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CITY OF PORT ANGELES l7- ? 2 1
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST
Date I ?--- 7- tl ')
Time II ~ 'J /I /I~ Received by II? E/VJ /1- (phone. person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
Sewer Foundation Framing Chimney Plumbing Final
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Phone No
Permit No
Sewer Excav Other
INSPECTION NOTES
Inspected Date/:;2 -- 7 - // '3 Time;;; ~ I P f' ,hJ By t' , IV
Remarks 5t:~VIC~ L-/IVE LE/1KIA/V:- J W~TE;/r ~P/""/~
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RESTORATION REQUIRED. .... YES ~ NO
SURFACE RESTORATION
SURFAC~ TYPE 0 Unimproved 0 Gravel
~s/(~I 6 o Repaired by City
f ~ 10 0 0 Repaired by Permittee
o No Damage Found
~phalt 0 PCC 0 Other
Work Order # / '1 J :;2 7
o COMPLETE
rr1NCOMPLETE
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STREET SUPERINTENDENT (DATE)
City of Port Angeles
Public Works Departnlent
Water Distribution Repair Report
IWork Order No / ~ .}.;;- ?
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DATE REPORTED
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CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT 0
LEAKAGE SURVEY 0 OTHER 0
TYPE OF MAIN
I ,;2- ?-{/ ) TIME II' 1 {/
ADDRESS S} , /11 /1 t< //1' tE
C, .r SIZE /;2 li
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~DP.M.
DATE OF REPAIR.
REP AIR LOCATION
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DEPTH OF MAIN
CLOSEST VALVE DEPTH.
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COMPONENT REPAIRED.
MAIN JOINT 0 CIR. BREAK 0 SPLIT BELL 0 LONG BREAK 0
HOLE 0 CLAMP D OTHER
SERVICE TAP D CORP STOP D PIPE ~URB STOP D FITTING D
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
OTHER.
COMPONENTS OF REPAIR. CLAMPD DRESSERD OTHER /(Ef?LA[t:'f S€.RvlCi:. LIlVJ,2
SITE CONDITION GRA VEL 0 ASPHALT Er'SIDEW ALK 0 CURB 0
TOP SOIL AREA D SOIL TYPE
CUTS ASPHALT CUT10.-tI) FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE P.P.M.
WATER OFF FROM
M.TO
M.
FROM
M.TO
M.
APP ARENT CAUSE OF LEAK. .Ye;c f/ Ice L '(1/ (:: L e /I t:=- ,4 r
FIT (IIV' 5"a N - 5el< //)/': ~ L-IN~ ,. 5H 1/ T 0 j;::-F epIC'/':
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CITY OF PORT ANGELES l7- ? ~ 1
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST
Date I ?-..- 7- (J J
Time II 'J Ii /I~ Received by II< t:/VI /I- (phone~ person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
S)~
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I 7 ~1- /J
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PRI//~
, ~
Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
INSPECTION NOTES
7 (' ',-
Inspected Date / ;2- -- /./ Time,) ~ I t/ f'1'? By i' 11't/
Remarks 5 E J(' VI C F' L/ IV E L E /1- K / ,A/V-. W /t T CJ l &: P / -1/?'
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RESTORATION REQUIRED
YES ~ NO
SURFACE RESTORATION
SURF~ TYPE 0 Unimproved 0 Gravel
~SIr 'o!? 0 Repaired by City
17/ 10 [] Repaired by Permittee
o No Damage Found
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~phalt D PCC 0 Other
Work Order # / ~ J :;;.. 7 J .
lXJ COMPLETE . ~"e.L' \i'<':1)."J.,,\'I-ed vJ\ \11\
0'lNCOMPLETE ~{2 b~~(:r \i~\~'~ .
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STREET SUPERINTENDENT
(DATE)
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362 04- / ';)... 0 0
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Application Number
pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use
Property Zoning .
Application valuation
04-00001200
.000000
536 MARINE DR
06-30-00-0-0-4940-0000-
PUBLIC WORKS UTILITES
Date
12/27/04
INDUSTRIAL LIGHT
1000
Owner
Contractor
CENTRAL WASH. GAMING LLC.
536 MARINE DRIVE
PORT ANGELES WA 98362
( 36) 417-8114
C&J EXCAVATING
PO BOX 430
CARLS BORG
(360) 683-7741
WA 98324
Permit STREET ALLEY RESTORATION
Additional desc
Permit Fee 230.00 Plan Check Fee .00
Issue Date 12/27/04 Valuation 1000
Expiration Date 6/26/05
Qty Unit Charge Per Extension
1. 00 230.0000 ECH STREET ALLEY RESTORATION 230.00
Permit SANITARY SEWER HOOK UP
Additional desc
Permit Fee 35.00 Plan Check Fee .00
Issue Date 12/27/04 valuation 1000
Expiration Date 6/26/05
Qty Unit Charge Per Extension
1. 00 35.0000 EA SAN SEW REPAIR 35.00
Permi t RIGHT OF WAY
Additional desc
Permit Fee 45.00 Plan Check Fee .00
Issue Date 12/27/04 Valuation 1000
Expiration Date 6/26/05
Qty Unit Charge Per Extension
1. 00 45.0000 ECH RIGHT OF WAY PERMIT 45.00
Fee swrunary Charged Paid Credited Due
----------------- ------~--- ---------- ------~--- ----------
Permit Fee Total 310.00 310.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 310.00 310.00 .00 .00
Separate Permits are required forelectricai work, SEPA, Shoreline, ESA, 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 wili 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 buiider)
T:\PLANNING\FORMS\1102.15 [11/1412003]
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST:
.
Date
1'2-/ u1-p1 Time
Received by
~
I 1
(phone. person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection Phone No. ~ 5'3, 771/
Type of Inspection (circle appropriate one): Permit No. tJ? - I Z-OC>
r70undation---Framing--Chimney - Plumbing- -Final~Sewer-Excav.--Other------._------- ---------
INSPECTION NOTES: ~;~rJ(::J .
Inspected: Date 'I ~ - ~ Time l ~'''\. By J 4 .A) 0(j2.1;;;(~
Remarks: If th ~\ ,
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RESTORATION REQUiRED...... YES X NO
SEE ,fJ,nlcZ-'" lv1.e;x-_
.
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved DGravel
o Repaired by City
o Repaired by Permittee
o No Damage Found
...,1 \--, I
~!I '-
ISll Asphalt 0 PCC
,
Work Or,der #
JZ( COMPLETE
o INCOMPLETE
o Other (
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DNISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
pin number
Property Address
ASSESSOR PARCEL NUMBER:
Applicatlon description
Subdlvlslon Name
Property Use
Property Zoning . . .
Applicatlon valuatlon
12/27/04
04-00001200 Date
.000000
536 MARINE DR
06-30-00-0-0-4940-0000-
PUBLIC WORKS UTILITES
INDUSTRIAL LIGHT
1000
Owner
Contractor
CENTRAL WASH. GAMING LLC.
536 MARINE DRIVE
PORT ANGELES WA 98362
( 36) 417-8114
C&J EXCAVATING
PO BOX 430
CARLS BORG
(360) 683-7741
WA 98324
Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
STREET ALLEY RESTORATION
Plan Check Fee
Valuation
.00
1000
230.00
12/27/04
6/26/05
Qty Unit Charge Per
1.00 230.0000 ECH STREET ALLEY RESTORATION
Extension
230.00
Permit
Addltional desc
Permit Fee
Issue Date
Expiration Date
SANITARY SEWER HOOK UP
Plan Check Fee
Valuation
.00
1000
35.00
12/27/04
6/26/05
Qty Unit Charge Per
1.00 35.0000 EA SAN SEW REPAIR
Extension
35.00
Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
RIGHT OF WAY
Plan Check Fee
Valuation
.00
1000
45.00
12/27/04
6/26/05
Qty Unit Charge Per
1.00 45.0000 ECH RIGHT OF WAY PERMIT
Extension
45.00
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 310.00 310.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 310.00 310.00 .00 .00
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Separate Permits are required for electrical work, SEPA, Shoreline, ESA, 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 ovisions of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a per . does not
~~~~ve authori / ~:4r cancel the provisions of any state or local law regulating construction or the pertor ance of
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Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder)
T.\PLANNING\FORMS\1102.15 [11/14/2003]