HomeMy WebLinkAbout627 W 10th St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362 D _ J DJ
Application Number
pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
subdivision Name
Property Use
Property zoning
Application valuation
04-00001084 Date
.784480
627 W 10TH ST
06~30-00-0~2-9755-0000~
PUBLIC WORKS UTILITES
11/19/04
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Owner
Contractor
LISA & RYAN HAINSTOCK
627 W 10TH ST
PORT ANGELES WA 983627306
OWNER
Permit SANITARY SEWER HOOK UP
Additional desc
Permit Fee 35.00 Plan Check Fee .00
Issue Date 11/19/04 valuation 0
II Expiration Date 5/19/05
I
Qty unit Charge Per Extension
1. 00 35.0000 EA SAN SEW REPAIR 35.00
I
Fee summary Charged Paid credited Due
------~~~~------- ~~-------- ~~~------- -----~~~~~ -------~~~
Permit Pee Total 35.00 35.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 35.00 35.00 .00 .00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utililies, privale 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:\PLANNING\FORMS\1102.15 [11/14n003]
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application descr~ption
Subdivision Name
Property Use
Property zoning . . .
Application valuation
04-00001084 Date
.784480 _
627 W 10TH ST
06-30-00-0-2-9755-0000-
PUBLIC WORKS UTILITES
11/19/04
~
o
Owner
Contractor
LISA & RYAN HAINSTOCK
627 W 10TH ST
PORT ANGELES WA 983627306
OWNER
Permit SANITARY SEWER HOOK UP
Additional desc
Permit Fee 35.00 Plan Check Fee .00
Issue Date 11/19/04 valuation 0
Expiration Date 5/19/05
Qty Unit Charge Per Extension
1. 00 35.0000 EA SAN SEW REPAIR 35.00
Fee summary Charged Pa~d Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 35.00 35.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 35.00 35.00 .00 .00
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Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinances governing thiS type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
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Signature of Contractor or Authorized Agent
IL/I'?/DLJ
Date
Signature of Owner (if owner is builder)
T IPLANNING\FORMS\1102 15 [11/14/2003]
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