HomeMy WebLinkAbout124 Juniper Ln - Building (l %wF CITY OF PORT ANGELES
�111 PUBLIC WORKS UTILITIES
321 EAST 5TH STREET, PORT ANGELES WA 98362
Application Number 11- 00001341 Date 11/30/11
Application pin number 124810 REPORT SALES TAX
Property Address 124 JUNIPER LN
ASSESSOR PARCEL NUMBER: 06- 30- 15 -3 -2- 9060 -0000- on your state excise tax form
Application type description PUBLIC WORKS UTILITES
Subdivision Name to the City of Port Angeles
Property Use (Location Code 0502)
Property Zoning RS9 RESDNTL SINGLE FAMILY
Application valuation 0
Application desc
Install 2 driveways
Owner Contractor
LESLIE JUDITH SPOTKOV TRUST FRED THOMPSON CONSTRUCTION
124 JUNIPER LANE 413 DEER TRACKS
PORT ANGELES WA 98362 PORT ANGELES WA 98363
(360) 452 -8316 (360) 928 -3088
Permit DRIVEWAY INSTALLATION
Additional desc CONSTRUCT 2 DRIVEWAYS
Permit Fee 360.00 Plan Check Fee .00
Issue Date 11/30/11 Valuation 0
Expiration Date 5/28/12
Qty Unit Charge Per Extension
BASE FEE 360.00
Special Notes and Comments
Contact City Inspector prior to start of construction
417 -4831
Fee summary Charged Paid Credited Due
Permit Fee Total 360.00 360.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 360.00 360.00 .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 o •inances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume t..; ve aut• y to violate or cancel the provisions of any state or local law regulating construction or the performance of
construc
A A./ 0117..Z .diorAVII■aleam
Sig,of Contract. or Authorize gent Date Signature of Owner (if owner is builder) Date
T:Forms /Buildine Division /Public Works Permit
PERMIT INSPECTION RECORD
CALL 417 -4831 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 C21
YES NO l
PW UTILITIES (Engineering Division)
WATERLINE METER `l,
SEWER CONNECTION
SANITARY
STORM
SITE DRAINAGE.
SITE EROSION
PARKING
SIDEWALK
CURB &`GUTTER
DRIVEWAY A PPROACH
°BACK FLOW' DEVICE,
4 t
w v "t b k t� t�
..REQIRED
U PRIR TO OCCUPANCY /USE
O;
FIN INSPECTIONS
RESIDENTIALk.. DATE YES° 'NO E COMMERCIAL DATE ACCEPTED
CONSTRUCTION R W PW/ CONSTRUCTION `R W
ENGINEERING "ss 417- 4807': PW ENGINEERING
FIRE 417 -4653 FIRE DEPT..
PLANNING DEPT 417 -4750 PLANNING. DEPT.
BUILDING
417 :BUILDING
4815 vv
T Forms /Building Division/Pubhc Works Penm[
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number 10- 00000880 Date 9/02/10
Application pin number 887040
Property Address 124 JUNIPER LN REPORT SALES TAX
ASSESSOR PARCEL NUMBER: 06-30-15-3-2- 9060 -0000-
Tenant nbr, name LESLIE JUDITH SPOTKOV TR on your state excise tax form
Application type description RES ADDITION to the City of Port Angeles
Subdivision Name
Property Use (Location Code 0502)
Property Zoning RS9 RESDNTL SINGLE FAMILY
Application valuation 74362
Application desc
319 SF GARAGE WITH 2ND FLOOR SUNROOM CVRD DECK
Owner Contractor
LESLIE JUDITH SPOTKOV TRUST PENINSULA PRIDE CONST INC
124 JUNIPER LANE 90 THOMPSON RD.
PORT ANGELES WA 98362 PORT ANGELES WA 98363
(360) 452 -8316 (360) 417 -6990
Structure Information 000 000 319 SF GARAGE /2ND FLR SNRM /CVR DECK
Other struct info HARD SURFACE AREA
Permit BUILDING PERMIT RESIDENTIAL
Additional desc 319 SF GARAGE /2ND FLR SNRM ETC
Permit pin number 171678
Permit Fee 845.25 Plan Check Fee 549.41
Issue Date 9/02/10 Valuation 74362
Expiration Date 3/01/11
Qty Unit Charge Per Extension
BASE FEE 670.25
25.00 7.0000 THOU BL- 50,001 -100K (7.00 PER K) 175.00
Permit MECHANICAL PERMIT
Additional desc
Permit pin number 172007
Permit Fee 79.60 Plan Check Fee .00
Issue Date 9/02/10 Valuation 0
Expiration Date 3/01/11
Qty Unit Charge Per Extension
BASE FEE 50.00
2.00 14.8000 EA ME- HEATER(SUSP /WALL /FLOOR -MTD) 29.60
Permit PLUMBING PERMIT
Additional desc
Permit pin number 172015
Permit Fee 57.00 Plan Check Fee .00 f
Issue Date 9/02/10 Valuation 0
Expiration Date 3/01/11
Qty Unit Charge Per Extension
BASE FEE 50.00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work has commenced, or if required inspections have not been requested within 180 days from the
last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions
of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does
not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
2 o l q rc A S 6 ��C. Lc o Owt.1.ne 1Jf n 42∎Lou
Date Print Name Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder)
T:Forms /Building Division /Building Permit
J
BUILDING PERMIT INSPECTION RECORD
PLEASE PROVIDE A MINIMUM 24 -HOUR NOTICE FOR INSPECTIONS
Building Inspections 417 -4815 Electrical Inspections 417 -4735
Public Works Utilities 417 -4831 Backflow Prevention Inspections 417 -4886
IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED.
POST PERMIT IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE.
Inspection Type Date Accepted By Comments
FOUNDATION:
Footings
Stemwall
Foundation Drainage Downspouts
Piers
Post Holes (Pole Bldgs.)
PLUMBING:
Under Floor Slab
Rough -In
Water Line (Meter to Bldg)
Gas Line
Back Flow Water FINAL Date Accepted by
AIR SEAL:
Walls
Ceiling
FRAMING:
Joists Girders Under Floor
Shear Wall Hold Downs
Walls Roof Ceiling
Drywall (Interior Braced Panel Only)
T -Bar
INSULATION:
Slab
Wall Floor Ceiling
MECHANICAL:
Heat Pump Furnace FAU Ducts
Rough -In
Gas Line
Wood Stove Pellet Chimney
Commercial Hood Ducts FINAL Date Accepted by
MANUFACTURED HOMES:
Footing Slab
Blocking Hold Downs
Skirting
PLANNING DEPT. Separate Permit #s SEPA:
Parking Lighting ESA:
Landscaping SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE
Inspection Type Date Accepted By
Electrical 417 -4735
Construction R.W. PW Engineering 417 -4831
Fire 417 -4653
Planning 417 -4750
Building 417 -4815
T:Forms /Building Division /Building Permit
CITY OF PORT ANGELES
FL
DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Page 2
Application Number 10- 00000880 Date 9/02/10
Application pin number 887040 REPORT SALES TAX
Qty Unit Charge Per Extension on your state excise tax form
1.00 7.0000 EA PL -WATER LINE 7.00 to the City of Port Angeles
Special Notes and Comments (Location Code 0502)
August 26, 2010 5:41:05 PM sroberds.
The proposal will result in a 319 sq.ft. addition to an
existing sfr in the RS -9 for total lot coverage of 2 No
land use issues anticipated.
Electrical load calculations and electrical permits are
required if installing new electrical.
Any modifications to the City's electrical facilities will
be at the customer's expense.
"Any and all contractor(s) and subcontractor(s) doing work
under this permit in the City Right of Way is required to
provide written documentation that the City has been named
as an additional insured"
Construct the 2 driveways to City Standards. A separate
Right of Way Construction application must be completed by
the contractor performing the work in the right of way. A
permit for this work is required. Concrete with exposed
aggregate or other non standard finishes(including colors or
dyes)are not allowed in the City road right of way. Broom
finish only. An inspection by Public Works Engineering is
required prior to pouring concrete.
The existing sanitary sewer clean -out needs to be relocated
to the exterior of the foundation, an inspection is required
by Public Works prior to back fill of ditch. 24 hour advance
notice is required.
Other Fees STATE SURCHARGE 4.50
Fee summary Charged Paid Credited Due
Permit Fee Total 981.85 981.85 .00 .00
Plan Check Total 549.41 549.41 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 1535.76 1535.76 .00 .00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work has commenced, or if required inspections have not been requested within 180 days from the
last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions
of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does
not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
Date Print Name Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder)
T:Forms /Building Division /Building Permit
V YI
BUILDING PERMIT INSPECTION RECORD
O
PLEASE PROVIDE A MINIMUM 24 -HOUR NOTICE FOR INSPECTIONS
Building Inspections 417 4815 Electrical Inspections 417 4735
Public Works Utilities 417 4831 Backflow Prevention Inspections 417 4886
IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED.
POST PERMIT IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE.
Inspection Type Date Accepted By Comments
FOUNDATION:
Footings 1O 1 3--1 O
Stemwall 1 14•— v
Foundation Drainage /.Downspouts
Piers
Post Holes (Pole Bldgs.)
PLUMBING:
Under Floor Slab
Rough -In
Water Line (Meter to Bldg)
Gas Line
Back Flow Water J FINAL Date it 3O Accepted byjZjj
AIR SEAL: 1 TLV
Walls
Ceiling
FRAMING: io i �L C/I
Joists Girders Under Floor
Shear VV Hold Downs 4 4 2 i 1 P6
WaI1 R Ceiling
Drywall (Interior Braced Panel Only)
T -Bar
INSULATION: 6 2 I
Slab
Wall Floor Ceiling
MECHANICAL:
Heat Pump Furnace FAU 1 Ducts
Rough -In
Gas Line
Wood Stove Pellet Chimney /1 119 Accepted
Commercial Hood Ducts FINAL Date
MANUFACTURED HOMES:
Footing Slab
Blocking Hold Downs
Skirting
PLANNING DEPT. Separate Permit #s SEPA: /<7/
Parking Lighting ESA:
Landscaping SHORELINE:
■rx-
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE `cc�
Inspection Type Date Accepted By C
Electrical 417 -4735
Construction R.W. PW Engineering 417 -4831
Fire 417 -4653
Planning 417 -4750 (0
Building 417 -4815 /l 3 O
T:Forms /Building Division /Building Permit
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PROJECT STATUS UPDATE
Permit 10
Date: y,-G, i I
phoned the: Applicant. at
Property Owner I� �S at (5 2-- '5.5 (o
Contractor at
(left a phone message, o discuss,'
The permit (has expired, will expire soon). is the status of this project?
Please call and schedule a final inspection.
Or
Submit a "permit extension request" letter.
Or
Let me know if the project is abandoned.
.51 ji 1_, 0 l' .I f
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T:Fonns /Building Division /Project Status Update
RECEIVED
APR11 2011
a g 1S C ITY OF PORT ANGELES
1 2-- TUN' for- Layfre BUILDING DIVISION
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n,,,(,..j.`, BUILDING PERMIT APPLICATION Print in ink
CITY OF PORT ANGELES For City Use Only:
a Attn: Building Permit Technician 1 Date Received S- 0_10
321 E. Fifth St., Port Angeles, WA 98362 Permit �0 (360) 417 -4815 fax (360) 417-4711 Date Approved i
rt 1"i .2 t
Applicant in rG t,�. 5 13 f20.( II I� c o Ph C ei 7 7 q 2 L1 O
Property Owner L.e s 1 i Sp o -I-1< o v Phone 1} zi 2. -3I (o
Property Owner's Address 2 y Ju v i pe v i-n
Contractor Pend nS iQ. Pr‘'ete C0v►s uc 1n Phone O# q 17- Log 0
Contractor's Address 1 0 Thompson R d. Pod kinTz l e$ Wt4 q 8 3 Lai
License Fen i vt`q! 00 M Expiresjept. 26 1 0 E -mail (3erti4►n6 da1 ®01yp. e
PROJECT ADDRESS l 9 au n i er' Lan e_
P
Parcel Number 0650 152. 8660 Lot Zoning S
Project Type Brief Description: it Residential Multi- family Commercial Industrial
Check all that apply
New Construction 2- S 0�41/4 ,tn,\ /a5 -f-- d i0 ,F-, 9 sift.. S
d Addition ►r• a
Remodel l s q
Repair
Demolition RemovQ. I WIKc ew5 it rOz of 44ie ex{erri or eo.sr side of the- hefy+.e,
Re -roof House garage other tear off re -roof lay over one layer
KHeat System Heat pump wood- burning stove gas fireplace pellet stove other
Other Z Pl`G a. Wa heztRiCS. i v1 5tylYzrrr
Floor Areas Existing (sq. ft.) Proposed (sq. ft.)
Basement 4,0 0 per sq. ft.
1 Floor l ,CO' 0 s S.tohyi
2 Floor 3 i q o►vowt r
3 Floor
Garage 3 1 (1
Carport
Covered Porch 1( ((nJ S4•
Deck
Shed
Other Kenne( 2
TOTAL VALUATION 7 31,2 .t-iO
Total footprint of structures 1 939 sq. ft. T Lot size C IO) 71 S sq. ft. Lot coverage 2. 1
Site Coverage the amount of impervious surface on a parcel, including structures, paved driveways, sidewalks, patios,
and other impervious surfaces. (see PAMC 17.94.135 for exemptions) Site coverage
Max. height of proposed structures afro Z 0 ft. Occupancy group of bedrooms
Will a lawn sprinkler system be installed? Vte Occupant load of full baths
Will a fire sprinkler system be installed? avo Construction type kyQ s4 ILA of half baths
1 have read and completed this application and know it to be true and correct. I am authorized to apply for this permit and understand
that it is my responsibility to determine what permits are required, and to obtain permits prior to working on pro cts.
Wick( .5 L
Dater O Print Name .0 G o Sig nature or V I (KAA 8 8
P l.2
T:Forms /Buil ing Division /Building permit application
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Clallam County Assessor Treasurer Property Details 67767 LESLIE JUDITH SPOT... Page 1 of 6
i CIallam County Assessor Treasurer
Property Search Results 67767 LESLIE JUDITH SPOTKOV TRUST for Year 2010 2011
Property
Account
Property ID: 67767 Legal Description: TPA SHORT PLAT #81 -10 -7
V10 P89 PARCEL 4 SURV
V36 P67 2.28A
Geographic ID: 0630153290600000 Agent Code:
Type: Real
Tax Area: 0010 PA 121 PORT ST CNTY H2 L Land Use Code 11
Open Space: N DFL N
Historic Property: N Remodel Property: N
Multi Family Redevelopment: N
Township: Section:
Range:
Location
Address: 3804 S OLD MILL RD Mapsco:
PORT ANGELES, WA 4 0 .5,
Neighborhood: Cycle 4 Res Map ID:
Neighborhood CD: 10952130 isr`' ),0,-Pi
Owner
Name: LESLIE JUDITH SPOTKOV TRUST Owner ID: 53820
Mailing Address: 124 JUNIPER LANE Ownership: 100.0000000000%
PORT ANGELES, WA 98362
Exemptions:
Taxes and Assessment Due
Property Tax Information as of 08/19/2010
Amount Due if Paid on: MR
First Half Second Half:
Year Statement ID Taxing Jurisdiction I Base Due: Base Due Penalty Interest Base
2010 49555 ST SCH STATE SCHOOL $298.10 $298.11 $0.00 $0.00 $5.
2010 49555 CC -GEN COUNTY $158.63 $158.65 $0.00 $0.00 $31
l 2010 49555 PORT PORT $22.30 $22.29 $0.00 $0.00 $4
2010 49555 PORT ANG PORT ANGELES $367.30 $367.31 $0.00 $0.00 $72
12010 49555 SD #121 SCHOOL DISTRICT #121 $386.13 $386.13 $0.00 $0.00 $77
2010 49555 NTH OLY LIB NORTH OLYMPIC LIBRARY $46.10 $46.10 $0.00 $0.00 $.c
'2010 49555 HOSP #2 HOSPITAL #2 $65.08 $65.08 $0.00 $0.00 $1
2010 49555 WSMET PK DIST WILLIAM SHORE MET PARK DIST $20.71 $20.71 $0.00 $0.00 $4
12010 49555 CITY STORMWATER CITY STORMWATER $36.00 $36.00 $0.00 $0.00 $7
2010 49555 FIRE PATROL FIRE PATROL $8.70 $8.70 $0.00 $0.00 $1
1 2010 49555 WEED CONTROL WEED CONTROL $0.94 $0.95 $0.00 $0.00 1
1 2010 49555 FP Fee FIRE PATROL COUNTY FEE $0.25 $0.25 $0.00 $0.00 1
2010 49555 T0TAL• $1410.24 $1410.28 $0.00 $0.00 $282
2009 677672008 ST SCH STATE SCHOOL $311.28 $311.27 $0.00 $0.00 $62
1 2009 677672008 CC GEN COUNTY $157.54 $157.52 $0.00 $0.00 $31
i 2009 677672008 PORT PORT $22.32 $22.31 $0.00 $0.00 $4
f 2009 677672008 PORT ANG PORT ANGELES $345.55 $345.52 $0.00 $0.00 $6.
http: /vpn.clallam. net: 8084 propertyaccess /Property.aspx ?cid =0 &year= 2010 &prop_id =67... 8/19/2010
ELECTRICAL PERMIT
CITY OF PORT ANGELES p
360- 417 -473
Application Number 11- 00000445 Date 5/11/11
(.5.\
Application pin number 560685 REPORT SALES TAX
Property Address 124 JUNIPER LN on "our excise tax form
ASSESSOR PARCEL NUMBER: 06-30-15-3-2- 9060 -0000
Application type description ELECTRICAL ONLY to the City of Port Angeles
Subdivision Name (Location Code 0502)
Property Use
Property Zoning RS9 RESDNTL SINGLE FAMILY
Application valuation 0
Application desc
3 circuit addition
Owner Contractor
LESLIE JUDITH SPOTKOV TRUST JEFF NELSON ELECTRIC f
124 JUNIPER LANE 7062 OLD OLYMPIC HWY. v
PORT ANGELES WA 98362 PORT ANGELES WA 98362
(360) 452 -8316 (369) 460 -4291 a 1
Permit ELECTRICAL ALTER RESIDENTIAL
Additional desc 1 f
Permit pin number 185454 v
.Permit Fee 78.70 Plan Check Fee .00
Issue Date 5/11/11 Valuation 0
Expiration Date 11/07/11
Qty Unit Charge Per Extension
1.00 73.5000 ECH EL- BRANCH CIRCUIT WO /FEEDER 73.50
2.00 2.6000 ECH EL -ECH ADDNT BRANCH CIRCUIT 5.20 .4()
Fee summary Charged Paid Credited Due
Permit Fee Total 78.70 78.70 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 78.70 78.70 .00 .00
C----.
INSPECTION TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE
ROUGH -IN 5 1 P Q
FINAL
COMMENTS: j1 Ig WS 0 MISS 1
IT WILL EXPIRE SIX (6) MONTHS FROM LAST NSISI N `z'
PERM °Ar7
0
Signature of owner or Electrical Contractor X Date:
G:AEXCHANGE \BUILDING
ELECTRICAL PERMIT
CITY OF PORT ANGELES
360 -417 -4735
Application Number 11- 00000445 Date 5/11/11
Application pin number 560685 REPORT SALES TAX
Property Address 124 JUNIPER LN on your excise tax form
ASSESSOR PARCEL NUMBER: 06- 30- 15 -3 -2- 9060 -0000- y
Application type description ELECTRICAL ONLY to the City of Port Angeles
Subdivision Name
Property Use (Location Code 0502)
Propert Zoning RS9 RESDNTL SINGLE FAMILY
Application valuation 0
Application desc
3 circuit addition
Owner Contractor
LESLIE JUDITH SPOTKOV TRUST JEFF NELSON ELECTRIC
124 JUNIPER LANE 7062 OLD OLYMPIC HWY.
PORT ANGELES WA 98362 PORT ANGELES WA 98362
(360) 452 -8316 (369) 460 -4291
Permit ELECTRICAL ALTER RESIDENTIAL
Additional desc 1
Permit pin number 185454
Permit Fee 78.70 Plan Check Fee .00
Issue Date 5/11/11 Valuation 0
Expiration Date 11/07/11
Qty Unit Charge Per Extension
1.00 73.5000 ECH EL- BRANCH CIRCUIT WO /FEEDER 73.50
2.00 2.6000 ECH EL -ECH ADDNT BRANCH CIRCUIT 5.20
Fee summary Charged Paid Credited Due
Permit Fee Total 78.70 78.70 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 78.70 78.70 .00 .00
INSPECTION TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE
ROUGH -IN
FINAL
COMMENTS:
PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION
Signature of owner or Electrical Contractor X Date:
G:\EXCHANGE\BUILDING
RECEVII-
�c�ftr
MAY 10 2��1 1
CITY OF PORT ANGELES PERMIT APPLICATION 0
Building Division/Electrical Inspections ELECTRICAL
321 East Fifth Street P.O. Box 1150 Port Angeles Washington, 98362 INSPECTIONS
Ph: (360) 417 -4736 Fax: (360) 417 -4711
Date: .6.
V1 9 Family .Dwelling 1 Single Famil Dwellin Multi-Family or Commercial* Commercial Addition Alteration Remodel Repair*
Y
Plan Review y Be Required, Please Complete El trical Pian,geview 1 fiormatio Sh t
Job Address: a /f'�. o /�p D (01-
Building Square Footage: .i 1:0/ 7/00V ;40 A-
Description of above 2. 5`T0/v.? A DA7T7on/ &el of 4 be7'7'
Owner information Cont Information
L z‘ Ne-
Name: ��S 4 -7 C. SPOT 1Uj Name: E SD's
Mailing Address: /c 1 'h./A/ /A£ R. Mailing Address: 32s OE Gds/ T /08
City: p4- State: 4a Zip: ?k ate– City: Sl6+2 VF'-4 State: Uhl Zi 4 73"2
Phone: Fax: Phone: LI/n0 TI I Fax: l 4 1 2 Y 1 1 1
License Exp. License Exp. ---I C–' c' P.P
/'2411 (201 Z__
Item Unit Charge Qty Total (Qty Multiplied by Unit Charge)
Service /Feeder 200 Amp, 119.90
Service /Feeder -400 Amp. 145.50
Service /Feeder 401 -600 Amp 204.60
Service /Feeder 601 -1000 Amp, 262.20
Service /Feeder over 1000 Amp. 372.50
Branch Circuit W/ Service Feeder 2.60
Branch Circuit W/0 Service Feeder 73.50 _i___ 73' SO
Each Additional Branch Circuit 2.60 2- s,
Temp. Service/ Feeder 200 Amp. 92.70
Temp. Service /Feeder 201 -400 Amp. 110.30
Temp. Service /Feeder 401 -600 Amp, 148.70
Temp, Service /Feeder 601 -1000 Amp 167.90
Portal to Portal Hourly 95.90
Sign /Outline.Lighting 88.20.
Signal Circuit LimitedEnergy First 1500 sf Commercial 95.90
Note: $5.00 for each additional 1500 sf
.Signal Circuit/ Limited Energy -1 2 Family Dwelling 63.90
Signal Circuit/ Limited Energy Multi- Family Dwelling 63.90
Manufactured Home Connection 119.90
Renewable Electrical Energy- 5KVA System or Less 102.30
Thermostat 56.00
NEW CONSTRUCTION ONLY:
First 1300 Square Ft. 110.30
Each Additional 500 Square Ft. or Portion of 35.20
Each Outbuilding or Detached Garage 73.50
Each Swimming Pool or Hot Tub 110.30
.$.7 S .,70 Total
.Owner as defined by RCW.19.28.261: (1) Owner will occupy the structure for two years after this electrical permit is finalized. (2) Owner is required
to hire an electrical contractor if above said property is for sale, rent or lease. Permit expires after six months of last inspection.
After reading the above.statement, I hereby certify that I am the owner of the above named property or a.licensed electrical.contractor..1 am making
the electrical installation or alteration in compliance with the electrical laws, N.E.C., RCW. Chapter 19.28, WAC. Chapter 296 -46B, The City of Port
Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications.
Signature of owner, electrical contractor or electrical administrator: Casheck
Credit Card
i Ad e
1 Dated: kc 01/0112010
OF pORi,M,
'Ittc w30
Si
cons tio
A
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER
Application type description
Subdivision Name
Property Use
Property Zoning
Application valuation
Application desc
Connect to sewer
Owner
LESLIE JUDITH SPOTKOV
3804 OLD MILL RD
PORT ANGELES
WA 983623734
Permit
Additional desc
Permit pin number 134080
Permit Fee 120 00
Issue Date 9/09/08
Expiration Date 3/08/09
Fee summary Charged
Permit Fee Total 120 00
Plan Check Total 00
Other Fee Total 1125 00
Grand Total 1245 00
nature
T•\Policies \1102.15R [1/05]
08 00001131
519948
124 JUNIPER LN
06 30 15 3 2 9060 0000
PUBLIC WORKS UTILITES
RS9 RESDNTL SINGLE FAMILY
0
OWNER
SANITARY SEWER HOOK UP
ractor or Authorized Agent Date
CITY OF PORT ANGELES
PUBLIC WORKS UTILITIES DIVISION
321 EAST 5TH STREET PORT ANGELES, WA 98362
Plan Check Fee
Valuation
Contractor
Paid Credited Due
120 00
00
1125 00
1245 00
00
00
00
00
Date 9/09/08
Qty Unit Charge Per Extension
1 00 120 0000 EA SAN SEWER HOOKUP 120 00
Other Fees SEWER SYSTEM DELV CHARGE 1125 00
00
00
00
00
00
0
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
co n
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
T•\Policies \1102.15R 1/05]'
RESIDENTIAL"`
CONSTRUCTION RW PW
ENGINEERING 417 -4807
FIRE, 417 -4653 I
PLANNING DEPT 417 -4750 I
'BUILDING 417 -4815 I
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 I.
CONSTRUCTION RW
PW ENGINEERING
FIRE DEPT
PLANNING DEPT
BUILDING
September 9 2008
Leslie Spotkov
124 Juniper Lane
Port Angeles, WA 98362
RE Sanitary sewer utility service
Dear Leslie.
This letter is to the verify that the $120 00 sanitary sewer connection and $1125 00 sanitary sewer
system development fee has been paid and PW U permit 08 -1131 was issued allowing
connection to the Juniper Lane sanitary sewer main for your property located at 124 Jumper Lane,
Clallam County parcel 0630153290600000
Prior to connecting your buildmg sewer line into the 6" side sewer lateral line, please call (Public
Works Utilities Depar tment) 417 -4807 to schedule an inspection.
I have enclosed a copy of Clallam County Environmental Health Service information sheets and the
required forms for decommissioning the existing septic tank.
If you have questions, feel free to contact me at 417 -4807 or e -mail tfunstonO:ci vofna.us
Sincerely
llfiru
W A S H I N G T O N U S A
Public Works Utilities Department
Trema Funston,
Engmeenng Specialist
ORT NGELES
Phone 360- 417 -4805 Fax 360 -417 -4542
Website www cityofpa.us Email publicworks @cityofpa.us
‘`31 East Fifth Street P 0 Box 1150 Port Angeles, WA 98362 -0217
Application Number
Pin number
Property Address
ASSESSOR PARCEL NUMBER
Application description
Subdivision Name
Property Use
Property Zoning
Application valuation
Owner
LESLIE JUDITH SPOTKOV
3804 OLD MILL RD
PORT ANGELES
Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
Qty Unit Charge
1 00
Fee summary
Permit Fee Total
Plan Check Total
Grand Total
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET PORT ANGELES, WA 98362
Per
14 7000 ECH
A' F
61 70
00
61 70
Charged
WA 983623734
T•\Policies \1102_15 building permit inspection record05.wpd [1/4/2005]
05 00000068 Date 1/31/05
891204
--3-e44-gi.D-P4442b-RD 1 2.4 "So flo L
06 30 15 3 2 9060 0000
MECHANICAL PERMIT
RS9 RESDNTL SINGLE FAMILY
10800
Contractor
MECHANICAL PERMIT
HEATPUMP DUCTS FURNACE
61 70
1/31/05
7/30/05
PENINSULA HEAT
502 W 8TH ST
PORT ANGELES
(360) 457 2775
Plan Check Fee
Valuation
BASE FEE
ME INSTALL 100- FAU
Paid Credited
61 70 00
00 00
61 70 00
WA 98362
00
00
00
00
0
Extension
47 00
14 70
Due
1=)'c?'
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
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 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
PLANNING DEPT SEPARATE PERMIT #'s
PARKING/LIGHTING
LANDSCAPING
RESIDENTIAL
ELECTRICAL LIGHT DEPT
FIRE 417 -4653 1
PLANNING DEPT 417 -4750 1 r- x
BUILDING 417 -4815 1 l^'' 1
T•\Policies \1102_15 building permit inspection record05.wpd [1/4/2005]
YES NO
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
DATE YES NO COMMERCIAL DATE ACCEPTED
YES 1 NO
417 -4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION RW PW/ CONSTRUCTION RW
ENGINEERING 417 -4807 PW ENGINEERING
os 2t -ors{
SEPA.
ESA.
SHORELINE.
1 FIRE DEPT
PLANNING DEPT.
BUILDING
1 1 1
1 1 1
1 1 1
Applicant or Agent:. /�644e ATV. eA
Les& 1e
Address:
PROJECT ADDRESS
L DESCRIPTION Lot:
BUILDING PERMIT APPLICATION
Fill out COMPLETELY and in INK. Your application and site.plan MUST BE
COMPLETE to be accepted for review If you have any questions, call
(360) 417 -4815
Credit Card Holder Name:
Billing Address:
Credit CardType VISA MC
TYIT,OF WORK.
'esidential New Constr Re -roof
Multi family Addition Move
Commercial Remodel Demolition
0_ Repair Sign
BRIEF DESCRIPTION OF THE PROJECT
COMMERCIAL/RESIDENTIAL. Occupancy Group:
No. of Stories: Lot Size: Existing Sq Ft.
Existing lot coverage Proposed lot coverage
PLANNING USE ONLY
Stove
Ei Garage
O Deck
Other,
City
rvv 1 !n e
Occupant Load.
ESA/Wetland(s): Yes No SEPA Checklist required? Yes No Other
Phone:
Owner
Address: L i 6/0 NV/ R City ✓T 1
Architect/Engmeer•
Contractor Pe (,i1 5i Ai 0.- tzleaf State License jJU l d
507 tk) g City P) r1- 41-,344'
129 7u n ■p-eArs
Phone:
aS
Block: Subdivision
Phone:
L 7- 7 755
Zip 9e%t—V-'
ZONING.
CLALLAM COUNTY PARCEL NUMBER. 64, a 1 3 Z C 1 G. 0
Phone' q 5 775
5
Zip
Exp. Date:
•SIZE/VALUATION
SF /SF
SF /SF
SF /SF
TO AL ALUATIOIW, 80 C7
Construction Type:
Proposed Sq. Ft. TOTAL Sq.Ft.
Total lot coverage
FOR OFFICIAL USE ONLY
Date Rec. 1 -2 a"' 5
Permit e
Date Approved:
Date Issued:
APPROVALS
PLAN
BLDG
DPWI
FIRE.
OTHER.
BUILDLNG PERMIT APPLICATION SUBMITTAL. The Building Division can provide you with information on the application and
plan submittal requirements if you have questions.
VALUATION OF CONSTRUCTION In all cases, a valuation amount must be entered by the applicant. This figure will be reviewed
and may be revised by the Building Division to comply with current fee schedules. Contact the Permit Coordinator at 417 -4815 for assistance
PLAN CHECK FEE. IF a plan check fee is due it must be submitted at the time the building permit application and construction plans are
submitted. All other permit fees are due at the time of permit issuance.
EXPIRATION OF PLAN REVIEW If no permit is issued within 180 days of the date of application, the application will expire. The
Building Official can extend the time for action by the applicant up to 180 days upon written request by the applicant (see Section 107 4 of
the Uniform Building Code, current edition) No application can be extended more than once.
I hereby certify that I have read and examined this application and know the sa e to be true a correct. I am authorized to apply for this permit and
understand that it is my responsibility to determine what permits are requi d,n the City's an' -t I ust o in such permits prior to work.
T •\FORMS\APPS\Buildingpermit.wpd Applicant ��;1 ,,.t// r Al D ate: 24
r
CITY OF FORT ANGELES ftRMIT APPucAnoN
Roi<tdxng li?iviston/Vectr icat ltnspections
321 East Fifth Street -- P.O. Box 1150 / Port Angeles Washington, 98362
Ph., (360) 417-4735 Fax: (360) 4174711
Date,, 7—,Q ! 4
1AL'1. & 2 Single Family Dwelling
RECO
�-- P 2 1
EACTRICAL
VNSPEMONS
* Plan RWew May Be Re uiredw Plea 6e Complete Electrical Plan R view Information Sheet
Job Address; ..JJ
Building Square Faalage:
Description of above
Owner Information r / � Contra I rmat om ,
Name: U"C" game• o _ C: G ��
Melling A re5 ; � tutaRln� d
City: State, :Ip:
Phone: _ -Fax: City; Slate -,,tom gyp: —
Lic nse SOX, p- i
Wane # I Fxp, license �I! Exp_ ^-
�rsz S � 1f�
Item Unit Charge
SanricelFesdar200Arnp. $190,00 Total (Qty.Muldptl ipd by Unit Chy-tgpi
ii
ServicelFeeder201-400Amp. $146,00
SenricelF'eeder401 -600 Amp $ 205.00 _ $
ServlcelFeedor 601.1000 Amp. $ 26200
SenricelFeeder over 1000 Amp. $ 373.00
Branch Circuit W1 Service Feeder $ 5.00
Branch Circuit W10 Service Feeder $ 63.00
Each Additional Brranch Circuit 5 5,00 $
$
Branch Circuits 1-4
$ 75.00 $�.l
Temp. Servicel Feeder 200Amp. $ 03.00 $�
Temp. Service /Feeder 201AOO Amp. $110.00
Temp. S0MMIFeeder 401.600 Amp, $149.00 g
Temp. Service/Feeder 601 -1000 Amp . $168.00 $- - -
Portal to Portal Hourly $ 96,00 $
Signal Circuil/ Limited Energy -1 & 2 Family Dwelling $ 64.00 " $
Manufactured Horne Connection $120.00 $
Renewable Electrical Energy -8KVA System or Less $102.00 $
Thermostat $ 56,00 — - $
Note: $5.00 for each additional T-Stat
NEW CUC" qy qN�j;
First 1300 Square Ft. $120,00 $
Each Additional 500 Square Ft, or Portion of $ 40,00 $�
Each Outbuilding or Detached Garage $ 700 "° $
Each Swimming Pool or Hot Tub $110.00 $
� Iratal
Owner as defined by ROW, 19.28.261, (1) Owner WRI occupy the structure for two years after this electrical permit is finalized. (2) Owner is required
to hire an electrical contractor if above said property is for sale, rent or lease, Permit expires sitter SIX months of last inspection.
After reading the above statement, I hereby cer►tfy that I am the owner of the above named property or a lic0sed electricd contn war. I am making
the electrical installation or alteration In compliance with the electrical laws, N.E.C., RCW. Chapter 19.28, WAG. Chapter 29646F 1. The City of Port
Angeles Mrrnioipal Code, and utility Specfircations and PAMC 14.05.050 regarding Electrical Permit Applications.
Signature of owner, electrical co ctor or electrical administrator: ❑ Cash C7 Chaos
` CredkCerd# &-t'A
01lD1r7�12
C
ELECTRICAL PERMIT
CITY OF PORT ANGELES
360 -417 -4735 .
Application Number , , , , .
14- 00001146
Date 9/26/14
Application pin number
463120
DITCH
Property Address , . .
124 JUNIPER LN
ASSESSOR PARCEL NUMBER:
06-30-15-3-2- 9060 -0000-
Application type description
ELECTRICAL ONLY
Subdivision Name . . , , . .
f
Property Use
FINAL
COMMENTS:
Property Zoning , , , . , . .
RS9 RESDNTL SINGLE FAMILY
Application valuation . . . .
0
Application desc
---
--- ------ -.._____
Gate ccx"trol power
Owner
Contractor
LESLIE JUDITH SPCTKCV TRUST
SIMPSON ELECTRIC
124 JUNIPER LANE
243036 W HWY 101
PORT ANGELES WA 98362
PORT ANGELES
WA 98363
(360) 452 -6316
(360) 457 -9270
Permit . . . . . . ELECTRICAL
ALTER RESIDENTIAL
.Additional desc 1 -4 CIRCUITS
Permit Fee 75.00
Plan Check Fee
.0.0
Issue Date 9/26/14
Valuation
0
Expiration Date 3/25/15
Qty Unit Charge Per
Extension
BASE
FEE
75,00
Fee summary Charged
Paid Credited
Due
Permit Fee Total 75.00
75,00 ,00
DO
Plan Check Total .00
.00 00
,00
Grand Total 75.D0
75.00 00
,00
REPORT SALES TAX
on your excise tax form
to the City of Port Angeles
(Location Code 0502)
INSPECTION TYPE
DATE:
RESULTS:
INSPECTOR:
DITCH
SERVICE
ROUGH -IN
f
FINAL
COMMENTS:
PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION
Signature of owner or Electrical Contractor Date:
GAIEXCHANGEIBUILD[NG
r
ti.
RECOVED
t� Op PORr.t
CITY OF PORT ANGELES PERMIT APPLICATION
Building Division /,Electrical Inspections FEB � c� 2 1,5 � —
321 .East Fifth Street -� P.O. BOX 11.50 /Port Angeles Washington, I" � �
Ph: (360) 417 -4'735 Fax: (360) 417 -4711. W ICAL �;j�
dNSPECTIONS
Date: " _ 3 1S' �0 1 & 2 Single Family Dwelling
Plan Review May 130 Re �, � ase Complete EIectrfcE�l Plan Review Information Sheet
J ntr Address:
Building Square Footage:
pescri tlo
p n of above
owner Info atlo
Name: r dCp
City; _L I k- State: r.tj,41 zlp:
Phome;-SQ— f„6„ Fex: _.
License #/ 1 F.xp,_
ttem
Service /Feeder 200 Amp,
Ser0celFeeder 204 -400 Amp,
ServlcelFeeder 401 -600 Amp
ServlcelFeoder 601 -1000 Amp.
Servlce/Feeder over 1000 Amp,
Branch Circuit W1 Service Feeder
Branch Circuit W10 Service Feeder
Each Additional Branch Circuit
Brameh.Cirsults 1 -4
ramp, Serulcel Feeder 200 Amp.
Temp. $ervlce /Feoder201.400Amp.
Temp, Service /Feeder 401 -600 Amp,
Temp. Service /Feeder 601.1000 Amp.
Portal to portal Hourly
Signal Circuit/ Llmited Energy -1 & 2 Family Dwelling
Manutaotured Home Connectlon
Renewable Electrical rnergy - 5KVA System or Less
Thermostat
Nate: $5.00 for each additional T-Stat
NE .W CO kqRVgLo-k ONLY:
First 1300 Square Ft
Each Additional 500 Square I=t. or Portion of
Each Outbullding or Detached Garage
Each Swimming Pool or Hot Tub
_unitunit Chara@
$120.00
$ 446.00
$ 205,00
$ 262.00
$ 373.00
5,00
$ 63.00
$. 5.00
$` .78 D0.
$ 93.00
$110,00
$149.00
$16$.00
$ 96.00
$ 64.00
$120.00
$ 402.00
56.00
Contractor information
Name, "),- n4--r C: L,l... -'
Malling Address:
C +IY' � Slate: i r 4- ZI
Phone; �- ,mod Fax: 7
License t`! ExP,ZW-P. 9 ,3 �'
r �S d>r+r�v�1 �c O•rsL.,
]l otal IQ Multnl n
hf, .,d b LUnit CharQef
7>' $
$
$1,20.00
$ 40.00
$
$ 74,00
$110.00
�
$ 5,4!:�IoTatal
Owner as defined by RCW,19,28.261: (1) Ownerwill occupy the structure forgo years after this electrical permit is flnalized. (2) G weer is required
to hire an electrical contractor if above said property is for sale, rent or lease, Permit expires after six months of last inspection.
After reading the above statement, I hereby certify that I am the owner of the above named property or a licensed electrical contras tor. I am making
the electrical installation or alteration in compliance with the electrical laws, N•E.C., RCW. Chapter 19,28, WAC. Chapter 296 -469, The City of Port
Angeles Municipal Code, and Utility Speeiflealions and PANIC 14.05.050 regarding Electrical Permit Applications,
signa r of owner, electrical col7tractor or electrical administrator: ❑ COsh ❑ Check
rlpl=1 1 +
a
ELECTRICAL PERMIT
CITY OF PORT ANGELES
360 -4.17 -4735
Application Number 15- 00000173 Date 2/23/15
Application pin number 984974
Property Address , , . . , . 124 JUNIPER LN
ASSESSOR PARCEL NUMBER; 06-30-15-3-2- 9060 -0000-
Applicataon type description ELECTRICAL ONLY
Subdivision Name
Property Use
Property zoning . , RS9 RESDNTL SINGLX VAMTLY
Application valuation . , , 0
----------------------------------------------------------------------------
Application desc
Bathroom remodel
----------------------------------------------------------------------- - - - --
Owner Contractor
- ----------------- -- - - -- ------------------ - - -- --
LESLIE JUDITH SPOTKOV TRUST SIMPSON ELECTRIC
124 JUNIPER LANE 243036 W HWY 101
PORT ANGELES WA 98362 PORT ANGELES WA 98363
(360) 452 -8316 (360) 457 -9270
Permit , . . . . . ELECTRICAL ALTER RESIDENTIAL
Additional desc 1 -4 CIRCUITS
Permit Fee 75.00 Plan Checic Fee 00
Issue Date 2/23/15 Valuation . . . . {�
Expiration Date 8/22/15
Qty Unit Charge Per Extension
. BASE FEE 75.00
Fee summary Charged Paid Credited Due
Permit Fee Total 75,00 75,00 .00 .00
Plan Check Total 00 00 OD 00
Grand Total '75.00 75.00 .00 ,00
REPORT SALES TAX
on your excise tax form
to the City of Port Angeles
(Location Code 0502)
INSPECTION TYPE
DATE:
RESULTS:
INSPECTOR:
DITCH
SERVICE
ROUGH -IN
FINAL
�
COMMENTS:
PERMIT WILL EXPM SIX (6) MONTHS FROM LAST INSPECTION
Signature of owner or Electrical Contractor X Date:
GAEXCHANGMBUILDING
1
d