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FEE RECEIPT NUMBER
CITY OF PORT ANGELES
DEPARTMENT OF LIGHT
APPLICATION AND ELECTRICAL PERMIT
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PERMIT NUMBER
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, TOTAL'FEE /5: ~O' ~ DI5' ~),t '
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CO~T. LtC. NO. TIMETOCOMPLETE NO. STORIES LEGAL OCCUPANCY
ELECTRICAL PERMIT '6NL Y NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT
Site Address 3/0 v.Jc;r V=rtl,V'Vj-
CORRECT ADDRESS 1$ RESPONSIBILITY OF APPLICANT PERMITS WITH WRONG AD
Own~r C.I1' 11_ C,..t;J ,..'"
Owner's Address ,~/O W~'t- ';='rn->'\"'-
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Installation By
Installers Address
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Day Phone.. Installers Phone
Application is hereby made for Permit to Install Electrical Equipment as follows:
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Wiring Math.o.d
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NUMBER AMP 120V 240V NUMBER AMP 120V 240V
USE OF CIRCUIT PER 100A FEE USE OF CIRCUIT PER 100R FEE
CIRCUITS CIR 10 30 CIRCUITS CIR 10 30
LIGHT SIGN
liGHT' - , 50 VOLTS
OR LESS
CONVENIENCE MOTOR
CONVENIENCE - MOTOR .
APPLIANCE , . MOTOR
DISHWASHER FIRE ALARMS
DISPOSAL BURGLAR ALARM
RANGE MISC.
OVEN
WATER HEATER
LAUNDRY
DRYER REINSTALLATION LIGHT FIXTURE # -
FURNACE SUB TOTAL FEE 1
GAS. OIL
FURNACE ENERGY FEE
ELECTRIC - - -
BASIC FEE
ELECTRIC HEAT
TOTAL FEE
ELECTRIC HEAT SIZE OF SERVICE SWITCH OR CIRCUIT BREAKER
A.C. UNIT QCH\ AMP / /if _ PHASE
FEEDER SIZE OF SERVICE ENTRANCE CONbuCTORS
SERVICE AW.G.
I SUB-TOTAL - ID
SIZE OF GROUND SIZE OF ENTRANCE SWITCH
I certify that the work to be performed under this permit will be done by the installer and in conformance with the N.E.C. Electrical Code.
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1!6NTRACTOR OR OWNER A AUTHORIZED AGENT)
Permission is hereby given to do the above described w.ork, according to the conditions hereon and according to the approved plans and:'
specifications pertaining thereto, sUbject to compliance with the Ordinances of the City of Port Angeles.
. DIRECTOR OF CITY LIGHT
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Date Application made
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Date Permit Issued
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By 47J!
PLANS APPROVED
Notify Department of City light by Street Address and Permit Number when ready for inspection. Work must not
_ be covered or c~rrent turned on before inspection and O.K. for covering or service has been given by Inspector in
Writing on Permit Placard, A. ' Permits Phone: 457-0411 Ext. 158.
PERMIT PLACARD MUST BE KEPT POSTED ON THE WORK - SEE OVER _
WHITE. Original CANARY. Duplicate PINK - Triplicate WHITE CARD -Inspector's Report
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REPORT.OF INSPECTOR
DATE OF VISIT MADE BY REMARKS
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O.K. FOR COVERING
\~hll\'l.., 1/J.. O.K. TO CONNECT SERVICE
FINAL O.K.
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