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Home My WebLink About1326 W 15th St - Engineering 0........'....... . . .: .," ,0 ~.-~...-..,.."......,............~ CITY OF PORT ANGELES PUBLIC WORKS DEPARTMENT --- PERMIT NUMBER 41 1 - t". ""r t~; '1- " r~'3i' 'r t.- Vay Permit :i"'1: +- -;~.~. t 1 t i C'l J .! Ll , ~ ",.;"".:.:...,;._:,:.",.>:,<:>.,&t.,;:;;.&M~;'\f~~.;:;\>~,,:.,,-<-_., .. " ,.., Electrical Permits /Inspections Hot Tap (watermain) F H. Install/ Meter W/M Installation Water System Developement Charge .<-., Sanitary Sewer Permit Sanitary Sewer Tap/Cap or MH Tap Sewer System Development Charge ULlD 215/ Equivalent Service Connection Fee ACCOUNT NUMBER 001 2291000 001 2392000 60032290014 600.34220015 600 34220016 711 32210017 71132210018 711 32210019 71132210020 711 32210021 711 32210033 711 32240011 711 34150000 711 34320000 711 34320010 711 34583000 711 34895000 DOLLAR AMOUNT FILL-IN COMPLETELY - TOTAL EACH FUND AND GRAND TOTAL /J t(.,,(./"lbL-Z '- 13 a.U'?4;2.-/o /Y2t/J fA) /5'f!! G:\GrO\4lIAccl\FormslRfN.Rec\Put>-Wks Last R....sed Dec. 1999 ACCOUNT PERMIT ACCOUNT DOLLAR NAME NUMBER NUMBER AMOUNT Surcharge ($4 50) 001 2291 000 D R.A. Fees Plus Interest 001 2392000 Burning Permit Fee 600 32290014 Fire Inspect/Permit Fee 600.3422001 5 Fire Sprinkler Plan Review Fee 600 34220016 Construction 71 1 3221001 7 Plumbing 71 1 3221 0018 Mechanical 71 1 3221001 9 Sign 71 1 3221 0020 Clear/Grade Permit 71 1 32210021 House Moving 71 1 3221 0033 Sidewalk/Driveway/Curb PermiURight of Way Permit 71 1 3224001 1 Publications 71 1 341 50000 Blueprints- Aerial 71 1 34320000 Administration Cost (5%) 71 1 3432001 0 Plan Check Fee 71 1 34583000 Engineering Service Fees 71 1 34895000 ~~~1~it~%t*'!}ilt~~t.m:rA~:~I;Nel!~~1f(JNP}{~;$];11k1lfh~il~l:;')@lrtllFf ~ StreeU Alley Restoration 752.3221 0032 Storm Drain/ Tap 752.3449001 0 SIW Co-Op 752.36990000 ~~~fftl111~l:t'Mm~f~m~lfIJlt~i~"$,]~.I;I;J?:f.uND?j;'nW;i;{i:D: ':;;:,~;':. ,1:~:: i{~:;''':~-~ ::, ;~<. 'F!r'."':rQl'~.~\'Jt';; ::!&ilf:i1JtQ~~1I1i1.99g18 ,.~ ""''''', </~:,},~ ";"""";"', ,c",.,',,- Electrical Permits / Inspections 91 1 3221 0028 1ti'\'lt111tl~ll1ifft4ni~t~it9TAL:"CI~R!liPfVISIO~~j1iinj1?HFw)1i"iM"?Y".," :;lJH[g71'~tfftJf~Wlni f:#il'J)j~Y~1$1i~1;1:gpg?1~~); P B I.A. 650. 231 9200 'Y.i, jJH1~;rO:t.f$tfl$llM Jnlj)J:jK~~~1i1j,~QQgl&~Ai; k.~'%i*ltf~tl~1~1'e0'J4;f'I"'.PF{QY~MENJ";f;:~Ng@ii;J';<ti~~i~ ~ tiE;,fj);~JQ:;\f!fll1'POIjj;nf~; Property Sales 71539510010 ~ ~\flb1i..tT~J;.I;W"Pt1PF{QV~Pt1.ENrj,EVrU~Mi)~'!;1i .~,'" c., ;;MdI~;t;9:I.kltj} }ffMjj~j;~ll~111i1i1.Q!lQl~(~~# ;:"':'.;-",',',,< ."!--.,.'...._.._,v;.".:.: Hot Tap (watermain) 753.34340023 F H. Install/ Meter 753 34340024 W/M Installation 753 34340025 ~ Water System Developement Charge //1/'(,0- 753 34480010 /0' ?-. ~':::.:::: T _WAlEI'( .,:':(:", ;4;;'\:'I"Q;r~rt;;~i}; :m;~;;;~~iit1;~~PQQ'ij~~j:' Sanitary Sewer Permit 754 32210029 Sanitary Sewer Tap/Cap or MH Tap / / /:7~ ~ 754 34350018 r, n Sewer System Development Charge /' 754 34350024 /~S -'''''.._~ ULlD 215 / Equivalent Service Connection Fee 782.34350025 ~~1n1\it~~qligll:~W~iI;W~)"ER.'FQNg:;:1x;::'" "::-';":">""'~'~( ,,"- .'Y' T L "'C.! 'Y:'~~~1;1;~:1~i!m1.1i~ Milwaukee Dr Assessment 755 34370030 ~a'Y'i~TE lilll "'~~;; ;",,4Q4~,11~j.QPQ;;ij)Ej' ~ ~ ~ CITY OF PORT ANGELES PUBLIC WORKS DEPARTMENT FILL-. IN, COMPLETELY - TOTAL EACH FUND AND, :1ND TOTAL }_ --f~ ,,# .I -' If I u I J ~~ & tP /ag~ ~P"4-- 3/'1 e,5T 14G>~ /g'()O ,?"-'U, )1//-5-- jrt~ G~~ ~._~.,~ PUBILIC WORKS & R/W PERMIT Issued: I 1 Permit No Work Order' 1106 o OWNER/APPLICANT D Attached Notes NATHAN BRUNS 1326 W 15TH ST Port Angeles, WA 98363 000/604-7046 PROJECT INFO Work is Plans Required Contractor' Performance Bond Required Proof of Insurance. Work to Perform: PROPERTY LOCATION 1326 15TH ST W Lot: 7 Subdivision Parcel No TPA 06300004332 Slock: 433 D Long Legal Value Work: $000 Start Date 1 1 Finish Date. 0001000-0000 Amount: $000 PROJECT NOTES D Install D D Repair D D Watermain D Sanitary Sewer Storm Drain Underground Tele/Elec D Misc 1 1 9-23-2000 paid for dropin water meter i~e ~ ) 9-8-2000-PAID SEWER PERMIT & ROW PERMIT ONLY PER TF (pLP7 FEES ASSESSMENT d--qJ~I~ 1 ) RIW Excav' ~ f 15 ) Other San Sewer' 2) Sidewalk: $000 16) Sew Tap Wye/Man Tap' 3 ) Curb/Gutter' $0 00 17 ) Sew Capl W/M Removal: 4 ) Driveway' $0 00 18 ) Alter Repair Sewer' 5 ) Dwy Culvert: $0 00 19 ) Storm Drain. 6 ) Street Cut: $0 00 20 ) Catch Basin per ea. 7 ) Other RIW' $0 00 21 ) Sewer System Dev' 8 ) Fire Hydrant: $0 00 f \Jf:2 ) Milwaukee Dr Sew Ass: 9) Res Water Servo 5/8" C$150JJ!Dd~4 23) RIW Use Perm: 10 ) Comm Water Servo $0 00 Irz€ ~ 24) Admin Cost (D R.A) 11 ) Other Water Service $0 00 U 25 ) D RA. 12.)Water System Dev' $745 00 ~ 26) Misc: 13) San Sewer SFR ~13)~ TOTAL FEE. 14 ) San Sewer MFR $000 G1pfC fA add unit: 0 (p1jJ3' ( Amount Paid: Receipt No Inspection Fee $0 00 Balance Due. $000 $000 $000 $000 $000 $000 $1,02500 $000 $000 $000 $000 $000 $2,060.00 $290 00 $1,770.00 1~/7-4!oO 1j50~ }v' / /f1 / PUB/LlC WORKS & R/W PERM/T Issued 3/29/2001 Permit No Work Order' PROPERTY LOCATION_ 1326 15TH ST W Lot: 7 Subdivision Parcel No 1106 o OWNER/APPLICANT !I Attached Notes NATHAN BRUNS ---r 1326 W 15TH ST Port Angeles, WA 98363 360/417 -0246 PROJECT INFO Work is Plans Required Start Date Contractor' BL YN CITY BUILDERS Performance Bond Required Amount: Proof of Insurance Work to Perform Block: 433 TPA 06300004332 Long Legal ---- ~ M ~ E Value Work: $000 / / Finish Date 360/000-0000 / / $000 Install II Repair Watermain ~] Sanitary Sewer C Storm Drain D Underground Tele/Elec r J Misc - ~ PROJECT NOTES_ __ reC# 6665 $150 00 reC# 6639 $140 00 Nathan to pay $ 1800 84 3/26/2001 paid 3/29/01 pressure tested main for 39 minutes @ 210 Ibs ok per Wayne Groff 9-23-2000 paid for dropin water meter Bacteriological test ok 9/25/00 9-8-2000-PAID SEWER PERMIT & ROW PERMIT ONLY PER TF 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 5/8" 10 ) Comm Water Servo 11 ) Other Water Service 12 )Water System Dev' 13 ) San Sewer SFR. 14) San Sewer MFR. add unit: 0 Receipt No 6953 Inspection Fee $000 $45 00 $000 $000 $000 $000 $000 $000 $000 $15000 $000 $000 $745 00 $95 00 $000 15 ) Other San Sewer' 16) Sew Tap Wye/Man Tap 17 ) Sew Cap/ W/M 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 (D RA) 25 ) D RA 26 ) Misc: $000 $000 $000 $000 $000 $000 $1,025 00 $000 $000 $000 $000 $000 TOTAL FEE. $2,060.00 Amount Paid $2,06000 Balance Due $0.00 s ~~ CITY OF PORT ANGELES PUBLIC WORKS - BUILDING DNISION 321 EAST STH STREET, PORT ANGELES, WA 98362 PUBILle WORKS & R/W PERMIT D Attached Notes OWNER/APPLICANT NATHAN BRUNS 1326 W 15TH ST Port Angeles, W A 98363 000/604-7046 417- DZ 4 {,tJ PROJECT INFO Work is Plans Required Contractor' Performance Bond Required Proof of Insurance Work to Perform Issued / / PROPERTY LOCATION 1326 15TH ST W Lot: 7 Subdivision Parcel No Permit No Work Order. 1106 o TPA 06300004332 Block. 433 D Long Legal Start Date. Amount: D Install D Repair D Watermain PROJECT NOTES Value Work. / / Finish Date. 000/000-0000 $000 D Sanitary Sewer D Storm Drain D Underground Tele/Elec $000 / / D Misc pressure tested main for 39 minutes @ 210 Ibs ok per Wayne Groff 9-23-2000 paid for dropin water meter Bacteriological test ok 9/25/00 9-8-2000-PAID SEWER PERMIT & ROW PERMIT ONLY PER TF FEES ASSESSMENT- ~5 160 "Y- /()/~7 -:JJ- W (p ttlJ;~'1 .-/10- tilt 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 5/8" 10) Comm Water Servo 11 ) Other Water Service 12.)Water System Dev' 13 ) San Sewer SFR 14 ) San Sewer MFR add unit: 0 Receipt No Inspection Fee $000 RW SANITARY $45 00 $000 $000 $000 $000 $000 $000 $000 $150 00 $000 $000 $745 00 $95 00 $000 WATER 15 ) Other San Sewer' 16) Sew Tap Wye/Man Tap 17) Sew Cap/ W/M 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 DWY STORM $000 $000 $000 $000 $000 $000 $1,02500 $000 $000 $000 $000 $000 $2,060.00 $290 00 $1,770.00 DRA ~ ~~ E ,~~~ ~ ~~r~~ ~~.'~~~,.. r'\ rv~ ~ rfJ ' ~ '~ \ ~. N 2 OTHER I v 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 Iitws 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. Signature of Contractor or Authorized Agent Date Date Signature of Owner (if owner is builder) From To: Subject Trenia Funston CPOSSING Public Works Permit # 1106 Nathan Burns Cheryl when payment for permit 1106 for Nathan Burns @ 1326 West 15th Street comes in would you notify me Payment due $1770 00 Thanks Trenia CITY OF PORT ANGELES 321 E.5TH ST · PO BOX 1150. PORT ANGELES, WA 98362 (360) 457-0411 · INQUIRIES (360) 417-4614 EIN #91-6001266 6582 000177000 668582788378323232 73484848484852535449 2 INVOICE I STATEMENT INVOICE # 1000004561 INVOICE DATE 12/06/00 CUSTOMER H BURNSN NATHAN BURNS ""1\1- OC~!o 1326 WEST 15TH PORT ANGELES WA 98362 11.1..1..1...11..11....1.111...11...11...11...11...11.....1.11 PAYMENT AMOUNT DUE DATE 12/06/00 DETACH AND RETURN THIS STUB WITH YOUR PAYMENT SAVE THIS STUB FOR YOUR RECORDS DESCRIPTION Remaining balance owing P/W Permit #1106 Contractor paid water meter and right of way portion See permit for other items AMOUNT 1770 00 S~'t~ Q..o~\a'R W~~ \D ~~'i ~\~ ~ 0:t1 i~~4>-M~ ? 00 I f2,.tJY' ~ W F\-- '7 cg38 L St(~ ~ETURNED CHECKS will be subject to a service charge FINANCE CHARGES will be assessed in accordance to the current policies of the CITY OF PORT ANGELES, WA. PAYMENT DUE upon receipt. =lEMITTO CITY OF PORT ANGELES, PO Box 1150, Port Angeles, WA 98362 INVOICE . AMOUNT 1770 00 CURRENT 30 - 59 DAYS 60 - 89 DAYS 90 DAYS OR OVER FINANCE CHARGE PLEASE PAY 'Z/110 . ..... ell~' OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . . . INSPECTION REPORT. . . . . . ..... REQUEST Date Time Received by /32b h//~ ~t-'.I#!AUI F ~ G' , (phone, person) Location of Work to be inspected If~t.: Ally Name of person requesting inspection Address of person requesting inspection Phone No Type of Inspection (circle appropriate one) Permit No /1/)0 Sewer Foundation Framing Chimney Plumbing Final Sewer Excav ~~ ~.s...... t'"E.~ I INSPECTION NOTES Inspected Date It) - ~ - C (!) Remarks ? ~..s5".....~ -J.~ sT." Time II- WJ By....---f.) t '7~ u.J /01"" 3'0 -.: ~ . ~ ;;).. L (;) Ok RESTORATION REQUIRED YES NO SURFACE RESTORATION SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC D Other D Repaired by City Cl Repaired by Permittee CI No Damage Found Work Order # D COMPLETE D INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) STATE OF WASHINGTON DEPARTMENT OF HEALTH WATER BACTERIOLOGICAL ANALYSIS SAMPlE COIl..ECTION: READ INSTRUCOONS ON BACK OF GOlDENROD copy .,............. - ....fol_ u_...... _. ~ j I r TYPE OF SAMPlE (chej:k only one in lhis column) Q =~~ WAJR 0 Chlorinated (Residual: _ TotaJ~ Free) check lrea1ment~ . 0 Rltered --.-.., 0 Untreated or Other O REPEAT~E Previous presence lab #I Date WASHlNaI'C!N ~___ Cl. RAW SOURCE,; WATER Source #I 0 []J 2; NEW coNsTRucTION or REPAIRS o OTHER (Specify) REMARKS: o Total CoIifonn o FecaJ~ l > (lAB USE OM..Y) DRINKING WATER RESULTS , -t1:J~~i1SFACTORY. Corlfonns present 0 SATISFAC:TORY. ,'f,'.?'. . ,., ~CoIiforms iIblI8ilt Rl:PEATD ~nt 0 E.CoIiabsent ,; -SAMPlES REQUIRED 0 FecaJ present 0 FecaJ absent OTHER I..ABORATORY RESULTS , .'!PfAlcouFORM --C- /100 ml E. COlI _1100mi FECAlCQUFORM _/100 ml PlATE COUNT _ hnl ANOTHER SAMPlE REOlJRED ;......- . ' i SAMPlE "!QTTESTED BECAUSE: D. San1J)Ie too old o Wrong container ~bm l~ V'-" o ~.....-t ,......... :~_~ .' '"J~REVERSE SIlE OF GREEN COPY FOR EXPlANA11O'UlF RESlA..~ , lM Np. '(7 DIGITS) DATE. TIME RECeIVED RECEIVED ~ rA Z -l>'W19 q It 5 'dO I: 'is . 6 hd oJ- 1>A TEST UNSUITABLE BECAUSE: o ConIIuent growth DlNTC o Turbid Clituie o -Excii\is'ifebrJs c, , ..', ; t:",,,,.: ,j,_ ,[",1'.' -. -., /'\ REMARKs lABORATORY: ~~J ..( ~~-td A (t's~k ~"'_^^....-ne'\'.""", BUILDING PERMIT INSPECfION RECORD , CALL 4174815 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 LOCATION KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE ACCEPTED COMMENfS I YES NO FOUNDATION: FOOTINGS WALLS FOUNDATION DRAINAGE ELECTRICAL (LIGHf DEPT) ROUGH-IN I J I PLUMBING UNDER F1..ooR I SLAB ROUGH-IN WATER LINE BACK F1..0W I WATER AIR SEAL WALLS CEILING I I FRAMING JOISTS I GIRDERS SHEAR WALL WALLS I ROOF I CEILING DRYWALL T-BAR INSULATION SLAB I WALL I F1..ooR I CEILING I I MECHANICAL CHIMNEY WooDSTOVE I PELLET DUCTS PW UTIUTlES I SITE WORK (Engineering Division) WATERLINE I METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE I EROSION CONTROL PARKING OTHER , FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY /USE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRICAL L1GHf DEPT 417-4746 ELEClRICAL L1GlIT DEPT CONSTRUCTION R W I PWI CONSTRUCTION R W ENGINEERING 417-4807 PW I ENGINEERING FIRE (MUL TI-FAM ONLY) 417-4654 FIRE DEPT BUILDING 417-4815 BUILDI1"G GENERAL COMMENTS: PW-II02,15 (41961 PUB/LlC WORKS & RJW PERM/T Issued: 11/13/2000 Permit No: Work Order: 1124 o OWNER/APPLICANT 0 Attached Notes NATHAN BRUNS 1326 W. 15TH ST Port Angeles, WA 98363 000/604-7046 PROJECT INFO Work is: Plans Required: Start Date: Contractor: OWEST COMMUNICATIONS Performance Bond Required: Amount: Proof of Insurance: Work to Perform: PROPERTY LOCATION 1326 15TH STW Lot: 7 Subdivision: Parcel No: Block: 433 TPA 06300004332 o Long Legal Value Work: $0.00 1 1 Finish Date: 3601000-0000 II $0.00 I2:iJ Install 0 o Repair 0 D Watermain I2:iJ Sanitary Sewer Storm Drain Underground Tele/Elec o Misc PROJECT NOTE!': trench in alley behind 1326 W 15th St approx 200' FEES ASSESSMENt 1.) R/W Excav: $0.00 15.) Other San Sewer: $0.00 2.) Sidewalk: $0.00 16.) Sew Tap Wye/Man Tap: $0.00 3.) Curb/Gutter: $0.00 17.) Sew Capl W/M Removal: $0.00 4.) Driveway: $0.00 18.) Alter Repair Sewer: $0.00 5.) Dwy Culvert: $0.00 19.) Storm Drain: $0.00 6.) Street Cut: $0.00 20.) Catch Basin per ea: $0.00 7.) Other R/W: $0.00 21.) Sewer System Dev: $0.00 8.) Fire Hydrant: $0.00 22.) Milwaukee Dr. Sew Ass: $0.00 9.) Res Water Serv: $0.00 23.) R/W Use Perm: $0.00 10.) Comm Water Serv: $0.00 24.) Admin Cost (DR.A) $0.00 11.) Other Water Service: $0.00 25.) D.RA $0.00 12.)Water System Dev: $0.00 26.) Misc: $0.00 13.) San Sewer SFR: $0.00 TOTAL FEE: $0.00 14.) San Sewer MFR: $0.00 add unit: 0 Amount Paid: $0.00 Receipt No: Inspection Fee: $0.00 Balance Due: $0.00 'C:f1" ~M :LJ~1Ud PUBUC WORKS Permit To Perform Work In Street Right-of-Way APPLlCA TION is hereby made to the municipality of PORT ANCElES to perform work as noted hereon and as shown on attached drawing: \ fLZ ,..j G 8- A- LL ~ c:S B t-t lt0 D \ ~Lb A fYLv ';( W c) I (L) kJ t'LfA.56 ,seE Pr T\ A C \-\ E- b S /:..E" TC li /J w 1 s-rJf'sf: 00- b5/ u Approved: Water Department - Superintendent f~dJ:- Sewer Department - Superintendent / 0 b<1 Y 5 of tZEC.S I Pi By [\(\.~ ~ (~~CMJ- "V) 3&>0 - '-{78 -'fl../Z"L Contractor Owner US WEST /ATTN: MISTY (.,I \ - G-;:~ STREt:..r .1)A::':I5m6\lT BREMERlDN I WI\SH 1 NGJDN qB33 THE ABOVE APPLICA nON IS HEREBY GRANTED SUBJ ECT TO APPLICANT'S: 1I~1 The estimated time for completion of the above work is uJ \ T t1/,J Date cJ'tJ0 ' 2.-. ~2e:vo Complying with all Municipal Ordinances; Notifying the Street Superintendent of the time the work will start, and when it will finish; Prosecuting the work with diligence and with due respect to all property. contracts. persons' rights and the interests and convenience of the public: Saving the Municipality harmless from any and all damages which may accrue to any person or property because of this installation or the maintenance thereof; D<lle /I~/~ -:;?-~ ~.~. City of "Po R.. T A.NG EL E-S Complying with following special conditions: fram-Exael Ullllt~ Can&lruatlan 1-36Q-462-5668 T-933P.QQ2/QD2 F-6D4 prllD!"'lll '/lEST ~RAC !Q1milza 1 '"OU 1 r.UflUI nil DSW Order Form/Sketch NUIllDSf 0-1::.51 U Wife Cenler AI S ~ CllCl iugmlMd /1-1- (;)0." COMPLET! aN! BOX.ONLY (A, or ~ WD:::062. 72 - B. ENGINEfiRING C, PFlEPRDVlSlDNINrI i FII.SkMcll~l "..,..tltJ4IHfftl I C Orfler 11 1. Reqll8lt Ctop f'"burleU ;..,.- . :1 1 a TN . 2. Report PretlUlV hU tI80Il I Drdlr CP'ed fDr following ,,"ona compll1llCl .-.. -. :1 . 1. Over seD' (Al4ra11--- __- C Type af prebury: \ 2. Right 01 way or perrnns -a C PloW Ji. OpDll Trench I reqUlrill _ ye.5..__;- Q Conduit C : 3. New canalNClIan. no 3. DUI DN C laellllllS Q .",::md_...uy.UI'O-P _ 0 \ 4. Nil pSlIll . a F1 4. Hilmi R'ady fa', CinlllSNI: 0....- ; Q F2 Ves No C D IInClI ALWAYS REQUIRED - D. CUSTOMERNaml fa-\' ~\......"A". AcSdras~ 1~!:I~t IS''\!'- ST - PhonlNumaer CBI!I.?f;-b233-'I''sXi:"' City. t:>r A ~. - SUbcjlvlslon _ - 0'2. <I '- La! ft Block- CaunlY r I... tiLl""" secnon - Flan e ToWl\ltl- - Ii. SUSMITI'ED BY Name Lnry "')uh.~ ~...... DCE! 4'ho-6:uq. PagElr CuammEll'CllnlllI:'lIlC: SUPllVIsllr Tel. " VMS POllitt YerballyC Card:" F. SKITCH _ Flsau/red an all "rder. CFD'sd and ODS RfI~ir. Fa tel L.FfAQ Complete L. In'a tin 1111 ord,,. tlr lik.r"hN L. L L. C (,l III eJ L.l! "'R,S N,I.I.W 1-144.....7 w.s.p,o,c: a.A.MoN Section RanSI TawnlhtJJ : it of Pect ~ ff.... Roecll-!n8 yLO Nav-Q1-2DDQ Q5:211'1II O;HHD al104flll ~r::;JI 'ECHNICIAN PADE; I. INSTALt.ATlQN & RBPA1R 1 oraen j,LJD.. 1'3;:U,,\1\J 15;-111 JTN . CF'ea tllr RSW 0 :. Cree Clnnllt Illcale iNCAP '- C I. Repair ces .~.. ft Q I. Creel Illr F1.F2. alSO nEle~ SSW 0 i. Temp placed . nsed skll1d1 . IllplaIntG pBlOW S. Found Temp. Slime Job Other LaCl1lon '1 Add Une ..... ,..'U ... . . . .. .. . . . . . . PP;r~~~O - . . . ..' I PI~ ~ f;-I- .:..-4 I 'L' . . . I pf~ . . . I . . W 1&..10 :S1" . . pt~'ll!""-.' 0 . t . . .. . . . .. .. . . . .. . . .. . . 5,,~+101' ~. ~ - - . 1!l.__CI aafllnJlAtJ'ill r -M I _ - - j' - 23& ..L M -;r;rmlmll C C,T - -eeL PR' BF - s S,N - - . . - . . . . , , . . . : :-I-N: .. II.J... .. . . 1UfII. , . . . . . . . . . . . . . . . . . . . . . . \AI: . I !;rll . ~rT . . . . . . . . . .. . . . . . . '(1 . . . V . . : : ~ :\!I' :-- :::t! . . . . . . . . . . . . . . ~~,l.. ~\ltl . . . . . . . . . . . . . . . . '. . . . . . . . . . . . . . . . . . .. r .. t , . . . . ,,1'...... I lisnd.b,u ;J \~ I~cle ;rosli IIUfiIIJ .nll =DllIIIIlmIa -