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MY OF PORT ANGELES
360417-4755 -10
Application Number . . . . . 20-00001309 Date 11/12/20
Application pin number . . . 693786
Property Address . . . . . . 433 E 8TH ST
ASSESSOR PARCEL NUMBER: 06-30-00-0-2-2895-0000-
Application type description ELECTRICAL ONLY
Subdivision Name . . . . . .
Property Use . . . . . . . .
Property Zoning. . . . . . . . COMMERCIAL NEIGHBORHOOD
Application valuation . . . . 0
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Application desc
Door opener
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Owner Contractor
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CLALLAM COUNTY PUBLIC HOSPITAL SIMPSON ELECTRIC
939 CAROLINE ST 243036 W HWY- 101
PORT ANGELES WA 98362, PORT ANGELES WA 98363
(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 . . . . 11/12/20 Valuation . . . . 0
Expiration Date 5/11/21
Oty Unit Charge Per Extension
BASE FEE 86.00
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Fee summary Charged Paid Credited Due
----------------- ------ --- ---------- ---------- ----------
Permit Fee Total 86.00 86.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 86.00 86.00 .00 .00
)REPORT SALES TAX
on your excise tax form
to the City of Port Angeles
(Locatfon Code 0502)
INSPECTION TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE
ROUGH-IN A, I--
FINAL
COMMENTS:
PERMIT WILL EXPIRE SD((6)MONTHS-PROM-LAS,too"rRON
Signature of owner or Electrical Contractor X Date:
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Pubilt: Works awd I[Jtifitlies Depitrtment
121 F_ 5111 Street, Port Angeles, WA IW02
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3 60.417,473 www.city0fpums,
Prolect Address:
Project Description:
ED Mufti-Family Residential t;r commercial/Industrial I Public Building Square footage:
Name: --
Mailing Address: _Phone:, V_
ELECTRICAL CONTRACTM INPORNIAT[ON
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Name: cenw,
Mailing Address- ,;,. �=Lf-T, 99vi"A Expiration Date: /.9-
Email:. Phone. � 7
Unit ChaMe)
$
Service/Feeder 260 Amo; s0i
;'
ServicetFeederi6i4i Amp6
ServicalFeeder 401-6WAmp, $225.00
SeMee/Feeder 601-1000 Amp. $288.00
ServicelFeeder over'l 00()Amp. $410"00
Branch Circuit WWI Service Feeder $5.00
Branch Circuit W/O Service Feeder $74.00 $
Each Additional Branch Circuit $
Branch circuits 1 $
Temp.SerAce/Feeder 200 Amp. $142.00 $
Temp. Service/Pedder 201-400 Amp. $121.00
Temp.Servioe/Fsader0l-W Amp, $14"!9_0
Temp.SerAWFeade0 601,71,000 Amp. $186.00,
Portal to Portal Hourly
Sign J Outline Lighting sm.,00:
Signal CircultlLimited Energy�,Mu*fqft 488,001
Signal CircuitlLimited Jnergy 60,"d�ca—mmov-clef, 'W
(Note-$6.00 for each idti&;i-itlki. 7
Renewable E100,Energy:5KVA Systi orless $
Thermostat(Note, $5 for each additional) $
$ P4 TOTAL
Owner as defined by FtCW.19-28.2e1 t(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
SM malting the electrical Installation or alteration in compliance with the electrical laws,N.E.C.,RCW.Chapter 19.28.WAC.Chapter 29&
46B,The City of Port Angeles Municipal Code,and Utility Specifications and PAMC 14'.6.050 regarding F.Jectrical Permit Applicadons.
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Date Print Name Signature(Ea) Owner-E] Electrical Contractor I Mministrator)
[Electrical Permit Applications may be submitted to City Hall or eJectt1calPermits@cjtyofPa,Vs or faxed to 360.417.4711]