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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
PUBILIC WORKS & R/W PERMIT
o Attached Notes
OWNER/APPLICANT
CHARLES & LINDA NEMISH
115 WILLIAMS PLACE
SEQUIM, WA 98382
000/605-2187
PROJECT INFO
Work is
Plans Required Start Date
Contractor' RAYMOND CONSTRUCTION
Performance Bond Required Amount:
Proof of Insurance
Work to Perform
Issued
7/06/2000
Permit No
Work Order'
1070
o
PROPERTY LOCATION
1317 8TH ST E
Lot: FS
Subdivision
Parcel No
Block.
CRESTHAVEN
063011550420000
D Long Legal
Value Work
$000
/ /
Finish Date
360/457-3119
/ /
$000
~ Install
D Repair
D Watermain
~ Sanitary Sewer
D Storm Drain
D Underground Tele/Elec
~ Misc
dwy
PROJECT NOTES
san sewer in utility easement North side of lot (private line)
water line North side of 8th Street dropin water meter
FEES ASSESSMENT-
1 ) R/W Excav' $000 15 ) Other San Sewer' $000
2.) Sidewalk $000 16) Sew Tap Wye/Man Tap $000
3 ) Curb/Gutter' $000 17 ) Sew Cap/ W /M Removal $000
4 ) Driveway' $145 00 18 ) Alter Repair Sewer' $000
5 ) Dwy Culvert: $000 19 ) Storm Drain $000
6 ) Street Cut: $000 20 ) Catch Basin per ea $000
7 ) Other R/W $000 21 ) Sewer System Dev' $745 00
8 ) Fire Hydrant: $000 22.) Milwaukee Dr Sew Ass $000
9) Res Water Servo 5/8" $150 00 23 ) R/W Use Perm $000
10) Comm Water Servo $000 24 ) Admin Cost (0 RA) $000
11 ) Other Water Service $000 25 ) 0 RA. $000
12.)Water System Dev' $1,02500 26) Misc $000
13 ) San Sewer SFR $95 00 TOTAL FEE $2,160.00
14) San Sewer MFR $000
add unit 0 Amount Paid $2,16000
Receipt No 6364
Inspection Fee $000 Balance Due $0.00
RW SANITARY 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.
Sianature of Contractor or Authorized Aaent
Date
Date
Sianature of Owner (if owner is builder)
.....
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
.....
/
REQUEST
Date
Time
Received by
(phone, person)
Location of Work to be inspected
Name of person requesting inspection oF' yo e s e t11 ~ Il yt <i (}.fJ h"; +
Address of person requesting inspection Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Fina~~~ Other
---I'
J3/7
-.I ,--...
i07D
INSPECTION NOTES
Inspected Date
Remarks
"\ '"\
Time
/
By
RESTORATION REQUIRED
YES
NO
, ,
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
o Repaired by City
[] Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER,
INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCA nON
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE ACCEPTED COMMENTS
I YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE
ELECTRICAL (LIGlIT DEPT)
ROUGH-IN I I
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
WATERLINE
BACK FLOW / WATER
AIR SEAL
WALLS
CEILING I I
FRAMING
JOISTS / GIRDERS
SHEAR WALL
WALLS / ROOF / CEILING
DRYWALL
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILING I I
MECHANICAL
CHIMNEY
WooDSTOVE / PELLET
DUCTS
PW UTILITIES / SITE WORK (Engineering Division)
WATERLINE/METER
SEWER CONNECTION
SANITARY
STORM
SITE DRAINAGE / EROSION CONTROL
PARKING
OTIiER
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELEClRlCAL LIGlIT DEPT 417-4746 ELEClRlCAL
LIGlIT DEPT
CONSTRUCTIONR.W /PWI CONSTRUCTION - R.W
ENGINEERING 417-4807 PW / ENGINEERING
FIRE (MUL TI-FAM~ ONLY) 417-4654 FIRE DEPT
BUILDING 417-4815 BUILDING
GENERAL COMMENTS:
PW.II02.15 [4196J