HomeMy WebLinkAbout1017 Homestead Ave - Building
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DMSION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr, name
Application type description
Subdivision Name
Property Use
Property zoning . . .
Application valuation
06-00000954 Date
275866
1017 HOMESTEAD AVE
06-30-14-3-2-0500-0000-
MIKE SANDERS
MECHANICAL APPL. PERMIT
8/30/06
UNKNOWN
4500
Owner
Contractor
.
.
SANDERS, MICHAEL/STACEY
1017 HOMESTEAD ST
PORT ANGELES WA 983622731
( 36) 452-0929
PELLET HEAT CO.
230 EAST 1ST SUITE C
PORT ANGELES WA 98362
(360) 457-4406
Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
MECHANICAL PERMIT
85787
50.00 Plan Check Fee
8/30/06 Valuation
2/26/07
.00
o
Qty Unit Charge Per
1.00 50.0000 ECH ME-WOOD BURNING APPL.
Extension
50.00
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 50.00 50.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 50.00 50.00 .00 .00
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'Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requf!lsted within 180 days from the last
inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presum to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
constru ion.
....
.
. .
..
i
Date
Signature of Owner (if owner is builder)
Date
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T:\Policies\1102_15 building permit inspection record05.wpd [1/412005]
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
CALL 417-4807 FOR PUBLIC WORKS UTILITIES
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULA TE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE I DOWN SPOUTS
PIERS
POST HOLES (POLE BLDGS.)
PLUMBING
UNDER FLOOR I SLAB
ROUGH-IN
.
WATER LINE (METER TO BLDG)
GAS LINE FINAL DATE ACCEPTED BY:
BACK FLOW I WATER
AIR SEAL
I
WALLS
CEILING I
FRAMING
JOISTS I GIRDERS
SHEAR W ALLlHOLD DOWNS
WALLS I ROOF I CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB I
WALL I FLOOR I CEILING I I
MECHANICAL
HEAT PUMP I FURNACE I DUCTS
GAS LINE
WOOD STOVE I PELLET I CHIMNEY FINAL ' DATE ACCEPTED BY:
COMMERCIAL HOOD I DUCTS
MANUFACTURED HOMES
FOOTING I SLAB
BLOCKING & HOLD DOWNS
SKIRTING
PLANNING DEPT. SEPARATE PERMIT #'5 SEPA:
P ARKlNGILIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL, INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R. W.I PWI CONSTRUCTION - R. W.
ENGINEERING 417-4807 PW I ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 , / PLANNING DEPT.
BUILDING 417-4815 '--'tIt IOh VW BUILDING
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8-29-06; 2:39PM
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13604520503;#
..... ......"-'''-'-. ..........."-'......'-"......
BUILDING PERMIT ~A' 'p' p~'U'~' ,~~~~, "-,-,,
. CATION
Fm ollt COMPLETEL'r'
COMPU; and In ]~, Your I.ppll '
TE to be ac''''pted for J'C)'icw If catIOn llnd iil. plan MUST BE
. ' yOu 113"<<= all} qu t1
(3M) 417-48]5 ~s 0115, call
Applicant or ,A.gent:fk.~ r:-r ~~ L f"\ . -
Own,," M 1I<'f-~ <:c' = Phon" ~'57- 440_(-
, __ ~'"-.J{)f:f7 ~ '-L.J
Address: 1017 {:-JCi~ 'S~o ^ Phone:
.. ~J';;:1_ ,City:~ ~
Archirect/Engillt:cr: bl\lE"\ Zip; Q8'3<Q.2.__
ConrractorYVI l r-:T J-kn-r-;"'.... Phone::;
~~ State Liee::J'l~c ~ u ~~ ~ -
Address;2::O C EIJ5T ) sr City:~)7 .~ t;:){,~'; w /7-0 7 p~one:~-440<O
PROJECT ADDRESS: -'- ZlP: q&3b 2
LEGAL ZONING:
J DESCRIPTION: Lo[: _ Block:
CLALL~\1 COlNfY PARCEL NUMBER'. . SubdlVJ5ion:1;..UO/1X~ ~g,S7 Nv..JSIN 0,' 7,1l
..Qb~_ \43?~(Y)(y')()
Credit C.ard Holder NalUlI:
BilJill~ AllLlrrn:
Credit CardType YlSA~C
TYPE OF WURK:
'f,. RcsiUt:nli~1 0 New Con,t!. L:J Re-roof
:J '",blli-family 0 Addition 0 Move
., Curnrru=rqaI 0 Remodel 0 D~U101itioD
o Repalr:J Sign
BRl r.:F' DESCRIPTION OF TIlE l"Ro.rECT:
Cily~
.Il:qJ. Date:
N
~ Sto\,e
o Garage
o Deck
o Other
I U~'T""AU::
SIZHivALUAll ON:
SF. @ S ISf. = i
SF, @ S ISf. "" 3
SF.@:\ ISF. ::l: $
,_ TOTAl. VALUATION $ 4~,OO
Hsl.urr ~& I ~ MI4:<CN~Y _'m...Q1N~
COMMERCIAL/RESIDENTIAL: Occupancy Oroup; OC:llpant Load:
NQ: ~rst{Jrie': _ Lot S~c: Existing &j. Fl, __ &. Proposed Sq, Fl.
F..'<1St1J18 101 co"~ra8e _ % &. Proposed lot co':erDgc ___,~.'O - Tetallot coveca~c:
r PLA.."N11'lG USE ONLY:
COUStr\lC;;tiOD Type:._.
.. TOT AI.. Sq.f'l.
~.
f::.: .vW~llan<l(s): c::J Yec; C No SEPA Cb~ckjisl required? 0 Yes 0 No Othel:
APPRO\-ALS: ;
PLA;"I: '
--_I
8LOG:
DPWU:
1<'LRE: -----
OTB.B.R:==
RT ITlf)fNG PER.!\'lIT APPLICATION St'BMlfT AL: The Building Division C4::l provid~ yuu wilh infor!IUlior. on me appliL<ltJ~n .1pJ
r:-1nn :;:;bm.:t!al requircmellb jf you have ql)I:StiO/U.
\-' A.l. UATION UF CONSTRUCTION: III nil (IUe~. II valulIlion amollnl mmt be entered by the applicant. TlUs fi~e will be re",ewC'd
......-:d ~uybe revIsed by the Bulldinf; Divj~i<)l1 to comply with c:urr~nt fee ,chedule" CCllltaCl the P~rmil CoordiJutor a.t~ L 7.11815 {craSSl~I.ar..~.
PT.-A...' CHECK FEE: /l' 'd plan checK fee is du~ it must be 9ubmmed at lhe time the buildiDg pennit llpplic~tiOIl aud CUO:;lrur:t;l"in ?I:a.n~ are
;,lIbrrunflU, ^1I other p<;rmit fcc' aIe dw: It the time: of pennil i~""ance.
EXPrRA-nON OF Pl.t\N REVIEW: It'uo permit i~ IS3Ucd within 180 dl.Y3 orll1~ uate o:apphclIlion, the llppUClltlOO 'YiII expire. Tht:
R'J :Idi...g 0ftkial (;1I0 ~x.tcnd the t~ for anion 1:-jllhe applicant up lo 180 dllY' upon written request by lhe appJicam (~ee Section I O"J.4~i
~t: Cnifoml Building Code. current edition), 'Nu application can be: ex.~nded more tha.o once,
: herBby certify Iflall have IYJad 'i)r;d erarn~1ed this application and know th9 same 10 b8 tf1Je and cor",ct. I ~ authorized ',0 BPf'Y lor r:~!5 permit and
'Jnd6rs:Bnd thel ~ i:; my ./'fJ$pon,sibility to d~t(J(miTle w/J':tl permits are reqiJJ~d ,not rn.~' . t must obtoln such permIts pnor /0 worl<
Applieant: Dille:: 0, 1- &:'J ,CJ ~
r.\FnR ,,,t~\"'PP.';\fl,o"t1I"W""""\ W?d ~
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CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
.121 EAST 5TH STREET. PORT ANGELES. WA 9R~62
Application Number
pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
04-00000599 Date
.855968
1017 HOMESTEAD AVE
06-30-14-3-2-0500-0000-
ELECTRICAL ONLY
3/06/05
RS9 RESDNTL SINGLE FAMILY
o
Owner
Contractor
Sanders, Mike
1017 HOMESTEAD ST
PORT ANGELES
(360) 452-0929
OWNER
WA 983622731
Permit
Additional
Permit Fee
Issue Date
Expiration
ELECTRICAL NEW RESIDENTIAL
desc 320 A SERVICE&SUB-FEED GARAGE
141.50 Plan Check Fee
7/12/04 Valuation
Date 8/31/05
.00
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Qty
1. 00
1. 00
Unit Charge Per
94.8000 ECH
46.7000 ECH
EL-RM-201-400 1ST SRV FEEDER
EL-R-OUTBD/DTCH GAR SEP
Extension
94.80
46.70
Fee summary Charged Paid Credi te~d Due
----------------- ---------- ---------- ---------- ----------
p'ermi t Fee Total 141.50 141.50 .00 .00
plan Check Total .00 .00 .00 .00
Grand Total 141.50 141.50 .00 .00
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COMMENTS! ACTION NEEDED
~
ELECTRICAL PERMIT INSPEQ'JON RECORD
CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COliER,
INSULA TE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE
DATE
COMMENTS
NO
r/uM- &jY1,/J~
:J-/O- O~ AzO
GENERAL COMMENTS:
PW-II02.1S (06}
L
CITY OF PORT ANGELES
FIRE DEPARTMENT PERMIT
321 East 5e" Street, Port Angeles, WA 98362
Application Number ..... 04-00000233 Date 3/23/04
Pin number ....... 398254
Property AddreSs ...... 1017 HOMEST~ A~
ASSESSOR PARCEL NUMBER: 06-30-14-3-2-0500-0000-
Application deBcription · . . FIRE ABANDON TANK INSPECTION
Subdivision Na~e ......
Property Use ........
Property Zoning ....... RS9 RESDNTL SINGL~ FAMILY
Application valuation .... 800
Owner Contractor
FREDRICK R/T~24I R KREPPS PETTIT OIL CO.
1017 ~OMEST~AD ST 638 M3%RINE DRIVE
PORT ~GELES WA 983622731 PORT A~GELES WA 98362
(360) 457-9404
Permit ...... UNDERGROUND TANK RES
Additional desc . . A~2~DON IN P~CE, SLIIRRy FILL
Permit Fee .... 15.00 Plan Check Fee . . .00
Issue Date .... 3/23/04 Valuation .... 0
Ex~piration Date . . 9/19/04
Qty Unit Charge Per Extension
BASE FEE 15.00
Fee s%unmary Cha~ged Paid Credited Due
Permit Fee Total 15.00 15.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 15.00 15.00 .00 .00
This permit becomes null and void if work authorized is not commenced within 180 days, if work is suspended or
abandoned for a period of 180 days afer the work has commenced, or if required inspections have not been requested with
180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be
tree and correct. All provisions of recognized standards, laws and ordinances governing this type of work will be comp led
with whether specified herein or not. The granting of this permit does not presume to give authority to violate or cancel
the provisions of any state or local law regulating the work specified in the permit.
Signature of Contractor or Authorized Agent Date Signature o£Owner (if Owner is builder) Date
FIRE PERMIT INSPECTION RECORD
Call 360-417-4655 for fire inspections. Please provide a minimum 24-hour notice. It is unlawful to cover, insulate
or conceal any work before inspected and accepted. Post permit in a conspicuous location.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
Inspection Type I Date Passed Comments
FIRE SPRINKLER
Underground piping hydrostatically tested
Underground piping flushed
Interior piping hydrostatically tested
Interior piping inspection
Dry system air tested at 40 psi (24 hours)
Sprinkler final
FIRE ALARM
Rough-in inspection
Alarm final
LP-GAS Completed by Contractor:
Underground piping inspection/pressure test
Test # 1
Above ground piping inspection/pressure test Piping pressure test psi
Time initiated
Tank (container) inspection Test #2
Appliance inspection Piping pressure test psi
LP-gas final Time initiated
UNDERGROUND STORAGE TANK (UST) ABANDONMENT
Removal of flammable/combustible liquids
Tank appropriately abandoned
UST abandonment final
PERMIT OTHER (specify)
GENERAL COMMENTS:
2/15/00
From: Ken Dubuc
To: Roger Vess
Date: 3/31/04 11:05AM
Subject: Permit 398254
Roger,
Permit 398254, for the abandonment of an oil tank at 1017 Homestead Ave is finaled.
Thanks,
Ken
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use . . . .
Property Zoning . . .
Application valuation
04-00000601 Date
.644022
1017 HOMESTEAD AVE
06-30-14-3-2-0500-0000-
RES DETACHED GARAGE
7/29/04
RS9 RESDNTL SINGLE FAMILY
8252
Owner
Contractor
SANDERS, MICHAEL/STACEY
1017 HOMESTEAD ST
PORT ANGELES
(360) 452-0929
Structure Information
Construction Type
Occupancy Type
Other struct info
OWNER
WA 983622731
NEW DETACHED 896 SF GARAGE
TYPE V NON-RATED
GARAGES, CARPORTS, SHEDS
TOTAL % LOT COVERAGE
CONSTRUCTION TYPE
HARD SURFACE AREA
NUMBER OF STORIES
EXISTING LOT COVERAGE
LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE
NUMBER OF UNITS
Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
ELECTRICAL NEW RESIDENTIAL
2-200A PNL/DETACHED GAR./H-TUB
180.70 Plan Check Fee
7/29/04 Valuation
1/26/05
.00
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10.38
V-N
1. 00
2069.00
28558.00
896.00
2965.00
1. 00
Qty
1. 00
1. 00
1. 00
1. 00
Unit Charge
78.7000
23.4000
48.1000
30.5000
Per
ECH
ECH
ECH
ECH
EL-RM-0-200 1ST SRV FEEDER
EL-RM-0-200 ADD SRV FEEDER
EL-R-OUTBD/DTCH GAR SEP
EL-R-HOT TUB W/SRV
Extension
78.70
23.40
48.10
30.50
~
Special Notes and Comments
When roof gutters are installed, drains will located in dry
wells or piped to approved storm drain locations.
Proposal will result in 896 sq. ft. workshop to sf residentia
use in RS-9. Lot coverage and setbacks are good. Ratio
of accessory to primary is good. No land use issues are
noted.
Electrical load calculations and elctrical permits are
required.
Any modifications to the City'S electrical facilities will
be at the customer's expense.
Other Fees
STATE SURCHARGE
4.50
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 180.70 180.70 .00 .00
Plan Check Total .00 .00 .00 .00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as 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 the same to be true and correct. All provisions of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T:\PLANNING\FORMS\1102.15 [11/14/20031
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDA TlON DRAINAGE/DOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN I
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW / WATER
AIR SEAL
WALLS
CEILING I
FRAMING
JOISTS / GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS / ROOF / CEILING
DR YW ALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL / FLOOR I CEILING I
MECHANICAL
HEAT PUMP
GAS LINE
WOOD STOVE / PELLET / CHIMNEY
HOOD / DUCTS
PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT #'s:
WATERLINE / METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'s SEPA:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W. / PW/ CONSTRUCTION - R.W.
ENGINEERJNG 417-4807 PW / ENGINEERJNG
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
T:\PLANNING\FORMS\1102.15 [11/14/2003]
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CITY OF PORT ANGELES
DEP ARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
pin number
Other Fee Total
Grand Total
04-00000601
.644022
4.50 4.50
185.20 185.20
Page 2
Date 7/29/04
.00 .00
.00 .00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as 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 the same to be true and correct. All provisions of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
Signature of Owner (if owner is builder)
Date
Signature of Contractor or Authorized Agent
Date
T:\PLANNING\FORMS\ 1102.15 [11/14/2003]
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDA TlON DRAINAGE/DOWN SPOUTS A .--..
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # 1;- (I) - 0 L/ ~:?.Q74> ~A-C~ 'OK-
ROUGH-IN I --~
PLUMBING 12 - 3-D LI t:~52--z (JvUM- 0/(
UNDER FLOOR 1 SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW 1 WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS 1 GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS 1 ROOF 1 CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL 1 FLOOR 1 CEILING I I
MECHANICAL
HEA T PUMP
GAS LINE
WOOD STOVE 1 PELLET 1 CHIMNEY
HOOD 1 DUCTS
PW UTILITIES 1 SITE WORK (Engineering Division) SEPARATE PERMIT #'5:
WATERLINE 1 METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'s SEPA:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 3)4'h ,-' /fc1v ELECTRICAL
LIGHT DEPT
, I CONSTRUCTION - R.W.
CONSTRUCTION R.W. 1 PWI
ENGINEERJNG 417-4807 PW / ENGINEERJNG
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-48]5 BUILDING
T:\PLANNINGlFORMS\1102.I5 [11114/2003]
.fl!!lT....,,,
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
"}
Application Number
pin number . . . .
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use . . . .
Property Zoning . . .
Application valuation
04-00000601 Date
.644022
1017 HOMESTEAD AVE
06-30-14-3-2-0500-0000-
RES DETACHED GARAGE
7/21/04
RS9 RESDNTL SINGLE FAMILY
8252
Owner
Contractor
SANDERS, MICHAEL/STACEY
1017 HOMESTEAD ST
PORT ANGELES
(360) 452-0929
Structure Information
Construction Type
Occupancy Type
Other struct info
OWNER
WA 983622731
NEW DETACHED 896 SF GARAGE
TYPE V NON-RATED
GARAGES, CARPORTS, SHEDS
TOTAL % LOT COVERAGE
CONSTRUCTION TYPE
HARD SURFACE AREA
NUMBER OF STORIES
EXISTING LOT COVERAGE
LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE
NUMBER OF UNITS
10.38
V-N
1. 00
2069.00
28558.00
896.00
2965.00
1. 00
-.... .
Q-
-.:J
.---------------------------------------------------------------------------
Permit BUILDING PERMIT -RESIDENTIAL
Additional desc
Permit Fee 190.75 Plan Check Fee 76.30
Issue Date 7/21/04 Valuation 8252
Expiration Date 1/18/05
Qty Unit Charge Per Extension
BASE FEE 92.75
7.00 14.0000 THOU BL-2001-25K (14 PER K) 98.00
"t-
- .....
~
(\,
:z.
~
Special Notes and Comments
When roof gutters are installed, drains will located in dry
wells or piped to approved storm drain locations.
proposal will result in 896 sq. ft. workshop to sf residentia
use in RS-9. Lot coverage and setbacks are good. Ratio
of accessory to primary is good. No land use issues are
noted.
Electrical load calculations and elctrical permits are
required.
Any modifications to the City'S electrical facilities will
be at the customer's expense.
--- (/\
~
t
.---------------------------------------------------------------------------
~
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()
----------------------------------------------------------------------------
Other Fees
STATE SURCHARGE
4.50
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 190.75 190.75 .00 .00
Plan Check Total 76.30 76.30 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 271.55 271.55 .00 .00
I/tparate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
.11 and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
-* a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
tjspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
Jlws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
gresume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
~::VWJ? ('~~~I<'lcY
$lgnature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date
T:\PLANNING\FORMS\1102.15 [1 ]/14/2003]
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULA TE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDA TION DRAINAGE/DOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN
PLUMBING
UNDER FLOOR 1 SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW 1 WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS 1 GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS 1 ROOF 1 CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL 1 FLOOR 1 CEILING I
MECHANICAL
HEA T PUMP
GAS LINE
WOOD STOVE 1 PELLET 1 CHIMNEY
HOOD 1 DUCTS
PW UTILITIES 1 SITE WORK (Engineering Division) SEPARATE PERMIT #'s:
WATERLINE 1 METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'s SEPA:
PARKING/LlGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W. / PWI CONSTRUCTION - RW.
ENGINEERJNG 4] 7-4807 PW 1 ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNrNG DEPT.
BUILDING 417-4815 BUILDING
T:\PLANNING\FORMS\I102.15 [II/I412003J
\i......~. T....G~
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it: -=--
~
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
Pin number
04-00000601
.644022
Page 2
Date 7/21/04
"parate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
"'11 and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
.. a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
Iftspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
I~s and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
Obnstruction.
Signature of Owner (if owner is builder)
Date
Signature of Contractor or Authorized Agent
Date
T:\PLANNING\FORMSIII02.15 [11/14/2003]
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES I NO
FOUNDATION: ,,"
FOOTINGS .sg .- i 1)-0 J..f If.:! , &~ .1. L ~p
WALLS R -7 - r') .j. J L '-
FOUND A TlON DRAINAGEIDOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW / WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS / GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS / ROOF / CEILING i /-')..J...-OJ JL
DR YW ALL (INTERIOR BRACED PANEL ONL Y)
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INSULATION
SLAB
WALL / FLOOR / CEILING I I
MECHANICAL
HEAT PUMP
GAS LINE
WOOD STOVE / PELLET / CHIMNEY
HOOD / DUCTS
PW UTILITIES I SITE WORK (Engineering Division) SEPARATE PERMIT #'5:
WATERLINE 1 METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'s SEPA:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W. / PW/ CONSTRUCTION - R.W.
ENGINEERJNG 417-4807 PW 1 ENGINEERJNG
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 4 I 7-4750 PLANNING DEPT.
BUILDING 417-4815 11 -II ~--.n_r:{' ,oJ LL-- BUILDING
T:\PLANNING\FORMS\1 102.15 [1 ]/14/2003]
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Fill out COMPLETELY and in INK. Your application and site plan MUST B
COMPLETE to be accepted for review. If you have any questions, call
(360) 417-4815
FOR OFFICIAL USE ONLY:
Date Rec.: -, ,c~ ...dy'
P~u#~'i-~~
Date Approved: 1, . -/
Date Issued:
BUILDING PERMIT - APPLICATION
Owner:
..- "
,.'")c.,..Y\k: .
Phone: ~Lc L - Ll ,,) Z-c..J\ l~ 1
Phone:
Applicant or Agent: N\ \ k-<:. <'7 C ,,,d ~ ,-<,.
Address: li"\ 7 Hc,Y\-es~,~. A-vE
City: p~ A .
Zip: QS :,u;L
Architect/Engineer:
~
Phone:
Contractor
~
State License #:
Exp:
Phone:
Zip:
ZONING: k <:.~ ~ (1
Address:
City:
PROJECT ADDRESS: / { 1"7 H G,'Y\<,c-rlfC'<..::-\ A-v C
LEGAL DESCRIPTION: Lot: Block: Subdivision:
CLALLAM COUNTY PARCEL NUMBER: CLc.:> (), 4 /,2 l" ,', ()()
Credit Card Holder Name: N\..~ t V,cc -I;:' \ C ~ )(;.', J ..(> ,,',
Billing Address: I () II H L'\"""'-{A.<t.{~ A-v~ City: ~'. A..
Credit CardType VISA )( MC # i~ 1'1 (> ~~c(1I O\c.iqi i~!.~ '2 Exp. Date: ~
TYPE OF WORK: SIZEN ALUATION: CJ.2.1
o Residential 0 New Constr. 0 Re-roof 0 Stove ?5'\(,p SF. @$ ~ /SF. = $ a I 2-5 L .If'-f
o Multi-family 0 Addition 0 Move )!\ Garage SF. @ $ /SF. = $
o Commercial 0 Remodel 0 Demolition 0 Deck SF. @$ /SF. = $
o Repair 0 Sign 0 Other TOTAL VALUATION $
BRIEF DESCRIPTION OF THE PROJECT: LS'y.., .~L; L't'- ;,,~, \c.",.hA "..:.,c.:>\;'''' Sh......p ~ j"S-l-0:7_11
"" \.c Cc-'.-....; u~ \
A.d.~ +-'C-I- -l-vb (; ,-c
COMMERCIALIRESIDENTIAL: Occupancy Group: Occupant Load: Construction Type:
No. of Stories: _ Lot Size: 9- '(!!;,~JjJ Existing Sq. Ft. 'Z.O~ & Proposed Sq. Ft. ~q lP = TOTAL Sq.Ft. '2..9<.t'6
Existing lot coverage fJtL % & Proposed lot coverage3d..1.-% = Total lot coverage 10, .~ c;( %
APPROVALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:_
PLANNING USE ONLY:
ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other:
BUILDING PERMIT APPLICATION SUBMITTAL: The Building Division can provide you with information on the application and
plan submittal requirements if you have questions.
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: IF a plan check fee is due it must be submitted 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: If no permit is issued within 180 days of the date of application, the 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. I am authorized to apply for this permit and
understand that it is my responsibility to determine what permits are required ,not the City's, and. that I must obtain such permits prior to work.
T:\FORMS\APPS\Buildingpennit.wpd . Applicant: ",{J,{.<<...G, ...JJ (\,..~,~,^.k (-A-----nate: r; I q / 2D(~'f
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CITY OF PORT ANGELES - Construction Plans I
The Issuance of this permit based upon these plans. specifi.
cations and other data shall not prevent tt!e bl,i'jing official
from thereafter requiring the correction of errors in said
plans, specifications and other data, or from preventing
building operations being carried on thereunder when in
violation of all codes and ordinances of this jurisdiction.
(SECTION 303(cl .. U . arm 'Idin~ Code~~
Approval Date ~ t By JlL.
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CITY OF PORT ANGELES
PUBLIC WORKS . ELECTRICAL DIVISION
]21 EAST 5TH STREET. PORT ANGELES. WA 98]62
ELECTRICAL PERMIT
Issued: 1/22/98
Permit No:
6195
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
1017 HOMESTEAD DR
Lot:
Block:
Sub:
Parc No:
Port Angeles,
360/000-0000
T:
WA 98360
~
Long Legal:'
S:
CONTRACTOR-----------------------------DESIGNER---------------------------------
COLEMAN ELECTRIC
PO BOX 1326
PORT A~GELES, WA 98362
360/452-4519
,
000/000-0000
PROJECT TNFO--------------------------------------------------------------------
prj Type: RES. MISC. prj Value: $0.00
Occ Type: Cnstr Type: ADD HEAT
Occ Grp: Occ Load: Land Use:
Electrical Heat Service Type
Baseboard KW: 0 Riser Voltage: 120,240
X Furnace KW: 15 X Overhead Service Diameter: X-1 -3
X Heat Pump KW: 10 Underground Service Service Size: 200 AMPS
Fan/Wall KW: 0 Temp Service Feeder Size: 0 AMPS
PROJECT NOTES-------------------------------------------------------------------
REMOVE OIL HEAT, INSTALL 15KW FURNACE AND 10 KW HEATPUMP
PROJECT FEES ASSESSMENT---------------------------------------------------------
. Service: $0.00
Additional Feeders: $0.00
Circuit Wiring: $41.00
Temp Service: $0.00
$0.00
Misc
TOTAL FEE:
Amount Paid:
$41. 00
$41. 00
----.-----------------------------
----,-----------------------------
TOTAL FEE:
$41.00
Balance Due:
$0.00
COMMENTS/ACTION NEEDED
ELECfRICAL PERMIT INSPECfION RECORD
CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER,
INSULATE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPIt DATE I ACCEFTED COMMENTS
I YES I NO
UllCtl
jgi,-,u-lN { COVER
lYICH
,
II/Z3K/XI -~ I
GENERAL COMMENTS:
PW-II02.1'I4"96l
" .
~ (p Cl)
ELECTRICAL PERMIT APPLICATION
FOk OFFlC!AL USE O~!LY
lJJldl(n ____._...___..___~
I'~",ri\~ .__..__...______
lhl~ Alll'(l>~C:.J
Ultcl\"<;u~,j _~____~_
The Elecirical Permit Application must be filled out completely.
Please type or reprint in ink. If you have any questions, please call (360) 417-4735
Fax number: (360) 417-4711
tJLj-5"1'1
Owner or Elec. Contractor Agent: ""-.'\ k:.:t .s.c::t~:OS
Property Owner: ~ Q............-(.
Phone: 3(,:;0 46Z.ofz'loax:
Phone:
Address:
10 \ ., 140 "'^ -Es.\-< CLd. A-..rC
Cily: Qo.-+
~........~s
'-J
Zip: Qa-3(o7
Electrical Contractor: bc.....-:>>-r\:€.. ~
License #:
Exp:
Phone:
Address:
,
City:
Zip:
INSTALLATION WIRED BY: ){OWNER 0 ELECTRICAL CONTRACTOR
Credit Card Holder Name: N\~ e..."'-o..-€..\ ~. ':::> Cl.~ r S
Billing Address: \0 \ ., \--\0~........,S.\eG.... A-vC(;ity: ? A .
Credit Card Number: '- Exp. Date:
Zip: q I? 3.4>"z"
VISA: /MC:
PROJECT ADDRESS:
\01/ ~C^-<..L~ ~C
TYPE OF WORK:
Check !ill that apply:
o New
!ill Alteration/Addition
~esidential 0 Multi-family
o Commercial 0 Mobile Home
Sq, Ft "'-ev.::> 5~p'::: 8'l<'" ~
o Remote Meter ~Detached garage .K1..Hot Tub 0 Swim Pool 0 Septic Pump
o Low Voltage 0 Telecom. 0 Sign
Number of Circuits added or altered:
DESCRIPTIONOFTHEELECTRICALPROJECT: I.",~\\ ?'Z= ~~~.r-~",-c:.~ - ~p)~c...a..
'7' K';.~'''~
c..... .... e....v : -+-
7110 ~D ?C\.^<iC.\
~! .7 - 'Z 00 ~p ?Q.A"'-\S
~ \...\."..1,.. -....,6
e....~
-e ke. . Sa-,," (' c -1-.,
~ 'Z-'Eh<..3,z.. Slt~~p
Electrical Heat Load Additions and or Subtractions
0~
Service Information
:J Baseboard
:J Furnace
D Heat Pump
:J Fan-Wall
LRA
o Overhead Service
o Temp Service
o Underground Service
Voltage:
Phase: 0 1 0 3
Service Size:
Feeder Size:
_KW
KW
TON
KW
;:IELECTRICALPERMIT APPLICATION '.
Jl<<) ?j~p(
, hereby certify that / have read and examined this application and know that same to be true and correct, and / am
3uthorized to apply for this permit. f understand it is not the City's legal responsibility to determine what permits
3re required; it remains the applicants responsibility to determine what permits are required and to obtain such.
'II r{ . L c,.", c." "0;;.'" ",".,",.~.....e ~CJ.- D.~ '1- '-04
Owner or ~Iec. Cont. Signature: t..... . ~~ ~- Date: '1-
~S _ ~
~rL
t..- 3) tl ft,5
PERMIT FEE: $
lEi/. 5"0
IElIEC1"IRl~CAl ~ ~S[P>IEC1"~(Q)~
W~IRl~~G IRllElPJOIRnr
417-4735
PERMIT II
o~_ S-'Z'1
'<.};t..I bL
ADDRESS
/c)/7 rIr>~
APPROVED NOT APPROVED
o ...,....,...'".,., DITCH ..,...........,...' 0
o .............. ROUGH IN/COVER.. .. .. .. ...... 0
o .,..,.".,.",..,. SERVICE ,.".,..,.,....,., 0
o .,.,.... ,., ..~.,., FINAL..,.,.. ...,.,.,.. ,..0
CORRECTIONS NEEDED: "brei tCec...-, /;<.1 hA,e4(;i!.,5
@ G~o &A7c..-
.:r~.f1~ CJJ /P~r>v/'
:Ju-r'rA'
TO &f:;v -:J /770,/
"h?A2q./ DnA//)
NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
OLYMPIC PRINTERS, INC. (380) 452-1381
- DO NOT REMOVE -
July 12, 2004
Mike Sanders
P.A.F.D
Hi Mike,
Enclosed are your plans with a couple of added notes.
The inspections required for your project follows;
I. Ditch
2. Service and Rough-in
3. Final
If you have any questions please call me at 417-4735.
Thank you,
Alan Oman
Electrical Inspections
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ELECTRICAL PERMIT APPLICATION
"Ok UFl'ICU\.!... USlO on!... Y
'-l"lV\{~l .._. "..__________
h'''''I~ ~ ._ ____._____ ______.~
1)aI~Aj)I'm"cd
lJa\tls;o"J_______~__
The Electrical Permi, Application must be filled out completelv.
Please type or reprint in ink. If you have any questions, please call (360) 417-4735
Fax number: (360) 417-4711
{)L( - foot
Sav-...A(-!.r ..::::....
Phone: Li -5> 'L - dl 'L "I Fax:
Property Owner: S ~ V"-"- I-=-
Address: \ D \"/ '-\"'""-""-<;k,,,,,", A.. J e:::-
Phone:
?A-
Zip: "( R- sC:C "Z
City:
Electrical Contractor:
<!:>."'--"-""~.--
License #:
Exp:
Phone:
Address:
,
City:
Zip:
INSTAllATION WIRED BY: ~WNER 0 ELECTRICAL CONTRACTOR
Credit Card Holder Name: I--,,--'ch__"-""-\ L' .5>=...~~
Credit Card Number: Exp. Date:
",
.
Zip: 9iS5:c.c '2'-.
VISA: /' MC:
Billing Address: \0 Ie t--\co>~Skc,,-.L.lA,.~C City:
FA-
PROJECT ADDRESS:
\D\,
(.-\.."".-.....=s~... AvcF'
TYPE OF WORK:
Check .illI that apply:
o New
~teration/Addition
J<:lResidential
o Multi-family
o Commercial
o Mobile Home
Sq. Ft
CJJ
-{:::.
o Low Voltage 0 Telecom. 0 Sign \
'S'-
a
o (?\O'c-<< t"><':s-\-; ~~ ~
A-d- ~ :5 co A-.-...,p
o Remote Meter
o Detached garage
ffi-Hot Tub 0 Swim Pool
o Septic Pump
Number of Circuits added or altered:
\
'-'f' d ~<k b:, s-\' ';; ........"''''.4-0
~ 3Zc ~....~-\-t..r ~c, ":,.a..
DESCRIPTION OF THE ELECTRICAL PROJECT:
\-\.c--=-:r--
Do..J'-e...\
,---,-,:~
L - z..c,D A ""-P p",- ~----<Z. \s
-\-l...c'- .......'-'b
c.~rc-"--,: .&..
~
y\C\"-l-::' CLke<<2.j
S_..!:v-:,-I-\ed -l .J>,??r",~J.. bj
f-'\\ '" ''''-''-"-.\ ,
Service Information
Electrical Heat Load Additions and or Subtractions
=:i Baseboard
:J Furnace
::J Heat Pump
::J Fan-Wall
o Overhead Service
o Temp Service
o Underground Service
Voltage:
Phase: 0 1 0 3
Service Size:
Feeder Size:
_KW
KW
TON_ LRA
KW
f hereby certify that I have read and examined this application and know that same to be true and co
for this perm I understand it is not the City's legal responsibility to determine what permits
3re required; it remains the applicants responsibility to determine what permits are required and to obtain such.
~G i0Src'17'lY CrediICardHolder'sSignalure: '-:::t:~ :::tt::.~ Date: O-dz-Lky.
.oAOe it-my (
ufLiJl-' . =- Owner or Elec. ConI. Signature:, ~. Dale: O[-z... <--Io':;t
Or; 4fJ {"(Vi 7g:~b .
./Jfi.-: '1 J ;l-;umA PH '/13,10 PERMIT FEE: $ /3;2., tv
~[..
j-k,m6 0.50 .j /80 r 70
::lELECTRICALPERMIT APPLICATION
/1!tJ ~~;0r