HomeMy WebLinkAbout1303 Golf Course Rd - Engineering
PUBILlC WORKS & R/W PERMIT Issued: 6/18/2004
I l Attached Notes
OWNER/APPLICANT -'==------------- PROPERTY LOCATION
,
DOROTHY SCHMUCK i 1303 GOLF COURSE RD
307 MT PLEASANT RD I Lot:
Port Angeles, W A 98362 Subdivision:
000/604-7552 I Parcel No:
PROJECT INFO ' --------
Work is: Value Work:
Permit No:
Work Order:
1405
o
Block:
063013230110
[6) Long Legal
$0.00
Plans Required: Start Date: 1 1 Finish Date: 1 1
Contractor: OWEST COMMUNICATIONS 3601000-0000
Performance Bond Required: Amount: $0.00
Proof of Insurance:
Work 10 Perform: [6) Install D Sanitary Sewer D Misc
D Repair D Storm Drain
D Watermain 1[6) Underground Tele/Elec
PROJECT NOTES
24' push under Golf Course Rd at above address
FEES ASSESSMENT
1.) R/W 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 Capl W/M 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: $000
10.) Comm Water Serv: $0.00 24.) Admin Cost (D.R.A) $0.00
11.) Other Water Service: $0.00 25.) D.R.A. $0.00
12.)Water System Dev: $0.00 26.) Misc: $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
JUN
18
2004
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11
42 FR TRRFTON B
253 471
1324 TO 13604174709
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Tacoma, 'WA 98409
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To: City ofPort Angeles Fax: 360-417-4709
From: Qwest Communications Oats: 06/18/04
Re: Pages: 5
cc: Ryan Fuqua
o Urgent o For R&\Il&w o Please Comment o PI_ Reply o Plaas8 Recycle
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NolD&:
T. FWlston,
P.ennit applications:
WQ0403050/452M
.TIiltnk you,
-Ryan
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APPLICATION is l1er~by made to the municipality of PORT ~lO'l: . to perform work as
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THE ABOVE APPLlCA TION IS HEREBY GRANTED SUBIEcr TO APPl.ICANr'S: ;;,;;,;
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Complying With all Municipal Otdinances;
Notifying the Street Superintendent of the time the work will sta..:. and when it will fInish;
ProseCUting the wark with diligence and with due respeCt ta all propsrt)', contracts, psnon.'
rishts and the interests and convenience of the public;
Saving the Municipality harmleu (111m any and all damage. whIch r~ay accru~ to any penon
or propcny beC81.lte of this inltallatlon or the maintenance thereof;
following specllll conditions:
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This request for permit is for the placement of underground telephone
0'..lr customer O,t the following address:
This work 'Nil! reauire:
Trenching in (he R/W [tOtal footage)
5"
P'..lsh or bore 2 inch PVC or SIP under roadway (total footage)
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Push or bore 2 inch PVC or SIP under driveway (total footage)
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Push or bore 2 inch PVC or SIP under multiple driveways (total footage) [)
** TOTAL
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PAGE.03 **
DW- 2--00,-1-1-9)
~~~~ry
CITY OF PORT ANGELES /
,/
DEPARTMENT OF PUBLIC WORKS /
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
REQUEST .
Date d... - J.... \ - 6 t Time
Received by
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
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Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other (JJi"C+CV''''
INSPECTION NOTES
Inspected
Remarks
Date
Time
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By
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RESTORATION REQUIRED JJ.1\ YES
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NO J/
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SURFACE RESTORATION.
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 pcc
o Repaired by City
[] Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
o Other
l1q3
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)