HomeMy WebLinkAbout1408 Shirley Ct - Engineering
S-~'
~ . and RIGHT-OF-WAY PERMITS
W City Phone: 206-457-0411, ext. 124
..iUCANTIOWNEIL"I, "'" \!wx,,~. AD~RESS 0"0.,--111) 8: ~ ~'I
APPUCANT ADDRESS: PHONE ~~~~LEGAL OF JOB: L \l. ~~'1V,ewths
WORK IS [] OUTSIDE or [] INSIDE OF TRAVELED ROAD VALUE OF WORK IS:$ }.j"Z.. '51.- (it Jork is outside roadway
and is equal to or 1... than $2,000, then permit may be issued to other than licensed and bonded contractor,)
PLANS REQUIRED [] YES [] NO CONTRACTOR: DATES FOR START
PERFORMANCE BOND REQUIRED [] YES [] NO AMOUNT: $
PROOF OF INSURANCE: [] WorIt 52,000 or leis: $SO,OOO personal injury, $100,000 per incident, $20.000 propeny
[] Work over 52,000: $200,000 personal injury, $SOO,OOO per incident, $100,000 propeny
[] Right of Way Use: $300,000 personal injury, $300,000 per incident, $100,000 propeny
Permi_ IIIIlIentmda !bat DO IlJeet may be closed to traffic unless approved by tho City EngiDoer and Cbief of Police in advaDco of the
closure: !bat thero is a 24 hour minimum notice prior to inspoction, and to call 48 hours before digging 10: 1-800-424-5555.
PUBLIC WORKS CONSTRUCTION
PERMIT 00410
& FINISH
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COMMENTS/CONDmONS:
lJ IDIlaI1 [J Repair
lJWatormain
[J Saaitary s-
[J Storm DraiD
[J Utodwl'.......l TelepbonoIEloctrica1
(q:, S~ -- RECEIPT
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.JtMlT TOTALS $
c( <& 7 7 ISSUED BY: k
DATE: <.../ ~ 1'7f,
---- ~
WORK ORDER No.
OFFICE copy. CANARY PERMIT 0041 0
INSPECl'ION FBES $
PW.0209.03 (\21931
lNSPIlCI'Oll.'S COPY " WIllI'E
APPLICANT'S COPY . PINK