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HomeMy WebLinkAbout1034 Homestead Ave - BuildingPREPARED 10/09/07 9 05 30 INSPECTION TICKET PAGE 8 CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 10/09/07 ADDRESS 1034 HOMESTEAD AVE SUBDIV TENANT NBR HELEN LASTOVICA /J CLARK CONTRACTOR EVERWARM PHONE (360) 452 3366 OWNER HELEN LASTOVICA J CLARK PHONE (360) 452 7196 PARCEL 06 30 14 3 2 9030 0000 APPL NUMBER 07 00001139 MECHANICAL APPL PERMIT PERMIT ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS ME6 01 10/09/07 _LL MECHANICAL GAS LINE TIME 01 00 October 3 2007 1 24 47 PM 1pangrle KAY 452 3366 'GAS STOVE GAS LINE TUESDAY AFTERNOON COMMENTS AND NOTES CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 Application Number 07 00001139 Date 10/02/07 Application pin number 772600 Property Address 1034 HOMESTEAD AVE ASSESSOR PARCEL NUMBER 06 30 14 3 2 9030 0000 Tenant nbr name HELEN LASTOVICA /J CLARK Application type description MECHANICAL APPL PERMIT Subdivision Name Property Use Property Zoning RS9 RESDNTL SINGLE FAMILY Application valuation 840 Owner Contractor HELEN LASTOVICA J CLARK EVERWARM 1034 HOMESTEAD AVE 257151 HWY101 PORT ANGELES WA 983622731 PORT ANGELES (360) 452 7196 (360) 452 3366 Permit MECHANICAL PERMIT Additional desc INSTALL GAS LINE /STOVE Permit pin number 112318 Permit Fee 60 65 Plan Check Fee 00 Issue Date 10/02/07 Valuation 0 Expiration Date 3/30/08 Qty Unit Charge Per Extension BASE FEE 50 00 1 00 10 6500 ECH ME GAS PIPE 1 TO 5 10 65 Fee summary Charged Paid Credited Due Permit Fee Total 60 65 60 65 00 00 Plan Check Total 00 00 00 00 Grand Total 60 65 60 65 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 constructio or or Authorized Agent Date T \Policies \1102_15 building permit inspection record05 wpd [1/4/2005] WA 98362 P/1 ,0 0 Signature of Owner (if owner is builder) Date CALL 417 -4515 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 UNLAWFUL TO COVER, INSULATE OR CONCEAL AN!' WORK BEFORE INSPECTED AND ACCEPTED POST PERMIT IN A CONSPICUOUS LOCATION KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE. INSPECTION TYPE FOUNDATION: FOOTINGS SHEAR WALLS WALLS FOUNDATION DRAINAGE DOWN SPOUTS PIERS POST HOLES (POLE BLDGS.) PLUMBING UNDER FLOOR SLAB ROUGI -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 INSULATION SLAB WALL FLOOR CEILING I MECHANICAL ROUGH -IN HEAT PUMP FURNACE DUCTS GAS LINE WOOD STOVE PELLET CHIMNEY MANUFACTURED HOMES FOOTING SLAB BLOCKING HOLD DOWNS SKIRTING PLANNING DEPT SEPARATE PERMIT 4's PARKING /LIGHTING LANDSCAPING RESIDENTIAL ELECTRICAL LIGHT DEPT 417-47 BUILDING PERMIT INSPECTION RECORD DATE ACCEPTED lo YES NO 1 I 1 FINAL FINAL SEPA. ESA. SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY /USE DATE YES NO COMMERCIAL ELECTRICAL LIGHT DEPT CONSTRUCTION R.W PW/ CONSTRUCTION R.W ENGINEERING 417-48117 PW ENGINEERING I FIRE 417 -4653 I I I I FIRE DEPT PLANNING DEPT 417 -4750 I„ p I t l �i A L 1 I PLANNING DEPT BUILDING 417 -4815 1 I (1 e& I 1 1- r1 I !P I BUILDING T• \Policiesll 102 15 building permit inspection record05 wpd [1/4/201,5] COMMENTS DATE ACCEPTED BY. DATE ACCEPTED BY. DATE ACCEPTED YES I NO O 0 1 I I I 1 I Applicant or Agent 11E2M141 e._M -IVC. Owner /1/L-.. t Owner's Address la 34 40 C e4 ✓J ContractorfEngineer EVILWi _4A -N� Contractor/Engineer's Address /110Y 1D PROJECT ADDRESS /6.2 q 410,1451 A 0 LEGAL DESCRIPTION Lot: Block: CLALLAM COUNTY PARCEL NUMBER. D630/Vr,3,_9'a3ODDoO Residential Multi- family Commercial Repair Fill out COMPLETELY and in INK Your application, prescriptive energy form, plans, specs, and a 8 %z" x 11" site plan MUST BE COMPLETE to be accepted for review (360) 417 -4815 FAX (360) 417 -4711 Residential projects: submit two sets of plans Commercial projects submit three sets of plans TYPE OF WORK New Constr 0 a Addition Remodel Sign Re -roof ?'Stove Move Garage Demolition Deck Other BRIO' DESCRIPTION OF '173E PROJECT Lrtig- COMMERCIAL /RESIDENTIAL. Occupancy Group- Existing Structure(s) basement 1" floor 2' floor 3' floor Existing Structure(s) TOTAL Maximum Height of Proposed Structure(s) BUILDING PERMIT APPLICATION Sq. Ft. Sq Ft. Sq. Ft. Sq. Ft. Sq. Ft. Ft. Phone VS. Phone 6 IPotr 44,s L4 W362- State License V�2W1 *Kr NI- Expires if -11-d9 iQ i 44/6.4L‘S f36 Phone 2 -336 Q t /k_ ZONING Subdivision. /v LOT COVERAGE SF SF SF TOTAL VALUATION SIZE/VALUATION Occupant Load: Construction Type: Proposed Structure(s) basement 1" floor 2" floor 3' floor Proposed Structure(s) TOTAL TOTAL Sq. Ft. of existing proposed structures FOR OFFICIAL USE ONLY Date Rec. J© 2-07 Permit 071 1 C A. Date Approved: Date Issued: /SF /SF /SF S r ,14bV `OL% /0/ J,7 Sq Ft. Sq. Ft. Sq. Ft. Sq. Ft. Sq. Ft. Lot size Sq. Ft. Existing Structure(s) Sq. Ft. Footprint Proposed Structure(s) Sq. Ft. Footprint TOTAL Structure(s) Sq. Ft. Footprint Total Lot Coverage (Divide Total Structure(s) Sq. Ft. Footprint by Lot Size Sq. Ft.) 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 4315 for assistance PLAN CHECK FEE. The plan check fee must be paid at the time the building permit application is submitted. All other permit fees are due at the time of permit issuance. EXPIRATION OF PLAN REVIEW An application for a permit for any proposed work shall be deemed to have been abandoned 180 days atter the date of filing unless such application has been pursued in good faith or a.permit.has been issued, except that the building official is authorized to grant one or more extensions of time for additional periods not exceeding 130 days (90 days for commercial projects) each. The extension shall be requested in writing and justifiable cause demonstrated. (IRC/IBC 2006 105.3.2) I hereby certify that have read and examined this application and.knaw 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, and that must obtain such permits ri r to work. y Date 0La d I` Applicant T DIVISION1BIdgPermitAppl. -2006 CODE..y d Sig Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Tenant nbr name Application type description Subdivision Name Property Use Property Zoning Application valuation Owner JEFFREY CLARK 1034 HOMESTEAD ST PORT ANGELES Permit Additional desc Permit pin number 92098 Permit Fee 64 70 Issue Date 12/12/06 Expiration Date 6/10/07 Qty Unit Charge 1 00 14 7000 Fee summary Permit Fee Total Plan Check Total Grand Total CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION 32] EAST 5TH STREET PORT ANGELES, WA 98362 WA 983622731 MECHANICAL PERMIT Per ECH Charged 64 70 00 64 70 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 c e authori violate or ncel the provisions of any state or local law regulating construction or the performance of coy- ,uci,'on. ture of Co uthorized Age T \Policies11102_I5 building permit inspection record05.wpd [1/4/2005] 06 00001312 914336 1034 HOMESTEAD AVE 06 30 14 3 2 9030 0000 JEFF CLARK MECHANICAL APPL PERMIT RS9 RESDNTL SINGLE FAMILY 11900 Contractor BASE FEE ME INSTALL 100- FAU Paid Credited 64 70 00 64 70 Plan Check Fee Valuation 00 00 00 Date 12/12/06 PENINSULA HEAT 782 KITCHEN DICK RD SEQUIM WA 98382 (360) 681 3333 Extension 50 00 14 70 Due 00 00 00 0 0 0 Da e Signature of Owner (if owner is builder) Date I FIRE 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 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. FOUNDATION: FOOTINGS SHEAR WALLS WALLS FOUNDATION DRAINAGE DOWN SPOUTS PIERS POST HOLES (POLE BLDGS.) PLUMBING UNDER FLOOR SLAB ROUGH -IN WATER LINE (METER TO BLDG) SHOWER PAN MEDICAL GAS LINE AIR SEAL WALLS CEILING FRAMING JOISTS GIRDERS SHEAR WALL /HOLD DOWNS WALLS ROOF CEILING DRYWALL (INTERIOR BRACED PANEL ONLY) T-BAR I INSULATION SLAB WALL FLOOR CEILING MECHANICAL HEAT PUMP FURNACE DUCTS GAS LINE WOOD STOVE PELLET CHIMNEY COMMERCIAL HOOD DUCTS I MANUFACTURED HOMES FOOTING SLAB BLOCKING HOLD DOWNS SKIRTING PLANNING DEPT SEPARATE PERMIT #'s PARKING /LIGHTING LANDSCAPING RESIDENTIAL ELECTRICAL LIGHT DEPT CONSTRUCTION R.W PW/ ENGINEERING INSPECTION TYPE DATE 417 -4807 417 -4653 FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY /USE 417 4735 ELECTRICAL LIGHT DEPT ACCEPTED YES I NO I I I PLANNING DEPT 417 -4750 I Y^ e I _n I Y BUILDING 417 -4815 1 )(I J I 1 1 1 0 T• \Policies \l 102_15 building permit inspection record05.wpd [I /4/205] FINAL COMMENTS DATE ACCEPTED BY. I FINAL DATE ACCEPTED BY. SEPA. ESA. SHORELINE. DATE YES NO COMMERCIAL DATE ACCEPTED YES I NO CONSTRUCTION R.W PW ENGINEERING FIRE DEPT PLANNING DEPT BUILDING I I I I I I I I I I I 12/12/06 10 00 FAX 3606812086 Applicant or Agen Owner;e I Address:,_�0� 1. f C redit Card Holder Name: g Address: redit Card Type VISA X M E OF WORK; eeiden41 O New Constr. Multi f mill 0: Addition u ouunercial Ci. Ret4lel t7,R•pait DESCRfP TION'OF THE i LANNING USE ONLY BUILDING PERMIT APPLICATION FIR out COMPLETELY snd In INK Your application and site .plan MUST BE COMPLETE to be accepted for tevievw It.you have any questions; call (360) 417 4815 Architect/Fagineer. Contractor P �XI L�yt Cr +—Star Address; PROJECT ADDRESS: LEGAL' DESCRIPTION: Tot; cLALLAM'COUNTI'PARCEL NUMBER.. Ob 3(5- /4 -,3 ''1030 C O Re-roof o Steve O Move 'C Garage O Demolition t •0 Dirk of Stories: Lot Size: Existing Sq. Ft. g lot coverage Proposed lot coverage Phone: License g 1 City: 5eq Wl Block: Subdivision: Occupant Load: &Proposed Sq. Ft. Total lot coverage i SA/Wetland(a): D Yes D No SEPA Checklist required? 0 Yes O No Other. Peninsula Heat Phone: eV -3333 Phone: leS zip, 92312_ wit —•f p t„/4 S.e -Exp. Date: tSIZE/YALUATr6J lb A M EERCALlBESIDENTIAL. Occupancy Group: FOR OFFICIAL Date Rec.. Permit Date Approved: Date Issued: Phone: 65e/ 33 33 Zip: C) ZONING: SF t sP E .its `I Sri. �a A I f1 C:' LiC)0" �-'D-- ISF ti Construction Type! TOTAL Sq.Pt. 0,6 R102 SE LY- D6 e6, APPROVALS; PLAN BLDG: DriV0; FIRE: OTHER. ING PERMIT APPLICATION SUBMITTAL: The Building Division can provide you with infoanation on the application and l submittal tequ if you have questions. UATTON OF CONSTRUCTION. In all cases, a valuation amount must bennteled by the applicant This figure will be reviewed I may berevisedbytheBuilding with eu entfeeschedules. Contact the Permit Coordinator 481$ for assistance. C�CKFEE: IF.a plan check fee is due it must be submitted at the time the building permit application and constructionplans are c miffed. All other permit fees are due at the time of permit issoauce. IRAT ION OP BEVIEWs If= permit is issued within 180 days of the date of application, the application will expire. The ding Official cariextead'thetime for action by the applicant up to 180 days upon written request by the applicant (see Section 107 4 of Uniform Building Code, current edition). No application can be extended more than once. Iyreby certify that 1 have read and examined this application and brow the se, a to be true a correct I am authorized to apply for this permit and dersfend that ills my responslblrity to determine what permits are requi d the City's an. 1 ust In such pangs prior to work PORMSNAPPABulldingpermitwpd Applic ate: l /o fo r I '. " ':~'." ."..., -~._j,.. .....~ '~ Vi! CITY OF PORT ANGELES PUBLIC WORKS - ELECTRICAL DIVISION nl EAST 5TH STREET. PORT ANGELES. WA 98362 Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER: Application type description Subdivision Name Property Use Property Zoning . . . Application valuation 06-00001314 Date 511342 1034 HOMESTEAD AVE 06-30-14-3-2-9030~OQOO- . ELECTRICAL. QNr,y .:/ "" .J 12/14/06 RS9 RESDNTL SINGLE FAMILY o Owner Contractor CLARK, JEFF 1034 HOMESTEAD ST PORT ANGELES WA 983622731 PENINSULA HEAT 782 KITCHEN DICK RD SEQUIM WA 98382 (360)6 ~1.- 3333 . ,-' -'. ---------------------------------------------------------------------------- Permit . . . . . Additional desc . Permit pin number Sub Contractor Permit Fee Issue Date Expiration Date . :._-"-.i,-:..;>;-: ELECTRICAL ALTER RESIDENTIAL ." PEN. HEAT/ T-STAT 9213 0 PENINSULA HEAT 36.40 Plan Check Fee 12/14/06 Valuation 6/12/07 .00 o "- ~ ~ '- Qty Unit Charge Per 1.00 36.4000 ECH EL-LVT-FIRST THERMOSTAT Extension 36.40 Fee summary Charged Paid Credit~;l, Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 36.40 36.40 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 36.40 36.40 .00 .00 ~~ t \'\ ~ Con 1,ttOl ~ ~ \. , uAtit'<'r> ., ,1-'1;';' -- COMMENTS! ACTION NEEDED ........,- -r -~ - . '..~ ~ ....._. ,'~ ELECI'R1CAL PERMIT INSPECTION.RECORD CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PR0VIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COJ.'ER, INSULATE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPEC110N TYPE DATE COMMENTS NO Ex GENERAL COMMENTS: rw.I102.1514'96J "- / ,'s '\tii..~ ,:'.:'0 CITY OF PORT ANGELES PUBLIC WORKS - ELECTRICAL DIVISION J21 EAST STH STREET. PORT ANGELES. WA 98362 Application Number Application pin number Property Address . . . . ASSESSOR PARCEL NUMBER: Application type description Subdivision Name . Property Use Property Zoning . . . Application valuation 06-00001311 Date 12/14/06 285099 1034 HOMESTEAD AVE 06-30-14-3-2-9030-0000- ELECTRICAL ONLY . " ,....,..;.r~... RS9 RESDNTL SINGLE FAMILY o Owner Contractor CLARK, JEFF 1034 HOMESTEAD ST PORT ANGELES (360) 452-7196 WA 983622731 OLYMPIC ELECTRIC 4230 TUMWATER PORT ANGELES (360) 457-5303 WA 98363 Permit . . . . . Additional desc . Permit pin number Sub Contractor Permit Fee Issue Date Expiration Date ELECTRICAL ALTER RE'SIDENTIAL .:. OLY.EL./ HP-FURN. 92080 OLYMPIC ELECTRIC 48.10 plan Check Fee 12/14/06 Valuation 6/12/07 .00 o Qty Unit Charge Per 1.00 48.1000 ECH EL-R OR RM 1-4 ALT CIRCUITS Extension 48.10 " ~ tl) ~ Fee summary Charged Paid Credited Due ----------------- ---------- ---------- - . - . ---------- ---------- Permit Fee Total 48.10 48.10 .00 .00 plan Check Total .00 .00 .00 .00 Grand Total 48.10 48.10 .00 .00 . ...1.. } ~ ~ t ~ .. T ..) ..._, ".\ooI,I.,~ .'. . 6'~_-. COMMENTS/ACTION NEEDED '~.. fJ' . .._ __I" ~.;.. .~ ...... __~...~'. r IT .-, ELECfRICAL PERMIT INSPECfION .RECORD 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 IT IS INSPECTED AND ACCEPTED. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE .. INSPEC110N TYPE DATE COMMENTS NO GENERAL COMMENTS: PW-II02.15(4'96) 12/12/06 10:00 F~, 3606812086 PenInsula Heat 14104 , S. ,Ij~' L~ \'S i ...., ELECTRICAL WORK PERMIT APPLICATION Job wired by ~Elcctric.1 Contractor Q Owner Inmllation deliicriptioD o Commercial ;t RC$idcntlal rical COnlf;JClr DOl Purchaser's mailing addr s :;? C;5.e VI IY/ w+ Zl~~ TCk~l ""~ premJeff "C"/r:t riL Addr/~c~sk?7d A~ Clty7J/t-An. ?5. PhoDe number rD .!liChed~spcctiDD: Date ExpiTe5 o New Q Alteredl Addition . ~w U )-Ja~"t' ski- ,J , \ \ Own~r as defined by RCW.J9.18.16J:(1) OWller will occupy the srnl(.'IJ~re for cwo.- ::-_~. years after lilis elecmcal permir It fitl(Jli:!ed, (2) Oh/tj(!r is ft'fJIlin:d co IIii{' eJn ('[eC'lricaf .~. C(mrra~IDr if above said prop~! it for .fale. rent or Jeafe. CJ Cash . 0 Check # A.fter reading the above s~tcmcnt. I hereby ceniry that I am the own~r of the above "..". named pTOp~ pT:!I. liccnscd.-ckcrrical ContraCTOr, I am 11likinll the ClcC11'ical [118m). 0 Credit Card ViSa. Mastercard Imion Or all~rcl.lion in compliance with the electrical laws, N.E.C, RCW. Chapter A A f 0"1 L ~ 19.28, WA . ChapteT 296-468, The C of Pon Angcles MUI\icip\ll Cod~, ..nd Cilrd # _y-.!.':!....._~,;::(,__~_______ Utility S c Ii iltions. '. .Discover Expiration Da-tc of card ~n;pc~~~ Service Information Electrical Load Additions and or subtra~ o NO LOAD CHANGES o Baseboard KW Q Furnace KW .Jit\Hear Pump :.?> Ton _ LAR o Fan-Wall KW o Ove(head Service CJ Tamp Sal'Vice o Underground Service Voltage _ PhaseD1D3 Service Size: Feeder Size: SAME DAY INSPECTION, CALL BEFORE 7;00 AM 360-417-4735 . ROUGH-IN '\ /' THERMOSTAT '\ /' SERVICE '\ I "- D:r.l~ ^PI,raved K,y D~!~ ^pfln:",dily "- 1).le Arrr,),e,lAy./ FINAL / DITCH / 1<EEDER D:r.le .a,i'Jlf..~ed Ry D~l~ ^P",O\lellAy./ "- D~,~ .'\l"Pro~cd Oy ./ Inspection " \ Elecnical AI'ea, Rui1ding or Equipment lnspected Action Taken Dale . . Inspector ". LJ/!7 - "887 . ( ") i. ,\- / 1'"\, \V I II V Y' /' , V -.- , I') ,-, '., - , ~~$t) /-)II;:/a6 , ( 12/12/2006 09:27 3604523498 OLYMPIC ELECTRIC PAGE 01 '. &-10"1 s ELECTRICAL WORKPERMlT APPLICATION; " Jab wired by Cl Electrical Contrsctor r:I OWDer InstIllation description CI Commerdal ~SldeDl:lal E:kctri~1 contractor nsmo ./?h-~r-. ar-d'n'~ p~.s:)t5a\lini lldd.ua ~23"(? 7Z//o/W'A-r,.cd' Ci1b_ / State ZIP t22L:.r4///r'J LV,., ~F.fR:.7 Telephone nu~;e( FAX number -.5 i::? Premhu owne('s hlmr: / / A 1;::?1'1 /h.;/77~ ~7L /7'/" Addreu or laSlpeclloD .7?#-ch,-/<" C~r-rA,r,1..r Pbo.. nUlIlb;; ',?'.b.dul. 1..."tlO"'1.5: OWflU OJ' drfiMd b)' RCtr.J9,28.16J:(I) Owner wi/! occupy tire str-IICHIrl' Jor two )"tOn after ,his tllecrriCGJ pemlll Is finalized. (2) 014mer is N!ljllirrJ II) hire 011 l'/~clri.CDl COflJt12Clor 1/ above ~ajd Pf"DPt:,.1J' U /01' .fDle. ,.tJTf or leas~ AnCT readinJ the Ilbovt SLalemenl, r hereby ccrti(y tha~ 11m the owner of the above named property or 8 licensed electrical conlreclor. t am making the tlcelrical instal- luion l;Jf a.Uerallon in c:ompliilnee with the eleetrlcal Jews, N.E.C.. RCW. Chapter 19.2&, WAC. Chapter 296-4613. The Cily of Pori ^ngelt.S Munielpal Colle, and Utility Specineetions. SIEDllurt- of o,,:ur, tIICrrle.' tllnfrac:lor or elec:trlcal administrator License number Date expires rI/L j/~p?rc;,~(?/ aNew a Altered/Addition &r/7.?c~ r #~ . Cl Cash Cl Check # ~ilCard VlSlI Card # Mastercard Discover x Date: f#/&?b' Expiration Date of card o NO LOAD CHANG ES (J Baseboard KW t'.t"'1umace ~ KW 0 Overhead SaNies i21'ie.1 Pump ~Ton _LAR 0 Temp Service o Fan-Wall _ KW C Undergrouod Service SAME DAY INSPECTION. CALL BEFORE 7:00 AM 360-417-4735 ROUGH-IN THERMOSTAT Servlco InformBtlon VOltage Z. 1"0 Phase Ili", 0 3 Sorvlce Slzo: ~ Fe&der Size: SERVICE D~.. ApplllYtll D;r 0.., .l\l)Itll)vrclD)' D.' ....ppl'O...~ 8y FINAL DITCH FEEDER D", Apl'"''"'td BT D,. ^PI'f"IIvt:G .l5y P'lt "",,",~od By Inspeclion D~1c Area, Building or Equipmenl Inspectod ActiOn Taken ElocrriCA' Inspector '.' AflpJ2,J lfJ L-u~ ~Ao /2hzh6