HomeMy WebLinkAbout1115 W 11th St - Engineering
PUBILIC WORKS & R/W PERMIT
L I Attached Notes
OWNER/APPLICANT
J GILBERTSON
1115 W 11TH ST
Port Angeles, W A 98362
000/604-7468
PROJECT INFO
Work is
Plans Required
Contractor' OWNER
Performance Bond Required
Proof of Insurance.
Work to Perform
Permit No
Work Order'
-~ -~PROPERTY LOCATION--
1115 11TH ST W
Lot: 1 7
Subdivision
Parcel No
Start Date
Amount:
Issued
5/13/2002
TPA
063000031780000
_L_.
Value Work.
I I
Finish Date
206/000-0000
$000
! I Install [2\J Sanitary Sewer
[><:J Repair LJ Storm Drain
[I Watermain D Underground Tele/Elec
PROJECT NOTES-
FEES ASSESSMENT---
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 Serv-
11 ) Other Water Service
12 )Water System Dev'
13 ) San Sewer SFR
14 ) San Sewer MFR
add unit 0
Receipt No
Inspection Fee
7423
$000
~J Misc
----- --.._- - -- "-- -----
$45 00
$000
$000
$000
$000
$230 00
$000
$000
$000
$000
$000
$000
$000
$000
15 ) Other San Sewer'
16) Sew Tap Wye/Man Tap
17 ) Sew Capl W 1M Removal
18 ) Alter Repair Sewer'
19 ) Storm Drain
20 ) Catch Basin per ea
21 ) Sewer System Dev'
22 ) Milwaukee Dr Sew Ass
23 ) R/W Use Perm
24 ) Admin Cost (0 RA)
25 ) 0 RA.
26 ) Misc'
TOTAL FEE
Amount Paid
Balance Due
1271
o
Block. 317
L'\; Long Legal
$000
I I
$000
$000
$000
$35 00
$000
$000
$000
$000
$000
$000
$000
$000
$310 00
$310 00
$0.00
.....
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . . . .
REQUEST
6-- J3--o~
Date
Time
Received by /
,F
///5~/1!h
0nh Yl 6, I b-er1so Y)
(PhOne,eD
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
l ~oundatio~V Plumbing Final
INSPECTION NOTES ~-
Inspected Date ~/ 3-02-- Time It- () i\
Remarks Cf!' W\ e /.e...,..-..e...
Phone No
/o~/ ~
7-~707
J;;l1-J /
/
Permit No
Sewer Excav Other
By ,--VUi-
RESTORATION REQUIRED
YES
;(
.
NO
L
W
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SURFACE RESTORATION (5)( r)
SURFACE TYPE 0 Unimproved 0 Gravel IXl Asphalt 0 PCC
o Other
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
'2
(DATE)