HomeMy WebLinkAbout916 Georgiana St - BuildingApplication Number 10 00000896 Date 8/31/10
Application pin number 490624
Property Address 916 GEORGIANA ST
ASSESSOR PARCEL NUMBER 06 30 00 6 1 0308 0000
Tenant nbr name CAROL MORTENSEN ATTORNEY
Application type description SIGNS
Subdivision Name
Property Use
Property Zoning COMMERCIAL OFFICE
Application valuation 350
Application desc
10 SQ FT WALL MOUNTED SIGN
Owner
CHRM LLC
PO BOX 2700
PORT ANGELES
(360) 452 1112
Permit
Additional desc
Permit pin number
Permit Fee
Issue Date
Expiration Date
Qty Unit Charge Per
1 00
Fee summary
Permit Fee Total 47 00 47 00 00
Plan Check Total 00 00 00
Grand Total 47 00 47 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 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 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. gabfe-katt.--
t
Date Print Name Signature of Contractor or AuthoriVed Agent Signature of Owner (if owner is builder)
T:Forms /Building Division /Building Permit
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET PORT ANGELES, WA 98362
WA 98362
Contractor
SIGN
10 SQ FT WALL MOUNTED
171843
47 00
8/31/10
2/27/11
Charged Paid Credited
JACKSON S SIGNS GRAPHICS
472 MT PLEASANT RD
PORT ANGELES WA 98362
(360) 457 3703
SIGN
Plan Check Fee 00
Valuation 350
47 0000 PER S ALL SIGNS OR TO 25 SF
Due
Extension
47 00
00
00
00
REPORT SALES TAX
on your state excise tax form
to the City of Port Angeles
(Location Code 0502)
IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED
POST PERMIT IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE.
Inspection Type Date Accepted By Comments
FOUNDATION:
Footings
Stemwall
Foundation Drainage Downspouts
Piers
Post Holes (Pole Bldgs.)
PLUMBING
Under Floor Slab
Rough -In
Water Line (Meter to Bldg)
Gas Line
Back Flow Water
AIR SEAL.
Walls
Ceiling
FRAMING
Joists Girders Under Floor
Shear Wall Hold Downs
Walls Roof Ceiling
Drywall (Interior Braced Panel Only)
T -Bar
INSULATION
Slab
Wall Floor Ceiling
MECHANICAL.
Heat Pump Furnace FAU Ducts
Rough -In
Gas Line
Wood Stove Pellet Chimney
Commercial Hood Ducts
MANUFACTURED HOMES
Footing Slab
Blocking Hold Downs
Skirting
T:Forms /Building Division /Building Permit
BUILDING PERMIT INSPECTION RECORD
PLEASE PROVIDE A MINIMUM 24 -HOUR NOTICE FOR INSPECTIONS
Building Inspections 417 4815 Electrical Inspections 417 4735
Public Works Utilities 417 4831 Backflow Prevention Inspections 417 4886
Inspection Type
PLANNING DEPT Separate Permit #s SEPA.
Parking Lighting 1 ESA.
Landscaping 1 SHORELINE.
FINAL Date Accepted by
FINAL Date Accepted by
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE
Date Accepted By
Electrical 417 -4735
Construction R.W PW Engineering 417 -4831
Fire 417 -4653
Planning 417 -4750
Building 417 -4815 04 -0o 0 1 :Tt-L-
PREPARED 9/20/10 8 13 37 INSPECTION TICKET
CITY OF PORT ANGELES INSPECTOR JAMES LIERLY
ADDRESS 916 GEORGIANA ST
TENANT NBA CAROL MORTENSEN ATTORNEY
CONTRACTOR JACKSON S SIGNS GRAPHICS
OWNER CHRM LLC
PARCEL 06 30 00 6 1 0308 0000
APPL NUMBER 10 00000896 SIGNS
PERMIT SIGN 00 SIGN
REQUESTED INSP DESCRIPTION
TYP /SQ COMPLETED RESULT RESULTS /COMMENTS
BL99 01 9/20/10
SUBDIV
BLDG FINAL
September 17 2010 2 00 30 PM 1pangrle
JACKSON 457 3703
BUILDING FINAL SIGN (MORTENSEN LAW OFFICE)
THE MAIN ENTRANCE SIGN ARE ON THE ALLEY SIDE OF THE
BUILDING
COMMENTS AND NOTES
PHONE (360) 457 3703
PHONE (360) 452 1112
PAGE 2
DATE 9/20/10
\e),, c\
a o C,e
t
Project Address
Business Name
Parcel Number
$47 00 x 1
$85.00 x
$115 00 x
SIGN PERMIT .APPLICATION Print in ink
CITY OF PORT ANGELES
Attn. Building Permit Technician For City Use Oniy
321 E. Fifth St. Port Angeles, WA 98362 `764‘ Date Received_S 13-10
(360) 417-4815 fax. (360) 417 -4711 Permit 10
q
,.te-Approved
Applicant or Agent Carol L. Mortensen Phon 3 452 1112
Property Owner Carol L. Mortensen Phone 452 -1112
Property Owner's Address 916 Georaiana St fort Angeles, WA
Contractor /Engineer Jackson's 5ions Phone 457- 370,3
Contractor /Engineer's Address 472 Mt. Pleasant Rd. fort Angeles 98362
License jack gD22Mi Expires 1 -28 -2011
916 Georaiana St Port Angeles, WA
Carol L. Mortensen, Attorney at Law
Lot
Submit an 8 :Y 7Z 11 "Site-plan three of plans that include.
Type ofsign (wall- mounted, projecting, -freestanding, illuminated, other
Placement and sq. ft. area
How the sign will be securely attached°(Engineering specs may be required for freestanding signs),
Separation distance between the bottom of and freestanding signs and -the surface below
See "Chapter 14.36 Sign Code" of the City of Pert Angeles- Municipal Code for sign requirements.
Zoning co Q
Sign Tyne Brief Description. (Type,_ location, sq. ft.)
Sign in 48" x 30" single sided MDO plywood sign, WaII mounted
Sign #2 r?n gy ct UeLr s d e
Sign #3 izf -Nnp ice:„ i
Sign #4 J
Totals (Unit charges
Unit Charge Quantity multiplied by auantitiest.
47.00
GRAND TOTAL
.47.00
Sign(s)
Type of Sign Valuation 350.00
All signs less than or equal to 25 sq. ft.
Wall sign or marquees, over 25 sq. ft.
Freestanding sign or projecting .sign, over 25 sq. ft.
Make Checks Payable to City of Port Angeles
Credit Cards (Except American Express) are accepted
Existing sign(s) area None sq. ft. Proposed slgn(slarea- 10 sq. ft. Total sign(s) area 10 sq. ft.
Building facade area (height 18 ft: X width 25 ft) 450 sq. ft. (If a building has more than one
business.in it, only measurethe.area-of the building facade_that is.used :by the business applying for this permit.)
I :have read and completed this application and know it to be true ands correct. I am authorized to
apply for this permit and understand that it is my responsibility to: determine what permits are
required, and to obtain permits prior to working on projects
Date Ski l -200 Print Name dar- I7 Signature J' 40 SfLtAtzT
T.Forms/Buitdin DivisionlSign Permit:Appficafon.doc
1
Carol L Mortensen
916 Georglana St
Port Angeles, WA 98362 i I "l
ores
48" x 30"
411 mount Pleasant Rd.
Port flngeles. Wu 98362
FILE
CITY OF PORT ANGELES Construction Plans
The Issuance of this permit based upon these plans, specifi-
cations and other data shad net prevent the building official
from thereafter requiring the corrwdon of errors in said
plans, specifications and other deee, or from preventing
building operations being carried in thereunder when in
violation of all codes and ordllgnces of this jurisdiction.
,.to 2 tr c7 By :,lL–S
Wall
Lag bolt with washer
Sign
Lag bolt with washer
rZ
ive
Carol L. Mortensen
916 Georgiana St.
Port Angeles, WA
98362
452-1112
Clallam County Assessor Treasurer Property Details 62142 CHRM LLC for Year 2 Page 1 of 4
Clallam County Assessor Treasurer
Property Search Results 62142 CHRM LLC for Year 2010 2011
Property
Account
Property ID
Geographic ID 0630006103080000
Type Real
Taxes and Assessment Due
Property Tax Information as of 08/20/2010
Amount Due if Paid on E.
62142 Legal Description. DYKE LAND COMPANY'S
SUBDIV E 40' LT 6 BL 3
Agent Code
Tax Area: 0010 PA 121 PORT ST CNTY H2 L Land Use Code 65
Open Space: N DFL N
Historic Property N Remodel Property N
Multi Family Redevelopment: N
Township Section
Range
Location
Address: 916 GEORGIANA ST Mapsco
PORT ANGELES WA 98362
Neighborhood Cycle 5 Comm Map ID
Neighborhood CD 20953140
Owner
Name CHRM LLC Owner ID
Mailing Address: P 0 BOX 2700 Ownership
PORT ANGELES WA 98362
Exemptions.
2
207366
100 0000000000%
��First Half Second Half 1
Base Due Base Due Penalty Interest Base
I
Year Statement ID I Taxing Jurisdiction
2010 44802 ST SCH STATE SCHOOL $270 $270 60 $270 61 $0 00 $0 00 $27
2010 44802 CC -GEN COUNTY $143 99 $144 02 $0 00 $0 00 $14
2010 44802 PORT PORT $20.24 $20.24 $0 00 $0 00 $2
2010 44802 PORT
ORT ANG PORT ANGELES $333.42 $333 42 $0 00 $0 00 $3:
2010 44802 SD #121 SCHOOL DISTRICT #121 $350 51 $350 50 $0 00 $020 $3
2010 44802 NTH OLY LIB NORTH OLYMPIC LIBRARY $41_84 $41 85 $0 $0 00 $4
2010 44802 HOSP #2 HOSPITAL #2 $59 08 $59 07 $0 00 $0 00 $E
2010 44802 WSMET PK DIST WILLIAM SHORE MET PARK DIST 80 $18 79 $000 $0 00 $1
2010 4_4802 CITY_STORMWATER CITY STORMWATER $36 00 $36 0_0 $_0 00 _$0 00 $Z
2010 44802 WEED_CONTRO-L WEED CONTROL $0 82 $0 81 ry $0 00 $0 00 1
i 2010 44802 TOTAL. $1275.30 $1275.31 $0.00 $0.00 $127
2009 621422008 ST SCH STATE SCHOOL $315 80 $315 80 $0 00 $0 00 $6:
12009 621422008 CC -GEN COUNTY $159 83 $159 82 $0 00 $0 00 $31
2009 621422008 PORT PORT $22.64 $22.64 $0 00 $0 00 $4
i 2009 PORT ANG PORT ANGELES $350 56 $350 56 $0 00 $0 00 $7C
I 2009 621422008 SD #121 SCHOOL DISTRICT #121 $390 53 $390 55 $0 00 $0 00 $7E
12009 621422008 NTH OLY LIB NORTH OLYMPIC LIBRARY
$46 44 $46 44 $0 00 $0 00 $C.
2009 621422008 HOSP #2 HOSPITAL #2 $65 55 $65 54 $0 00 $0 00 $1
http. /vpn.clallam. net. 8084 propertyaccess /Property.aspx ?cid =0 &year= 2010 &prop_id =62 8/20/2010
C7
CERTIFICATE O OCCUPANCY
City of Port Angeles Building .Division
This certificate is issuedpursuant to the requirements of Section 11`O bf the j006 International Building
Code cert ing that at theaime,of:issuance this structure was in compliance with the various ordinances
of the City regulating building consthhCtion or use for the follo:Wing-
Business name Carol L 'Mortean S (Owner- Carol L Mortensen P S)
Business address 9 =1 {6 "'Georgian0 St
Property owner W Brent1Ba andrCh'arline; C Basd:en
Property owner s. address 273 Shady preek Lane, Port Angeles WA 98362
Automatic fire sprinkler{system P er
Use occupancy classaf cation B usiness
Building permit nuinber 09 1275
Type of construction. R:e`r E3C
Occupant load Pena°
12/21/09
Date
Post on the premises in a conspicuous place. 'This „certificate, shall•not be removed except.by the Building Official.
O
6—
PREPARED 12/16/09 8 17 48 INSPECTION TICKET PAGE 6
CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 12/16/09
ADDRESS 916 GEORGIANA ST SUBDIV
TENANT NBR CAROL L MORTENSEN P S
CONTRACTOR PHONE
OWNER W BRENT CHARLINE BASDEN PHONE
PARCEL 06 30 00 6 1 0308 0000
APPL NUMBER 09 00001275 CO CHANGE OF OCCP /USE
PERMIT CO 00 CHANGE OF OCCUP /USE
REQUESTED INSP DESCRIPTION
TYP /SQ COMPLETED RESULT RESULTS /COMMENTS
C099 01 12/16/09 JLL BLDG C/O FINAL TIME 01 00
t.� OVERRIDE TAKEN BY LPANGRLE DATE 12/07/09 TIME 11 40 13
December 7 2009 11 38 57 AM 1pangrle
CAROL 452 1112
C OF 0 FINAL CAROL MORTENSEN P S
AFTERNOON
COMMENTS AND NOTES
Print in ink
BUSINESS NAME 'Qa 1 1.. 0t-. 5e,4/1. p S
BUSINESS ADDRESS l 6 C�ee S-E- Zoning Go
Business mailing address PO a-7 '8 o ?tx-f- 4 IRA Phone 3�pD L L12--
Opening date /a -1 1- oR Days hours of operation {4 f .R 3o at)
Washington State Tax I D If-known list the name of 'the previous
business at this location
Brief description of proposed business `tPVkeetz (eAs I /■t C24
v v
1 Business owner's name errb I I— 'IA ar -Je q efl Phone 360- 67Q 31400
1 Business owner's home address D p {1 ,qt7
PLEASE/VOTE SV1Q- ‘Aopes +0 C-)1)"/ n j rt by
A Business License is also required for the followin businesses Taxi, Peddlers Second -hand dealer Pawnbroker Dance Ho el-
Motel Fireworks,. Ambulance Tattoo shop Contact the CityClerk at 417 -4634 for additional information. SAA
s s o1O
ACTION
New business
Transfer of business
location from a
PBIA location
Transfer of business
location from a
non -PBIA location
Change of ownership
Remodel
Temporary'business
Change of use
For City use only
Department
Building
Fire
PBIA
Planning
City Clerk
Public Works
CERTIFICATE OF OCCUPANCY APPLICATION
CITY OF PORT ANGELES
Attn Building Permit Technician
321 E. Fifth St. Port Angeles WA 98362 100 00
(360) 417 -4815 fax (360) 417 -4711
Iv
Approved Rejected
Initials date Initials date
1
1 12 I b-0q IR66
(2 -g-oa 5(
Iz1 -O
1V: L oO'
T:Forms /Building Division /Certificate of Occupy Icy A; placation
(oZ. 3 5 I 4 1 1t,
50 0;)
WILL THERE BE ANY OF THE FOLLOWING?
Electrical changes
New or relocated signs 1,01 l cep G.. Oer"
Construction changes
Mechanical changes (ventilation, heating, cooling, etc.)
Plumbing changes
Fire sprinkler system changes
Fire alarm system changes
New or relocated sewer or water service
Excavation or filling of lots
Work done in the City right -of -way
New driveway openings
Grading site drainage (parking lots, downspouts, etc.)
Landscape irrigation system'(backflow devices)
Is this a home occupation?
Is this a second -hand dealer or pawnbroker business?
Is there off- street parking for this business?
Is the street in front of this business paved?
Is there a sidewalk in front of this business?
Is.there a curb gutter in front of this business?
Cali for Certificate of Occupancy inspections before opening business.
Building Department Inspection 417 -4815 .Fire Department Inspection 417 -4653
Please provide a minimum 24 -hour notice for inspections
1 hereby apply for a Certificate of Occupancy' I acknowledge that I have read this ap
supplied is correct to the best of myy YP�
knowledge
Date loot Print Name l �I I__ tc.�t` a� Signature I
NO/
YES
t
Comments./ Conditions
Type of construction Occupant Load
Automatic fire sprinkler system required no
yes
Permit 111 1Z1
FEES
Certificate t Inspection
Parking Business Improvement Area (PBIA)
fee charged for downtown 'locations
LOA, A g
IF YES CONTACT
Electrical Dept. at 417 -4735
Building Div at 417 -4815
Public Works at 417 -4807
Water Dept. at 417 -4886
Planning Div at 417 -4750
City Clerk at 417 -4634
How many spaces? !.f
CPleaSe sign. up for utility services
at the cashier Counter
e thatthe information I have
1ht ap Ided to legal de p L ojjeaa
app are nh Topng apht Map fi 1e j al to mt 17t
apdr Ig p ,dt ed in th j/' Ange/e /a nd purpa
An rha tf an ap dray. Ig shall he th spa thillty or the C
Water main
WWater main
SWater main
Flartriral rlistrihn tinn ES 0
30
Feet
d 1)a im NA GD 88
Clallam County Assessor Treasurer Property Details 62142 W BRENT BASDEN A Page 1 of 7
Clallam County Assessor Treasurer
Property Search Results 62142 W BRENT BASDEN AND CHARLINE C BASDEN for Year 2009
2010
Property
Account
Property ID
Taxes and Assessments Due
Property Tax Information as of 12/07/2009
Amount Due if Paid on. M.
62142 Legal Description. DYKE LAND
COMPANY'S
SUBDIV E 40' LT
6 BL 3
Geographic ID 0630006103080000 Agent Code
Type Real
Tax Area. 0010 PA 121 H2 L Land Use Code 65
Open Space N DFL N
Historic Property N Remodel Property N
Multi Family Redevelopment: N
Location s c° �y2ow
Address. 916 GEORGIANA ST M apsco
PORT ANGELES
Neighborhood Cycle 5 Comm M ap ID
Neighborhood CD 20953140
Owner
Name
Mailing Address
W BRENT BASDEN AND CHARLINE C BASDEN Owner ID 12822
273 SHADY CREEK LANE Ownership 100 0000000000%
PORT ANGELES WA 98362
First Second
Half Half
Exemptions.
Statement Base Base Base Amount
Year ID Taxing Jurisdiction Due Due Penalty Interest Paid Due
2009 621422008 ST SCH STATE SCHOOL $315 80 $315 80 $0 00 $0 00 $631 60 $0 00
2009 621422008 CC -GEN COUNTY $159 83 $159 82 $0 00 $0 00 $319 65 $0 00
2009 621422008 PORT PORT $22164 $22 64 $0 00 $0 00 $45.28 $0 00
2009 621422008 PORT ANG PORT ANGELES $350 56 $350 56 $0 00 $0 00 $701 12 $0 00
2009 621422008 SD #121 SCHOOL DISTRICT #121 $390 53 $390 55 $0 00 $0 00 $781 08 $0 00
2009 621422008 NTH OLY LIB NORTH OLYMPIC LIBRARY $46 44 $46 44 $0 00 $0 00 $92.88 $0 00
2009 621422008 HOSP #2 HOSPITAL #2 $65 55 $65 54 $0 00 $0 00 $131 09 $0 00
2009 621422008 CITY_STORMWATER CITY STORMWATER $36 00 $36 00 $0 00 $0 00 $72.00 $0 00
2009 621422008 WEED_CONTROL WEED CONTROL $0 82 $0 81 $0 00 $0 00 $1 63 $0 00
2009 621422008 TOTAL. $1388.17 $1388.16 $0.00 $0.00 $2776.33 $0.00
2008 621422007 ST SCH STATE SCHOOL $335 36 $335 36 $0 00 $0 00 $670 72 $0 00
2008 621422007 CC -GEN COUNTY $162.27 $162.26 $0 00 $0 00 $324 53 $0 00
2008 621422007 PORT PORT $23 71 $23 70 $0 00 $0 00 $47 41 $0 00
2008 621422007 PORT ANG PORT ANGELES $349 45 $349 44 $0 00 $0 00 $698 89 $0 00
2008 621422007 SD #121 SCHOOL DISTRICT #121 $391 16 $391 16 $0 00 $0 00 $782.32 $0 00
2008 621422007 NTH OLY LIB NORTH OLYMPIC LIBRARY $47 15 $47 15 $0 00 $0 00 $94 30 $0 00
http. /vpn clallam.net 8084 /propertyaccess /Property aspx ?cid =0 &year= 2009 &prop_id =62 12/7/2009
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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
04-00000584 Date
.767984
916 GEORGIANA ST
06-30-00-6-1-0308-0000-
ELECTRICAL ONLY
7/02/04
COMMERCIAL OFFICE
o
, Owner
Contractor
ARMSTRONG, JOSH
333 GRIFFITH FARM ROAD
SEQUIM WA 98382
(360) 457-5752
COLEMAN ELECTRIC
P. O. BOX 1326
PORT ANGELES
PORT ANGELES
(360) 452-7594
WA 98362
Permit
Additional desc
Sub Contractor
Permit Fee
Issue Date
Expiration Date
ELECTRICAL ALTER RESIDENTIAL
FURNACE/HP
COLEMAN ELECTRIC
46.70 Plan Check Fee
7/02/04 Valuation
12/29/04
.00
o
~
~
Qty Unit Charge Per
1.00 46.7000 ECH EL-R OR RM 1-4 ALT CIRCUITS
Extension
46.70
~
~
'J
~
G\
~
~
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 46.70 46.70 .00 .00
Plan Check Total .00 .00 .00 ,00
Grand Total 46.70 46,70 .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:\PLANNlNG\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 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 I NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDA TION DRAINAGE/DOWN SPOUTS " n C
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN I
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW I WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS / GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS / ROOF / CEILING
DR YW ALL (INTERJOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILING I
MECHANICAL
HEAT PUMP
GAS LINE
WOOD STOVE / PELLET / CHJMNEY
HOOD / DUCTS
PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT #'5:
WATERLINE / METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMlT #'5 SEPA:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/uSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRJCAL - LIGHT DEPT. 417-4735 ?;; 104 k17 ELECTRJCAL
LIGHT DEPT
CONSTRUCTION R.W. / pw/ 7/ CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW / ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
v
L
T:\PLANNING\FORMS\1102.15 [11114/2003]
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:
Tenant nbr, name
Application description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
04-00000405 Date
.827680
916 GEORGIANA ST
06-30-00-6-1-0308-0000-
BASDEN ATTORNEY AT LAW
COMM REMODEL
6/06/04
COMMERCIAL OFFICE
800
Owner
Contractor
ARMSTRONG, JOSH
333 GRIFFITH FARM ROAD
SEQUIM WA 98382
(360) 457-5752
Structure Information
Construction Type . . . .
Occupancy Type . . . . .
OWNER
ADD BEAM /REMOVE SUPPORT WALL
TYPE V NON-RATED
BUSINESS:OFF/PRO/MED/REST
Permit
Additional desc
Sub Contractor
permi t Fee
Issue Date
Expiration Date
ELECTRICAL ALTER COMMERCIAL
ADD/ALTER 5 CIRCUITS
ANGELES ELECTRIC
59.40 Plan Check Fee
6/06/04 Valuation
12/03/04
~
~
.00
o
Other Fees
STATE SURCHARGE
4.50
~
~
~
I
Qty Unit Charge Per
1.00 59.4000 ECH EL-COMM ALT <5 CIRCUITS
Extension
59.40
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total: 59.40 59.40 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 63.90 63.90 .00 .00
tI\
~
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 tlerein or not. The. granting pf a permit does not
presume to give authority to violate or cancel the provisions of any state or 10car'law .regulating construction or ~he performance of
construction. . '. ,.
Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T:IPLANNINGIFORMSIlI02.15 [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 UNLA WFUL 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
FOUNDATION DRAINAGE/DOWN 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 I
FRAMING
JOISTS / GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS / ROOF / CEILING
DR YW ALL (INTERIOR BRACED PANEL ONL Y)
T-BAR
INSULATION
SLAB
WALL / FLOOR/ 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 ,l;~ YES NO COMMERCIAL DATE ACCEPTED
, b.<" YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ~J .J"eJ ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W. / PW/ / ~ , CONSTRUCTiON - R.W.
ENGINEERING 417-4807 PW / ENGINEERING
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
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Zoning . . .
Application valuation
03-00001124 Date 12/05/03
916 GEORGIANA ST
06-30-00-6-1-0308-0000-
RES NEW SFR
COMMERCIAL OFFICE
3500
Owner
Contractor
ARMSTRONG, JOSH
333 GRIFFITH FARM ROAD
SEQUIM WA 98382
(360) 457-5752
Structure Information
Construction Type
occupancy Type . . . . .
Other struct info . . . .
OWNER
FOUNDATION FOR MOVED HOUSE
TYPE V NON-RATED
SINGLE FAM & CONGREGATES
NUMBER OF UNITS
1. 00
----------------------------------------------------------------------------
Permit . . . .
Additional desc
Permit Fee
Issue Date
Expiration Date
BUILDING PERMIT -RESIDENTIAL
FOUNDATION FOR MOVED HOUSE
120.75 plan Check
12/05/03 Valuation
6/03/04
Fee
48.30
3500
j)
Qty Unit Charge Per
Extension
92.75
28.00
~
BASE FEE
2.00 14.0000 THOU BL-2001-25K (14 PER K)
----------------------------------------------------------------------------
Special Notes and Comments
Address numbers shall be plainly visible from the street.
Address numbers shall be a minimum of six inches high and be
in contrast in color of there background.
Other Pees STATE SURCHARGE 4.50
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 120.75 120.75 .00 .00
plan Check Total 48.30 48.30 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 173.55 173.55 .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 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 or.dj~... verning this type of work will be cornplied with whether specified herein or not. The granting of a permit does not
presume .t~,.g'V7?~ ority to ~~ or cancel the provisions of any state or local law regulating construction or the performance of
constructlQh. ! / /' /
J " ...
"'___m.~._u.,"._~
:3
r or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T:\PLANNING\FORMS\1102.15 [11/14/2003]
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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 I ACCEPTED COMMENTS
I VES I NO
FOUNDATION: ~~
FOOTINGS f2-tf.t>?
WALLS /"7-/'O-Cii
FOU1\TDA TION DRAINAGEiDOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEP ARA TE PERMIT: #
ROUGH-IN I I I
PLUMBING
UNDER FLOOR I SLAB
ROUGH-IN
WATER LINE (METER TO SLDG)
GAS LINE
BACK FLOW J WATER
AIR SEAL
WALLS I I I
CEILING T T
FRAMING
JOISTS I GIRDERS
SHEAR W ALUHOLD DOWNS
WALLS I ROOF / CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB r T
WALL I FLOOR I CEILING I I
MECHANlCAL
HEAT PUMP
GAS LINE
WOOD STOVE I PELLET / CHIMNEY
HOOD I DUCTS
PW UTILITIES I SITE WORK (Engineering Division) SEPARATE PERMIT #'5:
WATERLINE I METER
SEWER CONNECTION
$ANIT ARY
STORM
PLANNING DEPT. SEP ARA TE PERMIT #'5 SEPA:
PARKINGILIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQVIRED PRIOR TO OCCUPANCY/USE
RESJI)ENTlAL DATE YES NO COMM ERCIAL DATE ACCEI'TED
VES NO
ELECTRICAL - LIGHT DEPT. 417.4735 ELECTRJCAL
LIGHT DEPT
CONSTRGCTION R.W.I PWI CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW 1 ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLAN"NING DEPT. 417-4750 PLANNING DEPT.
BU1LDING 417-4815 BUILDING
T:\PLA:'\'NING\FORM$\1102.15 [11/1412003]
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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., i,-ZI-D3
Pennlt#'~
ate Appmved'~
BUILDING PERMIT - APPLICATION
Applicant or Agent: To;( A r -'V\':oJ 1'0>,( Phone:
Owner:. ~~d ~""~. Pn,~J1~' rC C Phone:
Addres-:m- qF'{;Q~. '(f\_^,J~\ ,^ ~~s<; ~ flt.JftS:?:( Ib ,j.. /lV/c~Jo ;
Architect/Engineer: (llrij 1A,'(JiC a(l~ IA IA.1f/(c; .L"'"C Phone:
Contractor State License #: Exp:
Address:
City:
'160- .?7b~
Zip: gS";),6z-'
Lf / 7 - 7.. 777
Phone:
Zip:
ZONING:
Subdivision: by ke. L.o.u.d
@o96Q::)C)
PROJECT ADDRESS:
C1(C
(,
(<}"QOrTj J~ I/>Q
Block: 3
CLALLAM COUNTY PARCEL NUMBER: 6 ~o 6C) ~ /
LEGAL DESCRIPTION: Lot:
c.o suk IT
)
Credit Card Holder Name:
Billing Address:
Credit CardType VISA MC #
TYP.J: OF WORK:
l2rResidential g/New Constr. 0 Re-roof
o Multi-family 0 Addition 0 Move
o Commercial 0 Remodel 0 Demolition
o Repair 0 Sign
BRIEF DESCRIPTION OF THE PROJECT:
1A-1i?>\JRf,J (f'}1A}r-. l(jo-.
COMMERC1AL/RES1DENTIAL: Occupancy Group:
City:
Expo Date:
o Stove
o Garage
o Deck
o Other
13" ,-I,{
SlZEN ALVA TION:
SF. @ $ /SF. ~ $
SF. @ $ /SF. ~ $
SF. @ $ /SF. ~ $
J;::L~1~~,ATZN, ~(:~~ <fa'"
L/fO v..J
Occupant Load:
Construction Type:
No. of Stories: Lot Size: ~O() Existing Sq. Ft.
Existing lot coverage % & Proposed lot coverage
& Proposed Sq. Ft. /22.. go- ~ TOTAL Sq.Ft. /2 Z 8"""
% - Total lot coverage 21 c.;. %
- -
-
APPROVALS:
PLANNING USE ONLY: PLAN:
BLDG:
DPWU:
FIRE:
ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other: OTHER:
-
BUILDING PERMIT APPLICATION SUBMITTAL: The Building Division can provide you with information on the application and
plan submittal requirements if you have questions.
VALVA TION 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 Pennit 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: 1fno 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 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, n t th City's, a I must obtain such permits prior to work.
T:\FORMS\APPS\Buildingpcrmit. wpd
Applicant:
Date: ~
11/7-11.,3
( 1
t;/~ORT~
~~
~~
~
"".;;;;.'
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
04-00000377 Date
.241840
916 GEORGIANA ST
06-30-00-6-1-0308-0000-
RES ADDITION
5/14/04
COMMERCIAL OFFICE
1800
Owner
Contractor
ARMSTRONG, JOSH
333 GRIFFITH FARM ROAD
SEQUIM WA 98382
(360) 457-5752
Structure Information
construction Type
Occupancy Type
Other struct info
TRIPLE M PROPERTIES
25556 HWY 101 EAST
PORT ANGELES
(360) 457-5752
ADD NEW HANDI CAP ACCESS/DECK
TYPE V NON-RATED
SINGLE FAM & CONGREGATES
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
LLC
WA 98362
21.00
V-N
2.00
1228.00
7000.00
247.00
1475.00
1. 00
--t>
----
~
----------------------------------------------------------------------------
Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
BUILDING PERMIT -RESIDENTIAL
HANDI CAP ACCESS RAMP
86.65 Plan Check Fee
5/14/04 Valuation
11/10/04
34.66
1800
Other Fees
STATE SURCHARGE
4.50
m
(t
(J
Q];
~,
p
Qty Unit Charge Per
Extension
47.00
39.65
BASE FEE
13.00 3.0500 HND BL-501-2K (3.05 PER C)
----------------------------------------------------------------------------
Special Notes and Comments
proposal is to add 247 sq.ft. of access ramp to residence in
the CO zone for a total lot coverage of 21%. No land use
issues are noted.
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 86.65 86.65 .00 .00
plan Check Total 34.66 34.66 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 125.81 125.81 .00 .00
:5
f
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and pubiic 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. Ail provisions of
laws and rdinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
pres 0 give a thority to violate or cancel the provisions of any state or local law regulating construction or the performance of
co ion.
Signature of Owner (if owner is buiider)
Date
T:\PLANNING\FORMS\1102.15 [11/14/2003]
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BIDLDlNG 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, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
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I YES I NO
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LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESJDENTlAL DATE YES NO COMMERCIAL DATE ACCEPTED
VES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W.I PWI CONSTRUCTION - R.W.
ENGINEERlNG 417-4807 PW 1 ENGINEERING
FIRE 417.4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
T:\PLANNING\FORMS\1102.15 [11/14/2003]
BUILDING DIVISION
CITY OF PORT ANGELES
* *
Correction Notice
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* *
Correction Notice
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BUILDING PERMIT - APPLICATION
FOR OFnC~L USE ONL''{:
D3.tL: Rec:S -;;,._{)t.f
P(;TTni,#:d/~ ~77
Fill out COI\IPLETELY and in INK. Your application and sHe plan 1VIUST BE
C01\1PLETE to be accepted for review. If YOll have any questions, call
I'ERJ\lITS (360) 417-4815 FAX(360)417-4711
Dau: Approved
I ~'_"':;<1"'1 \t
::J.81e Issued'
Applicant or Agent: Jcf:>V\ 'Avvv6-n'U'^'3
Owner S W\2.€X" LY€.C-W\.'& 9v'Of'el{"\iE:':>) \...L-G
Address &0C?-~\9\.9 ~. \tl\ City~y-\- ~e1e":,
Phone L-\tjl-c)l~
Phone: '-\C";)1-C':)iSd.
Zip CI"!;"3\Q'd-
A1 chItect/Engmeer: 0\ 'u.,V"'{>"o{.. 'De~'~\AJt)('(..~ l '!.V\C ~ Phone L\ \1- dill
ContractOJ:"\V\'{J'& \-\ \l~6 State L1cense #:ij:{II'\..l-'.l''i\P~~xp ~ Phone: Lf::n-~lC':)~
Address dl?0-CS~1o ~. \\)\ CityP<l-A- ~ Zip: C\~a..
PROJECT ADDRESS q\\Q Geor~\rHAD-- Sit. ZOl'rING: ~W\.W\JlYd.c,j
\.9 Block:?'\ Subdivision D~~~ ~ UJ'S
ru~DDO IO\ll?:lc8 CO06
LEGAL DESCRIPTION: Lot:
CLALLAM COUNTY PARCEL NUMBER:
Credit Card Holder Name:_'JO'SV\ ~S.1Yt::w'lA l>/r,
Billing Address: ~S -'-:J\9\D ___iliL.'"'
Credit CardType VISA .X Me _. _.'
TYPE OF WORK:
o Residential 0 New Constr, 0 Re-roof
o Multi-family 0 AddItion 0 Move
o Commercial 0 Remodel 0 Demolition
o Repair 0 Sign
BRIEF DESCRIPTION OF THE PROJECT:
SC~Y~"I\liA o.~19~
_ EJ."p, Date:
SIZEIVALUATION:
c;l,;::Q. '0 SF, @ $ q, /SF. ~ $ \l'?" 00
SF. @ $ /SF. ~ $
SF. @ $ /SF, = $
TOTAl V AlUATlON $
.-
o Stove
o Garage
o Deck
J!. Other ~
COMMERCIALIRESIDENTIAL: Occupancy Group: Occupant Load:
No, of Stories: ~ Lot Size: 700D Existing Sq. Ft. /22. '3 & Proposed Sq, Ft
Totallot coverage_'2./ %
Construction Type:
2iJ 7 ~ TOTAL Sq. Ft.J!:cJ';L
AFPROV ALS:
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 hrfonnatiou 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 TIns figure will be reviewed
and may be revised by the Building Division to comply with cunen! fee schedules. Contact the Pennit Coordinator- a141 7-4815 for assistance.
PLAN CHECK FEE: IF a plan check fee is due it must be submitted a! the tin1e the building penni! application and construction plans are
submitted. All other pemnt fees are due at the time ofpemnt issuance.
EXPIRATION OF PLAN REVIEW: Ifno penni! is issued within 180 days of the dale 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, CUITent edition), No application can be extended more than once,
I hereby cerlify that I have read and examined this application and know the sa e 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 reqUire the' 's, and that I must obtain such permits prior to work.
T:\FORlvlS\AJ'PSIBuiJdingponmt.wpd Applic Date: yrf
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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
04-00000054 Date
.937648
916 GEORGIANA ST
06-30-00-6-1-0308-0000-
RE-ROOF
5/11/04
COMMERCIAL OFFICE
2500
Owner
Contractor
Qty unit Charge Per
------------------------
TRIPLE M PROPERTIES
25556 HWY 101 EAST
PO T ANGELES
(3 0) 457-5752
ARMSTRONG, JOSH
333 GRIFFITH FARM ROAD
SEQUIM WA 98382
(360) 457-5752
--------------------------------------------- ------------
Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
BUILDING PERMIT - N
TEAR OFF/DECK/FELT/
106.75"
5/11/04
11/07/04
FEE
1.00 14.0000 THOU
----------------------------------------
4.5
Other Fees
Fee summary
Charged
Due
Permit Fee Total
plan Check Total
Other Fee Total
Grand Total
106.75
.00
4.50
111.25
.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 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.
--
(--?:J /v ,;.:::::/ )-cC
Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
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
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
DRYWALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULA TlON
SLAB
WALL / FLOOR / CEILING
MECHANICAL
HEA T 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.
ENGINEERING 417-4807 PW / ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
T:\PLANNING\FORMS\ 11 02. J 5 [1111 4/2003]
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use
Property zoning . . .
Application valuation
04-00000~ Date
916 GEORGIANA ST
06-30-00-6-1-0308-0000-
RE-ROOF
1/27/04
F{~k.I
Yrq lot/-
COMMERCIAL OFFICE
2500
Owner
Contractor
ARMSTRONG, JOSH
333 GRIFFITH FARM ROAD
SEQUIM WA 98382
(360) 457-5752
OWNER
(\ /
,/
----------------------------------------------------------------------------
Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
BUILDING PERMIT - NO PR FEE
TEAR OFF, SHEET, FELT, COMP
106.75 Plan Check Fee
1/27/04 valuation
7/25/04
.00
2500
-D
t)'
(;)
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p
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P
Qty Unit Charge Per
Extension
92,75
14.00
BASE FEE
1.00 14.0000 THOU BL-2001-25K (14 PER K)
----------------------------------------------------------------------------
Other Fees
STATE SURCHARGE
4.50
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 106.75 106.75 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 111.25 111. 25 .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 her-~Y certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and..CIt-ainariles gOYjl.[~ng this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume .to givli au,tlldrity td violate or cancel the provisions of any state or local law regulating construction or the performance of
cOI1~~rt,JgllQ.n_.- --7'(..-..--...--..~--.__
.. (., '-
Si~nat!Jre of ontractor or AuHiori"ie
Signature of Owner (if owner is buildelr)
Date
T:\PJtANNING\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 UNLA WFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCA nON.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATiON 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 I
FRAMING
JOISTS / GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS / ROOF / CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILING
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.
ENGINEERING 417-4807 PW / ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 1,.:./ -I 'l-o~ J. ~. BUILDING J/ - n--:.;;;:[ 1)::,
T:\PLANNING\FORMS\1102.15 [11/14/2003]
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i pORT "-\:
l'O~~~
r'Wii
~ --
'l.tii:-;--~
CITY OF PORT ANGELES
DEP ARTMENT 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
04-00000584 Date
.767984
916 GEORGIANA ST
06-30-00-6-1-0308-0000-
ELECTRICAL ONLY
7/02/04
COMMERCIAL OFFICE
o
------------------------
CJ
Owner
Contractor
------------------------
COLEMAN ELECTRIC
P.O. BOX 1326
PORT ANGELES
PORT ANGELES
(360) 452-7594
WA 98362
ARMSTRONG, JOSH
333 GRIFFITH FARM ROAD
SEQUIM WA 98382
(360) 457-5752
----------------------------------------------------------------------------
Permit
Additional desc
Sub Contractor
Permit Fee
Issue Date
Expiration Date
ELECTRICAL ALTER RESIDENTIAL
FURNACE/HP
COLEMAN ELECTRIC
46.70 plan Check Fee
7/02/04 Valuation
12/29/04
.00
o
~~
~~
~~
~
~t
~
Qty Unit Charge Per
1.00 46.7000 ECH EL-R OR RM 1-4 ALT CIRCUITS
Extension
46.70
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 46.70 46.70 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 46.70 46.70 .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:\PLANNlNG\FORMS\1102.15 [11/1412003]
BillLDING 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
I YES I NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE/DOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN I I
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW / WATER
AIR SEAL
WALLS I
CEILING I I
FRAMING
JOISTS / GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS / ROOF / CEILING
DR YW ALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB I
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 #'s:
WATERLINE / METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'s SEPA:
PARKING/LlGHTIN'G ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 7 t'l fo,! ~ ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W. / PW/ , , CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW / ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
T:\PLANNING\FORMS\ II 02.15 [11/14/2003 ]
~'PORT~
....4.0~~
irr'ltf!ii<'"
'L ~
~
't.ii-;;-~
CITY OF PORT ANGELES
DEP ARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
pin number
property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr, name
Application description
Subdivision Name
property Use
Property zoning . . .
Application valuation
04-00000405 Date
.827680
916 GEORGIANA ST
06-30-00-6-1-0308-0000-
BASDEN ATTORNEY AT LAW
COMM REMODEL
5/11/04
COMMERCIAL OFFICE
800
P~,(
1;4-
/)
Owner
Contractor
------------------------
------------------------
ARMSTRONG, JOSH
333 GRIFFITH FARM ROAD
SEQUIM WA 98382
(360) 457-5752
Structure Information
Construction Type . . . .
Occupancy Type . . . . .
OWNER
ADD BEAM /REMOVE SUPPORT WALL
TYPE V NON-RATED
BUSINESS:OFF/PRO/MED/REST
\
----------------------------------------------------------------------------
Permit . . . .
Additional desc
Permit Fee
Issue Date
Expiration Date
BUILDING PERMIT
ADD BEAM REMOVE
56.15
5/11/04
11/07/04
- COMMERCIAL
WALL
Plan Check
Valuation
Fee
36.50
800
----------------------------------------------------------------------------
BASE FEE
3.00 3.0500 HND BL-501-2K (3.05 PER C)
Qty unit Charge Per
Extension
47.00
9.15
-Q
-......
~
Other Fees
STATE SURCHARGE
4.50
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 56.15 56.15 .00 .00
Plan Check Total 36.50 36.50 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 97.15 97.15 .00 .00
~,j\
2 ~
..." ~
Y c'\~
r '-':'
?
~
~
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.
W. ~?O'\JL
Signature of Contractor or Authorized Agent
c;-( \~O Y
Date
Signature of Owner (if owner is builder)
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 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 A T JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES I NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDA TION DRAINAGE/DOWN 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 I ROOF / CEILING .c- ~ <).'1<.... 0 ;.{ .J ' J--
DRYW ALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILING
MECHANICAL
HEA T PUMP
GAS LINE
WOOD STOVE / PELLET / CHIMNEY
HOOD / DUCTS
PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT #'s:
WATERLINE / METER
SEWER CONNECTlON
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
CONSTRUCTlON R.W. / PW/ CONSTRUCTlON - R.W.
ENGINEERING 417-4807 PW I ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 -H ." ,/ ) J BUILDING
T:\PLANNING\FORMS\l 102.15 [11/14/2003J
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BUILDING PERMIT - APPLICATION
FOR OFFICV\_L USE O}~LY:
Date Rec.Oy-II-O <I
Pemlit #: 6lj - LIDS-
Date Approved:
Date Issued:
Fill out COMPLETELY and in INK. Your application and site plan MUST BE
COMPLETE to be accepted for review. If you have any questions, call
PERMITS (360) 417-4815 FAX(360)417-4711
Applicant or Agent: IS f2- C tJ/ fS.~ ~{)f:. 0
Owner: ~ Rc. ~\' (S..J..\<:.,/\ S 10
Address: l, ~o /A. 0 6;-,";" F;DI\\ st, City:
P. A.
Phone: ~ b D r ~ S :) ~ tl ~/ ~"1
Phone: ")(.0- Y S:J. - ~11{'?.3
Zip: 1'75~b L
Architect/Engineer:
Contractor
7~c: V\ \) ,,,< <...K
Phone:
State License #:
Exp:
Phone:
Address:
City:
Zip:
ZONING: ~v,..e..,L:l (
Subdivision: D1iIJ... ~'I\Y\ k Sv~ G
oS b~ooob
PROJECT ADDRESS:
~ll,
f:.
Gear j4V\ c;-...
Block: 3
V ~ --;; D ob (.,~
LEGAL DESCRIPTION: Lot:
~
CLALLAM COUNTY PARCEL NUMBER:
Credit Card Holder Name:
Billing Address:
Credit CardType VISA__MC #
TYPE OF WORK:
o Residential 0 New Constr, 0 Re-roof
o Multi-family 0 Addition 0 Move
o Commercial Is. Remodel 0 Demolition
o Repair 0 Sign
BRIEF DESCRIPTION OF THE PROJECT:
\t(.('l' tl.,J~ ~h \'\ ~ u"'~
City:
Exp. Date:
o Stove
o Garage
o Deck
o Other
SIZEN ALUATION:
SF. @ $ /SF. = $
SF.@$ /SF.=$
SF. @ $ /SF. = $
TOTAL VALUATION $
'is ClO
i (\ ~"Il VlC? .'" 'IV'.
COMMERCIAL/RESIDENTIAL: Occupancy Group:
No. of Stories: Lot Size: (~ \:) D Existing Sq. Ft.
Total lot coverage <./. 0}
Occupant Load: Construction Type:
& Proposed Sq. Ft. I Z 'l ~ = TOTAL Sq. Ft. I <... 1... ~
%
AFPROV ALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:
PLANNING USE ONLY:
ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other:
BUILDING PERMIT APPLICA TION 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. TIns 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 pernnt fees are due at the time of permit issuance.
EXPIRATION OF PLAN REVIEW: 1fno 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, cun-ent edition). No application can be extended more than once.
I hereby certify that I have read and examined this applicatiDn and knDw the same tD be true and correct. I am authorized to apply for this permit and
understand that it is my respDnsibility to determine what permits are required ,not the City's, and that I must Dbtain such permits prior to wDrk.
T:\FORMS\APPS\Buildingpermit.wpd Applicant: J 'M &l1YlL Date: ~~ () - D '!
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PUBLIC WORKS & UTILITIES DEPARTMENT
WAS H I N G TON, U. S. A,
November 18, 2003
~
~'
Sweet Dreams Properties, LLC.
255-566 Hwy 101
Port Angeles, W A 98362
RE: Port Angeles Landfill Waste Disposal Application, WDA 03-22; Building demolition
at 916 Georgiana Street
t
We have received your application for disposal of building demolition debris from the referenced
site and reviewed the testing results for lead content. Based on the testing results the debris
appears to be acceptable for use in the landfill. A copy of your approved application is attached,
This approved application must be shown to the landfill scale attendant at the time of disposal.
Please be advised that this disposal application is only for the materials and quantities listed in
the application. Materials not listed or in excess of the quantities noted may require separate
applications and approval.
Please call if you have questions.
Very truly yours,
&ten~ (r
City Engineer
Deputy Director of Engineering Services
GWK:tf
Enc1.: WDA 03-22
Copy: Ken Loghry
Zenovic & Assoc.
N:\PWKS\ENGINEER\ WDAPPLIC\03-22. WPD
FILE: Landfill Solid Waste Disposal Applications
321 EAST FIFTH STREET · P. O. BOX 1150 · PORT ANGELES. WA 98362-0217
PHONE: 360-417-4805 · FAX: 360-417-4542 · TTY: 360-417-4645
E-MAIL: PUBWORKS@CI.PORT-ANGELES.WA.US
To:
~
UJPA-03- 22-
PORT ANGELES LANDFILL
WASTE DISPOSAL APPLICATION
City of Port Angeles, City Engineer
321 E Fifth Street
P.O. Box 1150
Port Angeles, Washington 98362
NOTE:
Phone: (360) 417-4803
FAX: (360) 417-4709
All questions must be answered for waste to be approved.
1. Generator Information:
Company Name:
Mailing Address:
Contact:
Phone:
Project Name:
Project Location:
S ~I~ll J- Dr~c(l,,.,,<'; , Prop:t-rf/~f "- LC
2- <;-<:- ~C 11 L-J~ !e)!
f:--)rJ- II /ltpofftS / wA 9~3h .2-
Tr6 L, I}. rl'YKt- /(') v. /
tj '7 - ~7 -:)"2-
....
G..eL) ''1' q VI <;
q Ie h7~{')r9 /~ Vl~ ,J-
2. Other Contacts (if applicable):
Consulting Firm: ZMOdlc.. ~ 4"000'\7<5 I ;{-'\Jc
Contact: ~4C( f.;J!)~.c.C
Phone: '1/7- 0"-0'
Contractor Name:
Contact:
Phone:
Laboratory:
Contact:
Phone:
~
~t~
"\ I . I/v."
p~~ fF
fie, FP
c 1', Vl5+r~c:..Jtr)V'1
9-z ~ 33'<1' ()
AJv'L ~l>,2..q-rD..e',(~J 1",,-
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20(, - ~L{)-D/DO
I
.~
City of Port Angeles - Landfill Waste Disposal Application
Page - 1
3. SOurce of Waste:
Check the approPriale box below and briefly describe Ihe project, process, and/or cleanup Ih.t
Will or has Produced Ihe wasle reqUiring disposal. Include the gaSOline service slatlon number
(if applicable).
---------------~
CPIr6
CERClAJMTCA Remediation
Independent Remedial Action
Unused Chemical PrOduct Spill
.J-
if- d(~. 1,4~ ~-{'
t /6Jor I if'::: VL--1 I\' c. .
) J I
Agency Contact: _
UST Removal
-
~ther Source: _
0:~ ~::""(-l
I ~v..)~ {(
H()~ ~
-
-
-
.~
r () O{( .:v. {
I
=
~ ;0/ { ~ <;'
~ I
4. Waste Material Composition: (check all thaI apply and include percent of total>
- Soil --% -- Foundry Slag _%
ConCrete/AsPhalt _% -- Dredge Sediments %
- -
- Preserved WOOd --% ~ Debris WQ%
- Coal Ash --% -- Other (/ist)
- WOod Ash --% _%
_%
NOTE: Total must equal 100%.
5. Waste Material Contaminants: (check all that apply)
-
Gasoline _ Melals _ Diesel
Solvents _ Heating Oil _ PCBs
Unused Motor Oil _ Used Motor Oi/lWasle Oil
Other. fi'!!<:6 1~ ~ J'..,~ Olher Petroleum Producl __
(k~1> ~~
--
-
-
v/'
-
-
Unknown
--~._~------------_..._.._.
NOTE:
SUPPly any MSDS information wilh application, if available.
- --------------
Cily ot Port Angeles -landfill Waste DiSPosal APPJicaJion
f-} s t(
2e-t.1U i/,c..~
,
-
6. Estimated Quantity of Waste for Disposal:
--,1. 5:'-
Cubic yards /
Drums /
'to
Tons (estimate both)
Tons (estimate both)
Other
NOTE:
Estimated quantity for disposal must be within 20% of the quantity actually disposed.
(10% for projects over 7,500 tons or 5,000 cubic yards.)
7. Frequency of Disposal:
/ One time
Monthly
Annual
Other
8. Waste Sampling:
Proper characterization of the waste for disposal requires the collection of representative
samples. The methods and equipment necessary for obtaining representative samples of a
waste, and the frequency of sampling, will vary with the type and form of the waste, Check the
appropriate box and briefly describe how and where the waste was sampled, Include site maps
with sampling locations if possible.
Number of COMPOSITE samples -L & number of discrete samples per composite ~
Number of DISCRETE samples 5'
C), 3~t, - [lO,^".A~5,(Y'A ~ rl~ tk 5:~....u~ I So. ~01...<_, I ok. I.AJK44.J It
,(
'1' 1'1-1",,^ I (.2.. t()cJt 1':"....... ) 1A..,.J~6 6wll J 2lL ,t:'.",.......... oAJ({
NOTE 1: Unless prior approval has been granted by Port Angeles, the following sampling
frequency will be used:
0-25
25 - 100
101 - 500
501 - 1000
1001 - 2000
>2000
cubic yards
cubic yards
cubic yards
cubic yards
cubic yards
cubic yards
=
1 composite sample
3 composite samples
5 composite samples
7 composite samples
10 composite samples
10 plus one sample for each additional 500
cubic yards
=
=
=
=
=
NOTE 2: One composite sample shall contain a minimum of three/maximum of five discrete
samples.
City of Port Angeles - Landfill Waste Disposal Application
Page - 3
r~----
9. Waste Analysis:
The "Dangerous Waste Regulations" (WAC 173-303) shall be utilized to determine the
appropriate analytical requirements for waste characterization. Ecology Publication #91-30
(Revised April 1994) "Guidance for Remediation of Petroleum Contaminated Soils" shall also be
used to characterize petroleum contaminated soils from UST releases. Submit all laboratory
analytical results, QA/QC data, and Chain of Custody sheets along with this application.
(NOTE: The laboratory must be accredited by the Washington State Department of Ecology.)
a) List all analytical test methods used:
1iJ>~/311 hDOlJ6
.
b) Provide a narrative as to why the above analytical methods were selected:
fJu.'L 'f~
lY ~~
A ,.(. ();;
AA 9.0
5.,...."'"~T....-c4'5
PAl,..)?
'1"'4(~
6AJ "1"""..-..c..
~ j>~SJ.~/LI~Y
Y -1..J C'7"......e<S
NOTE:
Additional sheets attached:
k". YES
NO
10. Soil Classification: (**FOR PETROLEUM CONTAMINATED SOILS ONLY..)
Based on the analytical data and Ecology Publication #91-30, the soil classification is: (check
one)
Class 1
Class 2
Class 3
Class 4
Calculated Hazard Index
11. Dangerous Waste Affidavit:
Based on a review of the analytical test results, site history, and the applicable regulations, this
waste is classified as: (check one)
+
Neither Dangerous Waste (OW) nor Extremely Hazardous Waste (EHW)
Dangerous Waste (OW) and Waste Code:
Extremely Hazardous Waste (EHW) and Waste Code:
City of Port Angeles - Landfill Waste Disposal Application Page _ 4
12. Certification:
We, THE UNDERSIGNED, certify that this application is true to the best of our knowledge. All
information provided is correct and the enclosed analytical results represent the proposed waste
material to the best of our abilities.
(<~-
....
,~ \ 0'- L..
Printed Name
/) 11M <:;fmv..,
~,.,.. ()'"(,/~ !i<C.(..
?~"'\.Jc)v'(".' f AsSo~/~ I "Lv,.
~ (-0 )~QJ
Company
Oreo.~
Pfb~tk.\
,
Lt-. C
AJ() 1/
05103
Date
N:\POLlCY_P\1000_SW\1009_01 WPD
City of Port Angeles - Landfill Waste Disposal Application
Page - 5
,\j V L LdUVl OlVI 1'-'"'-', " ,~.
.
0\105 Aurola A~ N ~lIle Wf\ 98103
Tpll06'>470100. Fax 2066~A;936
www nvllaos corn
An~ysts R8fXJrt
Lead (Ph) TCLP
Client ZenovlC & ASSOCT~ loc
Add ress 519 South Peabody Street Surte 22
Port Angeles
Attention: Mr. Tracy Gudgel
Project Location 916 Georgiana, Port Angeles
Lab 10
23091324
Client Sample #'
03336
RL
mgJ.L
05
;OHA IH
#101861
; 1.~...Wl ~... ;
\ ...................- H",...... 1
lACCREDITED:
_LABORATO~Y j
Sampled by Clienl
Analy,ed by Holly Tunic
Delle 11{14/2003
my! L Milligrams per Iltcr
[lpm :: parts per million
Note ~cth_od 9C !esu..'ls are ar.ceptable unless stated otherwise
BCTTct1 Run No' 23 1113-7 - - -- ----
Batch #: 2314741.00
Matrix: Bulk
Method EPA 1311/70008
Client PrOlect #03336
Samples Received: 1
Total Samples Analyzed 1
Res u J ts
in mglL
< 05
Results in
ppm
< 0.5
_ DRAfT
J
RL '" Ilcportmg limit
.<"' :: Below the Ie-partin!] limit
J
Page 1 of 1
v .
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Zoning . . .
Application valuation
03-00001116 Date 11/21/03
916 GEORGIANA ST
06-30-00-6-1-0308-0000-
DEMOLITION
COMMERCIAL OFFICE
1500
Owner
Contractor
ARMSTRONG, JOSH
333 GRIFFITH FARM ROAD
SEQUIM WA 98382
(360) 457-5752
Structure Information
Construction Type , . . .
Occupancy Type . . . . .
JIM PFAFF CONSTRUCTION
PO BOX 1 JOYCE
JOYCE
(360) 928-3340
WA 98343
DEMOSFR
TYPE V NON-RATED
SINGLE FAM & CONGREGATES
Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
DEMOLITION
DEMO SFR
47.00
11/21/03
5/20/04
Plan Check Fee
Valuation
.00
o
Qty Unit Charge Per
Extension
47,00
BASE FEE
Other Fees
STATE SURCHARGE
4.50
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 47.00 47.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 51.50 51. 50 .00 .00
..0
~
~
o
(\)
o
,
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."
P
s
~
Separate Permits are reqUired for electrical work, SEPA, Shoreline, ESA, utilities, pnvate 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 ordin nces governing thiS type of work will be complied with whether specified herein or not. The granting of a permit does not
presum to e au ity to violate or cancel the proviSions of any state or local law regulating construction or the performance of
constr. c 0
Signature of Owner (if owner IS builder)
T \PLANNING\FORMS\1102 15 [11/14/2003]
Date
. oj
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 A CCEPTED. 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 T10N DRAINAGE/DOWN 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
DRYW ALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILING I
MECHANICAL
HEAT PUMP
GAS LINE
WOOD STOVE / PELLET / CHIMNEY
HOOD / DUCTS
PW UTILITIES / SITE WORK (Engmeenng 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.
ENGINEERING 417-4807 PW / ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT 417-4750 , / PLANNING DEPT
BUILDING 417-4815 /2/1/0.5 f.<V BUILDING
T \PLANNING\FORMS\1102 15 [11/14/2003]
BUILDING PERMIT - APPLICATION
FOR OFFICIAL USE ONLY
Date Rec J 1- Z )~6];
PermIt # ] I / b
Fill out COMPLETELY and in INK. Your application and site plan MUST BE
COMPLETE to be accepted for review. If you have any questions, call
(360) 417-4815
Date Approved
Date Issued
ApplIcant or Agent: -:rCs~ i1fWlS~
Owner: ,C:vVe.J Drea. W\S pR!)~
Address' 2 S-3- ~h II-wvy-- / (Jt City:
ArchItect/Engmeer:
Contractor~ ,--r,-~ P~Fr CCL-t State LIcense #:
Phone: lf57-S-7JZ-
LLC
f/orJ
Phone:
IJI'1,dzs Zip: 983 C-z-
Phone:
Exp: Phone: t'jZ?: S3r()
Address: CIty: Zip:
PROJECT ADDRESS: 9/ b G;.a'J)rcr /q:'4 ZONING: G ~ ~('
LEGAL DESCRIPTION: Lot: ECI (leT e. Block: BL3 SubdlVlslOn: Dy k1L J.ewr/ (('./ Subo/,",/
CLALLAM COUNTY PARCEL NUMBER: C g eO:') ~ (o:g C> ~ ~
Credit Card Holder Name:
Billing Address:
Credit CardType VISA MC #
TYPE OF WORK:
o ResIdentIal 0 New Constr. 0 Re-roof
o MultI-fanuly 0 Addition 0 Move
o CommercIal 0 Remodel 0 DemolItIOn
o RepaIr 0 SIgn
BRIEF DESCRIPTION OF THE PROJECT.
City:
Exp. Date:
SIZEN ALUATION:
SF @ $ /SF = $
SF @ $ /SF = $
SF @ $ /SF = $
TOTAL V ALUA nON $ ~ Q.ot!J
hq r-4: IA (ju \.(? , '....
o Stove
o Garage
o Deck
o Other
~('I
COMMERCIAL/RESIDENTIAL: Occupancy Group:
Occupant Load
ConstructIOn Type.
No. of Stones Lot SIZe' Existmg Sq. Ft. & Proposed Sq. Ft.
EXIstmg lot coverage _ % & Proposed lot coverage _% = Total lot coverage
APPROVALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:
PLANNING USE ONLY:
ESAlWetland(s): 0 Yes 0 No SEPA Checklist reqUIred? 0 Yes 0 No Other:
BillLDING PERMIT APPLICATION SUB MITT AL: The BUIldrng DlVlsIOn can provide you WIth InformatIOn on the applIcatIOn and
plan subnuttal 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 BUIldrng DIVISIon to comply WIth current fee schedules Contact the Penrut Coordmator at 417 -4815 for assistance.
PLAN CHECK FEE: IF a plan check fee IS due It must be subnutted at the tune the bUIldmg penrut applIcatIOn and constructIOn plans are
submitted All other penrut fees are due at the tIme of penrut issuance
EXPIRATION OF PLAN REVIEW: Ifno penrut IS issued wIthm 180 days of the date of applIcatIon, the application will expire. The
BUIldmg Official can extend the tune for actIOn by the applIcant up to 180 days upon wntten request by the applIcant (see SectIOn 1074 of
the Umform BUIldmg Code, current edItIon). No applicatIOn can be extended more than once
I hereby certJfy that I have read and examined this application and know the same
understand that It IS my responsibility to determine what permits are require
be true and correct I am authorized to apply for thIS perlnlt and
t obtain such permIts pnor to work.
Date H~b~?
r r
T \FORMS\APPS\BlIlldmgpermll wpd
~ VORT ""'"
~..O~<<;..
i1~~
"- ~
~
~C~
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use
Property Zoning .
Application valuation
03-00001124 Date
916 GEORGIANA ST
06-30-00-6-1-0308-0000-
RES NEW SFR
1/20/04
COMMERCIAL OFFICE
3500
Owner
Contractor
ARMSTRONG, JOSH
333 GRIFFITH FARM ROAD
SEQUIM WA 98382
(360) 457-5752
Structure Information
Construction Type
Occupancy Type
Other struct info
OWNER
FOUNDATION FOR MOVED HOUSE
TYPE V NON-RATED
SINGLE FAM & CONGREGATES
TOTAL % LOT COVERAGE
CONSTRUCTION TYPE
NUMBER OF STORIES
LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE
NUMBER OF UNITS
21. 90
V-N
2.00
5600.00
1228,00
1228.00
1. 00
~
~
Permit
Additional desc
Sub Contractor
Permit Fee
Issue Date
Expiration Date
ELECTRICAL NEW RESIDENTIAL
200 A. SERVICE
BOB'S ELECTRIC INC
76.30 Plan Check Fee
1/20/04 Valuation
7/18/04
.00
o
~f
'"
~
~
""
"-
~
\'
lt1
"')
"
Qty Unit Charge Per
1.00 76.3000 ECH EL-RM-0-200 1ST SRV FEEDER
Extension
76.30
Special Notes and Comments
Address numbers shall be plainly visible from the street.
Address numbers shall be a minimum of six inches high and be
in contrast in color of there background.
Other Fees
STATE SURCHARGE
4,50
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
- Permit Fee Total 76.30 76.30 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 ,00
Grand Total 80.80 80.80 .00 .00
-'18::-
SeparatePermits 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 [11114/2003]
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, 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
WALLS
FOUNDATION 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 I I I
FRAMING
JOISTS / GIRDERS
SHEAR W ALLiHOLD DOWNS
WALLS I ROOF / CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL I FLOOR / CEILING I
MECHANICAL
HEAT PUMP
GAS LINE
WOOD STOVE / PELLET / CHIMNEY
HOOD / DUCTS
PW UTILITIES / SITE WORK (Engmeenng DIVISIon) SEPARATE PERMIT #'s'
WATERLINE / METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'s SEP A-
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 0t,ftLl 1M ELECTRICAL
LIGHT DEPT
If .
CONSTRUCTION R.W. / PW/ CONSTRUCTION - R. W.
ENGINEERING 417-4807 PW / ENGINEERING
FIRE 417-4653 FIRE DEPT
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
T.\PLANNING\FORMS\1102.15 [11/14/2003]
6-02-204 7,39AM
FROM ANGELES ELECTRIC INC 360 452 9265
l::Lt:l.., I HIL;Jl.lI-'I::HMIT APPLICATION
P.1
.
,(~ "~k ~ ~j
~\~. """N 1"'-
...~('.
il;~-;::;'-~l' ,
Ple~s{> rype or repdnlln Ink.
,. cq /u)
"T1l(! E:l(>C1JiC~f PClIllil Arm1ic<<lion "iust b~J.lllcd Ol,;!\ comDlelcl\':
.......,"''''''1.\..\1:\/11<1.1
U...JRn":
"tln,il"
I)J.rl'lf>f\I"..w:
J);IlC'''''''ol:_
.
If you h~ve 2ny qllp.!':1Ions, pleas(/' call (360. 4'17~7J5
F~)' llurnhef: (360) 417~711
CYI- 7'0>
REQUEST INSPECTION 0
Proper1~ Owner:
Own., Of flec. Conl,ac',,, A9""':_l!..NGEl.Es....J:;1.Ef:1:R.l1:......
BetWt ~EW'
'0//6 GEBP;;"4NA-
J'hone;4 ~ 7 - q 7 1\4
Fox: 4 'i7-'l7"<;
AdrJiess:
Cily: .
Patr1M:~~
J\NGRLF.1460RS
Uc(!n~c ~I: Exp:
Phone;
V5Z- 7ftY,r-
Zip 9Y3b 'Z-
Electrical ContfaCloT: ANGELES 1,LECTIIl C 1 NC_
Add,.ss: 524 EAST FIRST
Phon.' ~., 7 - Q.2.6A..
_ Cily: POnT J\NGELES. WA
Zip; 98367
INSrALLATION WiRED BY: I. i OWNER xlfLECTRIC^L CONTRACTOR
Credit Card Holder Name: ".,,, <: i mps.on
Billing Address:
Credit Card Number:
Cily:
"
Zip:
~
VISA:_MC:_
Exp, Datt!:
PROJECT ADDRESS:
'fit
C~~rlIJ4-
~liOnlAdditiOn
TYPE OF WORK:
Check all thai apply:
[JNew
o Residental 0 Multi-family
~mmercial '0 Mobile Home
Sq, Ft.
o Remote Meter
o Detached garage 0 Hot Tub 0 Swim Pool
6
o Septic Pump
o low Vollage 0 Telecom, 0 Sign
Number of Circuits added or allered~
~/~ n7
/~'7 ~ ~
j)-t:.--
JS7 :e
DESCRIPTION OF THE ELECTRICAL PROJECT:
(f,SlfPu
('l~ kI
I
Elecirical Heat Load Additions
Service Information
o Baseboard
:J Furnace
:J Heal Pump
::J Fan-Wall
_KW
_KW
_KW
_KW
terC;verhead Service
o Temp Service
o Underground Service
Vol/age: ~JeI
Phase: S
SeNics Sizs: ~~
Feeder Size:~ .
'AMC 14.05.060(8): For Industrial, commercial, & residential p'ojects larger than a duplex, a one -line drawing of the Eleclrtcal Service &
'eeders, building size (sq. ~.), toad c"'c~talions, and the iype& 01 conductors and/or raceway is required and shall accompany lhe
::Iectf'ical Permil application.
'hereby certify that I have read and examined this application and know that same to be true and correct; and I am
wthorized to apply for this permit. I ':Jnderstand it is not the City's legal responsibility to determine what permi
ins the appli ts responSibility to determine what permits are required and to obtain such.
#~6 4- e,,,,;, c,," ",,",,', ':9"'''~' -7~' f-c"""
(Owner or Elt.c. ConI. SIgnature: _ _---'-. _-= Dale:
W'9019 It - ~
of--- As I ~ - ({..y-JL
/!tJ{J &,ft;01
c./ ~/
bl )'/
/h /t./IH- )
.j' 59 /-/ D
Jul 01 04 08:46a
Bobb~ O. Coleman
~
w~
~.... ~,1J
.
360-452-7594
p.l
.
ELECTRiCAl PERMIT APPLICATION
f':)fI Of~~n'l.:... USE Ol'.1... \'
n.,e/Jl.u.
"-1M ~.
bo"....wo_. _
o.cwu,",_
The Elecfritoilf Permit Application must be Riled OLIt corn"Ieh'.
Please- type or r.print in ink. If you have.-.yqueslfons.. pteasecall (360) 411~735
.FOUl: numb....: (360) 4t7~711
EtectJ1c:ar Conlr.ld:or:
Owner Of' Bet:_ Contractor Agent
Property Owner: ?
........., I
Ad_" ,57;;2
7t
/,/) I" Y1i
~ lice"..,: Exp:
C~ /l-~aJ~
~ONTRACTOR
Zip:
INSTALLATION WIRED BY:
[] OWNER
Credit Canl Holder Name:
Billing Addmss:
Credit Card Number:
PROJECT ADDRESS: 9/, ..!f~;/d~
TYPE OF WORK: Check all thaI apply: ~
L..I Residential 0 Mulli-tamily ~mmerCial
CJL/ - 58~
K
Fax.2 -?"-.<J'y
Cily.
Phone:_...
Z;p 9 -r3c. z.
Phone:
CIty:
Zip:___
Exp. Date:
V/SA.~ MC:
o A1terntion/Addition
o Mobile Home Sq. Ft
Number of Circuits added or altered:
o Remote Meter 0 Detached garage 0 Hot Tub 0 Swim Pool 0 Septic Pump 0 low Voltage 0 Telecom. 0 Sign
DESCIlIPnON OF TlfE ELECTRICAL PROJECT:
~(p--/- /C~/ rUK-N~_
Electrical Heat Load Additions and or Subtractions
Service Infonnatlon
I hereby certify that I have read and examined this application and know that same 10 be true and correcl. and I am
authorized to apply for this permit. I unden;tand it is not the City's legal responsibility to r/etermine whar permits
are required; it remains the applicants responsibility to det at pe its ired and to obtain such.
7//04.-
A/- [)~ A7 fS _
~anl
~a,;:mp
o Fan-Wall
ff~' yY'
":i. TON. lRA
KW
Credit Card Holder's Signature:
Owner or EJec:. Cont. Signature:
trV
o Overhead SeIVil:B
o Temp Service
[] Underground Service
Vollage:__ _
Phase; 0 1 U 3
S9IVice SiZE!:
Feeder Size;
Oate: 7 -I -t'/Lf
Date:
C:lELECTRICAlPERMITAPPUCA TION
fZ..r ~
PERMIT FEE: $
-Yk- 70
KiM;
4cO
.
7f/eJr
10
ftl'5l<<1
;
FROM BOB'S Electric
FAX NO. : 1 360 452 9943
Jan. 15 2004 03:47PM Pi
l
V'
~
ELECTRICAL PERMIT APPLICATION
FOil OfTlIClAL I :~r. n~l. v
1bI,,1Il......:
PrmIif .:
DfllrA.........'<fIt;
The E.lectrical Permit Application must b@ fIlled out eompJerl?Jy. o..r luw,/!
Please type or fl:!prlnt In Ink. It you have any quosUons. please call (360. 417-473Sf)I- II J&I
Fax number: (3&0) 417-4711 1
o..neTor Elsc. ContractorAgent.J!c,lUtA".r .(. a""t'If.n / ~Phono~-i'<7~P27F''''
....~- ~ 4~~~ _ _.,
Addross: _ _CIly:_
EIee',,,., ConltaclDt: A..I.1, p __ ~ .);A/c L~f 2.~XP:
Addross: ~Y:g d..." /1",,,,,1(' . CIIY: lh-f... t4tU'j'" /., c: fLJa
INSTALLATION WIRED BY: 0 OWNER 9(ELECTRICAL CONTRACTOR
Credit Card Holder Name: C ~A' / ~/ .../~, f' .
811/10g Address: :?~f ~ ~t?'R &K' City: A.f'T
Credit Card Number: '-
,
Zip: ...iLJe. C; ffZ,~
VISA:..6....-MC:_
PROJECT AODRESS:
-7/~ C7("'~~AJ?
Check alllhat apply: 0 New 0 Alleralion/Addition
TYPE OF WORK:
o Aesidenlal 0 Mulli-family
o Commercial 0 Mobile Home
Sq. Fl.
D Aemole Meter 0 Delached garage 0 Hot Tub 0 Sw,'m Pool 0 SeptIc Pump 0 Low VOltage 0 Tele 0 S'
' com, Ign
Number of Circuits added or allered:
~c-~;t!)~
<i"~
'''7~ ~.
DESCRIPTION OFTHE ELECTRICAL PROJECT:
. - ..
Electrical Heat Load AddlUons
ff'Z....~
Service Informal/on
o Baseboard
o Furnace
o Heal Pump
o Fan-Wall
_ t<:W
_ t<:W
_ t<:W
_ t<:W
o Overhead Servloe
o Temp Servloe
CJ Underground Service
Voltage:
Phase: 0 1 0 3
Servloe Size:
Feeder Size:
PAMC 14.05.060(B): For Industrial, commerclal,.& residential projecls larger !han a duplex. a <;>"" - line drawing 01 Ihe Eleotrioal Servioe &
Feeders. building size (sq. ft.), load caloulations. and the Iype & of oonduotors and/or raoeway is required and shalt accompany the
Electrical Permit appllcalion.
I hereby certify that I have read and examined this application and know that same to be tlVe and correct, and I am
authorized to apply for this permit. I understand it is not the City's (ega( responsibility to determine what permits
are required; It remains the applicants responsibility to determine what permits are required and to obtain s
:-
~~~, _U
Date:
/-/5-&4-
/-/~ -of
Date: