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Home My WebLink About1115 S Lincoln St - BuildingPREPA-RaEDD 3/30/11 8 24 35 INSPECTION TICKET CITY OMPORT ANGELES INSPECTOR JAMES LIERLY ADDRESS 1115 S LINCOLN ST SUBDIV TENANT NBR PHILLIP K ROUSH CONTRACTOR TRUBUILD PHONE (360) 301 0423 OWNER PHILLIP KATHLEEN ROUSH TTES PHONE (360) 457 0655 PARCEL 06 30 00 0 3 4260 0000 APPL NUMBER 11 00000113 RE ROOF PERMIT BNOP 00 BUILDING PERMIT NO PR FEE REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS BL99 01 3/30/11 BLDG FINAL March 29 2011 4 44 39 PM 1pangrle PHILLIP 457 0655 BUILDING FINAL RE ROOFED THE GARAGE THE PERMIT IS IN THE OPEN GARAGE COMMENTS AND NOTES PAGE 2 DATE 3/30/11 CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Tenant nbr name Application type description Subdivision Name Property Use Property Zoning Application valuation Application desc TEAR OFF RE ROOF THE GARAGE Owner PHILLIP KATHLEEN ROUSH TTES 1421 W 5TH ST PORT ANGELES WA 98363 (360) 457 0655 Structure Information 000 000 Permit BUILDING PERMIT NO Additional desc RE ROOF THE GARAGE Permit pin number 181149 Permit Fee 123 75 Issue Date 2/07/11 Expiration Date 8/06/11 Qty Unit Charge Per 2 00 14 0000 THOU Other Fees Fee summary Charged Permit Fee Total 123 75 Plan Check Total 00 Other Fee Total 4 50 Grand Total 128 25 123 75 00 4 50 128 25 1 7 i 4/' 4)yLt-1 T:Forms /Building Division /Building Permit 11 00000113 645454 1115 S LINCOLN ST 06 30 00 0 3 4260 0000 PHILLIP K ROUSH RE ROOF RS7 RESDNTL SINGLE FAMILY 3580 Contractor TRUBUILD 132 SPRING RD PORT ANGELES (360) 301 0423 RE ROOF THE GARAGE PR FEE Plan Check Fee Valuation BASE FEE BL -2001 25K (14 PER K) STATE SURCHARGE Paid Credited 00 00 00 00 Date 2/07/11 WA 98362 Extension 95 75 28 00 4 50 Due 00 00 00 00 00 3580 REPORT SALES TAX on your state excise tax form to the City of Port Angeles (Location Code 0502) 4 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 work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or can -1 the provisions of any state or local law regulating construction or the performance of constnudion. constrction. V Date Print Name Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder) 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 IN CONSPICUOUS 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 FAU Ducts Rough -In Gas Line Wood Stove Pellet Chimney Commercial Hood Ducts MANUFACTURED HOMES Footing Slab Blocking Hold Downs Skirting 1 FINAL Date PLANNING DEPT Separate Permit #s SEPA. Parking Lighting I I ESA. Landscaping I I SHORELINE. T:Forms /Building Division /Building Permit I FINAL Date Accepted by FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE Inspection Type Electrical 417 -4735 Construction R.W PW Engineering 417 -4831 Fire 417 -4653 Planning 417 -4750 Building 417 -4815 3 -30 -11 Accepted by Date Accepted By 5 BUILDING PERMIT APPLICATION Print in ink CITY OF PORT ANGELES Attn Building Permit Technician 321 E Fifth St. Port Angeles WA 98362 (360) 417 -4815 fax (360) 417 -4711 Applicant T)HlLt,W 12.01A,SF --r P1/4 ILe0N RCM i Phone O- 4 -O((5'5 Property Owner 5AIN.e, Phone Property Owner's Address 14-2\ W 5 l ?O t6,,eL.e Wf '3763 Contractor 772.U1BUILD Phone 300-- 301 64.2?j Contractor's Address 132 1P2LN61, PORT 1$4.1.61.-C- c WA Q8 34z License IVAAINIverfreini 31 ✓Expires/ E -mail -IyvlbUUldd -tA aqppA:tl,.an4 PROJECT ADDRESS It 14 Lw. -0L0 Pb(LT D4.s 6..e...€5 W,D‹ atg 3(zZ f Parcel Number Lot Zoning 12.- Project Type Brief Description. Residential Multi- family Commercial Industrial Check all that apply New Construction Addition Remodel Repair Demolition Re -roof House garage other .tear off re -roof lay over one layer Heat System Heat pump wood- burning stove gas fireplace pellet stove other Other Floor Areas Existing (sq. ft.) Proposed (g. ft.) Basement 1 1 Floor I 2nd Floor 3 Floor y Garage A Carport Covered Porch Deck Shed Other Total footprint of structures Site Coverage the amount of impervio and other impervious surfaces (see PA Max height of proposed structures ft. Occupancy group Will a lawn sprinkler system be installe Occupant load Will a fire sprinkler system be installeq. Construction type Date 2 71 It Print Name 1"Ktw1'P pzu60.1 Signature For City Use 0 Date Received Permit# L1 —Its Date Approved per sq ft. of bedrooms of full baths of half baths T Forms /Building Division /Building permit application a Co TOTAL VALUATION s•. ft. T Lot size s ft. Lot coverage ce on a parcel including structure aved driveways sidewalks patios 7 94 135 for exemptions) Site coverage I have read and completed this applica /on and know it to be true and correct. I 'gym authorized to apply for this permi nd understand that it is my responsibility to determine what permits are required, and to obtain permits prior to wo, in. on projects 7/ itaitAwt Clallam County Assessor Treasurer Property Details 59492 PHILLIP AND KATHL Page 1 of 3 Clallam County Assessor Treasurer Property Search Results 59492 PHILLIP AND KATHLEEN ROUSH TTES for Year 2011 2012 Property Account Property ID' 59492 Legal Description: N2 LOTS 10 &11 BL Geographic ID' 0630000342600000 Agent Code: Type: Real Tax Area: 0010 PA 121 PORT ST CNTY H2 L VVMP Land Use Code 12 Open Space: N DFL N Historic Property' N Remodel Property N Multi Family Redevelopment: N Township: Section: Range: Location Address: 1115 S LINCOLN ST Mapsco: PORT ANGELES, WA 98362 Neighborhood: Cycle 5 Res Map ID' 2 Neighborhood CD: 10955130 Owner Name: PHILLIP AND KATHLEEN ROUSH TTES Owner ID' 49639 Mailing Address: 1421 W FIFTH ST Ownership' 100.0000000000% PORT ANGELES, WA 98363 Taxes and Assessment Details Property Tax Information as of 02/07/2011 Amount Due if Paid on: First Second Half Half Base Base Year Statement ID Taxing Jurisdiction Amt. Amt. Penalty Interest Base Paid Amount Due 2011 154103 ST SCH STATE SCHOOL $186.03 $186.03 $0.00 $0.00 $0.00 $372.06 2011 154103 CC -GEN COUNTY CLALLAM $102.71 $102.69 $0.00 $0.00 $0.00 $205.40 2011 154103 SD #121 SCHOOL DISTRICT #121 $243.17 $243.17 $0.00 $0.00 $0.00 $486.34 2011 154103 CITY PORT ANG CITY OF PORT ANGELES $237.08 $237 08 $0.00 $0.00 $0.00 $474 16 2011 154103 PORT PORT OF PORT ANGELES $14 46 $14 45 $0.00 $0.00 $0.00 $28.91 2011 154103 NTH OLY LIB NORTH OLYMPIC LIBRARY $43.07 $43.07 $0.00 $0.00 $0.00 $86.14 2011 154103 HOSP #2 HOSPITAL #2 $42.16 $42.15 $0.00 $0.00 $0.00 $84.31 2011 154103 WSMET PK DIST WILLIAM SHORE MET PARK DIST $12.82 $12.81 $0.00 $0.00 $0.00 $25.63 2011 154103 CITY_STORMWATER CITY STORMWATER $36.00 $36.00 $0.00 $0.00 $0.00 $72.00 2011 154103 WEED_CONTROL WEED CONTROL $0.82 $0.81 $0.00 $0 00 $0.00 $1 63 2011 154103 TOTAL. $918.32 $918.26 $0.00 $0.00 $0.00 $1836.58 2010 42388 ST SCH STATE SCHOOL $184 16 $184.17 $0.00 $0.00 $368.33 $0.00 2010 42388 CC -GEN COUNTY CLALLAM $98.01 $98.01 $0.00 $0.00 $196.02 $0.00 2010 42388 SD #121 SCHOOL DISTRICT #121 $238.55 $238.55 $0.00 $0.00 $477 10 $0.00 2010 42388 CITY PORT ANG CITY OF PORT ANGELES $226 94 $226.91 $0.00 $0.00 $453 85 $0 00 2010 42388 PORT PORT OF PORT ANGELES $13 78 $13.77 $0 00 $0.00 $27.55 $0 00 2010 42388 NTH OLY LIB NORTH OLYMPIC LIBRARY $28 48 $28.48 $0.00 $0.00 $56.96 $0.00 2010 42388 HOSP #2 HOSPITAL #2 $40.20 $40.21 $0.00 $0 00 $80 41 $0 00 2010 42388 WSMET PK DIST WILLIAM SHORE MET PARK DIST $12 80 $12.79 $0 00 $0 00 $25.59 $0.00 2010 42388 CITY_STORMWATER CITY STORMWATER $36.00 $36.00 $0.00 $0.00 $72.00 $0.00 2010 42388 WEED_CONTROL WEED CONTROL $0.82 $0.81 $0.00 $0.00 $1.63 $0.00 2010 42388 TOTAL. $879.74 $879.70 $0.00 $0.00 $1759.44 $0.00 2009 594922008 ST SCH STATE SCHOOL $211.03 $211 03 $0.00 $0.00 $422.06 $0.00 2009 594922008 CC -GEN COUNTY CLALLAM $106.80 $106.80 $0.00 $0 00 $213.60 $0.00 2009 594922008 SD #121 SCHOOL DISTRICT #121 $260.97 $260.97 $0.00 $0.00 $521.94 $0.00 2009 594922008 CITY PORT ANG CITY OF PORT ANGELES $234.26 $234.25 $0.00 $0.00 $468.51 $0.00 2009 594922008 PORT PORT OF PORT ANGELES $15 13 $15 13 $0.00 $0.00 $30.26 $0.00 2009 594922008 NTH OLY LIB NORTH OLYMPIC LIBRARY $31.03 $31.03 $0.00 $0.00 $62.06 $0.00 2009 594922008 HOSP #2 HOSPITAL #2 $43.80 $43.80 $0.00 $0 00 $87.60 $0.00 2009 594922008 CITY_STORMWATER CITY STORMWATER $36.00 $36.00 $0.00 $0.00 $72.00 $0.00 2009 594922008 WEED_CONTROL WEED CONTROL $0.81 $0.82 $0.00 $0 00 $1 63 $0.00 2009 594922008 TOTAL. $939.83 $939.83 $0.00 $0.00 $1879.66 $0.00 Values Improvement Homesite Value: Improvement Non Homesite Value: NOTE. If you plan to submit payment on a future date, make sure you enter the date and click RECALCULATE to obtain the correct total amount due N/A N/A Exemptions: 342 http. /websrv8 clallam .net /propertyaccess /Property aspx ?cid =0 &year =2011 &prop_id =59492 2/7/2011 CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 32] EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number Pin number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Use Property Zoning . . . Application valuation 04-00000563 Date .387153 1115 S LINCOLN ST 06-30-00-0-3-4260-0000- ELECTRICAL ONLY 6/29/04 RS7 RESDNTL SINGLE FAMILY o Owner Contractor ROUSH, PHILLIP/KATHY 1421 W 5TH ST PORT ANGELES WA 983622740 OWNER Permit Additional desc Sub Contractor Permlt Fee Issue Date Expiration Date ELECTRICAL NEW RESIDENTIAL 400A SERVICE 94.80/SUB(5)22.70 STRAITS ELECTRIC 208.30 Plan Check Fee 6/29/04 Valuation 12/26/04 .00 o '" ......... .......... V\ Qty Unit Charge Per 5.00 22.7000 ECH EL-RM-0-200 ADD SRV FEEDER 1.00 94.8000 ECH EL-RM-201-400 1ST SRV FEEDER Extension 113.50 94.80 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 208.30 208.30 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 208.30 208.30 .00 .00 h (' " < (\ () ~ ~ " Separate Permits are required forelectncal work, SEPA, Shoreline, ESA, utilities, pnvate and public Improvements This permit becomes null and void if work or construction authonzed IS not commenced within 180 days, if construction orwork is suspended or abandoned for a period of 180 days after the work as 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 compiled with whether specified herein or not. The granting of a permit does not presume to give authonty to violate or cancel the provISions of any state or local law regulating construction or the performance of construction. Signature of Contractor or Authorized Agent Date Signature of Owner (If owner is builder) Date T \PLANNING\FORMS\1102 15 [11/14/2003] BUILDING PER1VlIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS CALL 417-4735 FOR ELECTRICAL INSPECTIONS PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE IT IS UNLA WFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE. INSPECTION TYPE DATE ACCEPTED COMMENTS YES NO FOUNDATION FOOTINGS WALLS FOUNDATION DRAINAGE/DOWN SPOUTS ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT # ROUGH-IN PLUMBING UNDER FLOOR 1 SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW 1 WATER AIR SEAL WALLS CEILING FRAMING JOISTS 1 GIRDERS SHEAR W ALLIHOLD DOWNS WALLS 1 ROOF 1 CEILING DRYWALL (INTERIOR BRACED PANEL ONLY) T-BAR INSULATION SLAB WALL 1 FLOOR 1 CEILING MECHANICAL HEAT PUMP GAS LINE WOOD STOVE 1 PELLET 1 CHIMNEY HOOD 1 DUCTS PW UTILITIES 1 SITE WORK (Engmeenng DlvlslOn) SEPARATE PERMIT #'s WATERLINE 1 METER SEWER CONNECTION SANITARY STORM PLANNING DEPT SEPARATE PERMIT #'s SEPA PARKINGILIGHTING ESA LANDSCAPING SHORELINE FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRICAL - LIGHT DEPT 417-4735 7.8 'Oq A"-D ELECTRICAL LIGHT DEPT CONSTRUCTION R W 1 PWI CONSTRUCTION - R W. ENGINEERING 417-4807 PW 1 ENGINEERING FIRE 417-4653 FIRE DEPT PLANNING DEPT 417-4750 PLANNING DEPT BUILDING 417-4815 BUILDING T \PLANNING\FORMS\1102 15 [111]4/2003] ti1'ORr~ CITY OF PORT ANGELES "...~<'( ",.-. DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION L~ 321 EAST 5TH STREET, PORT ANGELES, WA 98362 ~ "'"'""" tsUILUINC;i -""~t(MII - ISSUED: 9/18/2002 PERMIT NO: 13722 OWNER/APPLICANT PROPERTY LOCATION SAM TIKKA 1115 L1NCOLNS 1115 LINCOLN Lot: N2 LOT10 &11 Port Angeles, WA 98362 Block: 342 D Long Legal 360/457-8438 Subdivision: TPA T: S: Parcel No: 063000034260000 CONTRACTOR ARCHITECT EMERALD ROOFING NIA 133 LELAND AVE Port Angeles, WA 98362 , 98360-0000 360/452-4681 360/000-0000 PROJECT INFO Project Value: $3,597.00 SFD Units: 0 Commercial: 0 Project Type: RE-ROOF SFD SO FT: 0 Industrial: 0 ]I -. - Occupancy Type: RESIDENTIAL Garage: 0 J- - Occupancy Group: MFD Units: 0 )> VJ Construction Type: MFD SO FT: 0 r Zoning Use: ~ \j\ 0 PROJECT NOTES ~ - TEAR OFF 1 RESHEET 1 REFEL T 1 3T AB ~ J ~ ~. RECEIPT#9696 ~ r FEES ASSESSMENT [) - Building Permit: $97.25 Mise Fee 1: $0.00 .5 Plan Check: $0.00 Mise Fee 2: $0.00 State Surcharge: $4.50 Mise Fee 3: $0.00 House Moving: $0.00 Manufactured Home: $0.00 Sign: $0.00 TOTAL FEE: $101.75 Plumbing: $0.00 AMOUNT PAID: $101.75 Mechanical: $0.00 BALANCE DUE: $0.00 Radon: $0.00 Separate Permits are required forelectricai work, SEPA, Shoreiine, 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 fora period of 180 days after the work as 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 t e of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority o ate 0 cancel the provisions of any state or local law regulating construction or the performance of construc~ ~ /'-/' ..' ~ gnature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date T:\PLANNING\FORMS\1102.15 [4/2002] STRAITS ELECTRIC ~ Ob c }~li~~~jAX:'N'tj'60 '41if4l'f'~cp1fi02;~' ..". .... c:,.::::,Oj' _'~'_-_.~_,~.'.";' __'';~~f52.~:'.{tf,-,..., .', .~.S:i:f~;~~~~~f'~l~t~:h~~, . ' '':;;'11I'' ""'.. .. '''r'~'; '~'.,,, ,-,.,.. .' .""'..<"-~;'<--,.,. _'.,....::.:.1 .' -- ._;,l.,,", 1:.",\::.--",.~ ~ ~ . ~ .''''-''~f' '-:lIo.i~US!i~Y Y' ~~-...' 0/(\ > :~r': l!E:?,~~"~CAt-PERMIT APPLICATION <":~~":;;:rt:\'};~ :~ -.,: ~ ~ ~:t'..::;;] ~'~1r.~:" ~ ,.=~.:~'~" '.... :.i~.. ~'~. ..}.:.:;:;-=-~.... ,~~--'~:'~~II~C1rUlllJstbe.flIlMOl1tClm1DleteIv. :~~-;. '7-=;:~t~~ ~.....i< .,..~ i_ ~f!!. O",=k:;_ . . ......; . '." .:/ !>63 -00 "P~~.ot.~fr"'nt. IfYllUhavU!lYQUM1Iou,pleasai:alI(36G)4~T~S,'. (/7- . ~:'.-,~';i;,,~,{1-'lAA:"'~~,'- 'Faxl\lllllber.~l417-4111..', '. ~ .,. .<-', _. . ';:-'h"""_S'; >-."'=.,~..,-,~~.____ ,,_. _u_ ...... ::':Bii<'C'" ~':'1';" '-":,-;;~.... ". . . ..' .....,.,..... '. "'::,' V' ,'. ':'~":i.."". '~'i>~C""'t':"r"l'C:" ..,. 452-9104,,,:,;;';-'~i':4'57-=469B ." Owner<<~OIntradorAgent: -.: :?~:~':_.:~;'~~"">r....~:".'-:. '~hOna: .' ,..' ..::'"7fm.::'.;'.,,. . ....". 'fiJ'j'l ."".~... .,.........RlJ1 t:h .""..,.... ...... . . I ' .' ..,.........;. ,-'" ,,'... . I .......,-:<.,.. "--'-Owner: I '.''',' ".. .. .' . . ", p_-. . ......~." "-_ .. "W<. . ,'_, ,.~. . .... \ 2-1 a1.~'~:;';;;';i:;;&';;::::'" . .,.... --pA- . ,. '.~~;;;~.--:~ .-:::C-,__~. s't:i:'ait~c:i~'l~i:~~,I:, .,~ U~,,-l?~.r:~~*'O'?;.~~,(fiii{ 'c'PriOn...~52-'91 04 .~.:...:..:. ~... Box 291 A ":'~:>;:':',,',:':''''':''''''.'.:.:...., ,.....Port l!.ngeles,WA . "'ft' 96362 .......--. ......v. ."::!. ....'."............ '.'C.'."... . -v~ ""-"t'" INSTALLATlONWIREOBY, cO\ll(~i.,<,.:~.~:,~:cir1ElECTRICAl..CONT'RACTOR ... ,-,,-.. ~CardHold""N~me;3i~~~~;o:lh-e.chk ' . '. . '. .. .,.. . P.O. Box 29.1 i(.-~::~':7" '. Port Angeles. WA~. " ".' :., .98362 BtlI1ngAddres::c -.,... ...,.,.... City; . '. '-'p. . ". _..,.----..--,_. . Cn!ditCartl Number. ".'0 n'_f!,'1~::~j<:::" Er.D- D.~ . . VJ~.2 Me:_ '~Ro"ECTADDRE5S: IllS. S;,~.ui1Vlsfu..eJ- .. , "TYPE OJ: wnBK;, Check il!!.lhal apPlY: t:I New .' /i(AlrerallonlAd4itiiX.' . I'" , l(ResldIll1t1a1 tlA.. Multl-f.!mDy !J Coritmen:ial !J iO~ilE\ Home . S~R DRemoIeMeter :!JOelat:hed~ oHotTub dSIMmPool !JSeptic: nu,wVoltage DTe/ecom, QSi~ . I ' NumIleI of Circuits added Or -..d' . . 1l=-"'PTlONOFTHHJ.ECTRJCALPRoJE~; . f(f'I:la.c~v 'tNLLL+i .---1tLt: ~ ~_k+ ~. F1s.... '(5'.lofid CPnf-eflj lJlS't!LW~ A1uJiEA'~. ,~ ~ - D4 ~: en ,b.". FL..:.. :_.J HeBt Laad Additlans..n'; ""~""fru""""" . I s...;".... InfcnNIUcn a_be,,", _KW .. ----...- I . VOifSisJ'ii:;"'L"'O~ C) Fwnace .,-- tWoI . o. , .d~... SeNlce f'hase:.llt1 (J 3 [HioatPUnip _TON ~ "T~SeNlce SeNIl:e~ 4em A, :JFen-WaIJ _KW DU. .....,.lllIdSl!II'oIice FeederSlzlS' : I . tSlJO 1'\0... $"11 ,. A . '. : I . . ' r hereby cerlifY that I have read end emmined thi8 sP '!ClIlBIid know that same' to be true alid c;oneat, arid I ar. lUthoIfzed to apply forlhis permit. , utldemamJ It Is of th D I6gaJ 1Bl/POfIsibiJity to delSrmine Whatpe/lnits iIte {Squired; if remains the appRca.nts 1'G~$/b/JJty d .e; at fK'11.!'if8 BI'9 ~ endfD obtSflt ~. ,.("/0./04,, CredltCardHoId~S~~ JOh, ,r/Christte.TuCke::. Datu: . IA.-( Ownerar E1ec. CantSia I ,..'.... ,,'D8f8:~ ~ .--o-pqrtrOL <?--Jc... vJ'{;il::&;::.:, c/ . :'{,1'TP5L 7\'. .<5\[L S-rP,:u~JZ.... L/~Avt c.e. G.~ cU'~S Yc 'W1""j)~PER~UT~FEE!.~<:';u-,~. ~Q ::lEl.ECmlCAl.PERMlTAPPUCAl1ON '. . '.' ";'..,., ".'.',' . ...::, . ~~ i 9/f ~..:<c,.":.~?t :'};~t:};;ij-':, , T' Ok '~~t~lr';!i'il' .'. . 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