HomeMy WebLinkAbout525 W 4th St - Engineering
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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
PUBLIC WORKS CONSTRUCTION Issued: 12/19/96 LC Permit No: 597
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION-----------------------_
DEREK THOMSON 525 4TH ST W
525 W 4TH ST Lot: 14
Port Angeles,wA98360 Block: 74 Long Legal:
360/000-0000 Sub: TPA
PROJECT INFO----------------------------------------------------------__________
Work is N/A traveled road value Work: $0.00
Plans Required: N/A
Contractor: R. J. SERVICES
Start:
Finish:
Performance Bond Required: N/A
Proof Insurance:
Work to Perform:
Amount:
Watermain
Sanitary Sewer
/ /
/ /
$0.00
Storm Drain
Underground Tele/Ele
Misc
NOTES--------------------------------------------------_________________
PROJECT
PROJECT FEES ASSESSMENT--------------------------------------------_____________
R/W Excav: *
Sidewalk:
Curb/Gutter:
Driveway:
Dwy Culvert:
Street Cut: *
Other R/W:
Fire Hydrant:
Res Water Serv:
5/8"
3/4"
1"
Comm Water Serv:
1"
1 1/2"
2"
Oth Water Serv:
Water Sys Dev:
Receipt No:
Inspection Fee:
R/W
SANITARY
$40.00
$0.00
$0.00
$0.00
$0.00
$200.00
$0.00
$0.00
$0.00
San Sewer SFR:
San Sewer MFR: *
Add Unit: 0
Other San Sewer:
Sew Tap Wye/Man Tap:
Sew Cap/ W/M Removal:
Alter/Repair Sewer:
Storm Drain Tap:
Catch Basin per ea:
Sewer System Dev:
Milwaukee Dr. Sew Assess:
R/W Use Perm:
D.R.A. :
Admin Costs (D.R.A):
Misc:
$0.00
$30.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
------------------------------
------------------------------
$0.00
$0.00
$0.00
TOTAL FEE:
AMT PAID:
$0.00
WATER
BAL DUE:
DWY
STORM
DRA
OTHER
$270.00
$270.00
$0.00
Separate Permits are required for electrical work, utilities, private and public improvements. This permit becomes null and void ~ work or
construction authorized is not commanced within 180 days, ~ construction or work is suspended or abandoned for a pariod of 180 days atter
the work as commenced, or ~ required Inspections have not been requested within 180 days from the last inspection. I heraby certify that I have
read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work
will be complied wit whether apecified herein or not. The granting of a parmit does not presume to give authority to violate or cancel the
provisions of a y or loc law regulating construction or the performance of construction.
Date
Si nsture of Owner ~ owner la builder
Date