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HomeMy WebLinkAbout224 E 10th St - Building CITY OF PORT ANGELES PUBLIC WORKS - ELECTRICAL DIVISION 321 EAST 5TH STREET. PORT ANGELES. WA 98362 ELECTRICAL PERMIT ISSUED: 11/13/2002 PERMIT NO 7902 OWNEPJAPPLICANT PROPERTY LOCATION DAN HENDRY 224 10TH ST E 224 E 10TH STREET Lot: 4 Port Angeles, WA 98362 Block: 329 Long Legal 360/452-4405 Subdivision: TPA T: S: Parcel No: 063000032915000 CONTRACTOR ARCHITECT APS ELECTRIC N/A 546 BENSON RD. PORT ANGELES, WA 98363-0000 , 98360-0000 360/452-6753 360/000-0000 PROJECT INFO Project Type: RES. MISC. Project Value: $0.00 Occupancy Type: Construction Type: GARAGE Occupancy Group: Zoning Use: ~r, Electrical Heat: ill Baseboard 0 KW Riser · Underground Service ~ il Furnace 0 KW Overhead Service Voltage: 120,240 i I HeatPump 0KW ~ TempService Phase: ~ 1 ~J 3 (-3 ---- · Fan Wall 0 KW Service Size: 0 Feeder Size: 100 PROJECT NOTES DETACH GARAGE. RECEIPT # 9795 ~'~ FEES ASSESSMENT Service: $0.00 Additional Feeders: $0.00 Circuit Wiring: $46.70 Tern p Service: $0,00 Misc Fee: $0.00 TOTAL FEE: $46.70 AMOUNT PAID: $46.70 BALANCE DUE $0.00 COMMENTS/ACTION NEEDED ELECTRICAL PERMIT INSPECTION RECORD CALL 4 ! 74735 FOR ELECTRICAL I~SPECTIONS. PLEASE PROVIDE A IvflNIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO CO VER, INSULATE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED. ~EP PE~T C~ ~ ~PRO~D P~S AT JOB S~E 7 ~ ~ DITCH ROUGH-~ / CO~R SER~CE ~n~A~ I t,/~/o'/I GENERAL COMMENTS: fa ~~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNlTYDEVELOPMENT - BUILDING DMSION 321 EASTS:mSTREET,P0RT ANGELES, WA98362 BUILDING PERMIT OWNER/APPLICANT DAN HENDRY 224 E10TH STREET Port Angeles, WA98362 360/452-4405 T: CONTMCTOR OWNER VARIOUS Port Angeles, W A 99360 206/000-0000 PROJECT INFO Project Value: $4,500.00 Project Type: GARAGE NEW Occupancy Type:' RE~IDENTIAL Occupancy Group: Construction Type: Zoning Use: ISSUED: 71.0112002 PERMIT NO: 13520 PROPERTV']f6CATlON 224 10TH ST E ,.., " ].,,,,,,,';'~,4;t:;.,,,..,..~ Lot: 4 "Block: 329 D Long Legal SuBdivision: TPA ParcelNo: 063000032915000 S: ,'P ~ -l:... . 983qO-OOOO 360/poO-OOOO SFD Units: SFD sa FT: o o Commercial: Indusbial: Garage: MFD UnitS: MFD sa FT:.' o o PROJECT NOTES CONSTRUCT NEW 672 sa. FT. DETACHED GARAGE. RECEIp'Ttt9261 FEES ASSESSMENT Building Permit: Plan Check: State Surcharge: House Moving: Manufactured Home: Sign: Plumbing: Mechanical: Radon: $111.25 $44.50 $4.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 ,..(, ". Mise Fee 1: ,'.Misc Fee"'2: Mise Fee 3; ?~:, .~ $0.00 $0.00 $0.00 "" ~ ~ ,. J": ';' IQTAL FEE: . AMOUNT PAID.: BAtANCE DUE: $160.25 $160.25 $O~OO Separate Permits are required for electrical work, SEPA, ShQrelloe.1ESN:uijlitie~H.lrivate and public impl'Qv~ro~I]~. 1l1i!) RlrmJl~comes null and void if work or construction authorized is not ,commenced withm 180 daYSfif construction or work Is suspend,.d~...abandoned for a period of 180 days after the work as cornmenged, or if required Insp~ctlons have not been requestedwithln 180da~fromthe last Inspection. I hereby certify that I have'readand~xarrilned1til~'apj3lrcatlo'1 anStkhowthe'same to oeiftrtJe ahd'lm,I1'8t;t.AtiproV1$lonsof laws and ordinances governing this type ofwQrk will be compli~ with w~etherspecjfied herein or 0 The g . ting~'f'il';~ermlt(foes not presume. to give . authority to violate or cancel the provisions of any state.' or 10 I law regul 9 nstru on or the performance of construction. ' f . j' '~,.i,t.;. . Signature of Contractor or Authorized Agent., T:\PLANNING\FORMS\1102.1 S [412002] ;;"': 'c Date -. '2 "':l-C:::f~:..:_ Date "''0(-7';;';..,' ~('~~'_' ~ BUILDING PERMIT INSPECTION RECORD "t c ,. ~ ' " ~ l' CALL 417-4815 FOR BUILDING INSPECTIONS. PI;EASE PROVIDE A MINIMUM24 HOUR NOTICE. IT IS UNLAWFUl;. TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED ANDACCEPTED.POST PERMITINA CONSPICUOUS LOCATION. ~.~ KEEP PERMIT ~~,AND.'~~rROVED PLANS AT JOB SITE , DATE..;. , ~FAOCEPTED );0;::" '\' t YES NO ',c. ,i..; " . "'J-!J...3:-cJ12 ~ " .". . , COMMENTS " I ~I , INSPECTION TYPE ,. oft FOUNDATION: FOOTINGS WALLS .' ~$Ic::J:> FouNDATION DRAINAGE ;; ,~ A".'a. ,n 'I':V" , ,ii' ' .... " ELECTRI~ (LIGIIf DEP1). SEPARATILPERMIT: # . .... .' .., ROUGH-IN I PLUMBING UNDER FLOOIt/ SLAB ROUGH-IN ... . I 4 ":;' ... . ...", . ,. . WATER LINE GAS L~ BACK FLOW / WATER AIR SEAL '>.' ".." '. :', .,.. ... ~. . .. , " 1--'",.-. l,~>, '-1 .... i . " .. WALLS CEILING FRAMING JOISTS I.GlItDERS SHEAR WALL. WALLS / ROQFl CEILING - .. ; ~ ::::~-~ ; '. c ,,',t . I I .~ .' '" :::tl.1Z" .. .. ': . --:- ",,' .. .. DRYWALL T-BAR / INSULATION SLAB WALL/FLooRlCEILING . ,- , . I .'> :..' .-:- . .. .' "', MECHANICAL HEAT PUMP WOOD STOVE / PELLET / CHIMNEY' ". . HOOD / DUCTS PW UTlLmES / SITE WORK (Engineering Di~fon) SEPARATE PERMIT #'8: WATERLINE/METER . c_ o .' ." SEWER CONNECTION SANITARY STORM__...~~_.. '0," " ..." PLANNING DEPT. SEPARATE P!RMIT#'s PARKINGILIGHTING LANDSCAPING .. . :': ',; ;'! ',':' .J,:r . 'oO .., '.' .' ., , . .' " .' . SEPA: ESA: SHORELINE: PLA~G DEPT. . . ,j:Fll'f~~l'1sr~9~S REQt!l~!H'.R!O~,!Q ~qJ.P,AN~I!'S';"".. '. D'AtE.JYES 'cNO' COMMERCIAL DATE v;>, " " -: ". ,,~E ...... . -"",4..l7-4735 """,s "T ,', """,ELECTRICAl. .' ,,:" "';'1'1' "',"., ^ ..LlGHT})EPT' " v . -, "CONsTROCTIoN- RW. ': PW / ENGINEERING ; ..' FIRE DEPT. '. 'tUrD/.."-;J~' " PLANNlNg~~~~;X::~"I'", ,'; ",.;'JJfJ6T.A( J<//' BUILDING ....... .. '. :. Ac.cEn'ED YES'NO I; 'i "l\i~(, ,,_c. ." RESIDENTIAL I .,"'.' , ELECWC~ - q~J:IT DEPT. CONSTRucnON~w.1 PW/ ,. ENGINEERING. .... '. 417-4807 ..', ,He ~~~ \ ,.. '( -,~.>" 417~6S3 :)417:4750 417-4815 ," .... J'.' BUILDING " " T:\PLANNING\FORMS\II02.15 (412002) I BUILDING PERMIT - APPLICATION The Building Permit Application must beftlled out completely. Please type or print in ink. If you have any questions, please call 417-4815 /.j. Applicant or Agent: "DANH1Z~)j)~Y Phone:~-(5'2-'no5 Owner: l)~-1~""~fG Y Address: 'l-J1 IS '10TH OWA.)ff~ Phone: ArchitectJEngineer: City: ?v;(~ ' 13U,LJ Zip: 9/?'362 Phone: Contractor License #: Exp: Phone: Address: City: Zip: ZONING: ~V/s,Jfl4L PROJECT ADDRESS: LEGAL DESCRIPTION: Lot: l./ Block: Zq Subdivision: CLALLAM COUNTY PARCEL NUMBER:~M-:103C1I.sa::ctredit Card Holder Name: Billing Address~-r:R )( TYPE OF WORK. . o Residential ~ New Constr. o Multi-family 0 Addition o Commercial 0 Remodel o Repair SIZEN ALUATION: h 72. SF. @ $ /SF. =.$ SF.@$ /SF.=$ SF. @$ /SF. =$ TOTAL VALUATION $ <(500. Oc de ~A ed ga..V<:tS-Q..... ORe-roof o Move o Demolition o Sign o Wood-stove o Garage o Deck o BRIEF DESCRIPTION OF THE PROJECT: }J(?~ COMMERCIAL/RESIDENTIAL: Occupancy Group: Occupant Load: Construction Type: No. of Stories: I Lot Size: iPO{) % Lot Coverage: 3 () Ie>', % . Existing Lot Coverage: J4B'{ /sq. ft. + Proposed Lot Coverage: h ,'2- /sq. ft. = TOTAL LOT COVERAGE: 2 J 5b /sq. ft. PLANNING USE ONLY: APPROVALS: PLAN Notes: BLDG. DPW FIRE ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other: OTHER BUILDING PERMIT APPLICATION SUBMITTAL: Your application and site plan must beftlled out completely to be accepted/or review. The Building Division can provide you with more detailed information on the application and plan submittal requirements. Your completed application, site plan (for additions) and building construction plans are to be submitted to the Building Division. VALUATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applicant. This figure will be reviewed and may be revised by the Building Division to comply with current fee schedules. Contact the Permit Coordinator at 417-4815 for assistance. PLAN CHECK FEE: Your plan check fee is due at the time the building permit application and construction plans are submitted. All other permit fees are due at the time of permit issuance. EXPIRATION OF PLAN REVIEW: Ifno permitis issued within 180 days of the date of application, this application will expire. The Building Official can extend the time for action by the applicant up to 180 days upon written request by the applicant (see Section 107.4 of the Uniform Building Code, current edition). No application can be extended more than once. I hereby certify that I have read and examined this application and know the same to be true and correct, and I am authorized to apply for this permit. I understand it is not the City's legal responsibility to determine wh t ermits are required; it remains the applicants responsibility to determine what permits are required and to obtain su Applicant: Date: 6 -;if o~ T:\FORMS\APPS\Buildingpennit " ~ " 'j I' , 'f 'u. 0' IO~ '''i . fIov~r; '~. I '191 ~f' , w~f}t-:,.,' :,~~ :. t(7 . tp11. ' bO' ~ ;.1 I /15' ,~t:ER'TY LIN!. {: 1Iw -IIGN7;lW. J.~f 4 107;:' . . C OF PORT ANGELES - ConIIIuctIoft Plane Th Issuance of tbIs permit bISed upon tfIesI_ spedfio ca .nd olller clIta shin not pment tbllJuildln& officIII fro thereafter requirinl the comlCtiaII If IROIS IIIIld pIa So specifications and oIIIIrdatl, . fnlaIlIfMllIInI bu' ing operations bein. carried III tIlerI8l_ whea In vio tion,. of .n codes and ordiRlIlClll of iii jIIIIsdidIon. (S ION 303(cJ . Uniform Bui1dinl COcIe.a. /""} 1 / Ap rovalOale 7-I-CYZ Br ~ - - i' <~. '$ \!S.. - -::> 0 ~ - is () u .-:t: 1t .~ \fl . ~ --- - J 11 .. I I . . I . f . ~ ~ . i I, ' i 'II . ~ ; : I ~ r ; I, ~ i: t ~ ~ [ . \ K ,~ fl. : ; i 1 ~ , ~ . i ~ j ! ~ J ( r ~ I ~ ~ , .' " f i ~ I ! I i I. { . f ~ t t f ~ . f , f t l I I \ i \ . \ I . \ . \ \ t I , ' I . ~ t 1 ; ; i . : 1. I ... . I . ; 'I i-d. j; i l .~. \.. cJ i; 1 . 'r . , 1, . : """.. .. . I . I I I I I 11 .1 . 'I .t :~ // ZI ~ .. '_/ I,h: .. ~ . ~(J.,. )). . .~_..~,/ ~ d)\@> 'J'f\Z. · 10 . . c:.. · .A"f~~ ~ ~t1 Q ssV)Jt 1".,uZf?VlJ-t$ ( · J ?~i ,/tO~r ~.J 1I&) 21 X., . ~3~('i. ."! i -: , sd1..,i) . . . c;... . "i' '~<1 ~. .~... II' , ~.J- '_n.'/ . : -z.1. [1 1'1 II . -r "1\ . !' j, ~ I IIP/ . I ;r,_Jt . ..,'.;J.. . ~)1I1 "I : i!,ll I ~:I I;WdY' I i. I ~iI)' "lit ,'III "S '1/1/ I' I !,t! 'J .1 ~ \ ~ ~ ~ ~ ~ I " " I >5 I: I~ " ~ <: '" " ~ o ~ ~I~ :J ~ , ~:"~~I~~ It~ibHi1'_~ 638.f30 /0 TH :5T. - - S 560 :-i3-0i"E: ~ 9 6 01 '3 h 1- f- BLDC.K.. 3.z.9-&l..C:r:: !e) I; , I j :? THIe, SURVE" _e ACC.OMPf-l~ av F/et.-D 'TRAveRse l"'!e-rJolQ0'5 V&JN6 A , ~ ,It.NO!QI;( g~~~~~f:f:.:~~~N. 519.55 -- (j: I.:;, .,',1'" 49.94 j'::-; ..Ill j',-N jji<r. ;-~ [:l- Z 15 !JJ ~~ ~~ -m z ..0 N~~~W --~S4."'Z-- ~,:.. -f9.V3";, __IB4I.?7~_ --NSf#o3!.OZ:w ~/9.3Z. -- I 3URV~Y OF LOT 15, BLOCK 329 IN THE. TOWNSITE OF PeRT ANGELES, CLALLA/VI COUNTY WA5HIIVGTO"J. FOQ; DWI6HT AND JULIe BONDY. DATt:; APRIL 5, 1990 '< a r C ~ rT1 ~ SU/2VCYORS CERTIFICATe THIS MAP CORRecTLY REPRESENTS A SURVEY MAD5" BY ME OR UND€R- MY DIRECTION IN CONFORMANCE WITH ] THE SURVEY RECORDING ACT AT (j) THE REQUEST CF DWIGHT AND ~ i.'~;;;; 5, 1990 f~fD 1~EJf:i~ - ~ LICENSE No 22344 DESIGNED BY. DRAWN IIY, THG~lSA /U./.It:H PLAT CHECK BY, ?e.. FINAL CHECK .", BONDY SURVEY /I TH 5T ';..,.......JO SCALe. IN ~ L 2 ~ ~I i ~i ~k :,\1) ~l., ~ V) :~ ~ 1'9 ,. I H -t=- LE~END I . ceNO"f"E.~ SET 5/.," R~8~ W'TH PLASTIC .sURvey CAp srAMP<<O .NrI- NESAIZY 2234+." AlVa 2..)( 2." GUARD POST ~ OENOTES EX/STlNe WOOD ~ENCE F<:JI:Ii!: ~U~AllON Dl,A(&RAM SG..E 'lJC::lU...JMe l(p OF ~e...,.s. ~,a. TM1~ ~" .........e ~ OI'-l "THe::. '^"~.NerR:lN c:.ooRDl~ ~TeJ"-1 6R1D, NORTH ~. AU... ~I~ ARE. ReL-A,I......e. "TO "=AID 6RID. AU. _ Dl<eTANCe.% ARE. P.e.ouc..o;u::> .on:> ~I06R'C>. /2EC0/2DING CEl2T/FlQA7E: FILED Fa2 RECCRD AT THe REQUEST CF NORTHWESTeRN TERRITOR/ES,Ij'-C. 7HIS ~04Y CF~/990 AD A7:.&/v//NUTES PAST---LO'CLXK ---./!.J!LANO RECORDED IN VOLUME..Lk.OF Su,ev.EY~ R4GE 7:1. RECORDS OF CLALLAIv1 COUNTY, WASHINGTON. -.-............. -""""T. {?p;);y cttN;Y AUDITOR @ ~ NORTHWESTERN TERRITORIES, INe. .......~---.- --.--. CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . . REQUEST: Date ,-I/-C"'2- v Time Received by Rv (phone, person) location of Work to be inspected Name of person requesting inspection Address of person requesting inspection Type 0 (circle appropriate one): Foundation aming Chimney Plumbing F~~~ TION NOT -~~ -OC-.. Time 2~ J..j E jCJ~ '-'1 ~h Phone No. ,y~... >/~( Permit No. I~z.o Final Sewer Excav. Other By Inspected: Date Remarks: ~ /:::J r/)r &,1 RESTORATION REQUIRED . . . . .. YES NO "'-o\t.l^dCs..-\~o'-'- loc...CL.l~~V\. f'l1,~u...~~ I J 10" r 'tSt I' 1.--1 to ~los~ 1-~ ptf"C)~~)I r VL~ '3 :s"ca-~ ~e.. ~ ~<:.. k ~~C\--u..~ \f'-€ ~ ~ ]: <:. h~<. k~d p f"0 Foe 1/""')1 1;\A. e. ~ea...s u..v-ec:l ~V'OLA,.oI.... C, h<4So-e- .s4- ,-~e1- Ca. ~ Ct 1 ley N.e.ed6 to ho-ve-. SWC-" ti:.j 1-0 \o~*e... p~~1y (!,o ~ ""- €.v- s) p e ~ F ","0 v\.~ c,o.... \ \. 1-0 ko ~ '"7- 11- e '2.. (l) c httSe.-- I 2.'3.4 ,6' ~ SURFACE RESTORATION: SURFACE TYPE: D Unimproved D Gravel D Asphalt D PCC D Other D Repaired by City D Repaired by Permittee o No Damage Found Work Order # D COMPLETE D INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) <; rc7 ELECTRICAL PERMIT APPLICATION FOR OFFICIAL USE ONLY DatelRec: Pennit #: Date Approvecj" The Electrical Permit Application must be filled out comDletelv. #79oL -,A \ /I~ l.;"'1':>'/ Owner or Elee. Contractor Agent. -~ - 1".0 ..... ) ..' Ji.-Iv..L!F / Property Owner: ~ ~ +4P .101>$Y Address: ;1.J'l F .QTH' rffJ:5 , REQUEST INSPECTION 0 Phone: f...);J-ly05 Fax: Phone: City 1'O?~ /J~fY c: 5' ziP'j?f;:r[-1 Electrical Contractor: License #: Exp: Phone: Address: INSTAllATION WIRED BY: 'j OWNER Credit Card Holder Name: City: o ELECTRICAL CONTRACTOR Zip: Billing Address' City: Zip: Credit Card Number Exp. Date: VISA,-- MC,-- . PROJECT ADDRESS' ;;?-2.t.f €. I O~ TYPE OF WORK: Check ll!! that apply: ~ New o Alteration/Addition .~ Residential 0 Multi-family o Commercial 0 Mobile Home Sq. Ft t.a 72 Remote Meter }<10etached garage 0 Hot Tub 0 Swim Pool 0 Septic Pump o Low Voltage 0 Telecom. 0 Sign Number of Circuits added or altered: DESCRIPTION OF THE ELECTRICAL PROJECT: ])r-:7ACflr;;~ (:;/:;J?1A?,(z- ^~ - - I - - - ~.", I~I /H15 flM0 '-'(-,1+1 "-)r-'oI.~ 1<0 /"'\~)'-kn_ I :-JJ fJf$J C (' .J 1Kf: I" \L ~ti'> OA \1:: ?L(){, o Baseboard o Fumace o Heat Pump o Fan-Wall _KW _KW _ TON_ LRA -KW PERMIT FEE 'It /10 f?Hc.t-I;jJ7' ~ 97'15"' Service Information Electrical Heat Load Additions Jill Overhead Service o Temp Service o Underground Service Voltage: lZo/ ":20 Phase: ~1 0 3 Service Size: /00 Feeder Size: I hereby certify that I have read and examined this application and know that same to be true and correct, and I am authorized to apply for this permit. I understand it is not the City's /egal responsibility to determine what permits are required; it remains the applicants responsibility to determine what permits are required and to obtain such. lf/l'Zjrfl'/Y1 - ;Jv4 1fA..---Iv/ .r-f- ')-V 1. c.-(t'L-:v~-} '( r-r -L u.,,-a.y~ (w,tlS>..)) (, dt. k? ,:.) ..:JfL Credit Card Holder's Signature: / j) ;/ Owner or Elec. Cant. Signature: )7ffTRICArryTAPPLlCA~~.:( . ~ C ~- /fJ~z- Date: Date: //-/;(.-o;Z '> v; ~JO ELECTRICAL PERMIT APPLICATION FOR OFFICIAL USE ONLY Date/Roc: Pennil#: [late Approved: \!\ The Electrical Permit Application must be filled out comDletelv. .; j\' .If"'. ,. . \", ; , ,< Please type or reprint in ink. If you have any questions, please call (360) 417- 4735 Fax number: (360) 417-4711 ;# 790L. (; , REQUEST INSPECTION 0 Phone f-"V-Yy05 Fax: -I' '^A) j,'clJ0PY Owner or Elee. Contractor Agent: ==:..~ _ _ ~~t 14-- Property Owner: ~ ~ ~ .101:$:Y Address: ;1;2 </ F ~ Phone: 7;p:9-f:Sll City: jp?/ ,(jJ..f-.,E( 13- 5 Electrical Contractor: License #: Exp: Phone" Address: INSTALLATION WIRED BY: 'j OWNER Credit Card Holder Name: City: Zip: o ELECTRICAL CONTRACTOR Billing Address' City: Zip: Credit Card Number' Exp. Date: VISA~ MC~ PROJECT ADDRESS' ;22..Lj t. 106 TYPE OF WORK: Check all that apply: xr New o Alteration/Addition )\(I Residential 0 Multi-family o Commercial 0 Mobile Home Sq. Ft to 7 2 Remote Meter ')<fOetached garage 0 Hot Tub 0 Swim Pool 0 Septic Pump o Low Voltage 0 Telecom. 0 Sign Number of Circuits added or altered: DESCRIPTION OF THE ELECTRICAL PROJECT: ~E.7lf'CII tfjJ h AlK A ?:F ^--;- TTHs TIM!:" (, l!,;,~ I0F'o/.--=l --r.o /"\~ )nrJ1:. L>; ) j} AT$; C I. ) IKc It..lL . ~t:j> O^ \r: ?CU?' o Baseboard o Furnace o Heal Pump o Fan-Wall _KW _KW _ TON_ LRA _KW PERMIT FEE ft.7 0 ~C-~f/Jr # 97rS- Service Information Electrical Heat Load Additions Jill Overhead Service o Temp Service o Underground Service Voltage: tc.o/ ~~ Phase: ~ 0 3 Service Size: /00 Feeder Size: I hereby certify that I have read and examined this application and know that same to be true and correct, and I am authorized to apply for this permit. I understand it is not the City's legal responsibility to determine what permits are required; it remains the applicants responsibility to determine what permIts are required and to obtain such. If!I-d''f I -" ,J,/J If/I Jr., '.~ 7'J1oli.:":;-/ I': T" _ ((A.v.L<>-'",-( r W5"'~0 (,It "? I> ') ~ ' _ '1 _ / ' C d. S / /) re It Card Holder's ignature: / Date: Owner or Elec. Cont. Signature: ~pTRICArryTAPPLlCATION . ftC C W~- ~~Z- '-;} . V'f Date: I/-/p.;-(]r:.