HomeMy WebLinkAbout8th & Evans St - Building
r'~ PUBUC WORKS CONSTRUCTION PERMIT ....ll..O.i1..4
r= and RIGHT-OF-WAY PERMITS
~. City Phone: 206-457-0411, ext. 124
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.......UCANT/OWNER:...l1S.1 L){)Sr(1J)Y!itn. . ADDRESS OF JOB: J? Q f[ Q EVf+1iS
APPUCANT ADDRESS: PHONE LEGAL OF JOB:
WORK IS [J OUTSIDE or [J INSIDE OF TRA VEUD ROAD VALUE OF WORK IS:S (If work is outside roadway
and is equal to or less than S2.000, then permit may be issued 10 other than licensed and bonded contractor.)
PLANS REQUIRED [J YES [J NO CONTRACTOR: DATES FOR START & FINISH
PERFORMANCE BOND REQUIRED [J YES [J NO AMOUNT:.S
PROOF OF INSURANCE: [J Work $2.000 or leSs: S50.000 personal injury, S 100,000 per incident. S20.000 property
[J Work over $2.000: S200,000 personal injury, S500.000 per incidenl, SIOO,OOO property
[J Right of Way Use: S300,000 personal injury, S300,000 per incident, $100,000 property
Pemiitllle \IIIdentaIIda that DO _ may be e(need to traffic unI... approved by tho City Enem- and Chiof of Police in advmco of the
closuno; that there is a 24 hour m;n;mnm notice prior to inspection, and to call 48 bours before digging 10: 1-800-424-5555.
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mil............ - rrolM DlAD'f TAl' 1115.00
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WATD.IYS. DEY. C'HAI.OI mo.oo IEWW TOTALS I I
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COMMENTS/CONDmONS: II i I _ "" "".' a. ~
[J InIlaIl C Repair U ~ PUS l-\- '6' P V 6 f\J.-6lX.h, ~ 6 .~
C WalonDaiD L ( . A 7T:- f'lJ ~ '
CSaaitarySowor ~ a.q f!.;:J1./hf {..vi~ //)c
[J SlorIII DraiD j- ~
[J UIIIIergroaDd ToIcpboaeIEloctrical 0 -
JWIT TOTALS $
RECEIPT
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ISSUED BY:
DATE:
lNSPEcnON FEES $
pw~.m (l2J93)
INSPIlCI'OR'S COPY. WllJT1l APPLICAIn"S copy. PINK omCE COPY . C~AAY PERl'dIT
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