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PUBLIC WORKS CONSTRUCTION Issued 1/21/99 TF Permit No' 917
& R/W PERMIT Cond Work Order 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
STEVE GI SH : 408 5TH ST E
408 E 5TH 519 S PEABODY # 25 : Lot 8
PORT ANGELES,WA98125 : Block 198 Long Legal . t\.
360/457-7391 : Sub TPA ~
PROJECT INFO-------------------------------------------------------------------~
Work is N/A traveled road Value Work $0 OO~
Plans Required N/A Start / /
Contractor OWNER Finish / /
N/A
\\1
0\
I~
Performance Bond Required
Proof Insurance
* Storm Drain
Underground Tele/Ele
Misc
NOTES------------------------------------------------------------------_
Work to Perform
PROJECT
Amount
$0 00
INSTALL
Watermain
Sanitary Sewer
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"
1 "
Comm Water Serv
1"
1 1/2"
2"
Oth Water Serv
Water Sys Dev
Receipt No
InspectIon Fee
4439
$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
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
o
$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
TOTAL FEE
AMT PAID
$40 00
$40 00
$0 00
BAL DUE
$0 00
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . .. . INSPECTION REPORT. .
REQUEST
Date
q I~~_ Time
Received by
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
Sewer Foundation Framing Chimney Plumbing Final
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-1 D S -E c:s-t;b
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~
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Phone No
Permit No
Sewer Excav Other
INSPECTION NOTES
Inspected Date q 1J1)/<;':"~1
Remarks . ..fl' Jr t (I ~.
,.;1 ,_~.('" I, r.A i . 't ft' .../
· .. ,. t.. ,
Time
tI--.-o. il t,.
By
,
~!. I ~'
,>:, .
l. ' ( ~;/
1',.-
.
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RESTORATION REQUIRED
YES
NO
SURFACE RESTORATION
SURFACE TYPE D Unimproved 0 Gravel D Asphalt D PCC
D Other
D Repaired by City
[] Repaired by Permittee
[] No Damage Found
Work Order #
o COMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)