HomeMy WebLinkAbout1519 S I St - Engineering
PUBILlC WORKS & R/W PERMIT
D Attached Notes
OWNER/APPLICANT
Summers Properties
Issued: 7/16/2004
Permit No: 1407
Work Order: 0
PROPERTY LOCATION
15191STS
Lot:
Subdivision: tpa
Parcel No:
Block: 435
Port Angeles, W A 98360
000/600-0000
PROJECT INFO
Work is:
D Long Legal
Value Work:
$0.00
Plans Required: Start Date: 1 1 Finish Date: 1 1
Contractor: QWEST COMMUNICATIONS 360/000-0000
Performance Bond Required: Amount: $0.00
Proof of Insurance:
Work to Perform: I:><:i Install D Sanitary Sewer D Mise
D Repair D Storm Drain
D Watermain [:>-g Underground Tele/Elec
PROJECT NOTES
placement of 175' of buried service line @ 15th & "I" 81. including
25' road push across "I" St
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 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 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.R.A) $0.00
11.) Other Water Service: $0.00 25.) D.RA $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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JUL 15 2004 16 00 FR TRAFTON B
253 471
1324 TO 13604174709
7850B S. Tronan
Taooma, W A 98409
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To: City of Port Angeles Fax: 360-4174709
From: Qwesl Communications Dale: 07/15/04
Re: Pages: 5
ce: Ryan Fuqua
o Urgent o For R8\II9w o Please Cornmanl o Please Reply
o Pleasellacycle
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NolB&:
T. Funston,
Permit applications:
WW0401626/452C
Thank you,
-Ryan
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Water Oepanrnent - Superintendent i'i;)"i;/~"':(;;
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The estimated time for completion of'the above work is II) -DA,VS A'PT'e{L "P'~~i':c::;;l~~.\lW]
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JUL 15 2004 16:01 FR TRRFTON B
253 471
1324 TO 13604174709
~'1" <&Ved g)~
PUlI..c WCll'I(S
Perform Work In Street Right-of-Way
N is her:by made [0 [he municipality of PORI' ANGE:tEs
. to perform work as
nOTed hereon and as show" on anached draWing:
Placement of buried
to Include 175 feet
service wire for our customer at 1519 I
on the right-of-way with a 25 foot road
Approved:
Date
July 14
By F UQV4
I.DO If
,
Phone:253-473-0788
tAX 2. S3 - il7/- (52.,/
Contractor Owner X
DWE.ST /A1T-i~ ;BSw iDOIV\
7~S()4:;; TI'-lr:rt7N T"1<0"'14/ 'v'l
,
THE ABOVE APPLfCAT10ll/ IS HEREBY GRANTED SUBJEcr TO APPI.JCANT'S:
Complying with all Municipal Ordinances;
Notifying the Street Superintendent of the time the work willstllr:, and when It will finish;
Prosecuting the work with di1l&cnee and with dum respect to all property, conlr.l;lS, penons'
rights and the interesTs and convenien~ of the P\lblk;
Date
Saving the Municipality harmless from any and all damage. which rnay aCl;rue TO any penon
or properly because of this installation or The maintenance thereof;
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JUL
15 2004
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FR TRAFTON B
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P.03/03
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** TOTRL PRGE.03 **
Qwest Job #
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This request for permit is for the placement of underground telephone se
oUr customer at the following address:
15/q I ST .--.------.-.
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This work will require:
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Trenching in the R/W (total footage) I :L
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 pve or BIP under multiple driveways (total footage)
Applicant Signature/Date -6::;;il...;o ? ~ IS - 0 '/
Road Number
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