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1039 S Valley St - Building
Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Application type description Subdivision Name Property Use Property Zoning Application valuation Owner KEITH LLOYD WILLIAM RENA C 150 CLIFF ROBINSON LN SEQUIM WA 98382 68) 8337 Permit Additional desc Permit pin number Sub Contractor Permit Fee Issue Date Expiration Date Qty Unit Charge Per 1 00 36 3000 ECH Fee summary Permit Fee Total Plan Check Total Grand Total 36 30 00 36 30 COMMENTS /ACTION NEEDED CITY OF PORT ANGELES PUBLIC WORKS •ELECTRICAL DIVISION 321 EAST :8'i REE4`x 4i'.ORT ANGELES. WA 98362 06 00001334 259438 1039 S VALLEY ST 06 30 00 0 3 2550 0000 ELECTRICAL ONLY PUBLIC BUILDINGS PARKS 0 Contractor ELECTRICAL ALTER RESIDENTIAL SHAMP/ MTR REPAIR STORM DAMAGE 92353 SHAMP ELECTRICAL CONTRACTING 36 30 Plan Check Fee 12/29/06 Valuation 6/27/07 EL -R OR RM REPAIR METER /MAST Charged Paid Credited 36 30 00 00 00 lJ 36 '30 ,e.Y.t- 4 00 g 3t' 0 0 3 25 ,0 ONLY Rh ,lx e.rpR /Mar I i 'Er 'after Due Date 12/29/06 SHAMP ELECTRICAL CONTRACTING PO BOX 383 PORT ANGELES (360) 452 1689 13i 3- CAL-cai 1 I l 9./ �_-i j60) 4S 688 Li- 1%1 4�_SSAr�� WA 98362 00 0 Extension 36 30 Due 00 00 00 CALL 417 -4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE ACCEPTED COMMENTS YES 1 NO ELECTRICAL PERMIT INSPECTION RECORD DITCI1 1 I I ROUGH -IN COVER 1 1 1 SERVICE 1 1 1 71177a., 0-4-07.-0-1 1 1 1 1 1 1 1 1 1 1 1 1 GENERAL COMMENTS: PW- 1102.15 W961 BUILDING DIVISION CITY OF PORT ANGELES Correction Notice le7Sg s V 6- ITy Inspection of your work revealed that the following is not in accordance with the codes governing the work in this jurisdiction -1I IO 4o (Z SlZa• (A/ &W. S I 60 Jo S.oL\ Job Located at Date 7// 0 Li cam- t' t /f✓ I -e c QL aL S These corrections must be made and are not to be covered until reinspection is made. When corrections have been made, please call L// 7 z _r" for inspection Inspector for Building Division DO NOT REMOVE THIS TAG (i2r/ PREPARED 7/13/06 8 20 56 INSPECTION TICKET PAGE 8 CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 7/13/06 ADDRESS 1039 S VALLEY ST SUBDIV TENANT NBR BILL KEITH CONTRACTOR NU TREND ENTERPRISES PHONE (360) 683 6080 OWNER KEITH LLOYD WILLIAM RENA C PHONE 68) 8337 PARCEL 06 30 00 0 3 2550 0000 APPL NUMBER 05 00001171 RES MANUFACTURED HOME PERMIT BLM 00 BL MANUFACTURED HOME REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS BLFS 01 3/14/06 JLL BUILDING FOOT /SLAB TIME 13 00 3/14/06 AP 03/13/2006 11 28 AM DYASUMUR BILL 460 0915 03/14/2006 04 53 PM JLIERLY BLBT 01 4/18/06 JLL BUILDING BLOCK AND TIEDOWNS 4/19/06 AP 04/18/2006 01 33 PM JLIERLY 04/19/2006 09 12 AM JLIERLY BLFD 01 4/24/06 JLL BUILDING FOUNDATION DRAINAGE 4/25/06 AP 04/21/2006 04 01 PM PBARTHOL KEITH 460 0915 04/25/2006 08 11 AM JLIERLY DRW 01 4/27/06 JLL BUILDING DRYWELL 4/27/06 AP 04/27/2006 12 59 PM JLIERLY 04/27/2006 04 35 PM JLIERLY BL99 01 7/13/06 0UI11ING 6INAL 07/11/2006 01 12 PM PERMITS BILL KEITH 460 0915 *CALL 1ST HE LL MEET YOU* PERMIT BPR 00 BUILDING PERMIT RESIDENTIAL REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS DRW 01 4/26/06 JLL BUILDING DRYWELL TIME 13 00 4/26/06 DA 04/25/2006 12 21 PM DYASUMUR BILL 460 0914 04/26/2006 03 50 PM JLIERLY no holes dug at this time/j11 BL1 01 5/08/06 JLL BUILDING FOUNDATION FOOTING TIME 13 00 5/08/06 AP 05/05/2006 11 02 AM DYASUMUR BILL 460 0195 05/08/2006 04 33 PM JLIERLY this inspection is for garage footing and wall ok /j11 BL99 01 7/13/06 JL BUILDING FINAL 07/11/2006 01 13 PM PERMITS PERMIT PL 00 PLUMBING PERMIT REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS PL6 01 4/19/06 JLL PLUMBING WATER SUPPLY 4/19/06 AP 04/18/2006 03 21 PM PBARTHOL BILL 460 0915 04/19/2006 04 02 PM JLIERLY PL5 01 5/03/06 JLL PLUMBING BUILDING SEWER TIME 13 00 5/03/06 CA BILL 460 0915 05/02/2006 02 28 PM DYASUMUR 05/03/2006 04 35 PM JLIERLY forward to pw roger /j11 PL99 01 7/13/06 JLL PLUMBING FINAL CONTINUED ONTO NEXT PAGE PREPARED 5/08/06 12 34 49 INSPECTION TICKET PAGE 7 CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 5/08/06 ADDRESS 1039 S VALLEY ST SUBDIV TENANT NBR BILL KEITH CONTRACTOR NU TREND ENTERPRISES PHONE (360) 683 6080 OWNER KEITH LLOYD WILLIAM RENA C PHONE 68) 8337 PARCEL 06 30 00 0 3 2550 0000 APPL NUMBER 05 00001171 RES MANUFACTURED HOME PERMIT BPR 00 BUILDING PERMIT RESIDENTIAL REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS DRW 01 4/26/06 JLL BUILDING DRYWELL TIME 13 00 4/26/06 DA 04/25/2006 12 21 PM DYASUMUR BILL 460 0914 04/26/2006 03 50 PM JLIERLY no holes dug at this time/j11 BL1 01 5/08_! L BUILDING FOUNDATION FOOTING TIME 13 00 05/05/2006 11 02 AM DYASUMUR BILL 460 0195 COMMENTS AND NOTES PREPARED 5/03/06 13 05 21 INSPECTION TICKET PAGE 8 CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 5/03/06 ADDRESS 1039 S VALLEY ST SUBDIV TENANT NBR BILL KEITH CONTRACTOR NU TREND ENTERPRISES PHONE (360) 683 6080 OWNER KEITH LLOYD WILLIAM RENA C PHONE 68) 8337 PARCEL 06 30 00 0 3 2550 0000 APPL NUMBER 05 00001171 RES MANUFACTURED HOME PERMIT PL 00 PLUMBING PERMIT REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS PL6 01 4/19/06 JLL PLUMBING WATER SUPPLY 4/19/06 AP 04/18/2006 03 21 PM PBARTHOL BILL 460 0915 04/19/2006 04 02 PM JLIERLY PL5 O1 5/03/06 ,y7LI� PLUMBING BUILDING SEWER TIME 13 00 BILL 460 0915 05/02/2006 02 28 PM DYASUMUR COMMENTS AND NOTES Fi4/ dos 4 PREPARED 4/27/06 13 01 30 INSPECTION TICKET PAGE 10 CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 4/27/06 ADDRESS 1039 S VALLEY ST SUBDIV TENANT NBR BILL KEITH CONTRACTOR NU TREND ENTERPRISES PHONE (360) 683 6080 OWNER KEITH LLOYD WILLIAM RENA C PHONE 68) 8337 PARCEL 06 30 00 0 3 2550 0000 APPL NUMBER 05 00001171 RES MANUFACTURED HOME PERMIT BLM 00 BL MANUFACTURED HOME REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS BLFS 01 3/14/06 JLL BUILDING FOOT /SLAB TIME 13 00 3/14/06 AP 03/13/2006 11 28 AM DYASUMUR BILL 460 0915 03/14/2006 04 53 PM JLIERLY BLBT 01 4/18/06 JLL BUILDING BLOCK AND TIEDOWNS 4/19/06 AP 04/18/2006 01 33 PM JLIERLY 04/19/2006 09 12 AM JLIERLY BUILDING FOUNDATION DRAINAGE 04/21/2006 04 01 PM PBARTHOL KEITH 460 0915 04/25/2006 08 11 AM JLIERLY DRW 01 4/27/06 L BUILDING DRYWELL BLED 01 4/24/06 JLL 4/25/06 AP 04/27/2006 1, 59 PM JLIERLY COMMENTS AND NOTES PREPARED 4/ 12 38 35 INSPECTION TICKET PAGE 4 CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 4/26/06 ADDRESS 1039 S VALLEY ST SUBDIV TENANT NBR BILL KEITH CONTRACTOR NU TREND ENTERPRISES PHONE (360) 683 6080 OWNER KEITH LLOYD WILLIAM RENA C PHONE 68) 8337 PARCEL 06 30 00 0 3 2550 0000 APPL NUMBER 05 00001171 RES MANUFACTURED HOME PERMIT BPR 00 BUILDING PERMIT RESIDENTIAL REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS DRW O1 /26/06 I D 4 BUILDING DRYWELL TIME 13 00 04/25/2006 12 21 PM DYASUMUR BILL 460 0914 COMMENTS AND NOTES i Kate7 .)E 0 ocl- PREPARED 4/24/06 12 03 04 INSPECTION TICKET PAGE 5 CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 4/24/06 ADDRESS 1039 S VALLEY ST SUBDIV TENANT NBR BILL KEITH CONTRACTOR NU TREND ENTERPRISES PHONE (360) 683 6080 OWNER KEITH LLOYD WILLIAM RENA C PHONE 68) 8337 PARCEL 06 30 00 0 3 2550 0000 APPL NUMBER 05 00001171 RES MANUFACTURED HOME PERMIT BLM 00 BL MANUFACTURED HOME REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS BLFS 01 3/14/06 JLL BUILDING FOOT /SLAB TIME 13 00 3/14/06 AP 03/13/2006 11 28 AM DYASUMUR BILL 460 0915 03/14/2006 04 53 PM JLIERLY BUILDING BLOCK AND TIEDOWNS 04/18/2006 01 33 PM JLIERLY 04/19/2006 09 12 AM JLIERLY BLFD 01 4/24/,06 'LL BUILDING FOUNDATION DRAINAGE BLBT 01 4/18/06 JLL 4/19/06 AP 04/21/2006 04 01 PM PBARTHOL KEITH 460 0915 COMMENTS AND NOTES k.kk)z- PREPARED 4/19/06 13 26 01 INSPECTION TICKET PAGE 2 CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 4/19/06 ADDRESS 1039 S VALLEY ST SUBDIV TENANT NBR BILL KEITH CONTRACTOR NU TREND ENTERPRISES PHONE (360) 683 6080 OWNER KEITH LLOYD WILLIAM RENA C PHONE 68) 8337 PARCEL 06 30 00 0 3 2550 0000 APPL NUMBER 05 00001171 RES MANUFACTURED HOME PERMIT PL 00 PLUMBING PERMIT REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS PL6 01 g/ ekt JLL PLUMBING WATER SUPPLY 04/18/2006 03 21 PM PBARTHOL BILL 460 0915 COMMENTS AND NOTES PREPARED 4/18/06 13 37 15 INSPECTION TICKET PAGE 6 CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 4/18/06 ADDRESS 1039 S VALLEY ST SUBDIV TENANT NBR BILL KEITH CONTRACTOR NU TREND ENTERPRISES PHONE (360) 683 6080 OWNER KEITH LLOYD WILLIAM RENA C PHONE 68) 8337 PARCEL 06 30 00 0 3 2550 0000 APPL NUMBER 05 00001171 RES MANUFACTURED HOME PERMIT BLM 00 BL MANUFACTURED HOME REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS BLFS 01 3/14/06 JLL BUILDING FOOT /SLAB TIME 13 00 3/14/06 AP 03/13/2006 11 28 AM DYASUMUR BILL 460 0915 03/14/2006 04 53 PM JLIERLY BLBT 01 4/18/06 BUILDING BLOCK AND TIEDOWNS 04/18/2006 01 33 PM JLIERLY COMMENTS AND NOTES 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 KEITH LLOYD WILLIAM RENA C 150 CLIFF ROBINSON LN SEQUIM WA 98382 68) 8337 Other struct info COMMENTS /ACTION NEEDED CITY OF PORT ANGELES PUBLIC WORKS ELECTRICAL DIVISION 321 EAST 5TH STREET PORT ANGELES. WA 98362 05 00001171 163676 1039 S VALLEY ST 06 30 00 0 3 2550 0000 BILL KEITH RES MANUFACTURED HOME PUBLIC BUILDINGS PARKS 72315 Contractor NU TREND ENTERPRISES PO BOX 1780 SEQUIM WA SEQUIM WA 98382 (360) 683 6080 TOTAL LOT COVERAGE 11 50 EXISTING LOT COVERAGE 1 00 LOT SIZE 14000 00 PROPOSED LOT COVERAGE 1616 00 TOTAL LOT COVERAGE 1616 00 Permit ELECTRICAL NEW RESIDENTIAL Additional desc SHAMP/ MOBILE GARAGE Permit pin number 74435 Sub Contractor SHAMP ELECTRICAL CONTRACTING Permit Fee 126 80 Plan Check Fee Issue Date 4/13/06 Valuation Expiration Date 10/10/06 Special Notes and Comments Building address sign shall not be less than 6 not more than 12 in height Numbers colors must contrast with wall color they are mounted on (Ord 14 36 050 E) When roof gutters are installed drains will located in dry wells or piped to approved storm drain location No pressurized or pumping to curbs are allowed An inspection by Building Department is required prior to backfill 04/10/2006 04 15 PM SROBERDS The proposal includes a garage which has been approved to be moved to the east side of the structure Address numbers shall be plainly visible from the street Address numbers shall be a minimum of six inches high and be of contrasting color from the background Electrical load calculations and elctrical permits are required Customer underground service will be from the existing service pole No connection fee because there has been electrical service at this address in the past 11/28/2005 04 36 PM GMCLAIN 11/28/2005 04 38 PM GMCLAIN MAINTAIN CLEARANCES FROM SERVICE WIRES ANY EQUIPMENT Date 4/17/06 00 0 Qty Unit Charge Per Extension 1 00 78 7000 ECH EL -MANF HOME SERVICE FEEDER 78 70 1 00 48 1000 ECH EL R OUTBD /DTCH GAR SEP 48 10 n, ELECTRICAL PERMIT INSPECTION RECORD CALL 417 -4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED. FINAL GENERAL COMMENTS: KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE ACCEPTED YES I NO DITCH ROUGH -IN COVEYt SERVICE COMMENTS Pw- 1102.1511 Application Number Application pin number Special Notes and Comments UPGRADE WILL BE AT CUSTOMERS EXPENSE 11/28/2005 04 41 PM GMCLAIN A pressure sanitary sewer system will be required Sanitary sewer connection inspection is required by Public Works prior to back fill of ditch 24 hour advance notice is required Existing septic tank will require pumping and tank removed a copy of permit from Clallam County Environmental Health Dept is required and be on file prior to building permit issuance Other Fees Fee summary CITY OF PORT ANGELES PUBLIC WORKS ELECTRICAL DIVISION 321 EAST 5TH STREET PORT ANGELES. WA 98362 05 00001171 163676 Page 2 Date 4/17/06 SEWER SYSTEM DELV CHARGE 745 00 STATE SURCHARGE 4 50 Charged Paid Credited Due Permit Fee Total 126 80 126 80 00 00 Plan Check Total 00 00 00 00 Other Fee Total 749 50 749 50 00 00 Grand Total 876 30 876 30 00 00 ('OMMENTS /ACTION NEEDED ELECTRICAL PERMIT INSPECTION RECORD CALL 417 -4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED. GENERAL COMMENTS: KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE ACCEPTED YES I NO DITCH /7-a a� ROUGH -IN COVER SERVICE I i 7 -f. 1 FINAL C 1 1 1 1 1 1 1 1 COMMENTS rw- 1102.i514/961 PREPARED 3/14/06 13 12 37 INSPECTION TICKET PAGE 13 CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 3/14/06 ADDRESS 1039 S VALLEY ST SUBDIV TENANT NBR BILL KEITH CONTRACTOR NU TREND ENTERPRISES PHONE (360) 683 6080 OWNER KEITH LLOYD WILLIAM RENA C PHONE 68) 8337 PARCEL 06 30 00 0 3 2550 0000 APPL NUMBER 05 00001171 RES MANUFACTURED HOME PERMIT BLM 00 BL MANUFACTURED HOME REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS BLFS 01 31/' 0 JLL TIME 13 1► BUILDING FOOT /SLAB TIM 00 03/13/2006 11 28 AM DYASUMUR BILL 460 0915 COMMENTS AND NOTES imou-0 c7.(014. 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 KEITH LLOYD WILLIAM RENA C 150 CLIFF ROBINSON LN SEQUIM WA 98382 68) 8337 Other struct info Permit RIGHT OF WAY Additional desc Permit pin number 66597 Qty Unit Charge 1 00 Permit Additional desc Permit pin number Permit Fee Issue Date Expiration Date Qty Unit Charge 1 00 110 0000 Signature of Contractor or Authorized Agent T• \Policies \1102.15R (1/05] CITY OF PORT ANGELES PUBLIC WORKS UTILITIES DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 05 00001171 163676 1039 S VALLEY ST 06 30 00 0 3 2550 0000 BILL KEITH RES MANUFACTURED HOME PUBLIC BUILDINGS PARKS 72315 Contractor NU TREND ENTERPRISES PO BOX 1780 SEQUIM WA SEQUIM (360) 683 6080 TOTAL LOT COVERAGE LOT COVERAGE EXISTING LOT SIZE PROPOSED LOT COVERAGE TOTAL LOT COVERAGE Per EA SAN SEWER HOOKUP Date 12/06/05 Special Notes and Comments Building address sign shall not be less than 6 not more than 12 in height Numbers colors must contrast with wall color they are mounted on (Ord 14 36 050 E) When roof gutters are installed, drains will located in dry wells or piped to approved storm drain location No pressurized or pumping to curbs are allowed An inspection by Building Department is required prior to backfill Address numbers shall be plainly visible from the street Address numbers shall be a minimum of six inches high and be of contrasting color from the background Electrical load calculations and elctrical permits are required Customer underground service will be from the existing service pole WA 98382 11 50 1 00 14000 00 1616 00 1616 00 Permit Fee 50 00 Plan Check Fee 00 Issue Date 12/06/05 Valuation 72315 Expiration Date 6/04/06 Per Extension 50 0000 ECH RIGHT OF WAY PERMIT 50 00 SANITARY SEWER HOOK UP PRESSURE SYSTEM 66605 110 00 Plan Check Fee 00 12/06/05 Valuation 72315 6/04/06 Extension 110 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. Date Signature of Owner (if owner is builder) Date PW UTILITIES (Engineering Division) WATERLINE METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE SITE EROSION CONTROL PARKING SIDEWALK CURB GUTTER DRIVEWAY APPROACH BACK -FLOW DEVICE RESIDENTIAL CONSTRUCTION R.W PW/ ENGINEERING 417 -4807 FIRE 417 -4653 I PLANNING DEPT 417 -4750 I BUILDING 417 -4815 T\Policies \1102.15R [1/05] PERMIT INSPECTION RECORD CALL 417 -4807 FOR UTILITY 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 FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL DATE ACCEPTED YES I NO CONSTRUCTION R.W PW ENGINEERING I FIRE DEPT I PLANNING DEPT BUILDING T• \Policies \1102.15R [1/05) CITY OF PORT ANGELES PUBLIC WORKS UTILITIES DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 Page 2 Application Number 05 00001171 Date 12/06/05 Application pin number 163676 Special Notes and Comments No connection fee because there has been electrical service at this address in the past 11/28/2005 04 36 PM GMCLAIN 11/28/2005 04 38 PM GMCLAIN MAINTAIN CLEARANCES FROM SERVICE WIRES ANY EQUIPMENT UPGRADE WILL BE AT CUSTOMERS EXPENSE 11/28/2005 04 41 PM GMCLAIN A pressure sanitary sewer system will be required Sanitary sewer connection inspection is required by Public Works prior to back fill of ditch 24 hour advance notice is required Existing septic tank will require pumping and tank removed a copy of permit from Clallam County Environmental Health Dept is required and be on file prior to building permit issuance Other Fees SEWER SYSTEM DELV CHARGE 745 00 STATE SURCHARGE 4 50 Fee summary Charged Paid Credited Due Permit Fee Total 160 00 160 00 00 00 Plan Check Total 00 00 00 00 Other Fee Total 749 50 749 50 00 00 Grand Total 909 50 909 50 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 PW UTILITIES (Engineering Division) WATERLINE METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE SITE EROSION CONTROL PARKING SIDEWALK CURB GUTTER DRIVEWAY APPROACH BACK -FLOW DEVICE RESIDENTIAL CONSTRUCTION R.W PW/ ENGINEERING 417 -4807 FIRE 417 -4653 I PLANNING DEPT 417 -4750 I BUILDING 417 -4815 T•\Policies \I102.15R [1 /05] PERMIT INSPECTION RECORD CALL 417 -4807 FOR UTILITY 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 1 NO FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL DATE ACCEPTED YES I NO CONSTRUCTION R.W PW ENGINEERING I FIRE DEPT I PLANNING DEPT BUILDING 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 KEITH LLOYD WILLIAM RENA C 150 CLIFF ROBINSON LN SEQUIM WA 98382 68) 8337 Other struct info Permit Additional desc Permit pin number Permit Fee Issue Date Expiration Date Permit Additional desc Permit pin number Permit Fee Issue Date Expiration Date CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 Qty Unit Charge Per Signature of Contractor or Authorized Agent 05 00001171 163676 1039 S VALLEY ST 06 -30 00 0 3 2550 0000 BILL KEITH RES MANUFACTURED HOME NU TREND ENTERPRISES PO BOX 1780 SEQUIM WA SEQUIM WA 98382 (360) 683 -6080 TOTAL 'LOT COVERAGE 11 50 EXISTING LOT COVERAGE 1 00 LOT SIZE 14000 00 PROPOSED LOT COVERAGE 1616 00 TOTAL LOT COVERAGE 1616 00 BL MANUFACTURED HOME 66456 230 00 Plan Check Fee 12/06/05 Valuation 6/04/06 BASE FEE BUILDING PERMIT PUBLIC BUILDINGS PARKS 72315 Contractor RESIDENTIAL 66506 249 75 Plan Check Fee 12/06/05 Valuation 6/04/06 Qty Unit Charge Per Extension BASE FEE 95 75 11 00 14 0000 THOU BL -2001 25K (14 PER K) 154 00 Permit PLUMBING PERMIT Additional desc Permit pin number 66464 Permit Fee 72 00 Plan Check Fee 00 Issue Date 12/06/05 Valuation 0 Expiration Date 6/04/06 Qty Unit Charge Per Extension BASE FEE 50 00 1 00 7 0000 ECH PL- EA INSTALL WATER PIPE 7 00 1 00 15 0000 ECH PL- EA BLDG SEWER 15 00 Special Notes and Comments Building address sign shall not be less than 6 not more T•\Policies \1102_15 building permit inspection record05.wpd [1/4/2005] Date 12/06/05 0 0 72315 Extension 230 00 99 90 12315 Date Signature of Owner (if owner is builder) -n 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. OS Date 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. INSPECTION TYPE DATE ACCEPTED COMMENTS FOUNDATION: FOOTINGS WALLS FOUNDATION DRAINAGE DOWN SPOUTS 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 SHEAR WALL/HOLD DOWNS WALLS ROOF CEILING DRYWALL (INTERIOR BRACED PANEL ONLY) T -BAR INSULATION SLAB WALL FLOOR CEILING MECHANICAL HEAT PUMP FURNACE DUCTS GAS LINE WOOD STOVE PELLET CHIMNEY COMMERCIAL HOOD DUCTS MANUFACTURED HOMES FOOTING SLAB BLOCKING HOLD DOWNS SKIRTING ELECTRICAL LIGHT DEPT CONSTRUCTION RW PW/ ENGINEERING 417 -4807 FIRE 417 -4653 I PLANNING DEPT 417 -4750 I BUILDING 417 -4815 1 T•\Policies \1102_15 building permit inspection record05.wpd [1/4/2005) BUILDING PERMIT INSPECTION RECORD YES NO FINAL FINAL 417 -4735 ELECTRICAL LIGHT DEPT CONSTRUCTION RW PW ENGINEERING I FIRE DEPT I PLANNING DEPT 1 BUILDING DATE ACCEPTED BY. DATE ACCEPTED BY. 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 1 NO CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 Page 2 Application Number 05 00001171 Date 12/06/05 Application pin number 163676 Special Notes and Comments Chan .12' inF height colors must contrast with wall color the`p aie mounted 'on l ''(oid 14!a3ll 050 -E) When roof gutters are installed, drains will locateAlin dr Q 4 wells or piped to approved storm drain location No pressurized or pumping to curbs are allowed An inspection by Building Department is required prior to backfilli Address numbers shall be plainly visible from the street Address numbers shall be a minimum of six inches high and be of contrasting color from the background Electrical load calculations and elctrical permits are required Customer underground service will be from the existing service pole No connection fee because there has been electrical service at this address in the past ti',y" c) 11/28/2005 04 36 PM GMCLAIN 11/28/2005 04 38 PM GMCLAIN MAINTAIN CLEARANCES FROM SERVICE WIRES ANY EQUIPMENT UPGRADE WILL BE AT CUSTOMERS EXPENSE 11/28/2005 04 41 PM GMCLAIN A pressure sanitary sewer system will be required Sanitary sewer connection inspection is required by Public Works prior to back fill of ditch 24 hour advance notice is required Existing septic tank will require pumping and tank removed a copy of permit from Clallam County Environmental Health Dept is required and be on file prior to building permit issuance Other Fees SEWER SYSTEM DELV CHARGE 745 00 STATE SURCHARGE 4 50 Fee summary Charged Paid Credited Due Permit Fee Total 551 75 551 75 0 0 00 Plan Check Total 99 90 99 90 00 00 Other Fee Total 749 50 749 50 00 00 Grand Total 1401 15 1401 15 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-\Policies \1102_15 building permit inspection record05.wpd [1/4/2005) 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. INSPECTION TYPE DATE ACCEPTED COMMENTS YES I NO FOUNDATION: FOOTINGS 4 'b (4,40 WALLS FOUNDATION DRAINAGE DOWN SPOUTS 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 SHEAR WALL/HOLD DOWNS WALLS ROOF CEILING DRYWALL (INTERIOR BRACED PANEL ONLY) T -BAR INSULATION SLAB WALL FLOOR CEILING MECHANICAL HEAT PUMP FURNACE DUCTS GAS LINE WOOD STOVE PELLET CHIMNEY COMMERCIAL HOOD DUCTS MANUFACTURED HOMES FOOTING SLAB BLOCKING HOLD DOWNS SKIRTING PLANNING DEPT SEPARATE PERMIT #'s PARKING/LIGHTING LANDSCAPING RESIDENTIAL ELECTRICAL LIGHT DEPT BUILDING PERMIT INSPECTION RECORD /I4 !o 6 I 141'741 tj 4 1 I I FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL DATE ACCEPTED YES I NO 417 -4735 ELECTRICAL LIGHT DEPT CONSTRUCTION R.W PW/ CONSTRUCTION R.W ENGINEERING 417 -4807 PW ENGINEERING FIRE 417 -4653 11 1 I FIRE DEPT I 1 PLANNING DEPT 417 -4750 I I 1 1 1 PLANNING DEPT 1 BUILDING 417 -4815 1 BUILDING (•\Policies \1102_15 building permit inspection record05.wpd [1/ /200 ,Tw P r c� //s r1- g -7-ea& 4 k.-- FINAL 1 306 DATE 'JL L_- ACCEPTED BY. FINAL SEPA. ESA. SHORELINE. DATE ACCEPTED BY, r The City of Port Angeles Building Division. Upon reviewing your application and plans submitted for a Manufactured Home, the following are some of the items that will need to be taken in to consideration. Property Property boundary pins are to be identified and marked at footing inspection to verify minimum set back requirements. Manufactured homes. "Wains" installer tags must be on unit and appropriate box checked for each item completed. Manufactured home foundation design shall be included with the application. Foundations are required to be pit set with 12" maximum and 6" minimum reveal on foundation. Blocking and tie down inspection is required Wood framed skirting, framing shall be 2 "x 6" treated wood with %2" anchor bolts w/ 3 "x 3 "x 1/4" washer at 6' -0" OC and within 12" of P T sill ends. Stud pacing shall be 16" OC. 15/32" min thickness structural grade treated plywood 30 PCF equivalent -fluid weight soil pressure horizontal (max unbalanced back fill at 18" in height). Face grain across studs. Skirting, foundation crawl space and ventilation are required per WAC 296 -150M -0610 (1) (d) section 1 through 3. 1 Skirting must be made of approved material by the building division. Metal fasteners must be of hot dip zinc -galv stainless steel or other corrosive resistant materials. Ferrous metal members in contact with earth, except those made of galvanized or stainless steel, must be coated with asphaltic emulsion. Skirting must not trap water between the skirting and siding or trim. All skirting must be recessed behind the siding or trim. 2. The ventilation required is one (1) sf. Per 150 sf. of crawl space. A final inspection is required to be approved before occupancy can occur 3. Access to under floor area to be a min. 18 "x 24" and positioned so that all areas under manufactured home are available for inspection. Access opening must be covered and that cover must be made of metal, pressure treated wood or vinyl. Foundation protection requires finish grade to be a minimum of 6" slope in 10' -0" away from the foundation. Footing /downspout drains (if required) to be directed to a drywell or other approved locations. An inspection of the water, sewer, electrical, footing and down spout drains is required before backfill is allowed. If outside of (4) minute response area a sprinkler system or an exterior bell tied into the smoke detector, approved by the Fire department may be required. Garages. A continuous footing is required around the perimeter of the load bearing walls, although some manufactured homes are designed to accommodate a garage. The garage must be designed as though it is independent from the manufactured home. Sill and bottom plate anchor requirements for seismic zone D2. As per the 2003 IRC. Garages detached and attached to a manufactured homes, require standard wall bracing methods to be met, If they cannot be met, then refer to "Alternate Braced wall panel" Section of the 2003 IRC. If any of the aforementioned methods cannot be met, engineering design will be required for the "SHEAR WALL, ALTERNATE BRACED WALL PANEL" design under 2' -8" in width. This letter is not intended to cover all items required by the City of Port Angeles, but is to serve as a guide to help you understand frequently asked questions, "ALL WORK IS SUBJECT TO FIELD APPROVAL" 1/05 0 'Lr cL" O si A. 1 1! 'b' ,MTWIN dhtirrR+NLOtra tP r.. "r rMt. r?ffi;?;p.:. ;,..,:,;,epil ,irtr: ;)jf.• o? *r -„s1.; rzw:. it 41, .y1:::u•:::r+ rrinr St5a:iir:riMr's•'.t#MTii::r..L to 441F.P.:Ifr:Cir?,∎A•0?iir't!eS ii CITY OF PORT ANGELES Const Plans ..w.nr -1041004 ...a r The Issuance of this pernttd upon these pit s, specifi- cations and other data shall not pvpvent the building official from thereafter requiring the corri.'"on of errorsi said plans, specifications and other data, r from pre�nting building operations being carried on thereunder whKn in violation of all codes and ordinances of his jurisdiction. s Approval Date I 1 1 S By t i 1 1yytt I t� C 7 O P) I I r 1 ^?j?,r1,.':rt fo?smiP;h? •j!ui,.axr::im:P;,;?rsorfr! i- B SI. f ii,, �'_f�!'!r''Li�r' r7.T .�.,,F 'f�'f!f .r�iN,',!r9: i j r „rJr} '1T, .1 S?.�1. 1,1'T70:4 .i. i t�m:,/r?!/: ..ii 4 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 PERMITS (360) 417 -4815 FAX(360)417 -4711 Applicant or Agent: t k' 1 i<`e-- e Owner e,, 1 l K 42. L'k-41 Address. IS) CAt IZebtuso Architect/Engineer Contractor N U TREI 1 D y.f/1NS l t`i.STAd.I€lz. BUILDING PERMIT APPLICATION t, Credit Card Holder Name: Billing Address: Credit Card Type VISA MC TYPE OF WORK. );if Residential New Constr Re -roof Multi family Addition Move Commercial Remodel Demolition Repair Sign Other BRIEF DESCRIPTION OF THE PROJECT 1010 <0 a w l 1/1 COMMERCIAI RESIDENTIAL Occupancy Group: No. of Stones. P Lot Size: 1 o Existing Sq. Ft. Total lot coverage l I rJ PLANNING USE ONLY T•\Policies\BLr1102_13.wpd Applicanti/6 City °G cc r 44. NUTCLEt. '.State License it 2 :3 f City. ESA/Wetland(s) Yes No SEPA Checklist required? Yes No Other Phone: 3 O s/6O d 0 i S Phone: LV'%.u_, Zip 9k Phone: Exp /to l07 Phone: Address. AA City PROJECT ADDRESS j J 14.1(ty 5�r �F to ZONING LEGAL DESCRIPTION Lot: g Block: Subdivision. CLALLAM COUNTY PARCEL NUMBER. 0 b3o 00 0 3a.6"--15 0 0o a 04 0000 3 2,90 0 40 3c 0S2-5 0,60 Zip Exp. Date: SUE/VALUATION 0 Stove l ,40 SF /SF 4'°/ 1g Garage 5106 SF 21 3$ /SF 12-, t 6j- O Deck SF /SF TOT jAyATION 2 ig Occupant Load. Construction Type: 9FOR OFFICIAL USE ONLY Date Rec. 4—o S Permit d 1 Date Approved. 12_ 1 1Q'S Date Issued: 0 Proposed Sq. Ft. I Co I (G TOTAL Sq. Ft. APPROVALS PLAN BLDG DPWU FIRE. OTHER VALUATION OF CONSTRUCTION In all cases, a valuation amount must be entered by the apphcant. This figure will be reviewed and may be revised by the Building Division to comply with current fee schedules. Contact the Permit Coordinator at 417 -4815 for assistance. PLAN CHECK FEE. IF a plan check fee is due it must be submitted at the time the building permit application and construction plans are submitted. All other permit fees are due at the time of permit issuance EXPIRATION OF PLAN REVIEW If no permit is issued withm 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 R105.3.2 of the International Building/Residential Code, 2003). No application can be extended more than once. I hereby certify that I have read and examined this application and know the same to be true and correct. 1 am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required ,not the City's, and that I must obtain such permits prior to work. Date: //2. 05 �i�' B BOISE BUILDING SOLUTIONS DISTRIBUTION Engineered Wood Products 8720 216th Street SE PO Box 168 Woodinville, WA 98072 Tel: 425 486 7477 800 342 2299 Fax: 425 402 1567 1 isE 1 I I 1 1 I 1 I 1 tc.) i L, 1 Vli 1 9.7! 1 -t I I I .L 1. 9t 9 Sheet Job Location Date 1 1 of '1 1 i I: 1 i i I i i I I r BCI® Joists, VERSA-LAM® Beams and BOISE GLULAMTM Beams '4 1 1 hA,O deod 44, ,5 f CJ j'r A qaZ Z vticy..43 irorri -ICJ O) Z-Lct* C -1-0(v tAip oporw) n o x r f r)a-f} 9,»(1-7 0 v- 9 h/ xx� x 1 p a k ary at_ oh 9-210 L hi J� S �,n1.2 1V P Ft' Q1 Sur,'1}''a`1 s SQ °ll /L 01 ,f' 09 4o017 4$1I .4e I I 1 11 li I rPjgati)-1=' 1 I c M 1 1:11 I I I k _10111_1_ 1 1 i __1____J_____ 1 1 i r L______J J04-tidift7ai,:irwi i 1 1 I 1 1 -1- 1 i r 7 T 1 1 I 1 1 1 _I Ji 1 I 1 1 1! 11 111 T YN 4 corner s 1 2' -.r r _f L Foundation Plan Port Angeles, WA 5,5' Concrete stab 2500 psi #4 Reber continuous All sides Harried, OA„ Bee rogue COWnn &rpore require/4,»1s 6 Ancho'r's Equally Spaced (1326' 0,C.) ANCHOR DETAIL #4 rebar W TleDown Engineering Mdl MIJ2 Galvarnzed PN 59121 or equivalent Imbedded 5' Typical of 12 5 1 2'X2' pad 6 Anchors Equally Spaced (139.2` I1.C.) Concrete Notes' ASTM Std, C -150 C-33 Re -bar' ASTM A -615 Grade 40 #7000 1 4 #7001 #7002 //4002 #6003 #6004 INSTALLATION INSTRUCTIONS EXISTING CONCRETE H6003 1 CONCRETE MUST BE A MINIMUM 3 1/Z THICK AND IN GOOD CONDITION 2. MINIMUM SLAB AREA OF EACH ANCHOR IS 28 SQUARE FEET 3 DRILL PROPER SIZE HOLE IN SLAB A MINIMI.M OF 12" FROM ANY SIDE. 4 EXPANSION DOLT IS 5/8 x 3 1/2 W I I H MINIMUM 2 3/1-' EMBEDMENT AND 6,180 POUND PULL OUT 7 160 POUND SHEAR NEW CONCRETE fi6004 1 PLACE CONCRETE ANCHOR INTO WET CONCRETE AND ALLOW TO PROPERLY CURE. 2. ALTERNATE. CONNECTION REQUIRES #5 REBAR PROPERLY EMBEDDED IN CONCRETE. CHASSIS CONNEC_TISM 1 ATTACH STRAPS TO CHASSIS BEAM IN MANNER SHOWN 2 IF ANGLE OF SRA. STRAP IS GREATER THAN 67 STRAP CONNECTION CAN DE MADE FROM ANCHOR TO OPPOSITE CHASSIS BEAM 3 INSERT STRAP THROUGH SPIT DOLT CUT OFF EXCESS STRAP AND TIGHTEN BOLT UNTIL STRAP IS SNUG. DRILL 9/16' HOLE AT MID HEIGHT OF BEAM AND INSTALL 1/2" A307 BOLT 'T"PICAL) —N Z.1 SIDE VIEW C' BEAM CHASSIS SEE Y' BEAM CHASSIS NOTE /13 SHEEI (!1 FOR TIE DOWN INFO. r J \t Y •C I I JYO SAC IND. CONCRETE TIE DOWN ANCHORS #6005 3,56 CO NCl2E' TIF�pOWN /4002. PIER BOLT —ON TOP #7002 7' STEEL W/H E- OR SIDE V EW E C BEAM CHASSIS SEE I" BEAM CHASSIS NOTE (f3 SHEET A I FOR TIE DOWN INFO J U J T L J J J J J CONTRACTORS CERTIFICATION CHASSIS #7000 7' STEEL __STRAP_ lElliCKLE_ QE005 SPLIT BOLT NUT ALTERNATE CONNECTION r SIDE VIEW END VIEW END TIE DOWN I CERTIFY THAT I HAVE INSTALLED THE SAC IND INC ANCHORING SY AS PER THE INSTALLATION INSTRUCTIONS I HAVE MADE NO MODIFICATIONS TO THE ANCHORING SYSTEM OR TO THE BUILDING STRUCTURE COMPANY NAME: CONTRACTORS L1C Patio Slab Anchor This anchor If designed to Inserted thrauph a 314' hafh drilled or formed into on existing concrete slab. 1 conarata must be a 2300 PSI minimum tttrx'!ftiiitneee and 818 x 10!t 0 wire mesh or fiber m h instUtled Concrete slab must a1 °ow 4726 lbs of vertical tension on anchor without titling eta Sesames that the concrete .weights 150 lbe pfr cu. it Minimum distance tram the antror shalt to one edge of the slab •ts 4 in. ftOlrt 0rld rdgo and 2 tt. tram any other edge. If installed in a 4' Blab at minimum (lb- fences from edges, an coati i er al Ed& x10110 meets j6 ri Concrete Slab Anchor y Q This anchor to n n f N =tT �O dams exp tdtC Elefile'irt sr .eleioting Car.Grata slab. Attar nvlewlng reurietlnne listed to the ?Qht, edit a fill In x 3 in. hate 1n the glib whirl the mallet haul IS to co looted. Mute etas) expansion slaove ovor bait and Mau Into the Qrlied hole Puce tltkwscnar ama tree sxpantian belt Thread nut sore expsnelan bolt end tighten 1111111 maximum expansion of steed snpansion steive tut bean achieved Renu;va nut and wits! err and pan buthot hood ovor exposed bolt P1aw wisher end nut onto boll b attach anchor head, opinion nut. Concrete Anchor The MtJ2 is doefgned to be ine1ailod :nW a concrete slab al the time life MUM l5 OIInp Doused. norak. mush- bo- -a-- 2500-°•p t minimum sin with 4' minimum thtCl iess and VS x 10r 0 wire mesh or fiber masts Installed. CQfCrntc stab must allow 472$ :bs ct vertical tension on ancnor wlthct I Lifting. Tata.alsurnse Mat the concrete wetOhs 150 lbs per cu tt, MIPIlrurn distance from the anchor shah to one edge of the e;ab is 4 in. from arse adoc and 2 ft from any other bete. If InctaYed Ina 4' slab it minimum distances from edges, an eddtion3l layer of 8/6 ur 10110 =0 15 re=wntrmsotKJed. Slott roast be 8 in. minimum thiekneas al locattor finder my anchor to atlow 5 in. embedment of anchor's sad. Concnls must be a 7.500 PSI minimum stah wth 4• minim= tidekMSS and die x 1610 wire niash or ricer Mach triatatoa. Cat, 11e stab nuot RNOw 4726 Fat or vertical Ionia on anchor without ilnirri;. This esjurxs that tits t:o44►bte welghS 150 rata p8t far. tl. Minimum distance from the en;hor shaft 10 MD 0426 01 the stab is 4 .n. from ono edpe and 11 ti. frorr an} other edge. 11 installed In e slab at minimum dictuees rrern edges, an aadiirnat Byer of WI or 10110 wire meth or fiber tnsitt Ic re;Atnr*ar:dad, y (.7114:140:040.i NCSBCS/ANSI A225.1 are not available. 4.1.5.3 Perimeter blocking Place piers on both sides of side wall exterior doors and any other side wall openings greater than 4 feet (such as entry and sliding glass doors) under porch posts, fireplaces, and wood stoves; and under the locations where heavy pieces of furniture such as pianos, organs, waterbeds, etc. are expected to be placed. 4.2 Footings Footings shall be placed a minimum of 4 inches below grade in undisturbed soil. Support every pier with a properly designed footing (see 4.2 1 1) 4.2.1 Acceptable types of footings 4.2.11 Concrete Footings may consist of precast or poured -in -place concrete pads slabs, or ribbons at least 3 1/2- inches thick, with a 28 -day compressive strength of at least 3,000 pounds per square inch. 4.2.1.2 Pressure treated permanent wood Two layers of nominal 2 inch thick pressure- treated wood having 0 60 retention in accordance with AWPA C22 Standard, with the long dimensions of the second layer placed perpendicular to that of the first, may also be used 4.2.1.3 Other materials 8 OC Other materials approved for footings may be used when approved by local authorities if they provide equal Toad- bearing capacity and resistance to decay Examples include: 1/2 inch maximum crushed stone; 3/8 inch or 3/4 inch graduated gravel; coarse sand with grains no smaller than 1/16 inch, placed so it provides a soil- bearing capacity of at least 3,000 pounds per square foot. 4.2.2 Placement in freezing climates 4.2.2.1 Conventional footings In areas subject to ground frost heave place footings below the frost line Consult local authorities to determine the depth of the frost line. In the absence of a local code use the frost penetration map provided in figure 4 as a guide 4.2.2.2 Floating slab systems When properly designed by a registered professional engineer, a 'floating slab system° may be used above the frost line. The design shall accommodate the anchorage requirements identified in 5 4.2.2.3 Insulated foundations Footings may also be placed above the frost line when the home is provided with a perimeter foundation or skirting having insulation properties sufficient to prevent freezing of the soil under or adjacent to every load- bearing component of the foundation and acceptable for this purpose to the authority having jurisdiction Useful design guidelines may be found in the references found in Annex F Insulation systems should be compatible with the requirement to cross ventilate the entire space under the home. 4.2.3 Proper sizing of footings Proper sizing of footings depends upon the load- carrying capacity of both the piers and the soil. See table 4 -3 for recommended footing sizes. 4.3 Permanent foundations Check local building codes and regulations and consult a registered engineer when the home is to be sited on a permanent foundation (such as a full basement, crawl space or Toad- bearing perimeter foundation) To obtain a permanent foundation design that meets most local codes, write to the manufacturer of the home. Useful ideas and design guidelines can also be found in reference publications, such as those listed in Annex F 1' t t ERE 'aqt DO Crown and grade the site to slope away from the home and cover it with 6-mil-thick polyethylene sheeting or the equivalent. Single-section DON'T Grade the site so that water collects beneath the home. Multisection EEG EMI ME ME ME ME =elm A.mvAAV,4*, 40, —So Figure 3-2 Elimination of water beneath the home ell °20 0 4 rt21 ,L111 0 71 4 :Val, 114 :A 1`6,zti Single Strap Double Strap 2 -foot maximum I I 4725 lbs. 4725 lbs.' see chart 11 0" 11 0 Note 1 Unless listed/labeled for a higher capacity by the anchor manufacturer 2 Unless a greater spacing is specified by the anchor manufacturer 3 All homes located in Wind Zones II and 111 shall have a vertical tie j Frame 1 -beam 6' 0" 6' ,0 "2 to y Anchor -Zone:lll 4 6" 4 6 2 2 -foot maximum a Roof Section Live Pier Width Load Location (feet) (pounds per square foot) Table 4 -1 Minimum Pier Capacity Frame Plus Perimeter Blocking (Both Frame and Perimeter Blocking Required) Minimum Pier Capacity (pounds) Maximum Pier Spacing (feet) 4 N 6 1 8 1 10 8 20 Frame 900 1300 1800 2200 Perimeter 600 800 1100 1400 30 Frame 900 1300 1800 2200 Perimeter 700 1100 1400 1800 40 Frame 900 1300 1800 2200 Perimeter 900 1300 1800 2200 10 20 Frame 1100 1700 2200 2800 Perimeter 700 1100 1400 1800 30 Frame 1100 1700 2200 2800 Perimeter 900 1400 1800 2300 40 Frame 1100 1700 2200 2800 Perimeter 1100 1700 2200 2800 12 20 Frame 1300 1900 2600 3200 Perimeter 800 1200 1600 2000 30 Frame 1300 1900 2600 3200 Perimeter 1100 1600 2100 2600 40 Frame 1300 1900 2600 3200 Perimeter 1300 1900 2600 3200 14 20 Frame 1500 2200 3000 3700 Perimeter 900 1400 1900 2400 30 Frame 1500 2200 3000 3700 Perimeter 1200 1800 2400 3000 40 Frame 1500 2200 3000 3700 Perimeter 1500 2200 3000 3700 16 20 Frame 1700 2600 3400 4300 Perimeter 1100 1600 2200 2700 30 Frame 1700 2600 3400 4300 Perimeter 1400 2100 2800 3500 .1 40 Frame 1700 2600 3400 4300 Perimeter 1700- 2600 3400 4300 18 20 Frame 1900 2900 3900 4800 Perimeter 1200 1800 2500 3100 30 Frame 1900 2900 3900 4800 Perimeter 1600 2400 3200 3900 40 Frame 1900 2900 3900 4800 Perimeter 1900 2900 3900 4800 Soil Type Based on the unified classification system Rock or hard pan Sandy gravel and gravel Sand, silty sand, clayey sand, silty gravel, or clayey gravel Clay, sandy clay silty clay or clayey silt Uncompacted fill Peat or organic clays Table 3 -1 General Description of Soils Allowable Pressure (pounds per square foot) No allowances made for overburden pressure, embedment depth, water table height, or settlement problems 4,000 and uo 2,000 1,500 1,000 Special analysis is required Special analysis is required 'NOTE To be used only when none of the following is available: soils investigation and analysis of the site compliance with the local building code; and evaluation by a registered professional engineer architect, or building official. 2: Hereafter the words engineer" or "architect" shall refer to a registered professional engineer or architect. Section Width (feet) Roof Live Load (pounds per square foot) Table 4 -2 Minimum Pier Capacity Multisection Center -Beam Blocking Pier Load and Minimum Pier Capacity (pounds) Mating Wall Opening (feet), 5 I 10 I 15 I 20 1 25 I 30 I 35 20 600 1200 1800 2400 3000 3600 4200 30 800 1600 2400 3200 4000 4800 5600 40 1000 2000 3000 4000 5000 5000 7000 10 20 800 1500 2300 3000 3800 4500 5300 30 1000 2000 3000 4000 5000 6000 7000 40 1300 2500 3800 5000 6300 7500 8800 12 20 900 1800 2600 3500 4400 5300 6100 30 1200 2300 3500 4700 5800 7000 8200 40 1500 2900 4400 5800 7300 8800 10200 14 20 1000 2000 3000 4100 5100 6100 7100 30 1400 2700 4100 5400 6800 8100 9500 40 1700 3400 5100 6800 8400 10100 11800 16 20 1200 2300 3500 4700 5800 7000 8100 30 1600 3100 4700 6200 7800 9300 10900 40 1900 3800 5800 7500 9700 11600 13600 MPLE. 14 -foot section width 30- pounds -per- square -foot roof live Toad 18- foot -wide mating -wall opening ow down the "Section Width column to "14 feet." Follow across to "30 pounds per square foot" in the "Roof Live Load' column. Since the mating wall opening is 18 feet wide, follow across to column headed "20 (For any opening width that is not shown, use the next highest number on echart.) The required pier capacity is 5,400 pounds. existing patio door or addition of patio door Required perimeter support (see note 4) Figure 4-2 Typical blocking diagram for single- section home when manufacturer's instructions are not available Note (applies to both figures 4-2 and 4-3) 1 See table 4.1 for required pier capacity and spacing. 2. See table 4.3 and section 4.2 for footing requirements. 3. Piers shall be at a maximum of 2 feet from both ends. 4 Place piers on both sides of entry doors and at any other openings greater than 4 feet in width, such as patio or atrium doors; under porch posts, fireplaces, and wood stoves; and under those places where heavy pieces of furniture such as pianos, organs, waterbeds, etc. may be placed. Required perimeter F shall be sized support (see note r 1 according to table 4.2 or calcu- fated by a design professional and located under the bearing points of Patio door clear -span openings in center 1 mating walls i i I I I I I I i 1 1 1 1 1 I 1 1 1 Frame support Main beam 1 I 1 1 1 I I 1 I I I I 1 1 I I 1 Slide out fireplace III 1 Required perimeter support (see note 4) Front (hitch) 1 I Exterior door of home 1 1 1 1 1 1 i 1 1 1 L- Exterior door of home Exterior wall line of home Exterior wall line of home Figure 4 -3 Typical blocking diagram for multisection home when manufacturer's installation instructions are not available i54'f��t 70RTANGELBS WASHINGTON U S A. Purpose of Checklist: The State Environmental Policy Act (SEPA) Chapter 43.21C RCW requires all governmental agencies to consider the environmental impacts of a proposal before making decisions. An environmental impact statement (EIS) must be prepared for all proposals with probable significant adverse impacts on the quality of the environment. The purpose of this checklist is to provide information to help you and the agency identify impacts from your proposal (and to reduce or avoid impacts from the proposal if it can be done) and to help the agency decide whether an EIS is required. Instructions for Applicants: This environmental checklist asks you to describe some basic information about your proposal. Governmental agencies use this checklist to determine whether the environmental impacts of your proposal are significant, requiring preparation of an EIS Answer the questions briefly with the most precise information known or give the best description you can You must answer each question accurately and carefully to the best of your knowledge. In most cases you should be able to answer the questions from your own observations or project plans without the need to hire experts. If you really do not know the answer or if a question does not apply to your proposal, write "do not know" or "does not apply" (N /A) Complete answers to the questions now may avoid unnecessary delays later Some questions ask about governmental regulations such as zoning shoreline and landmark designations. Answer these questions if you can If you have problems please ask the City Planning Department employees to assist you. The checklist questions apply to all parts of your proposal, even if you plan to do them over a period of time or on different parcels of land Attach any additional information that will help describe your proposal or its environmental effects BACKGROUND 1 Name of proposed project: A. Address or general location of site. CITY OF PORT ANGELES ENVIRONMENTAL CHECKLIST ,�bc�� 2. Name address and phone number of applicant: l l k l r sb 6 114 R. L `t1 o Yb o o q i .5 3. Name, address and phone number of contact person if other than applicanK ILIA 4 Date checklist prepared 5 Agency requesting checklist: CITY OF PORT ANGELES B. How does this project relate to long -term plans? P-25 LCV Filing Fee *$250 *Admin. $100 10 VZ c�1 L)01 L PO4 `k Asti ?ika,5 6 Proposed timing or schedule (including phasing, if applicable): q,5 1 Ids. A. What is the long term objective of this proposal? d'a- tnvironmentai unecKllst EVALUATION FOR Page 2 AGENCY USE 7 Do you have any plans for future additions expansion, or further activity related to or connected with this proposal? If yes explain. Jo 8. List any environmental information you know about that has been prepared or will be prepared directly related to this proposal: N 6 9 Do you know whether applications are pending for governmental approvals of othe proposals directly affecting the property covered by your proposal? 1 6 If yes, explain 10 List any government approvals or permits that will be needed for your proposal, if known. b.c3L5 4.43 p e 4-- --r �-pp 11 Give brief complete description of your proposal, including the proposed uses and the size of the project and site. There are several questions later in this checklist that ask ycu to describe certain aspects of your proposal. You do notneed to repeat those answers on this page (Lead agencies may modify this form to inclu is a additio I s ecific i formation on project description) .Q v%4 s,, 4 /07 cI.t kc 1 dock. b h ou S t -4-- t fcl vutLeo g-1/4 h` a ``f Q C,� S Cot_ rec. -cam 12. Location of the proposal. Give sufficient information for a person to understand the precise location of your proposed project, including a street address, if any, and section township and range, if known. If a proposal would occur over a range of area, provide the range or boundaries of the site(s). Provide a legal description site plan, vicinity map and topographic map if reasonably available. While you should submit any plans requred by the agency you are not required to duplicate maps or detailed plans submittedwith any ,permit applications related to this checklist. I nag S. f1a.ij p„,..0-5-4-1--0 4 4 rz, e& 4 30 c.eEh o '1 0 °k- I L (S Sc I'2IC4 Ea 4 G .cb- k 0 PROJECT SPECIFIC ACTIONS Complete this section if your proposal involves a project specific action such as a subdivision, new construction, a new or expanding business, a site specific remne (not area wide) a conditional use permit, a shoreline permit, or similar action. ENVIRONMENT 1 Earth General description of the site (circle one) Flat, oiling, hilly, steep slopes mountainous, o er Environmental Checldist Page 3 B. What. is the steepest slope on the site (approximate percent slope)? Fick-4. C. What general types of soils are found on the site (for example clay sand, gravel, peat muck)? If you know the classification of agricultural soils, specify themand note any prime farmland pa( %L 10 o I Sc, m ga L! D Are there surface indications or history of unstable soils in the immediate vicinity? If so describe. (No E. Describe the purpose, type, and approximate quantities of any Filling or grading proposed Indicate source of fill. h wg_., F Could erosion occur as a result of clearing construction, or use? If so generally describe. N� G About what percent of the site will be covered with impervious surfaces after project construction (for example, asphalt or buildings)? bl cQt Lei- v° b1 s czQ; tc.q& H. Proposed measures to reduce or control erosion, or other impacts to the earth if any 1■90 02. cbsC ot. wi tt de.G -CLAr" 2. Air A. What types of emissions to the air would result from the proposal (1 e dust, automobile, odors industrial wood smoke) during construction and when the project is completed? If any, generally describe and give approximate quantities if known ate B. Are there any off -site sources of emissions or odor that may affect your proposal? If so, generally describe. Ao �-L- any C Proposed measures to reduce or control emissions or other impacts to air, if 0(4. 3 Water A. Surface. N i Is_there_any_surface_water_bod_y on or inthe immediate vicinity of the site (including year -round and seasonal streams, saltwater, lakes ponds, wetlands)? If yes describe type and provide names. If appropriate state what stream or river it flows into IL) Will the project require any work over, in or adjacent to (within 200 feet) the described waters? If yes please describe and attach available plans 1 44, EVALUATION FOR AGENCY USE Environmental Checklist Page 4 AGENCY USE Estimate the amount of fill and dredge material that would be placed in or removed from surface water or wetlands and indicate the area of the site that would be affected Indicate the source of fill material: p j4 iv) Will the proposal require surface water withdrawals or diversions? Give general description, purpose and approximate quantities if known. n1 f v) Does the proposal lie within a 100 -year floodplain? If so note location on the site plan IN q vi) Does the proposal involve any discharges of waste materials to surface waters? If so, describe the type of waste and anticipated volume of discharge 1,j B Ground 1) Will ground water be withdrawn or will water be discharged to ground water? Give general description purpose and approximate quantities if known N/A_ ii) Describe waste material that will be discharged into the Ground from septic tanks or other sources, if any (for example. Domestic sewage, indistrial, containing chemicals; agricultural wastes, etc.). Describe the general ske of the system, the number of such systems, the number of houses to be sewed (if applicable) or the number of animals or humans the system(s) are expected to serve. iJ `4 C Water Runoff (including storm water) 1.) Describe the source of runoff (including storm water) and method of collection and disposal if any (include quantities if known). Where will this,water flow? Will the water flow into other waters? If so, describe (40-S K ik ii) Could waste materials enter ground or surface waters? If so, generally describe. t.)1 4- D Proposed measures to reduce or control surface ground and runoff water impacts, if any 0 &A- 4 Plants A. Check or circle the type of vegetation found on the site. deciduous tree alder, maple, aspen, other X evergreen tree: fir cedar pine, other shrubs grass pasture crop or grain wet soil plants: cattail, buttercup, bullrush skunk cabbage, water plants: water lily eelgrass, milfoil, other Other types of vegetation,1" EVALUATION FOR Environmental Checklist EVALUATION FOR Page 5 B. What ki and k ,�rr}pu�t o�f i� 11 berpoved or altered? se, C Proposed landscaping use of native plants, or other measures to preserve or enhance vegetation on the site if any 0 1 4- no v& 5. Animals A. Circle any birds and animals which have been observed on or near the site or are known to be on or near the site Birds hawk, heron, eagle songbirds, other NI P: Mammals deer, bear elk, beaver other Rc.Lco o cio zo Asi (4 lco- Fish. bass salmon, trout, herring shellfish, other t.9 a B. Threatened or endangered species known to be on or near the site IJ.-v' C Is the site part of a migration route? If so explain no D Proposed measures to preserve or enhance wildlife, if any t1/4)/ 4- 6 Energy and Natural Resource A. What kinds of energy(Iectri natural gas oil wood store solar) will be used to meet the completed project's energy needs? Describe whether it will be used for heating manufacturing etc. B. Would your project affect the potential use of solar energy by adjacent properties? If so, generally describe. I Jo C. What kinds of energy conservation features are included in the plans of this proposal? List other proposed measures to reduce or control energy impacts ii any 7 Environmental Health A. Are there any environmental health hazards including exposure to toxic chemicals, risk of fire and expbsion, spill, or hazardous waste that could occur as a result of this proposal? If so describe. tje i) Describe special emergency services that might be required Ni A, ii) Proposed measures to reduce or control environmental PJ` health hazards if any B. Noise -2 i) What types of noise exist in the area which may affect your project (for example traffic, equipment, operation .other.)? ii) What types and levels of noise would be created by or associated with the project on a short-term or a long -term basis (for example. traffic construction operation, other)? Indicate what hours noise would come from the site iii) Proposed measures to reduce or control noise impacts if any AGENCY USE A)D(AQ--) Environmental Checklist Page 6 8 Land and Shoreline Use if any What is the current use of the site and adjacent properties? sc A. B C D E. What is the current zoning classification of the site? (V Has the site been used for agriculture? If so describe Describe any structures on the site. l\d Will any structures be demolished? If so what? 'S S52)S poP F What is the current Comprehensive Plan designation of the site? G What is the current Shoreline Master Program designation of the site? H Has any part of the site been classified as an "environmentally sensitive" ared? 4r 9 a If so specify J Approximately how many people would the completed project N9--o--(A-IL displace? K. Proposed measures to avoid or reduce displacement impacts How many people would reside or work in the completed project? L Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans, if any B Approximately how many units, if any, would be eliminated? Indicate whether high middle or low- income housing. B. What views in the immediate vicinity would be altered or obstructed? C Proposed measures to reduce or control aesthetic impacts, if any N(4 9 Housing A. Approximately how many units would be provided, if any? D Indicate whether high, middle or low- income housing. N p C Proposed measures to reduce or control housing impacts, if any q 10 Aesthetics A. What is the tallest height of any proposed structure(s), not including antenna what is the principal exterior building material(s) proposed? 11 Light and Glare A. What type of Light or glare will the proposal produce? What timeof day would it mainly occur? B Could light or glare from the finished project be a safety hazard or interfere with views? EVALUATION FOR AGENCY USE Apamc, 14 (A 1212-5 t ettAkAr lL-o Environmental Checklist Page 7 C What existing off -site sources of light or glare may affect your proposal? NI A D Proposed measures to reduce or control Tight and glare impacts, if any 0(4-- 12. Recreation A. What designated and informal recreational opportunities are in the immediate vicinity? tJf4 B Would the pr posed project displace any existing recreational uses? If so describe No C Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be provided by the project or applicant, if any 13. Historic and Cultural Preservation A. Are there any places or objects listed on or proposed for national, state, or local preservation registersknown to be on or next to the site? If so generally sk describe. d B. Generally describe any landmarks or evidence of historic, archaeological, scientific, or cultural importance known to be on or next to the site jriJ C Proposed measures to reduce or control impacts if any A.)(64- B. Is site currently served by public transit? if not, what is the approximate distance to the nearest transit stop? 2 r C How many parking spaces would the completed project have? Howmary would the project eliminate? NV D Will the proposal require any new roads or streets, or improvements to existing roads or streets, not including driveways? If so generally describe (indicate either public or private) N (A. E. Will the project use (or occur in the immediate vicinity of) water rail or air transportation? If so generally describe NM— F How many vehicular trips per day would be generated by the. compleed project? If known, indicate when peak volumes would occur If v /4. G Proposed measures to reduce or control transportation impacts if any N(A- 15 Public Services A. Would the project result in an increased need for public services (for example fire protection, police protection, healthcare, schools, other)? If so generally describe. 00 EVALUATION FOR AGENCY USE 14 Transportation A. Identify public streets and highways serving the site and describ proposed access to the existing street system. Show on site plans if any Baca -4 U 46162 S4`�'j Environmental Checklist EVALUATION FOR Page 8 AGENCY USE B Proposed measures to reduce or control direct impacts on public services if any fJ b 6,L t 16 Utilities A. LISTED SPECIES ILaS tdi/Ak tc( ENDANGERED SPECIES ACT (ESA) INFORMATION rcle es currently available at the site: electricity,.) natural gas (wat refuse servic tefepho sanitary sewer, septic system, o er B Describe the utilities that are proposed for the project, the utility providirg the service and the general construction activities on the site or in the immediate vici ty which might be needed kit +tLQ4 46 Q d $Tptpro 4 5 0o L F or press“ rZ 59 0A g$2,w-tr 17 Economics y10 A. If the proposal will result in expansion of an existing business, please describe the nature of the expansion (e g additional land and /or buildings, new equipment, new employees) Niptl B If the proposal is the creation of a new business, please describe (e g re -use of an existing building and site, construction of a new building) C Describe if the proposal is the first of its type in the community or what the similar uses are. D How many people will the proposal provide employment for at its completion and what types of jobs will be created (e.g sales clerks factory workers, etc. (Jobs created by the construction of the proposal sh Id be reported separately pi A E. Where will the f nate0ais, goods or services utilized by the proposal come from? -Occ-( 6ce35r e� 3 F Where will the goods ors ces produced by the proposal be utilized? G Who will utilize the goods p services produced by the proposal? iv 4 H Will the proposal alter the tax assessments of the area? If ESA listed species (salmon, trout, and chars, e.g. bull trout) are present or ever were present in the watershed where your project will be located, your project has the potential for affecting them, and you need to conply with the ESA. The questions in this section will help determine if the ESA listings will impact your project. Within the Cir of Port Angeles, the watershed is the Port Angeles Harbor Are ESA listed salmonids currentlypfesen in the watershed in which your project will be. Yes X N X Environmental Checklist Page 9 Has there ever been an ESA listed salmonid stock present in this watershed Yes X No Uncertain Please describe Puget Sound Chinook Salmon, Strait of Juan de Fuca summer chum salmon, and bull trout are listed as threatened species in the Elwha River, Morse Creek, and the Strait of Juan de Fuca including Port Angeles Harbor. If you answered `yes" to either of the above questions, ypu- should complete the remainder of this section If not, skip to Non gject fiction Section Page 13] 1 Name of watershed Port Angeles Regional Watershed (Elwha Morse). 2 Name of nearest waterbody hce f (0o -C 3 What is the distance from this project to the nearest body of water? (Often a buffer between the prgject and a stream can reduce the chance of a negative impact to fish) f�f 4 What is the current land use between the project and the potentially affected water body (parking lot, farmland etc.)? ito rA¢_ 5 Is the project above a natural permanent barrier (waterfall) natural temporary barrier (beaver pond), man made barrier (culvert, dam), other (explain) ►'1 o w� 6 If you checked any of the items listed in the above question #5, are there any" resident salmonid populations above the blockage? Yes No X Don't know 7 What percent of the project will be impervious surface (including pavement and roof area)? A.pp�X. t t,00 S� v 'Roo -E., B FISH MIGRATION The following questions will help determine if this project could interfere with migration of adult and juvenile fish (Both increases and decreases to water flow can affect fish migration 1 Does the project require the withdrawal of Surface water? (XD Name of surface water body IJcs Ground water? 1.0 Amount From where? Depth of well 2 Will any water be rerouted? 3 Will there be retention ponds? tic. If yes, will this be.an infiltration pond or a surface discharge Cher a municipal storm r system or a surface water body? If a surface water discharge name of waterbody !'u2_ EVALUATION FOR AGENCY USE Environmental Checklist EVALUATION FOR Page 10 AGENCY USE 4 Will new roads be required? (Increased road mileage may affect the timing of water reaching a stream and may impact fish habitat.) 5 Are culverts proposed as part of the project? 6 Will topography changes affect the duration /direction of runoff Mows? If yes, describe 7 Will the project involve any reduction of the floodway or floodplain by filling or other partial blockage of flows? If yes, how will the loss of flood storage be mitigated by your project? C WATER QUALITY 1 Do you know of any problems with water quality in any of the streams within this watershed? If so, describe 2 Will your project reduce or increase shade along or over a waterbody? 3 Will the project increase nutrient loading or have the potential to increase nutrient loading or contaminants (fertilizers, other waste discharges, or runoff) to the waterbody? 4 Will turbidity be increased because of the project activities? 5 Will your project require long term maintenance, i e bridge cleaning highway salting, chemical sprays for vegetation management, clearing of parking Tots? D VEGETATION 1 Will the project involve the removal of any vegetation from stream banks? 2. If any vegetation is removed, do you plan to replant? NON PROJECT SPECIFIC ACTIONS Complete this section only if your proposal involves a non-project specific act uch as a Comprehensive Plan Amendment, Zoning Code Amendment, area -wide s e (City -wide or large sub area),or other similar action When answen ese questions be aware of to what extent the proposal or the types of activities like result from the proposal would affect the item at a greater intensity or at a faster ra an if the proposal were not implemented Respond briefly and in general terms. 1 How would the proposal be likely to increa •'scharge to water; emissions to air production, storage, or release of toxic or ha or production of noise? ous substances; Environmental Checklist Page 11 Proposed measures to avoid or reduce such increases 2. How would the proposal be likely to affect plants, an als, fish, or marine life? Proposed measures to protect or conserve plants nimals, fish or marine life. 3 How would the proposal be likely 'o deplete energy or natural resources? Proposed measures to conserve energ and natural resources 4 How would the proposal be iik: y to use or affect environmentally sensitive areas or areas designated r eligible or under study) for governmental protection, such as parks, wilderne wild and scenic rivers, threatened or endangered species habitat, histori- or cultural sites, wetlands, floodplains, or prime farmlands? Proposed measures to pr ect such resources or to avoid or reduce impacts 5 How would t proposal be likely to affect land and shoreline use, including whether it wo d allow or encourage land or shoreline uses incompatible with existing plans? SIGNED. Proposed easures to avoid or reduce shoreland and land use impacts 6 H or public s Pro w would the proposal be likely to increase demands on transportation ices and utilities? osed measures to reduce or respond to such demand(s) Identify if possible, whether the proposal may conflict with local, state or f:deral laws or requirements for the protection of the environment. DATE. 9' 5 S 1, the undersigned, state that to the best of my knowledge, the above information is true and complete. It is understood that the lead agency may withdraw any declaration of nonsignificance that it might issue in reliance upon this checklist should there be any willful misrepresentation or willful lack o uII disclo re on my part. K PHONE. 36,0 `7 l EVALUATION FOR AGENCY USE {f W A S H I N G T O N U S A PLANNING DEPARTMENT GE:LE;S ENVIRONMENTALLY SENSITIVE AREAS APPLICATION TO THE APPLICANT Applications for land uses or developments proposed within areas listed, identified, mventoned, classified, rated or otherwise determined to be environmentally sensitive or which have been determmed by the Planning Director based upon a site specific analysis or such other information supplied which supports the findings that a site or area is likely to contain environmentally sensitive characteristics, shall be filed with all of the information requested on the application forms available from the Planning Department. The Planning Director may waive specific submittal requirements determined to be unnecessary for review of a specific application type All developments proposed on lots or parcels which may contain or adjoin environmentally sensitive areas as determined by the City shall be evaluated by the applicant to provide the necessary information for the Planning Department to determine if and to what extent the site contains environmentally sensitive characteristics. The Planning Director shall make the determination to classify a site or portion of a site as environmentally sensitive *Applications which are subject to the State Environmental Policy Act (SEPA) regulations shall not be acted upon until SEPA procedures have been completed. All land uses and developments proposed on or adjacent to lots or parcels listed, identified, mventoned, classified, or rated as environmentally sensitive shall include supporting studies prepared to describe the environmental hmitations of the site. No construction activity, including clearing or grading, shall be permitted until the information required by the City's Environmentally Sensitive Areas Protection Ordinance is reviewed and approved by the City When necessary, special environmental studies shall include a comprehensive site inventory and analysis, a discussion of potential impacts from the proposed development, and specific measures designed to mitigate any potential adverse environmental impacts of the applicant's proposal both on site and off site. *SEPA procedures take a minimum of 17 days to process. Reauired Information Spa S w5 s 1 A descnption of how the proposed development will or will not impact each of the following on the subject property and adjonung properties A. Erosion and landslide hazard, ,a0 -1A3L, B Seismic hazards, rc C Drainage, surface and subsurface hydrology, and water quality; no-vvL, D Flood prone areas, no E. Existing vegetation as it relates to steep slopes, soil stability and natura �1 habitat value (for wetlands refer to the City of Port Angeles Wetland Protection Ordinance), F Locally unique land forms ravines, marine bluffs, beaches and associated coastal drift processes; 0/A G Slopes between 15% and 25 25% and 40 and greater than 40% Y114 2 Recommended methods for mitigating identified impacts and a description of how these mitigating measures may impact adjacent properties. N (4 3 Any additional information determined to be relevant by the City or by the professional consultant who prepared the study 4 Such studies shall be prepared with assistance by experts m the area of concern which at a minimum shall include the following individuals A. Flood hazard areas Professional civil engineer hcensed by the State of Washington, 0/A btu(cAtit5 as occkscd4 or 6.e taa.c,tis B Landslide hazard areas, seismic hazard areas, and erosion hazard areas Geologist and /or Geotechrucal Engmeer; N(A C Steep slopes Geologist or Geotechnical Engineer; N(4 D Wetlands Biologist with wetlands ecology expertise, 6 t E. Streams, rivers, npanan areas, drainage comdors, ravme Geologist r Geotechmcal Engineer; n c- e v�ss e vt� t �c� -�1� dc6iA 4 to' rc F Manne bluffs, beaches. Geologist or Geological Engineer, Oceanographer Wa. 5 The City may m some cases retain consultants at the applicant s expense to assist with the review of studies outside the range of staff expertise. 2 6 All environmentally sensitive areas studies must be prepared under the supervision of the City The Planning Director will make the final determination on the adequacy of the studies. Applicant: Mailing Address LSO 9--o LA So N CAA Daytime Phone Number O 4 C E O D 4',1 Owner: Name Mailing Address 6avAll Q5 vJOc.a& Proiect: Name Legal Description. ea Daytime Phone Number S. wtQ_ Q$ a tilts -C Pronerty• nn Street Address. I)QU i"5{j ANA ck -e 1�� J Size of parcel (sq.ft.) SO 0 O S� Zonmg designation of property Comprehensive Plan designation of property APPLICATION INFORMATION P tP Briefly describe the project proposed for the site 1 O Dlo-ee.. o, X ct O 46. 4 ,l 0 (A cc-4i\ Ys-a .m e- apk -6 sa y e,wkot City of Port Angeles Environmentally Sensitive Areas Application Page 3 OWNER. 1 48_,LiLi 1.Li.i--Th4c-- G:\PLANNING\FORMS\ESA.APP PART III AFFIDAVITS (TO BE COMPLETED BY APPLICANT) APPLICANT. I, 4,,,L, is hereby affirm that all of the information included as part of this apphcation and all associated drawings are accurate and true to the best of my knowledge. Z K 9 <6-- 0 Applicant Date Applicant Date hereby affirm that I am the owner of the property where the project proposed m this apphcation is located and that I authorize this application. 9_15 -0 City of Port Angeles Environmentally Sensitive Areas Application Page 2 PORTANGEILES W A S H I N G T O N U S A. PLANNING DEPARTMENT REQUIREMENTS FOR A MAP SUBMITTED FOR CLEARING AND GRADING ON A PROPERTY CONTAINING AN ESA A map submitted for clearing and grading on a property that contains an environmentally sensitive area shall 1) be drawn on a sheet of paper with a minimum size of 11 by 17' 2) be drawn at a minimum scale of 1 =100' 3) show all property lines and dimensions 4) show the topography of the property identified by two foot or five foot contours 5) show the location and classification of all environmentally sensitive areas and required buffers located on the property (and dimension of buffer) and 6) clearly identify all areas of proposed clearing and grading This list will be used in reviewing your submittal map failure to satisfactorily address each of the items listed above will result in your submittal being returned to you for corrections Please be sure your submittal is complete If you have any questions please call the Planning Department at 417 -4750 esacgmap.REQ OF AORTA, CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 Application Number 05 00000341 Date 5/11/05 Application pin number 617332 Property Address 1039 S VALLEY ST ASSESSOR PARCEL NUMBER 06 30 00 0 3 2550 0000 Application type description DEMOLITION Subdivision Name Property Use Property Zoning PUBLIC BUILDINGS PARKS Application valuation 1500 Owner Contractor KEITH LLOYD WILLIAM RENA C BILL KEITH CONST 150 CLIFF ROBINSON LN 150 CLIFF ROBINSON IN SEQUIM WA 98382 SEQUIM WA 98382 68) 8337 (360) 683 -8337 Structure Information 000 000 DEMO SHED Construction Type TYPE V NON RATED Occupancy Type SINGLE FAM CONGREGATES Permit DEMOLITION Additional desc DEMO SFD 500SF Permit pin number 48603 Permit Fee 47 00 Plan Check Fee 00 Issue Date 5/09/05 Valuation 0 Expiration Date 11 /05 /05 Qty Unit Charge Per Extension BASE FEE 47 00 Fee summary Charged Paid Credited Due Permit Fee Total 47 00 47 00 00 00 Plan Check Total 00 00 00 00 Grand Total 47 00 47 00 00 00 Separate Permits are required for electrical work, SEPA, Shoreline ESA, utilities private and public improvements This permit becomes null and void if work or construction authorized is not commenced within 180 days if construction or work is suspended or abandoned for a period of 180 days after the work as commenced or if required inspections have not been requested within 180 days from the last inspection I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date T \Policies \1102_15 building permit inspection record05 wpd [1/4/2005] FOUNDATION: FOOTINGS WALLS FOUNDATION DRAINAGE DOWN SPOUTS PIERS POST HOLES (POLE BLDGS.) PLUMBING UNDERFLOOR /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 INSULATION SLAB WALL FLOOR CEILING MECHANICAL HEAT PUMP FURNACE DUCTS GAS LINE WOOD STOVE PELLET CHIMNEY COMMERCIAL HOOD DUCTS MANUFACTURED. HOMES FOOTING SLAB BLOCKING HOLD DOWNS SKIRTING 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. INSPECTION TYPE DATE ACCEPTED 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 I NO I ELECTRICAL LIGHT DEPT CONSTRUCTION R.W PW/ ENGINEERING 417 -4807 FIRE 417 -4653 PLANNING DEPT 417 -4750 BUILDING 417 -4815 T \Policies \1102_15 building permit inspection record05 wpd I)I /4 /20yr 417 -4735 ELECTRICAL LIGHT DEPT I/, YES I NO CONSTRUCTION R.W PW ENGINEERING FIRE DEPT PLANNING DEPT BUILDING COMMENTS I PORTANGELES W A S H I N G T O N U S A. PUBLIC WORKS UTILITIES DEPARTMENT Bill Keith 150 Cliff Robinson Rd Sequim, WA 98382 RE. Port Angeles Landfill Waste Disposal Application, WDA 05 -09; Building demolition at South Valley St, Port Angeles, Washington We have received your application for disposal of building demolition debns 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. Gary W Kenworthy, P.E. City Engineer Deputy Director of Engineering Services Fact. WDA05 -09 Copy: Kea Loghry 1 039 321 EAST FIFTH STREET P 0. BOX 1 150 PORT ANGELES WA 98362-0217 PHONE 360- 417 -4805 FAX 360- 417-4542 TTY 360 -417 -4645 E -MAIL publicworks ©cityofpa us 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: a U -e- tfi' Owner a t k K.Q k7t Phone: Address 1 6 e .t 12 So N (--✓1 -City. Architect/Engineer Phone Contractor i& l 1 K (e_ l State License ZILL k e -xp K b I -0S Phone:(-Sc ?SS' 74 7 Address. I S)(M (PP 122)(.01 es 0, t-n City Se/ r,<< '1.ci4 Zip 9 4e� ff.-- PROJECT ADDRESS 1 I O S i .t)cc I (eu &h\--1 P ZONING LEGAL DESCRIPTION Lot: I Z. Block: 2S Subdivision. T -A- CLALLAM COUNTY PARCEL NUMBER. 069 Dt r", 5''"oc3.oc, Credit Card Holder Name: Billing Address: Credit Card Type VISA MC TYPE OF WORK. VResidential New Constr Re -roof Multi- family Addition Move Commercial Remodel 'Demolition Repair Sign BRIEF DESCRIPTION OF THE PROJECT Stove Garage Deck Other' COMMERCIAL/RESIDENTIAL,. Occupancy Group Occupant Load. PLANNING USE ONLY ESA/Wetland(s) Yes No SEPA Checklist required? Yes No Other T•\RVESS\BLDG- forms brochures \2004- Buildingpermit.wpd Applicant: BUILDING PERMIT APPLICATION City- Phone t Co o z i& 6 0 5 Construction Type Exp. Date: SIZE/VALUATION 5A SF /SF SF /SF SF /SF TOTAL VALUATION /L )C 4TH w(7. GY� FOR OFFICIAL USE ONLY Date Rec. �I) �'OS, Permit ci C Jt{' Date Approved. sl Date Issued. Zip c 4S Date- S 5 -os No. of Stories Lot Size. 1 1'O OSF Existing Sq. Ft. 5 Proposed Sq Ft. n TOTAL Sq Ft. 0 Total lot coverage APPROVALS. PLAN BLDG DPWU FIRE. OTHER. VALUATION OF CONSTRUCTION In all cases, a valuation amount must be entered by the applicant. This figure will be reviewed and may be revised by the Building Division to comply with current fee schedules. Contact the Permit Coordinator at 417 -4815 for assistance. PLAN CHECK FEE IF a plan check fee is due it must be submitted at the time the building permit application and construction plans are submitted. All other permit fees are due at the time of permit issuance EXPIRATION OF PLAN REVIEW If no permit is issued within 180 days of the date of application, the application will expire. The Building Official can extend the time for action by the apphcant up to 180 days upon written request by the applicant (see Section R105.3.2 of the International Building/Residential Code, 2003). No application can be extended more than once. I hereby certify that I have read and examined this application and know the same to be true and correct. 1 am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required ,not the City's, and that I must obtain such permits prior to work. 60 Feet Vertical Datum =NAVD 88 Horizontal Datum =NAD 83/91 L Area Map 321 322 J17 322 This map is not intended to be used as a legal description. This map /drawing is produced by the City of Port Angeles for its own use and purposes Any other use of this map /dr ving shall not be the responsibility of the City 318; 110 Feet 0! Vertical Datum NA VD 88 Hor ntal Datum NAD 83/91 Area Map This map is not intended to be used as a legal description. This map /drawing is produced by the City of Port Angeles,fo its o} use and purposes Any other use of this map /drawing shall not be the responsibility of the City. 3 DAB: S 1 a —a 5 MESSAGE: 00/ TOO L W. OLYMPIC PENINSULA TITLE COMPANY TITLE INSURANCE ESCROWS AGENTS FOR TRANSNATION TITLE INSURANCE COMPANY To: FRO 6„41,7 K.,5/7L FAX y �1 4 l NUMBER OF PAGES TO FOLLOW: 495 W Spruce Suite S RO. Box 1479 SequiR WA 98382 0060) 6834179 FAX (360) 683074 4 14300-4684:664 aTaT,L 8TnsuTuad 3TdwLTO tLLZC89 09C IV3 9Z OT fIBJ 5002 /ZT /S0 Z00 /Z00 OLYMPIC PENINSULA TITLE COMPANY cLA OOWY 2005 MAY —6 PM 3: 52 TRANSACTION EXCISE TAX I I 1 11 PA D MAY 6 2005 J it V i AMOUNT A a'7QQ0 1 2005 1156037 c r c ou RE File Nurnbef 02081840 S((_. LPB -10 STATUTORY WARRANTY DEED Loyd Description Well: edd'I on pa LTS 11 12 ELK 325 TPA CLALLAM COUNTY WA Te*Pa►Cela: 063000 032545 063000 032550 THE GRANTOR KAREN D FOURTNER A MARRIED WOMAN AS HER SEPARATE ESTATE fo► end In conslderetlon of TEN DOLLARS AND OTHER GOOD AND VALUABLE CONSIDERATION In hand paid, conveys end warrants to WILLIAM LLOYD KEITH AND RENA C KEITH HUSBAND AND WIFE the foOowing described real mete, situated In the County of CLALLAM State of Washington: LOTS 11 AND 12 IN BLOCK 325 OF THE TOWNSITE OF PORT ANGELES SITUATE IN CLALLAM COUNTY, STATE OF WASHINGTON Doted: y 03 2 05 B I LX 12,€ e KAREN D F URTNER By By By State of WASHINGTON County of CLAIM On this 5Th day of MAY before me personally appearert KARF1 My Appt. Expires: 12 -19 -07 OLYMPIC 'tMbl''k M0 •,v •I(C040(0111 CO to me known to be the individual( described in and who executed the within and foregoing instrument and acknowledged that she /,E d 1/ signed the same as $4/het [fir/ free and voluntary act and deed for the uses and purposes therein mentioned, ozs v4FT under my hand and official seal the day and year la Vsgo44fohlitten 5610Ne-t ti a Nota blic in and for h State of WASHINGTON 1'). e 19• av Re9id et: PORT A ,,F OF wps0� 20 aTaTS uTusuTuad DTdmLTO 'LL2C89 09C XVd 9Z OT AEI 5002/ZT/50 Parcel Lookup Page 1 of 1 Parcel Number 0630000325450000 Site Address. 9999 S VALLEY ST PA Quit I I Back Taxpayer FOURTNER KAREN D Title Owner FOURTNER KAREN D Description LOT 11 BL 325 TPA 1015 S VALLEY ST PORT ANGELES WA 98362 0 L 1015 S VALLEY ST PORT ANGELES WA 98362 Value Summary' Note: Listed values do not reflect adjustments made for exemption programs such as Senior /Disabled or Current Use programs (except Commercial Forestland properties) Land Value 6 000 Improvements Value 0 Total Assessed Value 6 000 Property Characteristics Note: Use Code is for Assessor's purposes only Contact the appropriate planning or building departments for Zoning and allowable usage of property Use Code. 9100 UNDEVEL LAND Land Size (acreage) 00 Note. Acreage is not listed for all properties in the Assessor's records. More information about land size. Tax Status. Taxable Tax Code Area. 0010 Zoning Code P_PBP Note. Zoning and zoning codes change constantly Verify all zoning with the appropriate planning or building department. Building Characteristics (Click on Bldg. for more details.) Bldg. Type Blda. Style Total S.F. BD BA Tax History Sales History I Quit I I Back I 11439 49111 http. //65 161 10 164 /website /srtis_p pgm ?parcel= 0630000325450000 5/9/2005 Parcel Lookup Page 1 of 1 Parcel Number 0630000325500000 Site Address. 1103 S VALLEY ST PA xthizE Quit I I Back Taxpayer FOURTNER KAREN D 1015 S VALLEY ST PORT ANGELES WA 98362 Title Owner FOURTNER KAREN D 1015 S VALLEY ST PORT ANGELES WA 98362 Description LOT 12 BL 325 TPA Value Summary Note: Listed values do not reflect adjustments made for exemption programs such as Senior /Disabled or Current Use programs (except Commercial Forestland properties) Land Value 14 850 Improvements Value. 6 700 Total Assessed Value 21 550 Property Characteristics Note: Use Code is for Assessor's purposes only Contact the appropriate planning or building departments for Zoning and allowable usage of property Use Code. 1910 VACATION HMS Land Size (acreage) 00 Note: Acreage is not listed for all properties in the Assessor's records. More information about and size. Tax Status. Taxable Tax Code Area. 0010 Zoning Code P_PBP Note: Zoning and zoning codes change constantly Verify all zoning with the appropriate planning or building department. Building Characteristics. (Click on Bldg. for more details.) Bldg. Type Bldg. Style Total S.F. BD BA 01 Cabin One Story 316 1 1 Tax History Sales History Quit I I Back 11439 4921 http. //65 161 10 164 /website /sitis_p pgm ?parcel= 0630000325500000 5/9/2005 Date: 5/5/05 jQb Location,,, 1-1-05 South Valley St. Port Angeles, WA 98363 Q yner: Subject: Demolition cc/ Northwest Asbestos Consultants 406 Reed St. Port Townsend, WA 98368 360- 385 -0584 northwestasbestosconsultants@cablespeed.com Bill Keith 1103 South Valley St. Port Angeles, WA 98363 Subject: Regards to re- inspection, The purpose of re- inspection after ACBM was removed by the abatement contractor Assured Quality This area that was noted on 4/7/05 inspection report has been abated and all areas were left clean. I find this building ready for demolition as according to the regulations of Olympic Region Clean Air Agency and EPA guidelines. 3c){.0 Inspec Bob Witheridge EPA -AHERA Building Inspector Management Planner WAMOA- 0042 -04 Expires- 10/13/05 Olympic Region Clean Air Agency Assured Quality City of Port Angeles Permit Center To City of Port Angeles City Engineer 321 E Fifth Street P O Box 1150 Port Angeles Washington 98362 Contact. Phone Project Name Project Location. 2. Other Contacts (if applicable) Consulting Firm Contact. Phone t-f'!' Contractor Name 1 }A6 Contact. )�1tc� �w�J Phone ),J k Laboratory M /1. l Z Contact it-ILL,/ Phone ti��[�Inn b/ PORT ANGELES LANDFILL WASTE DISPOSAL APPLICATION z fJ4u Y Sri t7 w b O5 O Phone (360) 417 -4803 FAX. (360) 417 -4709 NOTE. All questions must be answered for waste to be approved. 1 Generator Information. Company Name L)t c. k.4 Mailing Address (lam <1Qc,/.1,0 eA; K r fr1 JA o/ aSP, City of Port Angclos Landfill W,rstc Disposal Application P qto 1 Source of Waste Check the appropriate box below and briefly describe the project process and /or cleanup that will or has produced the waste requiring disposal Include the gasoline service station number (if applicable) CERCLA/MTCA Remediation Independent Remedial Action Unused Chemical Product Spill 1 yz s 4 Waste Material Composition (check all that apply and Include percent of total) Soil Concrete /Asphalt Preserved Wood Coal Ash Wood Ash NOTE Total must eaual 100% 5 Waste Material Contaminants (check all that apply) Gasoline Metals Solvents Heating Oil Unused Motor Oil Used Motor Oil /Waste Oil V Other -5-1--,13 ft L'- Other Petroleum Product 5/3“ 5 5j' viz y &7' U P-P' Unknown Agency Contact UST Removal V Other Source c 4/ z..cS Foundry Slag Dredge Sediments XC Debris Other (list) NOTE Supply any MSDS information with application if available Diesel PCBs City of Port Angeles Landfill Wasto Disposal Application Pogo 2 Estimated Quantity of Waste for Disposal 0 Other Cubic yards Tons (estimate both) Drums 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 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 1 number of discrete samples per composite Number of DISCRETE samples j 5.4:/ �l� i./ �iL�1.,,t ✓l, C'b L�� �.1- tJ7z�'� 21 J x NOTE 1 0 -25 25 100 101 500 501 1000 1001 2000 >2000 Tons (estimate both) cubic yards cubic yards cubic yards cubic yards cubic yards cubic yards /.JYivu 2 Unless prior approval has been granted by Port Angeles frequency will be used Annual Other /Y I /f j XLiv-6—._r /F- 6‘12•111-1 6 v141 1" the following sampling 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 P age 3 9 Waste Analysis a) List all analytical test methods used fA4 -13/I 77_6o 3 Calculated Hazard Index 11 Dangerous Waste Affidavit. 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 b) Provide a narrative as to why the above analytical methods were selected ,4 4>z cc/ ix Pt-)4 S L kloy NOTE. Additional sheets attached. Y- 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 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 (DW) nor Extremely Hazardous Waste (CHW) Dangerous Waste (DW) and Waste Code Extremely Hazardous Waste (CHW) and Waste Code City of Poit Anctc.lrs Landfill Wasto Disposal Applic, it+on Pogo 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 o' ourrabilities Waste c nerator Sigriature /44.7 6:)06 Printed Name 7� --Jour c j AsoLiA t3, Company Zf�-c2S Date Approv;lxpiation Date NAPOUCy p11000 SW\1008 01 WPD r• City of Port Angelus Landfill Waste Disposal Application Pago 5 i5 2@(5 0 002AM NVL ABORA T OR i r; INC NO 4558 2/3 NVL Laboratories, Inc. 4708 Aurora Ave. N. Seattle, WA 98103 Tel: 206.547.0100, Fax: 206.634 1936 www.nvilabs.00m Client: Zenovic Associates, Inc. Address' 519 South Peabody Street, Suite 22 Port Angeles, WA 98362 Attention: Mr Tracy Gudgel Project Location S. Valley St, Port Angeles Lab ID 25029834 Analysis Report Toxicity Characteristic Leaching Procedure Lead (Pb) Client Sample 05130 A mg/ L =Milligrams per liter ppm parts per million Note Method QC results are acceptable unless stated otherwise. Bench Run No. 25-0414-2 RL mg/ L 05 Sampled by Client Analyzed by Holly Tuttle Date Analyzed 04/15/2005 AIHA IH #101861 Results in mg /L 16 A £,wkw eenlel Lead am 4WUetrlel e ACORBb1TeD LABORATORY Batch 2504942.00 Matrix: Bulk Method EPA 1311/7000B Client Project #05130 Samples Received: 1 Total Samples Analyzed 1 Results in ppm 16 DRAFT RL Reporting Limit Below the reporting Limit Page 1 of 1 tt; L4.1\ `1YL LnUi(f\ W 1 f'lV L. LaoorAtories. inc. 4708 Aurora Ave N, Seattle. WA 98103 Tel: 206.547.0100 Emerg. Pager' 206.344.1878 t.888.NVL.IABS (685.5227) Client Zenovic Associates. Inc_ Street 519 South Peabody Street. Suite 4 _port Angeles Project Manager x+2 Y 6 oesa4. Project Location S_ (14uAr 5-r y.,t r 4as 10 AstxstOS Air Phone: (360) 417 0501 Fax: (360) 417.0514 10 PCM NIOSH 7400) TEM (NIOSH 7402) U TEM (AHERA) 0 TEM (EPA Level 11) 0 Other 1Q Asbestos Bulk 10 PLM (EPA/6Q0/R- 93l116) 0 PLM (EPA Point Count) METALS C1 Total Metals CLP 2 a 4 5 6 7 8 9 10 11 12 13 14 15 Dot. mit Matrix ppm (AAS) El Arc F 0 ppb (GFAA) 0 Drinking water Ll Dust/wipe 0 Soil 0 Other Types 0 Fiberglass 0 Nuisance Dust of Analysts 10 Silica 0 Respirable Dust Condition of Package: 0 Good 0 Damaged (no spillage) 0 Severe damage (spillage) Seq. M1 Lab ID 1 Client Sample Number 1 Carnrnents 1 1 1. ,A 1 Pc s& 1C Paste. -es Piro Below Sampled y Relinquished by Received by Analyzed by 1 Results Called by 1 Results Faxed hIf1 r CHAIN of CUSTODY SAMPLE LOG 0 Paint Chios 0 Paint Chips (Area) 0 Waste Water IJVL Batch Number Client Job Number Total Samples Turn Around Time -IVU +77 L- BATCH ID 2504942 00 nSi 3c) D 1-Hr O 24-Hrs 0� 4��aa D,ys C�' 2-Hrs 0 2 Days 6Days 0 4 0 3 Days 06 to 10 Days Please calf for TAT less than 24 Hrs Email address -weto 0 PLM (EPA Grevimetty) 0 TEM Bulk RCM Metals 0 A$ 5 0 Arsenic (As) 0 Load (Pb) Barium (Ba) 0 Mercury (hug) 0 Cadmium (Cd) Selenium (Se) 0 Chromium (CO 0 Shyer (Ag) o Rotometer Calibration D Other' (Specify) 0 Mold/Fungus Comaany Date rune 1 r l, 4.10c 464ss& Zr. 1 4 F -6 -q 13. u.)i0 l 7 �✓�rlrG 4Qr 74 1 ci.--p ai 1 l o,Af, 1 ;#19, 1 0/ Special Instructions• Unless requested in writing. all samples win be disposed of Iwo (2) weeks after analysis. Other Metals U All 3 0 Copper (Cu) 0 Nickel (Ni) 0 Zinc (Zit) AIR I Buyer(s) Seller(s) Lender Property Closing Date Escrow Officer File Number SALES PRICE DEPOSITS FUNDS TO CLOSE REMITTER WILLIAM LLOYD KEITH MISCELLANEOUS ADJUSTMENTS DEPOSIT PAID DIRECTLY TO SELLER WILLIAM LLOYD KEITH, RENA C KEITH KAREN D FOUR'TNER LOTS 11 12 $LK 325 TPA PARCEL #063000 032545 PARCEL #063000 032550 05/06/2005 SERENA M RODR=GUEZ 02081840 PRORATIONS COUNTY TAXES from 05/06/05 to 07/01/05 1 04000 per day ESCROW CHARGES ESCROW FEE PAYEE OLYMPIC PENINSULA TITLE CO ESCROW FEE -SLS TAX PAYEE OLYMPIC PENINSULA TITLE CO RECORDING FEES /TRANSFER CHARGE$ RECORDING FEES Deed amount $19 00 PAYEE OLYMPIC PENINSULA TITLE CO THIS IS YOUR FINAL CLOSING STATEMENT ALL FIGURES ARE BASED ON THE ACTUAL CLOSING DATE AS NOTED ABOVE OLYMPIC PENINSULA TITLE COMPANY BY ESCROW 0 CER BUYER(S) FINAL CLOSING STATEMENT Prepared by OLYMPIC PENINSULA TITLE COMPANY 49 5 W SPRUCE, SUITE 5 SEQUIM, WA 98382 (360) 683 -4179 SUBTOTALS 27 250 52 BALANCE DUE FROM BUYER TOTALS 27,250 52 Proration Date 05/06/2005 DEBIT 27,000 00 58 24 160 00 13 28 19 00 CREDIT 17,250 52 10., 000 00 27,250 52 0 00 27,250 52 12/15/2006 15:04 FAX 1aJ001/001 ~ . L.[ n - LI-7 \ \ "" ELECTRICAL WORK PERMIT APPLICATION.;' Job wired by o Electrical Contractor 0 Owner Installation description ./ l:l Comhlercial ~ Residential ""', p~se~~~ Ci~('+Q~QSWkStatecf~~2- Telephone n ber FAX number .~ :;g.- :Bnr~~ ~et~~ ell D(,~ <l1- Phont number (0 sched~le inspection: o New o Altered/Addition O.QJ\J IU )~\ , f Owner a.~ defined by RCW:19.28.26J:(1) Owney will occu.py thf' JlrucllJrejor twO yearj' after this clecfr/ctJ! permit j.~ finalized. (2) Owner is reqlAlred TO hire all electrical co"trocmr if above said property is jor sale, re"t or ll~ose. After reading (he above statemem. I hereby certify that f om the owner of the a.bove named property or a licensed electrical contraclOr. I ;un milking 1he electrical inSw.l- lation or alteration in compliance ~ilh the ele~tric~l la.ws, N.E.C., RCW. Chapter 19.2g, WAC. Ch3.pter 296.468, The City of Port Angeles Mnnicip3.1 Code, and Utility Specifications. Slgnalure of owner. electrical t:ontractor or dtctdcol adm~nIU~~ X Date. 6'(0 o Cash o Cheek # ~Credit Card ~. Mastercard Discover Card# _D'l\_-,~_.____-____ Expiration Date of card ~n~,3 Service Information Electrical Load Additions and or subtractions o NO LOAD CHANGES o Baseboa'ti KW Cl Furnace 't()N o Heat Pump _ Ton _ LAR 1:1 Fen-Wall KW C Overhead ServIce D Temp Service o Underground Service Voltage Phase 0 1 0 J Servioe Size: _ Feeder Size: SAME DAY INSPECTION, CALL BEFORE 7:00 AM 360.417.4735 " ROUGH-Th' TIIERMOSTAT ,-- SERVICE \. Dille i\pp1Qved!ly D:l.1e ApprovedDy ORle Apllroved 'fly I FINAL DITCH FEEDER "- LIMe ....PVN..eUll,. " D8lc ),""'J\l\l~BY/ D., Approved lly Inspection ATea, Building or Equipment TTIspecled Action Tllken ElcctriC3.1 OaIe In!>pcctor 1;l/;lJJ~ .. I"1W ELECTRICAL INSPECTION WIRING REPORT 417-4735 r APPROVED NOT APPROVED o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 DITCH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Do 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ROUGH IN/COVER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Do 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SERVICE 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 oX Do 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FINAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CORRECTIONS NEEDED; @ @ ~t/JC~ (FUL-L LJL/'htJ (J) ~~P>A-, r ;Z;;1-U-- cr-~ . @ A~h?DVE ~/Z.O,.,., . ,;z ~i /u rn.L)^-1--r' ~"" .B~""'/ A/ Rr:> jc Ar-7ApVF-Z 3.F-<:""'^,<"l~/ "e~",,-d (fJ-/).A::J/1/..., ~~... / ,(Joe <;/Vr nP6N"'~, '" .'l vilA <n - rr L.JrHf...N /T /..5 t;; J_ ~,t'; (_5" c.. t.. ,~~ eA . L.../n-,8 r'vc.. o 5S'-?'-t/f'C-,!- ~ QL#~fL1 Ave) A ?Rnf' 7) 71# S~A/lr; /5 PbE/U...(). {O,k/<.L 7Jhl= 0 ~ r A ~E 7V WffG.K ~,d:J Tf-ft5 ~J~ NOTIFY INSPECTOR WHEN CORRECTIONS ARE COMPLETED WITHIN 15 DAYS - DO NOT REMOVE - OLYMPIC PRINTERS, INC. (360) 452.1381 ~. .' ..... , " ~O'RTANGEtE:S WAS H I N G TON, U. S. A. FAX TRANSMITTAL Department of Public Works/Utilities 321 East Fifth Street, Port Angeles, Washington Phone: (360) 417-4735 FAX: (360) 417-4711 TO: .P"7~ FROM: COMPANY: S~p LU.A:.:7l2{ c... FAX#: ~5'z.- /0'89 NUMBER OF PAGES INCLUDING COVER: .:;... {].f-"'c.... i-JHZ.AJ eo,-n'p~ .;Vo!.l:-:::Z: (y~ ~ f/1Zt'n?ArLJ Se..v77"N 0,""" ~ 5.t-rz.-v1 t:...L ~ D rt!JUHo rr 0'-. 77hE.- 5ttc.rlON /5 ;etL-l-oe..,A.t:..tJ" b/i/.E. Ct:>~.-a70N5 70 ;€.~e~'- 'Pf&J /972..e ("'or- Pt>~"fJ1U:J ~ s/7:f:... ~ ."'~.. ',./- ~ ~ORT "I..v -'.O~"O<,: f::: ,~(~ u '''''''-- _ "' ~~lml -0 u...... -==...:!I' CI) ~--=---~ (-0 ~ ",-,0- *ORKS f,. \.') ElECTRICAlINSPECT~ON WIRING REPORT 417-4735 . II\JSPECTOR - ) . APPROVED NOT APPROVED o .................... DITCH. . . . . . . . . . . . . . . . . . . . 0 D. . . . . . . . . . . . . . . . ROUGH IN/COVER. . . . . . . . . . . . . . . 0 D. . . . . . . . . . . . . . . . . . . . SERVICE. . . . . . . . . . . . . . . . . . .X D. . . . . . . . . . . . . . . . . . . . . FINAL. . . . . . . . . . . . . . . . . . . . 0 CORRECTIONS NEEDED: @ @ 5L!d:i/JC~ VLi:.. LL LJ.€/"hCJ (J) A' ,f' ;P .4-" IZ- .B/2-1!)-<~ ,A./ 80x' 47--~JFF-te... .5 .F<!" G./N C"l~? r;e,....);yd (1/ f' .'itA_ 5"D t1?-t? ,A:;) ,('7/" ,.. -:-- , ./ /'J ,Ch"c5.;Vr' r::/~t& . /7 /.5 /::)~~--N~~" cyG~ bJ~ @ AtCPnCiI./e ;;;; .. "/ )~.e:: L:..,,/n-,8 F"/?-CJr'YI . .~?' r>Vc.. (" s; c;.l.. ,e.,~ CA . /.1....-' . .?~j")'..J'r' ?"O? ,51f.~/1'C~ /Z.;f 6!/~~L1 ~ L) A P,"'FrH /7;' 7JhE Siz-1e. i/ I'-'.E' 1.5 ,J./LlZ{JI4O. (0?R7< L 7J.hF . 1"'JJe~ / . ~ ~E 70 t;.J/TG.-k ~~",LJ 7116 \ ~JC~ NOTIFY INSPECTOR WHEN CORRECTIONS ARE COMPLETED WITHIN 15 DAYS - DO NOT REMOVE - OLYMPIC PRINTERS. INC. (360) 452-1381 04/12/2006 08:03 FAX ~ 002/003 C-"- i(J L\ ~~~\.~-\I.l t2.',22 --j)'\.:tdrv (~. ~~~~-W o-~f0 l-" ~ ELECTRICAL WORKPERMlT APPLICATIO~ W$ Job wired by o Eleclrical Contraclor [J Owner Iniiullation description / o Commercial 5;( Residential Dale Expires I re;e. Purchaser'g mailing addrelis ~~ ~ ~3 ~,. Stat. W' r Wit :1&~~ Te.lep~ne numb or. F number '-fo~ - -\ .eJ ~r i'~' oW"fZ;..1'R' 6. (1 ---L \ ~ ~ fJV'A\::riJ !.::UlM ) Ad f"l!J,!j or Inspecdon Ci~~~~~}i~ \;J~ Phone number to schedule iuptc:tion: aNew a Altered/Addition ~\)clJu~y ~ ~QY'~ Owner as defined by RCW/9.2B.16J:(I) OW"ef' wr't( occupy tne stnicture for 0t'0 years Of/I!! Ihi~' e!eclricaJ pe,mir js [I1UlU=erJ, (1) Owner is requi,ed 10 MN an eltClriml contrac(of' !r tlbOYI! slJif/ proper-ry is for sale, "en, Or lease. After reading the abov~ statement, I t:lcreby cenif)' that r urn the O"Wncr of the above named propen.y or a licensed electrit:1l1 conrraCtOf. I 3m making the electrical in/ltaJ- lal;oo or 3ltera1ion in compliance with the electrical laws. N.E.C., RCW. Chapter 19.18, WAC, Chapter 296-46l3, The City of POrl Angeles Municip1l1 Code, and Utility Specifications. Signature of OWner, eledrical conlraclor or cledric.al "d o Check # Credit Card Visa Mastercard Discover Card# _..o.n....~~.____-____ x Date: Expiration Dale of card , Service Information ~" Electrical load Additions and or subtractions a NO LOAD CHANGES a Baseboard KW CI Furnace KW o Heat Pump _ Ton _ LAR a Fan-Wall KW a Overhead Service D Temp Service LJiTUnderground Sel"Vioe Voltage Phase a , a 3 Service Size: _ Feeder Sl:.e: .' SAME DAY INSPECTION. CALL BEFORE 7:00 AM 360-417-4735 ROUGH-IN THERMOSTAT DQtt Apllr\>v,cl Dy I1A'~ Aflprll"cd By SERVICE y{:fh ,~ b AlIllnl'\lull Dy DITCH J-fD ^ppru'.,d By FEEDER 4:f:? n. Inspection Oilre Area, Building or Equipment Inspected Action Taken Electrical Inspectof .- , z. JDh I .r ELECTRICAL INSPECTION' WIRING REPORT 417-4735 .. PERMIT # ~;to !NSPECTOR ADDRESS J./, APPROVED NOT APPROVED o .................... DITCH. . . . . . . . . . . . . . . . . . . .)1< O. . . . . . . . . . . . . . . . ROUGH IN/COVER. . . . . . . . . . . . . . ."0 O. . . . . . . . . . . . . . . . . . . . SERVICE. . . . . . . . . . . . . . . . . . )iC 0.. . . .. . . . . . . . . .. . . . . . FINAL. .. . . .. . . . . . . . . . . . . . 0 CORRECTIONS NEEDED~/.Ili'S" ,n"_ -,"", "q M~ Pt'9xu -i. (fJ @ /AlS~ rf~_or'l'.Jh-A.1&:...S DA/ ~Vr ~, .e..L B"'-A/~J-=" ~,~ .It:> 77~~ & t........//~--.$ ~ ...,/U. A-fu€<- LJ / fA- ;vcr ~~ /c>~ ~~-r'LI" ~ ~~A.,._ ~,- ~ p oJ ..J.y" .L..5: .tp /?1t7//1t- /Y~ ~/,-u:_ I Dn~s -vr- ~Q 7t:> So /r -0 c 4!)~~ r~ c..o v~ r.+Jr:l.u _ .......Ah~') ,. NOTIFY INSPECTOR WHEN CORRECTIONS ARE COMPLETED WITHIN 15 DAYS - DO NOT REMOVE - ~ OLYMPIC PRINTERS, INC. (360) 452-1381 ..":: IElECTRICAllNSPECTfO'N WIRING REPORT 417-4735 IN~ ADDRESS /tPS APPROVED NOT APPROVED o ..'''............. DITCH. . . . . . . . . . . . . . . . . . . . 0 D. . . . . . . . . . . . . . . . ROUGH IN/COVER' . . . . . . . . . . . . . . . 0 D. .. . . .. . . . .. . . . . .. . . SERVICE. . .. . . . . . . . . . . . . . . . 0 D. . . . . . . . . . .. . . . . .. . . . FINAL. . . .. . . . . . . . . . . . . ...0 CORRECTIONS NEEDED: ([) {:JA~~".Jt' 7'7> <--~/~-'</ "'fJ ~ on- . ..-n -6-.:;1',.,r @ 8nUI'M.-Ll..5 J./~ 7b ?A-n7T~'- ,.,.,~ /-'''.../J.L.S,:r>4L- /F 7?h5--L.5 A ~v.t.J.~ - ~~/( /l' /,NJ~____ /laa 7&.<:-771:>'" ...,.:: P.....~ / <r~ (j) ~ G,lbMM ,.:;..~ />'~./'''''-n4I "l' (."Joy y.;~ s ~ ~ IA./~ ~-J 77' I.R~ / ""''}'-'"1''''' Llt7 - 47~$' " NOTIFY INSPECTOR WHEN CORRECTIONS ARE COMPLETED WITHIN 15 DAYS - DO NOT REMOVE - OLYMPIC PRINTERS, INC. (360) 452-1381