HomeMy WebLinkAbout400 Golf Course Rd - Building
PUBILlC WORKS & R/W PERMIT
o Attached Notes
OWNER/APPLICANT
City of Port Angeles
Issued: 7/03/2003
Permit No:
Work Order:
1384
o
PROPERTY LOCATION
400 GOLF COURSE RD S
Lot: 17
Subdivision: Bellevue Hills
Parcel No:
Block: I
Port Angeles, WA 98360
000/600-0000
PROJECT INFO
Work is:
o Long Legal
Value Work:
$0.00
Plans Required: Start Date: I I Finish Date: I I
Contractor: OW EST COMMUNICATIONS 360/000-0000
Performance Bond Required: Amount: $0.00
Proof of Insurance:
Work to Perform: ~ Install 0 Sanitary Sewer 0 Mise
o Repair 0 Storm Drain
o Watermain ~ Underground Tele/Elec
PROJECT NOTES
open trench 86' east side of Golf Course Rd,
open trench from power pole to edge of pavement (54') west side, then
directional bore across GC Rd (36')
FEES ASSESSMEN"F
1.) R/W Excav: $0.00 15.) Other San Sewer: $0.00
2.) Sidewalk: $000 16.) Sew Tap Wye/Man Tap: $0.00
3.) Curb/Gutter: , $0.00 17.) Sew Capl W 1M Removal: $0.00
4.) Driveway: $0.00 18.) Alter Repair Sewer: $0.00
5.) Dwy Culvert: $0.00 19.) Storm Drain: $0.00
6.) Street Cut: $0.00 20.) Catch Basin per ea: $0.00
7.) Other R/W: $0.00 21.) Sewer System Dev: $0.00
8.) Fire Hydrant: $0.00 22.) Milwaukee Dr. Sew Ass: $0.00
9.) Res Water Serv: $0.00 23.) R/W Use Perm: $0.00
10.) Comm Water Serv: $0.00 24.) Admin Cost (DRA) $0.00
11.) Other Water Service: $0.00 25.) D.R.A. $0.00
12.)Water System Dev: $0.00 26.) Mise: $0.00
13.) San Sewer SFR: $0.00 TOTAL FEE: $0.00
14.) San Sewer MFR: $0.00
add unit 0 Amount Paid: $0.00
Receipt No:
Inspection Fee: $0.00 Balance Due: $0.00
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PllRI IG WORKS
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Permit To Perform Work In Street Right-of-Way
APPLICATION is hereby made to the municipality of PORT ANGELES . to perform work as
noted hereon and as shown on attached drawing: JOB # S;2.. VJ E <-! ~ 1-
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CHRIS CHRISTENSEN
Qwest, ENGINEER
360-452-2184 Approved:
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Water Department -Superintendent
Sewer Department - Superintendent
The estimated time for completion of the above work is
So ( 'Z.:O-eJ ~
Daie
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6
2..<rV 3
By t?)Ce.e. \
Contractor
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(check one)
Owner
THE ABOVE APPLICATION IS HEREBY GRANTED SUBJECT TO APPLICANT'S:
Complying with all Municipal Ordinances;
Notifying the Street Superintendent of the time the work will start. and when it will finish;
Prosecuting the work with diligence and with due respect to all property, contracts, persons'
rights and the interests and convenience of the public;
Saving the Municipality harmless from any and all damages which may accrue to any person
or property because of this installation or the maintenance thereof;
Complying with following special conditions:
lit? h ~
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Date
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Pn,'f.ry Commllnlc..l/on.. Ptwr r""""$""a-JB5-125/i
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Reason far reissue: Issue: Dote:
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REMARKS:
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Notice: Not for disclosure outside of Owest and affiliates exee t under written a reement.
DESIGNED BY: \)6\1.<:;' \)f\ v\ So i'-l JOB: ~ 2. w E 'H 1-
TELEPHONE: ?loo - <.t l"1-. 2..L T <{ GEO CODE: w 2."''1 Q.
TAPER CODE: '2.'{032.\ WC CLLI: PT'f\M\.u(-\Q)\ SH.O 2... OF3
PLAT REF: C 2. '1 ISSI: ISS DATE: .
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