HomeMy WebLinkAbout1721 E 5th St - Building
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FEE RECEIPT NUMBER
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CITY OF PORT ANGELES
DEPARTMENT OF LIGHT
APPLICATION AND ELECTRICAL PERMIT
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PE! IT NUMBER
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2~3 till .. . .
TOTAL FEE /p. .
CONT. LJC. NO. TIME TO COMPLETE NO. STORIES LEGAL OCCUPANCY
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ELECTRICAL PERMIT ONLY NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT
Site Address -; 7 Z I FA <;7 5/;f
CORRECT ADDRESS IS RESPONSIBILITY OF APPLICANT PERMITS WITH WRONG ADDRESSES ARE CANCELLED
Owner RCJA'FRT FRJrk.'5".oN' . l~stallation'BY 0 I//JLI/tJR.~;:;:)1 <; s:LFr"TR/L
Owner's Address /'72/ &hST .k;"'IT InstailersAddress /1i?/"'w 1/17
DayPhone4Fi'2 '"' E22/" InstailersPhone . 4;:;'1 -I7R<"1"3
Application is hereby made for Permit to i~~tall EI.~ctrica!Equipment as follows: r',1;(4A/r. E S'I Z Ii! of <S' E'RV /elF'
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Wiring Meth~d
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AMP 240V NUMBER AMP 120V . 240V
USE OF CIRCUIT NUMBER PEA- 120V-- 100R FEE USE OF CIRCUIT . PER 100R FEE
CIRCUITS CIR 10 30 CIRCUITS CIR 10 30
LIGHT SIGN
... . 50 VOL T8 - . .
LIGHT OR LESS
- . -- . -c- MOTOR- .. .. - .. -- 0
CONVENIENCE
.CONVENIENCE . .- . MOTOR .. . . ..
APPlIANCL . ~ . . .. . .. MOTOR .. ---- .. ---- .
DISHWAS,ttER .. .. - FIRE ALARMS O. - . . .
_...
DISPOSAL BURGLAR ALARM
. . .. .
RANGE MISC.
. . - .,
OVEN
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WATER HEATER
: LAUNDRY 0 0 . .
DRYER - .. .. REINSTALLATION LIGHT FIXTURE # 0 0
FURNACE - . SUB TOTAL FEE . . .
GAS - OIL
FURNACE ENERGY FEE
ELECTRIC .. . . ..
BASIC FEE
ELECTRIC HEAT . .. TOTAL' FEE .
ELECTRIC HEAT SIZE OF SERVICE SWITCH OR CIRCUIT BREAKER.
A.C. UNIT 200/t- . AMP. . . I ~ . PHASE
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FEEDER SIZE OF SERVICE ENTRANCE CONDtlCTORS
.. 4/0 AW.G. AJL..
SERVICE
I SUB. tOTAL SIZE OF GROUND SIZE OF ENTRANCE SWITCH
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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.
Date Application made
MtJt/ AI>>'
,19 9/:; By
TRACTOR OR OWNER (OR AUTHOR!ZED AGENT)
Permissio,!.is hereby given to do,the above described work, accord!ng to the.conditions hereon and according to the approved plans and
specifications pertaining thereto, subject to compliance with the Ordinances of t~e City of Port Angel~s. ~ ) '~ -;? r"\- \'
. . . . . . . . DIRECTOR OF CITY (IGHT '.
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By
PLANS APPROVED
~. Date Permit Issued
Notify Department of City Light by Street Address and Permit Number when ready for inspection. Work must not
be cover~d or. current 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.
WARNING
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
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DATE OF VISIT MADE BY REMARKS
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, LIGHT LIGHT 0
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TURN ON WATER 0 Date SHUT OFF WATER 0 \
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NAME ADDRESS ACCT. NUMBER
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" s 1"'1.!. DEPOSIT
, >. Mailing Address AMOUNT
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, .. The undersigned hereby makes application to the City of Port Angeles for Utility Service subject to the terms and conditions
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- ;;; of applicable City Ordinances which are hereby agreed to and are made a part of this application.
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", ~ NEW APPLICANTS:
i~ EMPLOYER ADDRESS
I '-I S-)-)1::.l to "f f(('(C'~'.vr'CT I1Lt-r~""'rJ .5 -(, 171/" ,(
-;' PHONE NO. 'J3, o~ //I",'<,J/
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I: 8 OWN 0 0 PROPERTY OWNERS NAME
RENT
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E PREVIOUS RESIDENCE
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I., ;;, APPLICANT ACKNOWLEDGES RECEIPT OF A COPY OF "CITY OF PORT ANGELES, GENERAL
.,; e INFORMATION RESIDENTIAL UTILITY SERVICE".
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I~ ~ ~ SIGNATURE , Date
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I ;:;1 Ol-YMPIC PRINTERS, INC.
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'( -(~, <6'<)' 4!,I'::!J O.K. FOR COVERING
'j-/'6/ rs- /JJ/ J O.K. TO CONNECT SERVICE
If ;J,.}, - 'Dr /jlLJ? FINAL O.K.
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