HomeMy WebLinkAbout203 E 11th St - Engineering
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PUBliC WORKS CONSTRUCTION
and RIGHT-OF-WAY PERMITS
City Phone: 206-457-0411, ext. 124
PERMIT 00425
...dUCANT/OWNER: Of\.{) I"t:> Lu"..... ADDRESS OF JOB: Z 0 ~ S-
APPUCANT ADDRESS: PHONE LEGAL OF JOB: 5 z.. I D <1- II ~ II<. .:32: 4
WORK IS 0 OUTSIDE or 0 INSIDE OF TRAVELED ROAD VALUE OF WORK 15:5 (If work is outside roadway
and is equal to or less than $2.000. then permit may be issued to other than licensed and bonded contractor.)
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pLANS REQUIRED 0 YES 0 NO CONTRACTOR:
PERFORMANCE BOND REQUIRED 0 YES 0 NO AMOUNT: 5
PROOF OF INSURANCE: 0 Work $2,000 or leSs: $50.000 per.;onal injury, $100.000 per incident. 520.000 property
o Work over $2.000: 5200.000 per.;onal injury. $500.000 per incident. 5100.000 property
o Right of Way Use: $300.000 per.;onal injury. $300.000 per incident. 5100.000 property
Permillell undentaDda that no atreet may be closed to traffic unless approved by the City Engineer and Chief of Police in advance of the
closure; that there is a 24 hour minimum notice prior to inspection. and to call 48 hours before digging to: 1-800-424-5555.
DATES FOR START
& FINISH
lit . . db; ct,....... .............a,fII....AaeNM.....,fllillCIIl'IbnfJt~.-ubl.............IOIlII~fr-....IIaWIlJ'.~
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Sipd:-,()7N1 /, / DATE: -::: r./c;t:,
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'. . . TY?E ../.. FEE .=0 PAID TY?E fEE o<n'o PAID II
\ JJQHT OF WAY EXCAV. .....00 --- 4f)~ SAI"II. SEWER tSFIl.l (6' \00 p~ 6'1.- 110.00 --- )( () <2Q!
.....;.-
SIDEW". "".00' SAN. sEWD tuFJ.'. hl..Dt .~.OO
.woum;a. 1115.1:0 SAN SEWEll nABl. ADO. UNrT U.OO
DlIVEWA Y SI15m Y7J SAI\IIEWEI. 0TliEU. Io4la-Uj.tO; 50.(1)> hi
lota-57X1 looo:n.rJ1O.OO'1:IuczM
DWY CULyBT ....... U SEWD TAP. BY CITY tlO SI1S,OOJS.)OO.OJ
wYElMAHHOU TAP
snEEI' cur . ....... .llII.oo (/ lfJ(J o.E SE'ND CAPfWATEJl METEJI. SW.O)
REMOVAL
QT1CEIIJOKT 0' WAY won ....... ALTEllAT1O~1 lJO.CO
J,El'ATJ. TO SEWEJ.
f1>J!~ OEPOSrr rrou,( DRAO\I TAP Sllj.CO I
m. 'NATO SDVICE I- X SII" "".00 --- ~e;/' Dr> CATCH BA..SlNS IN lOTS 'Ell. EACH ....00 1\
m. W"Tn SDV1CE I- X 314" U7S.CO s..IO.OO in ~lj.CO oo.u... i;
SECOlolDAJ. Y SEWER ASSESS. "
m. WAT'f:"I '6'1IVlCE ,- y '" -.00 s~SYs. DEV.CHAAGE S)2HD/EW1ro4 ~4::; 0 D Ii
,
toWN. WATD. SDl.VICE ,'..11,(0) MILWAUKEE DR. SEWER ASSESS. 113O.CO 1E\Wlro4
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WATEJl, SEJtVICE. 0T1IEIl EmMA'" RtoRT OF WAY USE PERMITS VARIES ". $100
WAT'El fYS. DEV. CH..UOE ~ If R.<HP.. TOTALS I I ,0;--
".~'*-....................~.. ,.naiulIlOOOw._tclDlcnbm ill... fOl_ ,..,....NlcJMIiD.. ~ Euap'nfUl if .,..-.~ 10 U. w.~ ofu-c .,_.......iD lb: 1QPUQ10(r.
""-;'-110"""""" ct..Clry 01'" .........w\DeipUCcdI:. ,.,.."." ps..............MaI.I too ......1O_mdIIU. 1l"V"""- .r.Dl. '" of lhI: Cil.. C.......... Suow.<< r.......v-........
COMMENTS/CONDITIONS:
[J InsWl 0 Repair
[JW8IemI&in
o Sanitary Sower
[J Storm Drain
a Underground TelephonelElectrica1
00
.JOOT TOTALS $ 2 3 I' <;,
RECEIPT
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~ / J 70 !:J
# 17s..) ISSUED BY: ~~ ~ DATE:"2,\~rC\6
WORK ORDER No. IT
APPLlcwrs COPY _ PINK OFflCE COPY. CANARY PERMIT 0 0 4 2 5
INSPEcnON FEES $
PW.0209.03 (111931
INSPECTOR'S COPY - WHITE
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PUBUC WORKS CONSTRUCTION
and RIGHT-OF-WAY PERMITS
d I? City Phone: 206-457-0411, ext. 124
....tUCANT/OWNER: ~4L-~ . ADDRESS OF lOB: Z-DO
APPUCANT ADDRESS: PHONE LEGAL OF JOB:
PERMIT
00422
ff.fJ-k" E J /~
WORK IS 0 OUTSIDE or 0 INSIDE OF TRAVELED ROAD VALUE OF WORK IS:$ (If work is outside roadway
and is equal to or less than $2,000, then permit may be issued to other than licensed and bonded contractor.)
PLANS REQUIRED 0 YES 0 NO CONTRACTOR: DATES FOR START & FINISH
PERFORMANCE BOND REQUIRED 0 YES 0 NO AMOUNT, $
PROOF OF INSURANCE: [J Worle $2,000 or leSs: $50,000 personal injury, $100,000 per incident. $20.000 propeny
o Worle over $2.000: $200,000 personal injury, $500,000 per incident. $100.000 propeny
o Right of Way Use: $300,000 personal injury, $300,000 per incident. $100,000 propeny
Pennillco undentmds that no a_ may be closed to lnffic unless approved by the City Engineer and Chief of Police in advance of the
closure; that there is a 24 hour minimum notice prior to inspection, and to call 48 hours before digging to: 1-800-424-5555.
Sipd:
.. . ~""--'~:~~""~_"""'''~fliPad~_''oI'' cdbrI CII'~.a.u......... ____IOU. ~Iraa.., 1WIOIIJ-...-ibilkY
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FEE
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'AID
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FEE
IF.D'D
'AID
lJCiKT Of WAY EXCAV. ...,'" SAN. SEWEJl (SFRI W 10 P/L. 6"..- "'.Ill
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SlIlEWAlJC --.Ill. SAN. SEWn /UF'R', Itl mil "',"
t./ 1//5:'JO SAN SE'W'EJl tuFR\. AOO. UNIT
olUlUTTl:l< sl'Um .::- .".,
D&lVEWA Y 1123.00 SAN lEWD O'I'HD.S. J,tiD-J7j.(X); so.cm lu
J,ta:..'730 IOOooo.L1O.00'23ul;ZJN
~CtJLynT ""'" SEWD. TAP. BY C1TY 1'10 SI1S.o'JISXO.CO
WYElMANHOLE TAP
STUEI' cur . ......... 1Dl'" SEWD. CAJ'N/ATD METER. S:m.CD
REMOVAL
omEI.lJOKT OP WAY WOlX ""'" ALT'EltATlONI 130.00
IlEPAfR TO SEWER
mE IlYDlW<T DEl'OSrr STORM DRAi1'I TAP sm.oo
us. WAT'D SDVJCE t- x.w- W>." CATCH BASiJ'o/S IN lOTS 'Ell EACH S<<I.OJ
US. WAT'D SD.V1C'E I- X )W 1"'.00 SECONDAAY SEWEll ASSESS. ~\o.oo in lOn.OJ Ot.U>Oo:
us. WAT'D SERV1CE ,- X to .-.00 SEWER SYS. DEV. CHARGE U2A.OOiEWr.4
COMM. WATD. SD.VJCE ." - 11,(0) MQ.WAUKEE DR. SEWER ASSESS. SljO.llOlEWM
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WATEJ, SD.V1C'E. 0'THEk
EmMATE
RIGKT OF WAY USE PERMrTS
VARIES Sj. SIOO
"ATn SYS. OEV. CHAaOE
S1~.OO /EWM
TOTALS
I /c:.5UJ
TlliI-w'.-....IiII...,..--'~ iI.,-.l_........doltal.......io-:nb.t iD... fq,1iII~.,....iD_~ E.acap'"",1 ill va- ..-IOu... Ie"" o(lfc I,_-...i iDlbI ~l""
~Of;!~~::~~ijt~I".-~-7;;;;=7;::;:..::€.,h Ce;;;;;~:2J
CJ Sallitary Sewer (l ,
CJ Storm Drain
CJ Uodergroond TelcphonelElectrical
- CO
JOOT TOTALS $ /2>7 '~ElPT
#.-lii::.L ISSUED BY:
DATE:
PW-0209.03 (121931
INSPECTOR'S COPY - W\ITrE APPLICANT'S COPY. PINK
WORK ORDER No.
OFFICE COPY. CANARY PERMIT 004 22
INSPECTION FEES $
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