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CITE' ON PORT ANGELES -- PUBLIC WORKS
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BUIL'dtNG DIVISION -- PERMIT APPLICATION t
rk
Agate
Received / Date Issued /C
Name
Address
Citv
Phone
Lic. No.
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Owner x )h'' ' . 1[I ti/
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Contra ctor j2-L/ar_! -AF
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Class of Work: New 1.1 Addition LA Alteration Repair Move Delpoirion
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Liescription of Work: L % �� % `J ✓ �- I l 5
Type of Permit: ❑ Building ❑ Plumbing Contractor _
[No.
Fixture Type )e Fee
Valuation W - Water Closet __
Lavatory
Permit Fee
titlub
Plan Check Fee Receipt #
Shop
Investigation Fee
Kitchen SI
Other
Disposer
Total $ Recci t #
Floor Drain / Floor S'ihk_
Building,Sc. Ft.
Clothes Washer
Occu anc•r Group
Urinal
Occupant Load No. of Stories
Water Heater
Type of Construction
Drinking Fountain
Occunancy Permit Issued
Lawn Sprinkler
Legal Description: Lot
Vacuum Breaker
Block
Solar Panels
Subdivision
Other
Land Use 'lone
Sub Total
Lot Area
Permit Fee
Lot Coverage % = Sq. Ft. _ Recei t # Total y
Si n Contractor
Mechanical Contractor
Sign n T e I 3
No. Type of Equipment Fee
Illumination
Elec, Furnace_
Overall Hei eht I
Heat Pump
St n Height
Oil Fu-,
Sq. Ft.
Kitchen Hood
Clearance
Woods) /fell S e/lnsert
%
Land Use Zone
Other
Fee
Total S Receipt #
Receipt # 0: -2— Total $ 7S 0
APPLICATION ACCEPTED BY PLANS CHECKED='-f—rrUANCEB
Special Conditions:
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SEPARATE PERMITS are required for electrical work, utilities, private and public
improvements. This permit becomes null and void if work or construction authorized is
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not commenced within 180 days, if construction or work is suspended or abandoned for a
period of IRO days after work has commenced. or if required inspections have not been
requested within 180 days from the last inspection. I hereby certify that I have read and
examined this application and know tSe same to be true and comet. All provisions of
laws and ordinances gc.veming this type of work will be complied with whether specified
Other Constru-tion/P.W. Permits:
herein or not. The gr_nting of a p^rrnit does not presume to give authority to violate or
cancel the provision, of any stale or local law regulating construction or the performance
tof construction.
Sewer R/W
Driveway Other _
:Water
S� m:e of Conaactor or Authorized Agent (Date)
Signuture of Owner (if owner is builder) (Date)
PEN PRINT.!NC.
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BUILDING PERMIT INSPECTION RECORD
CALL 457-0411 EXT. 125 FOR BUILDING INSPECTIONS. PLEASE. PROVIDE A MIN. 24 HOUR NOTICE. IT IS UNLAWFUL TO
COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERA41T CARD AND APPROVED PLANS AT JOBSITE
INSPECTION TVPF. nATR ArrFrrGn t'(—AIL4'2%I'rQ
FOUNDATION
Footin s
YES
-ML
Walls
Found. drainage
ELECTRICAL
Rough-in/Light Dept.
PLUMBING
Under floor I slab
Rough -in
Water line
_
Back flow/water
AIR EAI.
Walls
Ceiling_
_
FRAMING
.foists % girders
Shear wall
Walls / roof / ceiling_
Drywall
T-bar
INSULATION
Slab
_
Wall / Coor / ceiling
MECHANICAL
Chimney
Woodstove/Pellet
Ducts
P W, UTILITIES SITE
WORK
Waterline / meter
Sewer r Connection
Sanitary _
Storm
Site Drainage/Erosion Control
Parking
Other
FINAL INSPECTIONS RE UIRED PRIOR TO OCCUPANCY / USE
RESIDENTIAL
DATE
YES
NO
COMMERCIAL.
DATE
_
ACCEPTED
Electrical/Light Dept.
Phone Ext. 224
Electrical/Light Dept.
Ysa
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Construction-RW / PW-
Ext. 124 Engineering
_
Construction - RW
PW/En ineerin
Fire (Multi-fam. only)
Ext. 252
Fire Dept.
Building
Ext.125
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Building
GENERAL COMMENTS:
PEN PRINT. INC 1194
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
....... I ... INSPECTION REPORT ...........
REQUEST: n
Date ' _ I ( Time ,I� _ Received by _— (phone, person)
Location of Work to be inspected I '- I U `_1
Name of person requesting inspection
Address of person requesting; nspection
Type of Inspection (circle appropriate one):
Sewer 'Foundation Framing Chimney Plumbing
INSPECTION NOTE :
Inspected: Date
Remarks:
Final
_ Phone No. % " / c-Z
Permit No. 776
Sewer Excay. Other -� ray&
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RESTORATION REQUIRED ... , .. `_:"p NO
SURFACE RESTORATION:
SURFACE TYPE: ❑ Unimproved []Gravel
[J Repaired by City
❑ Repaired by Permittee
❑ No Damage Found
(Continue on reverse side if necessary)
❑ Asphalt ❑ PCC
Work Girder # _
❑ COMPLETE
❑ INCOMPLETE
❑ Other
STREET SUPERINTENDENT (DATE)
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