HomeMy WebLinkAbout240 W Front St - Engineering
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....-s'UCANT/OWNER: C J.t '1 L~ ~
APPUCANT ADDRESS:
PUBLIC WORKS CONSTRUCTION
and RIGHT-OF-WAY PERMITS
City Phone: 206-457-0411, ext. 124
ADDRESS OF JOB:.J>O\IJh\1')~UV1 -
PHONE LEGAL OF JOB:
PERMIT 0 0 4 34
FtV5T./6-ont
I-t~-(,I VIeS '\l i:: -\-c ,:r,
WORK IS [J OUTSIDE or 0 INSIDE OF TRAVELED ROAD VALUE OF WORK IS:$ (If work is outside roadwa'
and is equal to or less than $2,000, then permit may be issued to other than licensed and bonded contraclor.)
PLANS REQUIRED 0 YES 0 NO CONTRACTOR: DATES FOR START & FINISH
PERFORMANCE BOND REQUIRED 0 YES 0 NO AMOUNT: $
PROOF OF INSURANCE: 0 Worle $2,000 or leis: $50,000 personal injury, $100,000 per incident, $20,000 property
o Work over $2,000: $200,000 personal InJUry, $500,000 per lDcident, $100,000 property
o RighI of Way Use: $300,000 personallDjury, $300,000 per lDcidenl, $100,000 property
Pcrmilleo IIIldcrstands tbat no street may be closed to traffic unIeas approved by the City Engineer and Chief of Police in advance of th<
clOSW'll; that there is a 24 hour minimum notice prior to inspection, and to call 48 hours before dlgglDg to: 1-800-424-5555.
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""" ';:,.,,;, "",. "fl'O I I FEE I R.E.Q'O I PAU)
'EE PAU) TYPE -
WHTOf WAY EXCAV. "'.00 ~ A/~/ ~~)EWE..R (SFRJ W 10 P/L, 6.~~' ~oo
"'.00 / SAN. Sf.WER. rJ...FRl. lll...ul "'.00
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lIlXlUTTEIl 1m.oo SAN SEWER (MFR). ADD. UNIT 1',00
DIUVIlW. Y m.HXl SAN SEWER OTHERS. MiD-m,w, $O.CWIII
Mp;-S.1:1O \00 tx:X:\r.IM.t(m UOCU ~
""" CUl.VDT "'.00 sEWER. TAP. BY CITY NO SJ1HXVSXX),OO
wYElMANHOLE TAP
rnqrcur_ ~ s.4nJ.oo SEWER CAPiWATER METER. SW.OO
REMOV Ai.
0THEl IJOHT Of WAY WOJU( $<0.00 ALTERATIONI 130.00
REPAfR TO SEWER
DEPOSIT STORM DRAIN T...P Sl2.S,oo
1UiS. WATEJlID\1CE I" x 5/1" lj:iO.OO CATCH 8...SI1'o'S IN LOTS PER EACH S<lO.OO
lFJ. WATEJ, SEJ.V1CE I' X 3'''" lj75.oo SECONDAJl.Y SEWER ASStsS. ~IO.OO in S61~ 00 ou.1doe
'~W'''''' "X I- ""'.00 SE\VER SYS. DEV. CHARGE t32A.00IE\';'M
COW... WATEJ. SD.VlCE l. - S.I,<Xt> MlLWAUKE..E DR. SE"'NER ASSe.s.s. SI.'O.OORNM
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WATTI'R 1EJ.VJC'E.0T'HEIt EmM'T1! RJOHT OF WAY USE PERMITS VARfES S~. SIOO
WATEI m. OOV, CHAlOE S7.'O.OO/E'llo'M TOTALS , ,);//f~
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aWatermain (P/p77,P/e:.. c:/ec-/
a Smitary Sewer
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-"JtMITTOTALS $ RECEIPT ?4d' ISSUED B~l%--?t-~
DATE:4/; /c;{
INSPBCTION FEEs $
WORK ORDER No,
(f(J43I1
INSPECTOR'S copy, WHITE APPLICANT'S COPY, PINK OFFICE COPY, CANARY PERMIT
PW.0209 ,03 (12193)