HomeMy WebLinkAbout1635 W 5th St - Engineering
PUBILlC WORKS & R/W PERMIT
[J Attached Notes
OWNER/APPLICANT _--=-______m..___
C Crowder
1635 W 5th St
Port Angeles, W A 98363
000/604-7340
PROJECT INFO
Work is
Plans Required
Contractor. OWNER
Performance Bond Required
Proof of Insurance
Work to Perform
Start Date
Amount:
~ Install
D Repair
Watermain
PROJECT NOTES
FEES ASSESSMEN"F
1 ) R/W Excav.
2 ) Sidewalk.
3 ) Curb/Gutter.
4) Driveway.
5 ) Dwy Culvert:
6 ) Street Cut:
7 ) Other R/W
8 ) Fire Hydrant:
9) Res Water Servo
10 ) Comm Water Servo
11 ) Other Water Service
12 )Water System Dev.
13 ) San Sewer SFR
14) San Sewer MFR
add unit
--_...~
Receipt No
Inspection Fee
7412
$000
$45 00
$000
$000
$000
$000
$000
$000
$000
$000
$000
$000
$000
$000
$000
o
Issued
6/24/2002
1290
o
Permit No
Work Order.
..- PROPERTY LOCATION
1635 5TH ST W
Lot:
Subdivision
Parcel No
Block. 129
TPA
D Long Legal
Value Work.
$000
I I
Finish Date.
2061000-0000
I I
$000
LJ Sanitary Sewer
D Storm Drain
Underground Tele/Elec
C2:J Misc
SIDEWALK I DWY
15 ) Other San Sewer. $0 00
16) Sew Tap Wye/Man Tap $000
17 ) Sew Capl W 1M Removal $0 00
18 ) Alter Repair Sewer. $0 00
19 ) Storm Drain $0 00
20 ) Catch Basin per ea $0 00
21 ) Sewer System Dev. $000
22 ) Milwaukee Dr Sew Ass. $0 00
23 ) R/W Use Perm $0 00
24) Admin Cost (D RA) $000
25) 0 RA. $000
26 ) Misc: $0 00
TOTAL FEE.
$0.00
Amount Paid
$45 00
Balance Due
$0.00
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
REQUEST' I
Date S/ J {; I 0 -;:2-- Time Received by
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
Jt~4~ -IJJ
Phone No LjLP/- 32ZD
Permit No J-z., &f-D.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
,
S~~, ~#J~
INSPECTION NOTES )
Inspected Date f 1l;/07....- Time Z. ~ By f:rzlC-- WA-U2.A-TI+
Remarks <~_. '-,r":: -, L'< ,. , /, C '" ' ~,. - c.' ^ '. 0 J..-
;O,'!--_ .oIIr, 1"""-___ ~ -;--l'.......rAl
~
RESTORATION REQUIRED
, YES
NO
;"';7-> ! ~
~l
t
)
,
1-.1 P,,,.' L...' (;J
t._ ~...,
r
t
.....
1
j \f..t;, u.1 I
SURFACE RESTORATION:
SURFACE TYPE D Unimproved D Gravel D Asphalt D PCC
D Other
D Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
';c.r:..,. (.! It",l P .#/
STREET SUPERINTENDENT
,
/j"ty oz...
(DATE)