HomeMy WebLinkAbout718 Georgiana St - Engineering
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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET PORT ANGELES WA 98362
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PUBI:..1.~ nv~.:> ~6N;::S.d(u~.L.1.vJ.'l .lSsueC1: 7/17/98 LC Permit No: 853
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
TED SERR 718 GEORGIANA
718 GEORGIANA Lot: 5
Port Angeles,WA98362 Block: 39 Long Legal:
360/000-0000 Sub: NR SMITH
PROJECT INFO------------------------____________________________________________
Work is N/A traveled road Value Work: $0.00
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/ /
/ /
Plans Required: N/A
Contractor:
Start:
Finish:
-
Performance Bond Required: N/A
Proof Insurance:
Amount:
$0.00
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Watermain Storm Drain ~
Sanitary Sewer Underground Tele/Ele f1
Misc ~
PROJECT NOTES------------------------___________________________________________?\
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PROJECT FEES ASSESSMENT-------------------______________________________________ ~
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R/W Excav: $0.00 San Sewer SFR: $0.00 (
Sidewalk: * $60.00 San Sewer MFR: $0.00
Curb/Gutter: $0.00 Add Unit: 0
Driveway: * $125.00 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:
Water Sys Dev:
Work to Perform:
==============================
$0.00
$0.00
TOTAL FEE:
AMT PAID:
$185.00
$185.00
Receipt No: 4248
Inspection Fee:
-----------------------
$0.00
BAL DUE:
$0.00
R/W
SANIT \R Y
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.
Signature of Owner (if owner is builder)
Date
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT
v
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
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Phone No
Permit No
Plumbing Final Sewer Excav Other
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INSPECTION NOTES
Inspected
Remarks
Date
Time
By
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RESTORATION REQUIRED
YES
NO
SURFACE RESTORATION
SURFACE TYPE D Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
D Repaired by City
[] Repaired by Permittee
[] No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)