HomeMy WebLinkAbout1400 E Park Ave - Engineering
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CITY OF PORT ANGELES
PUBLIC WORKS - UTILITIES DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr, name
Application type description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
05~00001216 Date 12/08/05
908032
1400 E PARK AVE
06-30-14-2-1-0120-0000-
QWEST
PUBLIC WORKS UTILITES
PUBLIC BUILDINGS & PARKS
o
Owner
Contractor
UNITED STATES OF
% NISQUALLY NATL
OLYMPIA
AMERICA
WILD REF
WA 98506
OWNER
Permit RIGHT OF WAY
Additional desc BURIED CONDUIT ALONG PARK AVE
Permit pin number 66845
Permit Fee .00 Plan Check Fee .00
Issue Date 12/08/05 Valuation 0
Expiration Date 6/06/06
Special Notes and Comments
place phone conduit out of ditch flow line to back side of
ditch, 2' deep & compacted.
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Fee sununary Charged Paid Credited Due
---~~------------ ---------- -~-------- ---------- ----------
Permit Fee Total .00 .00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total .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 tast
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 cancei the provisions of any state or local law regulating construction or the performance of
construction.
Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T:\Policies\II02.15R [1/05]
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REMARKS:
I PARk Ave. I
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CONFIDENTIAL: DISCLOSE AND DISTRIBUTE SOLELY TO US WEST
EMPLOYEES HAVING A NEED TO KNOW
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DESIGNED BY: fRAlIJk Lo,kU..T
TELEPHONE: ("3""'1 'iSZ- 7'71
TAPER CODE: ,,3t>q21
PLAT REF: <czz.!>
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Notice - Not for Disclosure Outsideaf U S WBST and Affiliate" Except Under Written Agreement
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GEO CODE: wZ~ioL
WC CILL!: f'rMiuJAt> I
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F.'ark-Ave.
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Area Map
llus 111"1' IS nm Intelided /" h,' IJwd (1.\" !,'!!tI' dnal{"I<I"
{ll/.' lIIap .Irm","): 1\ proulI.'",! hI II", ('Ill' ,,[ l'or/ AlIl!dn lor 11.'- OWl! liS,' tllld pllrpfJ.W\ ,...-
All\' "Iha II.\(' of Ih" 111<11> drtllHIJJ! ,lwll /1,,/ fw rl". rnIJIJ/I.I//lifm of Ih~ (',/, ..."..
:gORTANGELES
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W .A. 5 H j r'>J G TON, U. S. A.
RIGHTOF WAY USE
PERMIT
NAMEOFAPPLlCAIH (}rAlfs-r LOI1?MfMduIYI,tvS
"-;5 N. OIlIOfdus-E.. i).el//E.:
[y,(J) 1/52.- 7" 7/
MAILING ADDRESS
D/ITE IZJpr,1P5
fb,.r /I~~EtRS_
PHONE NUMBER
STREET ADDRESS OF PROPOSED STREET USE
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DESCRIPTION OF REOUEST (include drawings required for clarity): [If street closure is requested, please state the name
of the...;;treet and limits of closure, tgflether with the duration of closure,] /'
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IS THE USE TEMPORARY OR PERMANENT? fl3,-"lItvtfyfJ
HOW LONG WILL THE OBSTRUCTION BE IN PLACE? ::{"fI,b/t11I1te/..j
WHAT ARETHE HOURS OF OPERATIOI,n (;)A~U&Hr gU!!/;/!f;IS'=> b.4A1 S
HOW [T WILL BE LIGHTED?
EXPLAIN THE NECESSITY TO USE THE PUBLIC STREET, SIDEWALK OR PLANTING STRIP. ARE THERE
ALTE ATE ARE/IS THAT COULD BE US?" LJI.
n;f-, $EE ('0 CtJ/f/lJlnl rlJlcF;;'R~
All]
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HOLD HARMLESS and INDEMNIFICATION AGREEMENT
In compliance with the Port Angeles Municipal Code, and In consideration of the issuance by the City of Port Angeles of a Street Use
Permit to the undersigned allowing the placement of the above described street use or obstruction, the undersigned for himself and
for his successors in interest, hereby agrees to indemnify, hold harmless, and defend the City of Port Angeles against anv claims or
lawsuits for personal injury or property damage arising out of, or in any way connected with, the Rlacement of the use or obstruction
on the City street, sidewalk, or pianting strip. . ,rH ',\ ~~
DATED this ~ day of I Jea,;<;)JEK'. ,~
__.~ J!1q"tc.' "",h
~ t: 'pplicant
me this -4- day of A. d..(C'
/1 11/ ~
A : (.. - l/ ~l , ,)-L-^''-:
OT ARY PUBL:IC in affd for the State of
Washington residing at /
(This permit, if approved, may be terminated by the City of Pori Angeles 'without cause and at any time)
SUBSCRIBED and sworn to
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Seal
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[OFFICE USE ONL Y)
Copies senl to:
Police
Fire
Planning _
Finance
Date:
Fee paid $ ~t- Receipt #
Agreement to emove Encroachment signed and
recorded on N[A
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Application reviewed and recommendation by City Engineer
deny or approve and with the following conditions:
Date application received I r 1/01j
Certificate of Insurance per PA C 11.12.140(8)
on N/A
Date
is tD
Application approved Dr denied by the Director Df Public Works
Date
......................._.............. ._...... ........_..............._.._........................._.......__n..........._._..___00....._00 ........______00._ nuu_ . __00000000 .
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Copies to: Applicant 0 Fire 0 Police 0 Street 0 Other
N:\PWKS\L1GHT\CONS\CA TE\ROWPER.wpd
o Address file 0 RUP file 0
ROBERT GONZALES (RCGONZAJ 01/27/2005 10;01 CLLI:STANDARD
RECORD NO: GONZOUWQRKSf.!EET SKt'CT:1 REV:2
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CONFIDENTIAL: DISCLOSE AND. DISTRIBUTE SOl.EL Y TO US WEST
EMPLOYEES HAVING A NEED TO KNOW
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REMARKS:
Notice - Not for Disclosure Outside of U S WEfT and Affiliates Except Under Wrltten Agreement
DESIGNED BY: (r<Atllk Lo(.klltiRT
TELEPHONE: C3lnD) 'iH- 71,,1
TAPER CODE: .-z'S6'1Z'/
PLAT REF: C 'Z.1..b
JOB: 5Zwf!.. ~1 L
GEO CODE: W2c''I:JL
WC CILL!: PlAllJuJAOf
ISSI: I ISS DATE: .
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