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Application Number . . 20-�00001059 Pat
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Application pin number 65II588 on ymx excise tax.form,
Property Address . 2122 W 12TH ST
ASSESSOR PARCEL NUMBER: 06-30-01-5-7-0400-0004 to the Ch)(of Port An9eles
Application type description ELSCTE ICAL tttdLY (Location Code 0+�Q'�)
Subdivision Name . .
Property.Use .
Property Zoning R39 RESMM SINGLE FANCILY
Application valuation 0
Application desC
DHP x'2
Owner Contractor
--- - - ---- ---------- --------------------,
TYLER a / SAMANTHA R BENEDICT BLACK DIAMOND ELECTRICAL CONTR
2122 W.12TH ST 502' BLACK DIAMOND RD
PORT AN ELES WA 98363500.9 PORT ANGELES WA 98363
(360) 460-4635 (360) S65-1035
Permit ELECTRICAL ALTER RESIDENTIAL
Additional dese
Permit iFee 6t,,0 .Plan Check Fee .00
Issue date 9/14120 Valuation 0-
Expiration Date
tty Unit Charge Per Extension
1.fl4 5.0000 ECH .'.AL-ECH ADDNT BRANCH CIRCUIT. 5.00
2.64 63.0000 ECH' EL-R BRANCH CIR WO/ SER FEED 63.00
Fee.sumtlmry` Charged' Paid Caredited Due
----�-------- ---------- --- ------ ----- -- --
Permit; Fee Total 6800 68.a0 .00 .00
#'lass Choi, Total � b0 E10 .00 .00
4tan4;,,total 68.00. 68-.00 .00 .00
INSPECTION T ;E DATE: RESULTS: INSPECTOR:
DITCH
SERVICE
ROUGH-IN-
FINAL
COMMENTS. .
PERMIT WILL EXPIRE S1X 6j M€?I S FROM LAST INSPECTION
Signatum of owner'dr-,Eje*j61 Contractor X Date:
c > �
1 - 2 SINGLE-FAMILY
ELECTRICAL PERMIT APPLICATION 3
Public Works and Utilities Department.
321 E. 5th Street, Port Angeles, WA 98362.
360.417.4735 1 www.cityofpa.us ( electricalpermits@,cityofpa.us
Project Address: 2122 W 12th
Project Description: Ductless x2 �w
n Single-Family Residential ❑ Duplex/ARU Building Square footage: �✓C�
OWNER INFORMATION
Name: Benedict _Email:
Mailing Address: Phone:360-460-4635
ELECTRICAL CONTRACTOR INFORMATION
Name: BDE License: BLACKEC894D2
Mailing Address: Expiration Date:
Email: Phone:360-461-3957
PROJECT DETAILS
112M Unit Ch2rae Quanthy Total(Quantity x Unit Charge)
Service/Feeder 200Amp. $120.00 $
Service/Feeder 201-400 Amp. $146.00 $
Service/Feeder 401-600 Amp. $205.00 $
Service/Feeder 601-1000 Amp. $262.00-- $
Service/Feeder over 1000 Amp. $373.00 $
Branch Circuit W/Service Feeder $5.00 $
Branch Circuit W/O Service Feeder $63.00 1 $
Each Additional Branch Circuit $5.00 1 $
Branch Circuits 1-4 $75.00 $
Temp. Service/Feeder 200 Amp. $93.00 $
Temp. Service/Feeder 201-400 Amp. $110.00 $
Temp. Service/Feeder 401-600 Amp. $149.00 $
Temp. Service/Feeder.601-1000Amp. $168,fiJ0 $
Portal to Portal Hourly $96.00 $
Signal Circuit/Limited Energy-1&2'DU. $64:00 $
Manufactured Home Connection $120.00 $
Renewable Elec. Energy: 5KVA System or less $102.00 $
Thermostat(Note: $5 for each additional) $56.00 $
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-
46B,The City of Port Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications.
9-16-20 Benjamin Shamp
Date Print Name Signature(;6 Owner ❑ Electrical Contractor/Administrator)
[Electrical Permit Applications maybe submitted to City Hall or electricalpermits@cityofpa.us or faxed to 360.417.4711]