HomeMy WebLinkAbout232 Vashon Ave - Engineering
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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
PUBLIC WORKS CONSTRUCTION Issued: 12/19/97 TF Permit No: 786
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
ANITA BOYD 232 VASHON
232 VASHON Lot: 2
Port Angeles,WA98362 Block: 4 Long Legal:
360/000-0000 Sub: pscc 2nd
PROJECT INFO-------------------------------------------------------------------~
Work is N/A traveled road Value Work: $0.00
Plans Required: N/A
Contractor: US WEST COMMUNICATIONS
Start:
Finish:
/ /
/ /
Performance Bond Required: N/A
Proof Insurance:
Amount:
$0.00
Work to Perform: INSTALL
Storm Drain
* Underground Tele/Ele
Misc
NOTES----------~--------------------------------------------------------
Watermain
Sanitary Sewer
PROJECT
PROJECT FEES ASSESSMENT---------------------------------------------------------
R/W Excav:
Sidewalk:
Curb/Gutter:
Driveway:
Dwy Culvert:
Street Cut:
Other R/W:
Fire Hydrant:
Res Water Serv:
5/8"
3/4"
1"
Comm Water Serv:
1"
1 1/2"
2"
Oth Water Serv:
Water sys Dev:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
San Sewer SFR:
San Sewer MFR:
Add Unit: 0
Other San.Sewer:
Sew Tap Wye/Man Tap:
Sew Cap/ W/M Removal:
Alter/Repair Sewer:
Storm Drain Tap:
Catch Basin per ea:
Sewer System Dev:
Milwaukee Dr. Sew Assess:
R/W Use Perm:
D.R.A. :
Admin Costs (D.R.A):
Misc:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
------------------------------
------------------------------
$0.00
$0.00
TOTAL FEE:
AMT PAID:
$0.00
$0.00
Receipt No:
Inspection Fee:
R/W
SANITARY
$0.00
WATER
BAL DUE:
$0.00
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 permrt does not presume to give authorrty to violate or cancel the
provisions of any state or local law regulating construction or the performance of construction.
Sionature of Owner (if owner is builderl
Date
Sianature of Contractor or Authorized Aaent
Date
DEC. -IS' 97(MON) 10:37 US WEST
l(-JJ~-~:I UI:IJ1M HUM MI~IY
TEL:360 452 8660
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Found. Temp
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CllRII'
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'117- ll'7tP,t
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PRE.PROVISIONING
Pre Burv [:J
Conduit Placed
BSW in Open Tr.
E.tend BSW on pan'al
Hamt/ 'Ready for SMIG
Panial [j Complete [:J
Partial C Complete 0
o"dUII Dr open trench lJ
D D NDt RfI,dy D
7-0cj8 u
BURIED SERVICE WIRE II:
WORK ORDER DATE:
Recommanded:
Approyad by;
PERMIT REQUIRED?
Received from
Jurisdicticn
COMPLITEO BV:
L --1L ---L....L C AI..3... 2.. L. ~ Call
CONTRACTOR'S ACCEPTANCE
Firm
Signature
Titlo
EC.!IL'1!'.- Pa!lBT /--1fi%'~ l17l- uSWes, grOUp doing work
/1. d 1" Bill to: USWest Cammunlcatlgfls
AhBntion:
Address:
City:
Is therF edditiDnal cu5'l mer billing? c:l Ves k:' NO
Does Tech fleed notifie ? 0 Yes )C No
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eBL PAIR eOl RIllP T!:RM ADDRESS
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