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PUBILlC WORKS & RJW PERMIT
D Attached Notes
OWNER/APPLICANT
Issued: 9/15/2004
Permit No: 1414
Work Order: 0
PROPERTY LOCATION
1502 N ST S
Lot:
Subdivision: Pilot
Parcel No:
Block:
0001000-0000
PROJECT INFO
Work is:
D Long Legal
Value Work:
$0.00
Plans Required: Start Date: 1 1 Finish Date: 1 1
Contractor: QWEST COMMUNICATIONS 3601000-0000
Performance Bond Required: Amount: $0.00
Proof of Insurance:
Work to Perform: ~ Install D Sanitary Sewer D Misc
D Repair D Storm Drain
D Watermain ~ Underground Tele/Elec
PROJECT NOTES
dig a splice pit on "N" St south of 14th at closure # 14.5
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 WIM 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.) 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
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PI IRI Ie WORKS
Permit To Perform Work In Street Right-of-Way
APPLlCA TION is hereby made to the municipality of PORr ANGELES
to perform work as
noted hereon and as shown on attaehert drawil'g: JOB # 42~IK310 ENG: DIANE HAGER 360-417-2174
DIG A SPLICE PIT ON "N" ST, SO\JTH OF W 14th. AT CL05URE. # 14.5
Q~'~EST
ENGINEERING
611 6TH ST
BREMERTON WA 98337
FAX 360-478-5639
e
/4/4
Approved:
Water Department - Superintendent
Sewer Department - Superintendent
The estimated time for completion of the ahove work is
SEPTEMBER 24, 2004
Date
AUGUST 25, 2004
By JUDY GRATRIX, FOR Qwest
360-478-5636
Contractor Owner X
(check one)
THE ABOVE APPLICATION IS HEREBY CRANTED SUBJECT TO APPLICANT'S
Complving with all Municipal Ordinances:
NotifYlIlg the Streel Superintendenl of the time the work will start. and when it will finish:
Pros\..'".'uting the \vork with diligence and with due' respect to all property, contracts. !1l?rsons'
ri~hts Jnd the intl'fl..'sts ;.iIld convl?nience of the public:
S~jving th.... Municip:_t1ity h;Hmless from any and all d3mJg~s which may accrue to any person
Or propl'rly beCause of this install3tion or the maintenance thereof:
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