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HomeMy WebLinkAbout3507 McDougal St - Buildingr AHERA Certified Inspector Certification his approved permit must be available at the job site Rev 07/11/02 Notification of Demolition Permit It is unlawful for any person to cause or allow the demolition (or major renovation) of any structure unless all asbestos containing materials have been removed from the area to be demolished. Work shall not commence on an asbestos project or demolition unless the owner or operator has obtained written approval from ORCAA. A written application for a demolition shall include a certification that there is no known asbestos containing material remaining in the area of the structure. n Project Site Address. 1Y7 �w C_- County e,?-4 City Po sZ tJ -;c6z- State: JAE zip qe -g_. Starting Date. 'l�l 1�� Completion Date 3 I3=: /0e. here is a 10 working day advance notification period from receipt of permit application) Property Owner Q TRUS i Telephone: ZO6 S4C 6l7! Fax. 26 4 Mailing Address. 3 7/ 6 'S Z:S4 Cit KEo J1 State VJA Zip' 98 Demolition Contractor K) i Eiu r' State License (44 .l t u E it c at l@ F Mailing Address. 7/4 YLir G T City PA State W A Zip Contact Person. Q,� 6 co t2 F:0+v Telephone: 340 4(O 36 I Fax. YES NO Demolition by Wrecking or Dismantling ($25 00 fee) check Training Fire. Demolition? (If yes, attach fire department request for training fire) Renovation, Alteration, Remodeling, Maintenance, or other Construction? Asbestos found or suspected* An ORCAA `Notice of Intent to Remove or Encapsulate Asbestos' form and appropriate fee must be submitted prior to any asbestos removal work. Asbestos removal projects involving demolition must be preformed by a Certified Asbestos Contractor and all friable or potentially friable asbestos must be removed before any demolition begins. Refer to ORCAA Regulation 1 Article 14 for additional requirements that may apply Asbestos Survey Completed by Enclose $25 Processing Fee 2940 B Limited Lane NW Olympia, Washington 98502 360 -586 -1044 800 -422 5623 fax 360 -491 -6308 homepage: www.orcaa.org email: info(cuorcaa.orq Certification of the Asbestos Survey must accompany this form r• t 1+ r pORTµ Signaturq'of 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 WALLACE E ADAMS FAMILY TRUST 3507 MCDOUGAL ST PORT ANGELES Permit Additional desc Permit pin number Permit Fee Issue Date Expiration Date Other Fees Fee summary Permit Fee Total Plan Check Total Other Fee Total Grand Total WA 983626743 73213 207 75 3/22/06 9/18/06 Charged 207 75 83 10 4 50 295 35 —ZZ- c T•\Policies \1102_15 building permit inspection record05.wpd 1/4/2005] CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 06 00000213 813613 3507 MCDOUGAL ST 06 30 14 3 2 0400 0000 ADAMS FAMILY TRUST RES REMODEL RS9 RESDNTL SINGLE FAMILY 10000 BUILDING PERMIT RESIDENTIAL Qty Unit Charge Per BASE FEE 8 00 14 0000 THOU BL -2001 25K (14 PER K) Special Notes and Comments The Fire Department has reviewed the project application and has no comments 03/09/2006 04 12 PM SROBERDS No land use issues noted Electrical load calculations and elctrical permits are required Clearance from bldg to service wire must be maintained Meter must be accessible to meter reader 03/06/2006 03 17 PM GMCLAIN Public Works Utility Engineering has no requirements for this plan review Paid Credited Due 207 75 83 10 4 50 295 35 Contractor KANDU ENTERPRISE 714 WEST 6TH PORT ANGELES (360) 565 8383 Plan Check Fee Valuation 00 00 00 00 Date 3/22/06 WA 98363 83 10 10 000 Extension 95 75 112 00 STATE SURCHARGE 4 50 00 00 00 00 p< (c 0\viAu 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 rt' that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordina ov rning this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to ity to violate or cancel the provisions of any state or local law regulating construction or the performance of constructii r gahorized Agent Date Signature of Owner (if owner is builder) Date 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 417 -4735 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/4/2b05] 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 YES I NO I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I (1e17AN Ub FINAL SEPA. ESA. SHORELINE: ELECTRICAL LIGHT DEPT CONSTRUCTION R.W PW ENGINEERING I FIRE DEPT I PLANNING DEPT I BUILDING COMMENTS FINAL DATE ACCEPTED BY. a DATE ACCEPTED BY., FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL DATE ACCEPTED YES I NO 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 WALLACE E ADAMS FAMILY TRUST 3507 MCDOUGAL ST PORT ANGELES Permit Additional desc Permit pin number Permit Fee Issue Date Expiration Date Qty Unit Charge Per Other Fees Fee summary null and void if work or constru for a period of 180 days a inspection. I hereby laws and ordi presume construc CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 WA 983626743 DEMOLITION 72199 50 00 3/06/06 9/02/06 Charged Permit Fee Total 50 00 Plan Check Total 00 Other Fee Total 4 50 Grand Total 54 50 T•\Policies \1102_15 building permit inspection record05.wpd [1/4/2005] 06 00000213 813613 3507 MCDOUGAL ST 06 30 14 3 2 0400 0000 ADAMS FAMILY TRUST DEMOLITION RS9 RESDNTL SINGLE FAMILY 10000 Contractor KANDU ENTERPRISE 714 WEST 6TH PORT ANGELES (360) 565 8383 Plan Check Fee Valuation BASE FEE STATE SURCHARGE Paid Credited 50 00 00 4 50 54 50 00 00 00 00 Date 3/06/06 WA 98363 00 00 00 00 00 0 Extension 50 00 4 50 Due Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes n authorized is not commenced within 180 days, if construction or work is suspended or abandoned ork as commenced, or if required inspections have not been requested within 180 days from the last I have read and examined this application and know the same to be true and correct. All provisions of this type of work will be complied with whether specified herein or not. The granting of a permit does not violate or cancel the provisions of any state or local law regulating construction or the performance of 7 Signatur of Co�r(ctor or A)1t l�or' a gent 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 FOUR 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 Ws PARKING/LIGHTING LANDSCAPING RESIDENTIAL YES NO I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I FINAL FINAL SEPA. ESA. SHORELINE: DATE ACCEPTED BY DATE ACCEPTED BY. FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL DATE ACCEPTED YES I NO ELECTRICAL LIGHT DEPT 417 -4735 ELECTRICAL LIGHT DEPT CONSTRUCTION R.W PW/ CONSTRUCTION R.W ENGINEERING 417 -4807 PW ENGINEERING FIRE 417 -4613 I I I I FIRE DEPT I I I PLANNING DEPT 417 -4750 I I A I I PLANNING DEPT I I I y BUILDING 417 -4815 I k)(r}i r e%4 V q^-i b (n I BUILDING I I I (•\Policies \1102_15 building permit inspection record05.wpd [1/4/2005] March 3, 2006 Kandu Enterpnse Greg Bondy 714 W 6th Port Angeles, WA 98362 RE Port Angeles Landfill Waste Disposal Application, WDA 06 -09, Carport Demo 3507 McDougal Ave We have received your application for disposal ofbuilding demolition debns from the referenced site. Based on the information submitted the debns 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 matenals and quantities listed in the application. Matenals not listed or in excess of the quantities noted may require separate applications and approval. Please call if you have questions. Very truly yours, t A 4.e. Gary W Kenworthy, P.E. City Engineer Deputy Director of Engineenng Services GWK:tf W A S H I N G T O N U S A Public Works Utilities Department Encl. WDA 06 -09 Copy Ken Login) PORTANGE LES N:\PWKS\ENGINEER \WDAPPLIC\06 -09 WPD FILE: Landfill Solid Waste Disposal Applications Phone 360- 417 -4805 Fax: 360 417 -4542 Website www.cityofpa.us Email publicworks@cityofpa us 321 East Fifth Street P 0 Box 1150 Port Angeles, WA 98362 -0217 Applicant or Agent: C�hZS.C, Owner \Ain 4 M L,. F 4.1■1(.J Tel) r Phone Address 3S(:) Plir Newel 1 City Doti; A1JC�ELTi Architect/Engineer Contractor V ANtSv E__0:1ZZAZIST State License eAkliNU F toot Address )1 (T City ApOGF2LT1 S PROJECT ADDRESS F" %o IAA C NO0 AL_ LEGAL DESCRIPTION Lot: Block. Subdivision CLALLAM COUNTY PARCEL NUMBER Credit Card Holder Name Billing Address. Credit Card Type VISA TYKE OF WORK mr Residential New Constr Multi family Addition Commercial Remodel —Repair Sign Other BRIEF DESCRIPTION OF THE PROJECT Total lot coverage I(7 PLANNING USE ONLY 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 BUILDING PERMIT APPLICATION MC i B IZ Ai 72_ ESA/Wetland(s) Yes No SEPA Checklist required? Yes No Other I hereby certify that I have read and examined this application and apply for this permit and understand that it is my responsibility to must obtain such permits prior to work. Applicant: Phone 46d 1" Phone 06 1 -A7 061 CxSf`� O®t..JLi Cot. Lx 01 FOR OFFICIAL USE ONLY ate Rec. 2-0M0 2 //per it a Ll ate Approved:3 Date Issued: a Zip (3 e3(0Z Phone 440 56r) Zip 98363 ZONING I 5 C) SIZE /VALUATION Re -roof Stove SF /SF Move Garage SF /SF Demolition Deck SF /SF TOTAL VALUATION LO "0)l cal_ 1 R CZT '1 J'JJ Lr x, f izia i COMMERCIAL /RESIDENTIAL Occupancy Group Occupant Load Construction Type No of Stories. 1 Lot Size I 4O6 Existing Sq Ft. 1l co Proposed Sq Ft. I tOO TOTAL Sq Ft. d 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 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 c. .extended more than once. me to be true and correct. I am authorized to hat permits are required not the City's, and that I Date: -Z Z7--.C) To: City of Port Angeles, City Engineer 321 E Fifth Street PO Box 1150 Port Angeles, Washington 98362 NOTE. 1 Generator Information: Company Name. -Mailing Address: Contact: Phone. Project Name: Project Location: Consulting Firm: Contact: Phone: Contractor Name: Contact: Phone. Laboratory* Contact: Phone PORT ANGELES LANDFILL WASTE DISPOSAL APPLICATION Phone: (360) 417 -4803 FAX. (360) 417 -4709 All questions must be answered for waste to be approved. 2. Other Contacts (if applicable): VAis&O 1Z Pmt )14 l f S Pb 2T GiL .CS W 4636 46d �61� 350 vt/l OA- W DA O (v- C-.)`1 3. 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 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 equal 100% 5 Waste Material Contaminants. Gasoline Solvents Unused Motor Oil Other 'R ccsF i►J Unknown (check all that apply) Agency Contact: UST Removal Other Source: Foundry Slag Dredge Sediments Debris Other (list) Metals Heating Oil Used Motor Oil/Waste Oil Other Petroleum Product NOTE: Supply any MSDS information with application, if available. Diesel PCBs 6. Estimated Quantity of Waste for Disposal: Cubic yards 3 Tons (estimate both) Drums Tons (estimate both) Other NOTE. Estimated quantity for disposal must be within 20% of the quantity actually disposed. (10% for projects over 7 500 tons or 5 000 cubic yards.) 7 Frequency of Disposal: One time 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 M A-\ t n 3O O 7 I NOTE 1 0 -25 25 100 101 500 501 1000 1001 2000 >2000 Monthly cubic yards cubic yards cubic yards cubic yards cubic yards cubic yards Annual Other L (F> Unless prior approval has been granted by Port Angeles, the following sampling frequency will be used: 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. 9 Waste Analysis: The "Dangerous Waste Regulations" (WAC 173 -303) shall be utilized to determine the appropriate analytical requirements for waste characterization. Ecology Publication #91 -30 (Revised April 1994) "Guidance for Remediation of Petroleum Contaminated Soils" shall also be used to characterize petroleum contaminated soils from UST releases Submit all laboratory analytical results, QA/QC data, and Chain of Custody sheets along with this application. (NOTE: The laboratory must be accredited by the Washington State Department of Ecology a) List all analytical test methods used: b) Provide a narrative as to why the above analytical methods were selected: E c► o N A M "Tc,�r 1 Iv 6 \AMC t73 75© 07 1 NOTE. Additional sheets attached: 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 Calculated Hazard Index 11 Dangerous Waste Affidavit: Based on a review of the analytical test results site history and the applicable regulations this waste is classified as. (check one) Neither Dangerous Waste (DW) nor Extremely Hazardous Waste (EHW) Dangerous Waste (DW) and Waste Code Extremely Hazardous Waste (EHW) and Waste Code Class 3 Class 4 12. Certification: We, THE UNDERSIGNED this application is true to the best of our knowledge. All information provide,'s -ct d e enclosed analytical results represent the proposed waste material to the Waste Generatbr Signatur 0 72x2 f' Printed Name 4A I INsj r n 2�2 is Company -Z7 O-G Date dhoom N:'POLICY P%1000 SW11009 01.WPD •.yn r::..m:..::. �:::::::v::::: S�+ f}�E •i L CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 Application Number 05 00000722 Date 8/08/05 Application pin number 933342 Property Address 3507 MCDOUGAL ST ASSESSOR PARCEL NUMBER 06 -30 14 3 2 0400 0000 Application type description RE -ROOF Subdivision Name Property Use Property Zoning RS9 RESDNTL SINGLE FAMILY Application valuation 1000 Owner Contractor WALLACE E ADAMS FAMILY TRUST OWNER 3507 MCDOUGAL ST PORT ANGELES WA 983626743 Permit BUILDING P ERMIT NO PR FE E Additional desc REPAIR ROOF Permit pin number 56846 Permit Fee 62 25 Plan Check Fee 00 Issue Date 8/08/05 Valuation 1000 Expiration Date 2/04/06 Qty Unit Charge Per Extension BASE FEE 47 00 5 00 3 0500 HND BL -501 2K (3 05 PER C) 15 25 Ot her Fees STATE SURCHARGE 4 50 Fee summary Charged Paid Credited Due Permit Fee Total 62 25 62 25 00 00 Plan Check Total 00 00 00 00 Other Fee Total 4 50 4 50 00 00 Grand Total 66 75 66 75 00 00 T \Policies\ 1102_15 building permit inspection record05.wpd [1/4/2005] 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 Of owner is builder) Date 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 I 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 CALL 417 -4815 FOR ]3UILDING 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 PLANNING DEPT SEPARATE PERMIT #'s PARKING /LIGHTING LANDSCAPING RESIDENTIAL ELECTRICAL LIGHT DEPT BUILDING PERMIT INSPECTION RECORD YES NO SEPA. ESA. SHORELINE. FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL DATE ACCEPTED YES I NO I 417 -4 ELECTRICAL LIGHT DEPT CONSTRUCTION R.W PW/ CONSTRUCTION R.W ENGINEERING 417-4807 PW ENGINEERING FIRE 417-4653 I I I I FIRE DEPT PLANNING DEPT 417 -4750 I e I I I PLANNING DEPT I I I BUILDING 417 -4315 I f ��(d r 11 11 I BUILDING I I I T- \Policies \1102 15 building permit inspection record05 wpd [1/4/20115] ?C R7,ir or 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 PERMITS (360) 417 -4815 FAX(360)417 -4711 Applicant or Agent: Phone Owner /L /rr g, Aei vr, 5 nn Address 5 7 /tl el�c�t( I s t: City A- fe s Zip v U Architect/Engineer Contractor State License Exp Address City PROJECT ADDRESS 71-1c.7 7}m ri(t .Sf LEGAL DESCRIPTION Lot: Block: Subdivision. Phone: 5 ,3. -�1' Phone: CLALLAM COUNTY PARCEL NUMBER. (9 (,3 0 M a f3/) f) Phone Zip ZONING FOR OFFIC US)r ONLY Date Rec. 00 ei �r Pen 1 Date Approved 1*/ Date Issued. 9 Credit Card Holder Name: Billing Address: City Credit Card Type VISA MC Exp. Date: TYPE OF WORK. SIZE/VALUATION Residential New Constr Re -roof Stove d (7 SF /SF Multi- family Addition Move Garage SF /SF Commercial Remodel Demolition Deck SF /SF Repair Sign Other TOTAL VALUATION r, Ot 2 BRIEF DESCRIPTION OF THE PROJECT P e (J__..... d,_P n eD 1..d A C V, PLANNING USE ONLY COMMERCIAL/RESIDENTIAL. Occupancy Group. No of Stories: Lot Size: Existing Sq Ft. Total lot coverage ESA/Wetland(s) Yes No SEPA Checklist required? Yes No Other Occupant Load. Construction Type: Proposed Sq. Ft. TOTAL Sq Ft. 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 maybe 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 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. I am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required ,not the City's, and that I must obtain such permits prior to work. TAPolicies\BL I102_13.wpd Applicant:( 1� /��°.����1� Date. rf S