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00 ! CAL PERMIT 1
CITY 6 PORT`AN'OELES T-
360-417-4735 360-417-4735
Application Number 19-00001655 Date 10/25/19
Application pin number 166755 REPORT STATE SALES<TAX
Property Address . . . . . . 200 W 1ST ST
ASSESSOR PARCEL NUMBER: 06-30-00-0-0-3300-0000- on your excise taX f
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Application type description ELECTRICAL ONLY to the City of Port Angeles
Subdivision Name (LOCafFOR Code 0502)Property Use . . . . . .
Property Zoning . CENTRAL BUSINESS DISTRICT
Application valuation . . . . 0
Application desc
Deli Lights r
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Owner Contractor
JOHN J & ROBIN R MILETICH SIASPSON ELECTRIC
312 RED DEER DR 243036 W HWY 101
PORT ANGELES WA 98362 PORT ANGELES WA 98363
(360).452-7175 (360) 457-9270
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Permit . . . . ELECTRICAL ALTER. COMMERCIAL
Additional desc 1-4 CIRCUITS,
Permit Fee . . . "86.00 Plan Check Fee .00
Issue Date -10/25/19 Valuation . . . 0
Expiration Date 4/22/20
Qty Unit Charge Per - Extension
BASE FEE 86.00
Fee .summary Charged Paid Credited Due
Pere Fee Total 86.`00 86.00 .00 :00
Plan Check Total .06 .00 .00 .00
Grand Total 86.00 86.00 .00 .00
INSPECTION TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE
ROUGH-IN
FINAL
COMMENTS:
PERMrr WILL EXPIRE SIX(6)MONTHS MOM LAST INSPE MON
Signature of owner or Electrical Contractor X Date:
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MULTI-FAMILY / COMMERCIAL
ELECTRICAL PERMIT APPLICATION
Public Works and Utilities Department
21 E. nth Street. Port Angeles. W"A 98362
360.417A7.35 1 vvtivv.cityofpa.us clecti-icatircr•irtits(:i`cityofpa.us
Project Address: Country Aire Natural Foods 200 W 1st St. Port Angeles, Wa 98362
Project Description: Altering 2 circuits in the deli for lights
El Multi-Family Residential 0 Commercial/Industrial/Public Building Square footage:
77
OWNtR JN FORMATION
Name: John Miletich Email:
Mailing Address: 312 Red Deer Dr Phone: 360-457-9348
ELECTRICAL CONTRACTOR INFORMATION
Name: Simpson Electric LLC License: SIMPSEL973RQ
Mailing Address: P.O. Box 1086 Expiration Date: 12/11/2021
Email: dlsimpson5l@gmail.com Phone: 360-457-9270
PROJECT DETAILS
j Unit Charge Quantity TQtal(Quantity x Unit Charge)
Service/Feeder 200 Amp. $132.00 $
Service/Feeder 201-400 Amp. $160.00 $
Service/Feeder 401-600 Amp. $225.00 $
Service/Feeder 601-1000 Amp. $288.00 $
Service/Feeder over 1000 Amp. $410.00 $
Branch Circuit W/Service Feeder $5.00 $
Branch Circuit W/O Service Feeder $74.00 $
Each Additional Branch Circuit $5.00 $
Branch Circuits 1-4 $86.00 1-4 $ 86.00
Temp. Service/Feeder 200 Amp. $102.00 $
Temp. Service/Feeder 201-400 Amp. $121.00 $
Temp. Service/Feeder 401-600 Amp. $164.00 $
Temp. Service/Feeder 601-1000 Amp. $185,00 $
Portal to Portal Hourly $96.00 $
Sign/Outline Lighting $88.00 $
Signal Circuit/Limited Energy-Multi-Family $88.00 $
Signal Circuit/Limited Energy/First 1500 sf Commercial $96.00 $
(Note: $5.00 for each additional1500 sf)
Renewable Elec. Energy: 5KVA System or less $113.00 $
Thermostat(Note: $5 for each additional) $56.00 $
$ 86.00 TOTAL
Owner as defined 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., RCW.Chapter 19.28,WAC.Chapter 296-
466,The City of Port Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications.
10/23/2019 Andrew P Simpson
Date Print Name Signature([:] Owner V Electrical Contractor/Administrator)
[Electrical Permit Applications maybe submitted to City Hall or electricalpermits@cityofpa.us or faxed to 360.417.4711]