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MAMMAL PERMIT
C�'4*f0R ANGELES t_ C
�"7-4735 •�
Aiic2ation Number . . 19-00002014 Date 12/19/19
Apply cation pin number 099588 REPORT STATE SALES TAX
Property Address . . . . . . 1812 W 12TH ST on your excise tax form
ASSESSOR PARCEL NUMBER: 06-30-00-0-3-6212-0000-
Application type description ELECTRICAL ONLY to the City-ofPort Angeles
Subdivision Name (Location Code 0502)
Property Use . . . . . .
Property Zoning .. . . . . . RS7 RESDNTL,SINGLE FAMILY
Application valuation 0
Application desc'
DHP----------------------------------------------------------------------------
Owner Contractor
JEDEDIAH JOHNSON BLACK DIAMOND ELECTRICAL CONTR
PO BOX`'422 502 BLACK DIAMOND RD"
NEAH BAY WA 98357 PORT ANGELES WA 98363
(360) 640-4234 (360) 565-1035
^permit . . -. ELECTRICAL ALTER`RESIDENTIAL
Additional desc
Permit Fee 63.00 Plan Check Fee .' .00
IssuO.Date 12/19/19 Valuation 0
Expiration Date 6/16/20
4ty Unit Charge Per Extension
1.00 63.0000 ECH EL-R- BRANCH CIR WO,/ SER FEED 63.00
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Fee summary Charged Paid Credited Due
--- -------- ---
Permit'Fee 'Total 63.00r 63.00 .00 .00
Plan Check Total .00 00 .00 .00
Grand Total 63.00 63.00 .00 100
INSPECTION TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE
ROUGH-IN !
FINAL ,
I I
COMMENTS:
PERMrt WILL WERE SIX(6)MONTHS FROM LAST 04SPECTION
Signature of owner or Electrical Contractor X Date:
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ELECTRICAL PERMIT APPLICATION
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Public Works and Utilities Department
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321 E. 5dh Street, Port Angeles, WA 98362
300.4\74735 � vvwvvcbvofpauu � ck:c{hodporn\it«Caci fpn.us
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Project Address: ^ `� —~
OWNER INFORMATION
Name: Email:
Mailing Address: Phone- 34,o- 690- 42-31
ELECTRICAL CONTRACTOR INFORMATION
Name: License:
Mailing Address: Expiration Date:
Email: Phone
PROJECT DETAILS
Item Unit Charge Quantity !QW(Quantity x Unit Charge)
Service/Feeder 200 Amp. $120.00 $______
Service/Feeder 2O14OVAmp. s146.00 $----_-____
Service/Feeder 4O1-OV0Amp. $205.00 ----__ $_----____-
Service/Feeder 0O14000Amp. $202.00 _---__ $------____
Service/Feeder over 18OUAmp. $373.00 _----_- o_-__-____
Branch Circuit W/Service Feeder *5.00 $_---___---
Branch Circuit WIO Service Feeder $03.00 _���= $------__--_
Each Additional Branch Circuit $5�00 _---__- $-----_____
Branch Circuits 14 $7500 $_-----__-_'
Temp. Service/Feeder 2OV Amp. $93.00 ----__- *
Temp.Service/Feeder 2O14OUAmp. $110.08 $__________
Temp,Service/Feeder 4O1'6OOAmp. $149.00 $__________
Temp. Service/Feeder 6O1'1OVOAmp. $188.00 $_---_____
Portal tu Portal Hourly *96.00 $___________
Signal Circuit/Limited Energy'1&2DU. m94�00 $_________
Manufactured Home Connection $120.00 $-----__-__-
Renewable Elec. Energy: 5KVA System orless $102.00 $_--__-___
Thermostat(Note: $5 for each additional) $58.00 $-----___---
First 138O Square Feet $120.00 $_-----____
Each Additional 5UU square feet- $40.00 $_-__-__-_'
Each Outbuilding/Detached Garage $74.00 _---___ *_----____
Each Swimming Pool/Hot Tub o110.00 *
TOTAL $---�a��-__'
Owner am defined byRCVK1S.28261:(1){xwnarwiU occupy the structure aorwvoyeamafte,thioe|axthoa|pennhia5no|ized.(2)[wmeris
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. 296-
46B,The City of Port Angeles Municipal Code, and Utilit S cifications and
PAMC 14.05.050regarding Electrical Pe it Applications.
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Date Print Name ,�/ k signature'0r" Owner FJ Electrical Contractor/Administrator)
[Electrical Permit Applications may be submitted to City Hall or electricalpermits@cityofpa.us or faxed to 360.417,4711