HomeMy WebLinkAbout2158 W 4th St - Engineering
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CITY OF.PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
PUBLIC WORKS CONSTRUCTION Issued: 2/13/98 LC Permit No: 806
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT-----------------------_PROPERTY LOCATION---------------_________
2158 4TH ST W
Lot: 23
, 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:
Performance Bond Required: N/A
Proof Insurance:
Work to. Perform:
Amount:
/ /
/ /
$0.00
Watermain Storm Drain ~
Sanitary Sewer ~ndergrOUnd TelelElc~)
lSC
NOTES-------------______________________________________________________
PROJECT
PROJECT FEES ASSESSMENT------------_____________________________________________
R/W Excav: *
Sidewalk:
Curb/Gutter:
Driveway:
Dwy Culvert:
Street Cut:
Other R/W:
Fire Hydrant:
Res Water Serv:
5/8"
3/4"
I"
Comm Water Serv:
I"
1 1/2"
2"
Oth Water Serv:
Water Sys Dev:
Receipt No: 3809
Inspection Fee:
R/W
SANITARY
$40.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
San Sewer SFR:
San Sewer MFR:
Add Unit: 0
Other San Sewer:
Sew Tap Wye/Man Tap:
Sew Cap/ W/M Removal:
Alter/Repair Sewer:
Storm Drain Tap:
Catch Basin per ea:
Sewer System Dev:
Milwaukee Dr. Sew Assess:
R/W Use Perm:
D.R.A. :
Admin Costs (D.R.A):
Misc:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
------------------------------
------------------------------
Si nature of Contractor or Authorized A ent
Si nature of Owner if owner is builder
$0.00
TOTAL FEE:
AMT PAID:
$40.00
$40.00
BAL DUE:
-----------------------
$0.00
$0.00
WATER
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.
Date
Date
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