HomeMy WebLinkAbout4206 Nicholas Rd - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
32] EAST 5TH STREET, PORT ANGELES, \VA 98362
04- 15x
Application Number
pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
04-00000158 Date
.182414
4206 NICHOLAS RD
06-30-09-5-3-0490-0000-
PUBLIC WORKS UTILITES
3/10/04
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UNKNOWN
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Owner
Contractor
HOPKINS RICHARD J
926 W 4TH ST
PORT ANGELES
OWNER
WA 983632108
Permit
Additional
Permit Fee
Issue Date
Expiration
Fee summary
Charged
Paid
credited
c;:~~~~?)
Due
Qty Unit Charge Per
1.00 640.0000 EA PW w/M SFR SIBil
Permit Fee Total
plan Check Total
-Grand Total
640.00
.00
640.00
640.00
.00
640.00
.00
.00
.00
.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 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
const~n. l
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Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date
T:\I'LANNING\rORMS\ll02.15 [I ]/14/2003)
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST:
Date d.- - ~ l-d V Time
. . .
Received by . (phone, person)
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Location of Work to be inspected 906 1 ,<-:w.. IAJCC-H"V- tr /<1- ,
Name of person requesting inspection -r-u.) f J {G X
Address of person requesting inspection ?i f& ~ f3 ' Phone No.
Type of Inspection (circle appropriate one): Permit No. O?f-75!;5
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other ~
INSPECTION NOTES:
Time
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Inspected: Date
Remarks:
By
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RESTORATION REQUiRED...... YES
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)U/11LUCdeY
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NO
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved o Gravel o Asphalt OPCC
c 111"1
F I q 0/&0-10
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F U?q{/J,?J2-"L
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
o Other
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)