HomeMy WebLinkAbout2125 W 15th St - Engineering
, .
,,-~
ti . . PUBLIC WORKS CONSTRUCTION
and RIGHT-OF-WAY PERMITS
~ City Phone: 206-457-0411, ex!. 124
...dUCANT/OWNER.:,\,YY\ 'J.-e..~+ ' . ADDRESSOFJOB:_J2-IZS. vi J6-M .
WO-{p~'J- / ~ 1 J I .LJ~~
APPUCANT ADDRESS: PHONE ~015 LEGAL OF JOB:'-r ~ ILve$fVIPJJ) "-+"';>
WORK IS lJ OUTSIDE or CJ INSIDE OF TRAVELED ROAD VALUE OF WORK IS:S AJ -z.. 'S L- t(il work is outside roadway
and is equal to or less than S2.000. then permil may be issued 10 other than licensed and bonded contractor.)
PERMIT
00409
PLANS REQUIRED lJ YES CJ NO CONTRACTOR: DATES FOR START & FINISH
PERFORMANCE BOND REQUIRED CJ YES lJ NO AMOUNT: S
PROOF OF INSURANCE: CJ Worlt $2.000 or leSs: S50.000 personal injury, Sloo,OOO per incident, 520.000 property
lJ Work over $2.000: S2OO.000 personal injury. S5oo,OOO per incident. S 1 00.000 properlY
lJ Right of Way Use: S3OO.000 personal injury, S3oo,OOO per incident. Sloo.000 properlY
Permittee undenwIdI that no _ may be cloeed to traffic unl_ approved by tho City Engin_ 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.
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COMMENTS/CONDmONS:
o Inatal1 lJ Repair
lJ WaIormain
lJ SaDitary Sower
lJ Storm DniD
lJ Undo.5'.......i TeiephoaelE1octrical
coD
JtMlTTOTALS S -z... 2. ClO-RECEIPT
# \ 87'0 ISSUED BY: ~
DATE:~f.,
WORK ORDER No.
.00409
OFFICE copy. CANARY PERl\DT
INSPECl10N FEES S
PW~.03 n:zml
INSPI!CJ'OR'S COPY . WI{fJ1;
APPLlCANrS COPY. PII'IK