HomeMy WebLinkAbout2110 W 4th St - Engineering
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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DNISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
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PUBLIC WORKS CONSTRUCTION Issued: 2/13/98 LC Permit No: 805
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
2110 4TH ST W
Lot: 19
, Block: Long Legal:.
000/000-0000 Sub: EDGECLIFF
PROJECT INFO--------------------------------------------------------------------
Work is N/A traveled road Value Work: $0.00
Plans Required: N/A
Contractor: DIVERSIFIED NORTHWEST
Start:
Finish:
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$O.O~
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Performance Bond Required: N/A
Proof Insurance:
Amount:
Work to Perform:
watermain ~~~ Drain ~
Sanitary Sewe u~derground Tele/Ele
NOTES-------------------------------------------------------------------
PROJECT
PROJECT FEES ASSESSMENT---------------------------------------------------------
R/W Excav: * $40.00 San Sewer SFR: $0.00
Sidewalk: $0.00 San Sewer MFR: $0.00
Curb/Gutter: $0.00 Add Unit: 0
Driveway: $0.00 Other San Sewer: $0.00
Dwy Culvert: $0.00 Sew Tap Wye/Man Tap: $0.00
Street Cut: $0.00 Sew Cap/ W/M Removal: $0.00
Other R/W: $0.00 Alter/Repair Sewer: $0.00
Fire Hydrant: $0.00 Storm Drain Tap: $0.00
Res Water Serv: $0.00 Catch Basin per ea: $0.00
5/8" Sewer System Dev: $0.00
3/4" Milwaukee Dr. Sew Aisess: $0.00
1" R/W Use Perm: $0.00
Corom Water Serv: $0.00 D.R.A.: $0.00
1" Admin Costs (D.R.A): $0.00
1 1/2" Misc: $0.00
2" ==============================
Oth Water Serv: $0.00
Water Sys Dev: $0.00
TOTAL FEE:
AMT PAID:
$40.00
$40.00
Receipt No: 3808
Inspection Fee:
SANIT ARY
$0.00
WATER
BAL DUE:
$0.00
RJW
DWY
STORM
DRA
OTHER
Separate Permits are required for electrical work, 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.
i nature of Contractor or Authorized A ent
Date
Si nature of Owner if owner is builder
Date