HomeMy WebLinkAbout1233 W 5th St - Engineering
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PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
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PUBLIC WORKS CONSTRUCTION Issued: 9/05/96 LC Permit No: 526
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
G. HALKETT 1233 5TH ST W
1233 W.5TH ST Lot: 9
Port Angeles,WA98362 Block: 115 Long Legal:
360/457-4840 Sub: TPA
PROJECT INFO----------------------------------------____________________________
Work is N/A traveled road Value Work: $0.00
Plans Required: N/A
Contractor: OWNER
Start:
Finish:
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$O.OO~
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Sanitary Sewer Underground Tele/Ele ~
PROJECT NOTES------------------------------______~~~:___________________________~
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PRO~CT~~S~-~-~--------------------------------------_____
R/W Excav: * ~-u:> San Sewer SFR: $0.00
Sidewalk: ~ San Sewer MFR: $0.00
Curb/Gutter: $0.00 Add Unit: 0
Driveway: $0.00 Other San Sewer: $0.00
Dwy Culvert: ~n t Sew Tap Wye/Man Tap: $0.00
Street Cut: c~~t_;" , Sew Cap/ W/M Removal: $0.00
Other R/W: $0.00 J~'lJ~ 0~ Alter/Repair Sewer: $0.00
Fire Hydrant: $0.00 I -;- 7~ Storm Drain Tap: $0.00
Res Water Serv: $0. 00 _~? / J Catch Basin per ea: $0.00
5/8" Sewer System Dev: $0.00
3/4" Milwaukee Dr. Sew Assess: $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
Performance Bond Required: N/A
Proof Insurance:
Amount:
Work to Perform:
Watermain
Receipt No:
Inspection Fee:
TOTAL FEE:
AMT PAID:
$40.00
$40.00 __;r...
-----------------------
$0.00
BAL DUE:
$0.00
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 giye authority to violate or cancel the
provisions of any state or local law regulating construction or the performan~e/.9f-6ol"Jstruction. //". // .-- /
l ~, / j///- : ALL. r' -- /1/
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Si nature of Contractor or Authorized A ent Date i nature of Owner if owner is builder Date
~
Date
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . .
/ c-!:?;,ulh(/Time
Received by
(phone, person)
REQUEST
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
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Phone No
Permit No
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Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
INSPECTION NOTES;- /
Inspected Date / [/ f ~')4, tile? Time
Remarks
By
<11{~ :./~'<s-'__
RESTORATION REQUIRED ..
YES Y NO
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
o Repaired by Permittee
o No Damage Found
)f1AsPhalt 0 PCC
Work Order #
~ COMPLETE
o INCOMPLETE
o Other
(Continue on reverse side if necessary)
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STREET SUPERINTENDENT
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