---------- Permit Fee Total 60.65 60.65 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 60.65 60.65, .00 .00 Separate Permits are required forelectrical work,SEPA,Shoreline,ESA,utilities,private and public improvements. This permit becomes null and void if work orconstruction authorized is not commenced within 180 days,ifconstruction orwork is suspended orabandoned 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 author violate or cancel the provisions of any state or local law regulating construction or the performance of construVon. I '7 Date Print Name Signature of Contractor or AutioriJed Agent Signature of Owner(if owner is builder) 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 IT IS UNLAWFUL TO COVER,INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INCONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Inspection Type Date Accepted By Comments FOUNDATION: Footings Stemwall Foundation Drainage/Downspouts 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/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 I FAU/Ducts Rough-In Gas Line Wood Stove/Pellet/Chimney Commercial Hood/Ducts MANUFACTURED HOMES: Footing/Slab Blocking&Hold Downs ,Skirfing PLANNING DEPT. Separate Permit#s SEPA: Parking/Lighting ESA: Landscaping SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY1 USE Inspection Type Date Accepted By Electrical 417-4735 Construction -R.W. PW /Engineerinq 417-4831 Fire 417-4653 Planning 417-4750 Building 417-4815 THE CITY F i oz, For City Use 0 'N"lki� OA W A S H I i� PT 0 N, U S. Permit# i Date Received: 321 E 5th Street Date Approved �4- Port Angeles,WA 983 6 P:360-417-4817 F:360-417-4711 Email:vermi 30ci Mfpa,us BUILDING, PERMIT APPLICATION Project Addr o i C-s Phone: m Primmy Contact: �0 ail: I # P't. rt4- : Em Name,1 PI Phg%e, _t_)_ Property Wilin (-0? Email Owner City I State Z' -01 — Name --77 1 W k I Phone F'1JWfh 7�1 Contractor Address &)-7 RWI Email Information city State State Contractor 9cense# r. I zip 1 Exp.Date: Legal Description: # Zoning: Tax Parcel# ProjeC VAUe: (materials and labor) ale &-31 t 0 030 $ 101Z 00 $ �5c) Residential W)& Commercial 0 Industrial 0 Public 0 Permit Demolition' 0 Fire 0 � Repair 0 1 Reroof(tear off/lay over) 0 Classification For the foi 19AA"9V 'rill out b I th pages of application: (check New Const,ruction 11 Exter or emodel 0I Addition 0 Tenant Improvement 0 appropriate) Mechanic�l A Plumbing [I Other 13 Fire Sprinkler System Propose4 Irrigation Syster t Proposed or Proposed Bathrooms Proposed Bedrooms or Existing? Yes 0 No El I Existing? Yes E No 13 In addition to standard hard copy submittals pleas!send a PDF cop�o all Stormwater plans and Engineering to www.stormwateroci ofpa.us Project escription I OVA ri c� li�� MEA.110 Lv!t 0-4 . 0 Is project in a Flood Zone Yes [3 NoC3 Flood Zone Type: If in a Flood Zone, what is t ,e value of the strui :ture before proposed improvement? $ i I I have read and complete he app icat on and�know it to be true and correct.I am authorized to apply for this permit and understand that it is my respoi ksibility to determine what permits are required and to obtain permits prior to work. I understand tha t plan review&I es are not refundable after review has occurred. I undersi I tand that I will forfeit revie's r fees if I withdr the application before the permit is I aw issued. I understand that if e permit is not p,cked up/issued within i8o days of submittal,the application will be considered abandon d and the fees will be forfeited. Date Print Name 7— ature