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Application Number . . . . . 19-00001104 Date 7/24/19`
Application pin number . . 938880 RE"T STATE,S'ALM TAX
Property Address . . . . . 907 GEORGIANA ST
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ASSESSOR PARCEL•NUMBER: 06-30-00-5-8-0145-0000=
Application type description- ELECTRICAL ONLY to the City of Port Angeles
Subdivision Name . .
Property Use . . . . . (Location Code 0502)
Property Zoning . . . . . . COMMERCIAL OFFICE
Application valuation . . . . 0
Application desc T
Eternet wiring X-ray
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Owner+ Contractor
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CLALLAM CO HOSPITAL DIST #2 ANGELES CONIIMISATIONS INC.
93-9 CAROLM,ST 102 ROSS LN:
PORT ANGELES, FTA 983623909 PORT ANGELES, WA'
PORT ANGELES WA 98362
(360)' 457-4375
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Permit . . . . ELF41MCAL ALTER COMMERCIAL
Additional desc .
Permit Fee 96.00 Plan Check Fee .00
Issue Date . . . 7/24./19 Valuation 0
Expiration Date 1/26/20
Oty Unit Charge Per Extension
1.00 96.0000 BCH EL-LIMITED 1ST 2:500 So FT 96.00
Fee summary Charged Paid Credited Due
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Permit Fee Total 96.00 3640. .00 00
Plan Cheek Total . Ab 00 c00 .00
Grand Total 96:00 96.00 .00 .00
INSt' I'IQN" #'E DATE: R>~SSMTS: INSPEC'110FL.
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P'EUW WILL EXPIRE SIX(6)MONM FROM LAST INSPECTION
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Signature of owner or Electrical Contractor X Date:
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RECEIVED MULTI-FAMILY / COMMERCIAL �U[ ? Jy0� �
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ELECTRICAL PERMIT APPLICATION �
Ptiblic Works and Utilities Department 'M
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121ESdh Street, Port Angeles, W.\98362
360-417.4735 1vvNvw.cityohpuus | e|ocbicw|perm itn��`it'o|pa.its
Project Address: um' Geo
Project Description: Ethernet Wring
[] Multi-Family Residential 91 Commercial/Industrial/Public Building Square footage: Project Area<1500sf
OWNER INFORMATION
Name: Olympic Medical Center Email: rgaieaoiympicmedicai.org
Mailing Address: 939 Caroline St. Port Angele ,WA 98362 Phone: 3604177000
ELECTRICAL CONTRACTOR INFORMATION
Name: Angeles Communications License: .601386512
Mailing Address: 102 Ross Lane Port Angeles,WA 98363 Expiration Date: 20 April 2020
Email: don@angelescommunicabons.com Phone: 3604674375
PROJECT DETAILS
item Unit ChaMW QUarytft T9_W(Quantity x Unit Charge)
Service/Feeder 200 Amp, $132.00 $
Service/Feeder 201-400 Amp. $160.00 $
ServicetFeeder 401-600 Amp. $225.00 $
Service/Feeder 601-1000 Amp. $288.00 $
Service/Feeder over 1000 Amp. $410.00 $
Branch Circuit NKService Feeder $5.00 $_________
Branch Circuit W/O Service Feeder *74.00 $
Each Additional Branch Circuit $5.00 $_________
Branch Circuits 1-4 *8100 $________
Temp.GemicelFeoder28OAnp, 02.00 $
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Temp.Gep�m�Foedur2D1~0OAmp. x121.00 s
Temp.Service/Feeder 4O1-6V0Amp. $164.00 $______--__
Temp. Service/Feeder 801-1ODOAmp. $185D0 $____---__
Portal hoPortal Hourly $SGVO �
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Sign/Outline Lighting %88.08 �__ $________
Signal Circuh8jmitedEnergy-Multi-Family '.�$OOOO � . - n -°
8gnal0muittLmited Commercial $96.00 -Xo96
(N�e.-$iUOfor each additional 150Do0
Renewable Elec. Energy: 5xVASystem orless $113.00 ' *
Thennostat(Note: $5for each additional) ` '&56.00 `` $
* 96LTOTAL
Owner asdefined by RCW 19,28.261: (1)Owner will occupy the structure for two years after this electrical permit is finalized.(2)Owner is
required to hire an electrical contractor if above said property is for sale, rent or lease. Permit expires after six months of last inspection.
After reading the above statement, I hereby certify that I am the owner of the above named property or a licensed electrical contractor, I
am maKing the electrical installation or alteration in compliance with the electrical laws,N.E(C., CVV VVACChapter 2963-
46B,The City of Port Angeles Municipal Code,and Utility Specifications and PAMC 14 05 50 r i Electrical Permit Applications.
19 Jul 2019 Dld Simpson
Date Print Name Signature(F-1 &ML_O�Ilectrical Contra�'�
[Electrical Permit Applications may be submitted to City Hall or electricalpermits@cityofpa.us orfaxed hz3SD.417.4711]