HomeMy WebLinkAbout509 S Lincoln St - Engineering
s
~~
CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
//"'/
PUBLIC WORKS CONSTRUCTION Issued: 10/17/97 TF Permit No: 742
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
JAY KETCHUM 509 LINCOLN S
509 S. LINCOLN Lot: 8&9
Port Angeles,WA98362 Block: 200 Long Legal:
360/452-5234 Sub: TPA
PROJECT INFO----------------------------------__________________________________
Work is N/A traveled road Value Work: $O.O~
/ / ~
/ / ~
Plans Required: N/A
Contractor: OWNER
Start:
Finish:
Performance Bond Required: N/A
Proof Insurance:
$0.00 V)
C"
""'..
Storm Drain ~
Underground Tele/Ele ~
Misc ~
PROJECT NOTES------------------------------------______________________________~
~ VV--- ~ ~ ~ ~ ~V:vvC-. ~~
~~ ~ U-QXt\ -- l)
PROJECT FEES ASSESSMENT-----------------------------____________________________
R/W Excav: * $40.00 San Sewer SFR: $0.00
Sidewalk: $0.00 San Sewer MFR: $0.00
Curb/Gutter: $0.00 Add unit: 0
Driveway: $0.00 Other San Sewer: $0.00
Dwy Culvert: $0.00 Sew Tap Wye/Man Tap: $0.00
Street Cut: $0.00 Sew Cap/ W/M Removal: $0.00
Other R/W: $0.00 Alter/Repair Sewer: $0.00
Fire Hydrant: $0.00 Storm Drain Tap: $0.00
Res Water Serv: $0.00 Catch Basin per ea: $0.00
5/8" Sewer System Dev: $0.00
3/4" Milwaukee Dr. Sew Assess: $0.00
1" R/W Use Perm: $0.00
Comm Water Serv: $0.00 D.R.A.: $0.00
1" Admin Costs (D.R.A): $0.00
1 1/2" Misc: $0.00
2 " ==============================
Oth Water Serv: $0.00
Water Sys Dev: $0.00
Amount:
Work to Perform: REPAIR
* Watermain
Sanitary Sewer
Receipt No: 3563
Inspection Fee:
TOTAL FEE:
AMT PAID:
$40.00
$0.00
----------------------- .l
BAL DUE: ~r1U'i11~
DRA OTHER {) riD)
R/W
SANITARY
$0.00
WATER
DWY
STORM
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 spec' rein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any stat ca a ulati g construction or the performance of construction.
Date
Si nature of Owner if owner is builder
Date
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
Address of person requesting inspection
Type of Inspection (circle appropriate one)
Sewer Foundation Framing Chimney
5"07 - 5/~ S- ~nc.o/'?
Phone No
Permit No
/.:~,
Plumbing Final Sewer Excav (~
" )
INSPECTION NOTES
Inspected Date ~ - ;;1. 7
Remarks
1 ? Time
(~""~T Ie .t-2
A iV\
/
By
----1 _' J
RESTORATION REQUIRED
__ ~__ _.' _'..'_ 5.!J-
YES
NO
(
J
j
) (
\",
(\
t.i
\
'4- )() ____~
-- - \
c
'-<,
~?,.[eY
,
'-
t, '
----
"fro '
....'r
-.t>
,
n
,
~
! f\ ;.~
I 2.
,,"
~ v- '"
..
::;
?c~'<
I
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
D Repaired by City
[] Repaired by Permittee
D No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . INSPECTION REPORT. . . . . .
REQUEST
Date "1- /'1- 7 'J
Time /1. s-c
Received by /J:.l
€ho~, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
5"D1' - 5/3 ~ LIr7 tC-t/lrr
/V1 iZ-.s ::r;;:y K?-77... ~ hv1
Phone No
Permit No
?4:?-
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other ..5j~~
INSPECTION NOTES
Inspected Date f- /L/- ~?
Remarks
Time / c..f S-'
By J<. .J"
~
/"Z) ~"
<f:
RESTORATION REQUIRED
YES ~/NO
~LO~
~ IN TO
~ p~;-./
-
v:::r?
-:J;t:S ~ ke
~~~~j
(TY f?)
/7'C
t:)0tutJ<...t~ 1..../ TO '-:?/fV~E--.t ,- ~PE1L
IS IO~/<-
SURFACE RESTORATION /0 X I C:.... (z-) Co;<. ~
SURFACE TYPE 0 Unimproved 0 Gravel ~halt 0 PCC 0 Other
o Repaired by City Work Order # ::sr /{)It:'j - 307-8
[] Repaired by Permittee Pi:f COMPLETE
[] No Damage Found 0 INCOMPLETE
;r/nE- / O~ ap IHE tAhl25T SIDE tUIJ..LK- Pt!)ttl26 r #lHlJe SE~V!
/f; ~0~d f//1 /?J1 ~~<'# t/:'-s/rr
(Continue on reverse side if necessary)' STREET SUPERINTENDENT (DATE)