HomeMy WebLinkAbout505 S M St - Engineering
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PUBLIC WORKS CONSTRUCTION
and RIGHT-OF-WAY PERMITS
City Phone: 206-457-0411, ext. 124
PERMITU U 4 ~ 7
.vtUCANT/OWNER: J\W"\ Si-V-Ol^\i-::.
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APPUCANT ADDRESS: PHONE LEGAL OF JOB:
WORK IS 0 OUTSIDE or 0 INSIDE OF TRAVELED ROAD VALUE OF WORK IS:5 (If work is outside roadway
and is equal to or less than 52,000, then permit may be issued 10 other than licensed and bonded conlractor.)
PLANS REQUIRED 0 YES 0 NO CONTRACTOR:J)IAvvlOY"€\ Q,"'>T DATES FOR START
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PERFORMANCE BOND REQUIRED 0 YES 0 NO AMOUNT: 5
PROOF OF INSURANCE: 0 Worle 52,000 or leSs: 550,000 personal injury, 5100,000 per incident, 520.000 property
o Worle over 52.000: 5200,000 personal injury, 5500,000 per incident, 5100,000 property
o Right of Way Use: 5300,000 personal injury, 5300,000 per incidenl, 5100,000 property
Permitteo UJ1dentaIlda that no .Inlet may be closed to traffic unI... approved by the City Engin_ and Chief of Police in advance of the
c1osun:; that there is a 24 hour minimum notice prior to inspection, and 10 call 48 hours before digging to: 1-800-424-5555,
ADDRESS OF JOB:
505
1/ [I
"3,.., lJ T +-\ M..
LT I D B l K \ 4~
& FINISH
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lIOKT OF WAY EXCAV. ...,., 4()~ S~. SEWEll (Inl to" WI PI\. 6-...... SIll'" ~O~ I
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0_,.,. SAN. SEWn tun:\. I tI\nit "'.110
<BIllI11'ml 1125.00 SAN SEWEIlIUF'R' . AOO. UNrr u,.,
DllVEWAT SIZSJlJ SAN lEWD. OTHDS . MiD-J73i.oo: ~"':r!.~.cxm u_
Ma-">>
~CULYDT ......, IEWEI TAP . BY C1TY NO Slzs.m.u:oDJ
HOLE TAl
mEET cvr . ...... DJO'" ....--- 700~ lEWD CAlfWATD. MEfER SZlS,tIJ
UMOVAL
011CD lIOKT 0' WAY woax ......, ALTD.ATIONI 130.110
aEPAra. TO SEWD.
mE HYIlO.V<T DEPOSIT STORM DRAIN TAP SllJ,CD
m.WATEJtSEllVIC'EI"X1'1" ~ 00
""'.110 CATCH BASINS rN lOTS PEJ. EACH ....110
m. WATEI. SDV1CE I. X ]1." U",., SECONOAAY SEWER ASSESS. 1-410.00 In UU.OO ClO.&u)e I
m. WA,-n ~VK:E I" X I. ~,., . to <701 eE- I
S~SYS.OEV.CHARGE
COWW. WATD SD\1CE I" - u,cm MQ.WAUKEE DR. SEWD ASSESS. ,,,om 1EWM
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WATEI. SEJl.VICE. oniEl EmMAYl! RIGHT OF WAY utE PERMrTS VARIES IS. SlOO
WATEJt SY$. DEV. CHAaOE 11~.co1EWM ~,.,~ I I PO
TOT ALl -
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COMMENTS/CONDmONS: 'I 11_
[J[J~..~nRepair C.OV\~T.e..uc..T "5ID6WfH-K A.-L.Otl'1 S-t:f., 5T ~D /4 .5/.
DSauilarySewer C'T<I To COnsTR.LJLT - MR. Sll2-0YlC] \ 0 ?4~
o Storm Drain ~ R- e 0 he Y-e_ Ie.- VY'l A [<2 or l N LOn L-l .--
DU~TelephonelEIectrica1 ~I5PR..Dn,{.~, OF ~V"i~L '1"/ ;:>OO~
~IOOTTOTALS $ ,;;(qr5~RECEIPT # W;~ ffiiffD BY: ~ DATE:1PJ1~
PW.0209.03 (121931
INSPECroR'S COPY . WHr\'E APPUCANT'S COPY. PINK
WORK ORDER No.
00427
OFFICE COPY. CANARY pERl\fiT
INSPEcnON FEES $
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