HomeMy WebLinkAbout1818 W Lauridsen Blvd - Engineering
PUBILlC WORKS & R/W PERMIT
o Attached Notes
OWNER/APPLICANT
City of PA
Issued:
5/27/2004
Permit No:
Work Order:
1401
o
__PROPERTY LOCATION
I
1818 LAURIDSEN BLVD W
Lot:
Subdivision:
Parcel No:
Block:
Port Angeles, W A 98360
000/600-0000
PROJECT INFO
Work is:
Plans Required: Start Date:
Contractor: QWEST COMMUNICATIONS
Performance Bond Required: Amount:
Proof of Insurance:
Work to Perform:
D Long Legal
Value Work:
$0.00
/ /
Finish Date:
II
360/000-0000
$0.00
12S] Install
D Repair
D Watermain
D Sanitary Sewer
D Storm Drain
[:8:] Underground T ele/Elec
D Mise
PROJECT NOTES
place buried service wore for customer at 1818 W Blvd 190' from L31-11
FEES ASSESSMENT
1.) RIW Excav: $0.00 15.) Other San Sewer: $0.00
2.) Sidewalk: $0.00 16.) Sew Tap Wye/Man Tap: $0.00
3.) Curb/Gutter: $0.00 17.) Sew Cap/ W/M Removal: $0.00
4.) Driveway: $0.00 18.) Alter Repair Sewer: $0.00
5.) Dwy Culvert: $0.00 19.) Storm Drain: $000
6.) Street Cut: $0.00 20.) Catch Basin per ea: $0.00
7.) Other RIW: $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.) RIW Use Perm: $0.00
10.) Comm Water Serv: $0.00 24.) Admin Cost (D.RA) $0.00
11.) Other Water Service: $0.00 25.) DRA $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: $000 Balance Due: $0.00
MAY 26 2004 15:36 FR TRAFTON B
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Permil To Perform Work In Street Iljih~f-Way
Approved;
Water Department - Superintendent
Date
5/21/04
Phone:253-473-0788
f'A'x. 2-S'3- 71-1~2'i
Cllmplylng wilh all Municipal Ordinances;
Notifying rhe Streer Superintendent of the time the work wi1lstar:. and when (r will finish;
ProsecutinG tile "'ark witl1 dilillcnce and with due respect to all property, conttal:ts. penons'
n&hts and rhe inleresTs and convenience of rhe public;
Dare
Saving Ihe Municipaliry harmless from any and all damages whll:h rtray aCCrue to any person
Or property because of rhis installation or the maintenance thereor;
Complying Wilh following special conditions:
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T. Funston,
Permit applications:
WQ0402766/452C
Thank you,
-Ryan
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This request for permit is for the placement of underground telephone
our customer at the following address:
IBI<6
w651
LAu/C.I05f,AI
BOt.Jl.EVA,cO
This work will require:
Trenching in the R/W (total footage)
Push or bore 2 inch pve or BIP under roadway (total footage)
Push or bore 2 inch Pve or BIP under driveway (total footage)
Push or bore 2 inch P"I .,,' EIP under multiple driveways (total footage)
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Applicant Signature; D,'
Road Number
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