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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, W A 98362
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PUBLIC WORKS CONSTRUCTION Issued: ?! /Zhr'7crTF Permit No: 986
& RIW PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
FIRST FEDERAL SAVINGS 535 1ST ST E
105 W 8TH ST Lot: 19~z..O
Port Angeles,WA98362 Block: NJe5 Long Legal:
360/417-3111 Sub:
PROJECT INFO--------------------------------------------------------------------
Work is N/A traveled road Value Work: $0.00
Plans Required: N/A
Contractor: CITY OF PORT ANGELES
Start:
Finish:
/
/
/
I
Performance Bond Required: N/A
Proof Insurance:
Amount:
~-
~
$O.OO~
~
Work to Perform: INSTALL * Watermain Storm Drain
Sanitary Sewer Underground Tele/Ele
Misc ~
PROJECT NOTES------------------------------------------------------------------~
---\
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PROJECT FEES ASSESSMENT---------------------------------------------------------
R/W Excav: $0.00 San Sewer SFR: $0.00
Sidewalk: $0.00 San Sewer MFR: $0.00
Curb/Gutter: $0.00 Add unit: 0
Driveway: $0.00 Other San Sewer: $0.00
Dwy Culvert: $0.00 Sew Tap WyelMan Tap: $0.00
Street Cut: $0.00 Sew Cap/ W/M Removal: $0.00
Other R/W: $0.00 Alter/Repair Sewer: $0.00
Fire Hydrant:. $0.00 Storm Drain Tap: $0.00
Res Water Serv: $0.00 Catch Basin per ea: $0.00
5/8" Sewer System Dev: $0.00
3/4" Milwaukee Dr. Sew Assess: $0.00
1" R/W U~e Perm: $0.00
Comm Water Serv: $0.00 D.R.A.: $0.00
1" Admin Costs (D.R.A): $0.00
1 1/2" Misc: $0.00
2 II ==============================
Oth Water Serv: * $4,442.00
Water Sys Dev: $0.00
TOTAL FEE:
AMT PAID:
$4,442.00
$4,442.00
Receipt No: 5353
Inspection Fee:
$0.00
BAL DUE:
$0.00
RlW
SANIT AR Y
WATER
DWY
STORM
DRA
OTHER
Separate Permits are required for electrical work, utilities, private and public improvements. This permit becomes null and void if work or
construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days
after the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify
that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing
this type 'of work will be complied with whether specified herein or not. The granting of a permit does no res to give authority to
violate or cancel the provisions of any state or local law regulating con~~n or h:?:.rf,.9onance of tr
Signature of Contractor or Authorized Agent
Date
Date
s
~~
CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
c~;z)
PUBLIC WORKS CONSTRUCTION Issued: ?! /Zhr7crTF Permit No: 986
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT---------------------___PROPERTY LOCATION------------____________
FIRST FEDERAL SAVINGS 535 1ST ST E
105 W 8TH ST Lot: /9 ~z..O
Port Angeles,WA98362 Block: NJe5 Long Legal:
360/417-3111 Sub:
PROJECT INFO--------------______________________________________________________
Work is N/A traveled road Value Work: $0.00
Plans Required: N/A
Contractor: CITY OF PORT ANGELES
Start:
Finish:
/
/
/
/
Performance Bond Required: N/A
Proof Insurance:
Amount:
~
$O.OO~
~
Work to Perform: INSTALL * Watermain Storm Drain
Sanitary Sewer Underground Tele/Ele
Misc ~
PROJECT NOTES-------------_____________________________________________________~
---\
~ /[t.w ~~-~mHZl~~
PROJECT FEES ASSESSMENT-----------______________________________________________
R/W Excav: $0.00 San Sewer SFR: $0.00
Sidewalk: $0.00 San Sewer MFR: $0.00
Curb/Gutter: $0.00 Add Unit: 0
Driveway: $0.00 Other San Sewer: $0.00
Dwy Culvert: $0.00 Sew Tap Wye/Man Tap: $0.00
Street Cut: $0.00 Sew Cap/ W/M Removal: $0.00
Other R/W: $0.00 Alter/Repair Sewer: $0.00
Fire Hydrant:. $0.00 Storm Drain Tap: $0.00
Res Water Serv: $0.00 Catch Basin per ea: $0.00
5/8" Sewer System Dev: $0.00
3/4" Milwaukee Dr. Sew Assess: $0.00
1" R/W Use Perm: $0.00
Comm Water Serv: $0.00 D.R.A.: $0.00
1" Admin Costs (D.R.A): $0.00
1 1/2" Misc: $0.00
2" ==============================
Oth Water Serv: * $4,442.00
Water Sys Dev: $0.00
Receipt No: 5353
Inspection Fee:
TOTAL FEE:
AMT PAID:
$4,442.00
$4,442.00
$0.00
-----------------------
BAL DUE:
$0.00
RlW
SANIT AR Y
WATER
DWY
STORM
DRA
OTHER
Separate Permits are required for electrical work, utilities, private and public improvements. This permit becomes null and void if work or
construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days
after the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify
that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing
this type 'of work will be complied with whether specified herein or not. The granting of a permit does no res to give authority to
violate or cancel the provisions of any state or local law regulating con~~n or h~?:.rf..9onance of co tr Q.
Signature of Owner (if owner is " rIder)
Date
Signature of Contractor or Authorized Agent
Date
"
. "
COST ANALYSIS
WORK ORDER NO.
LABOR 1,(, '1S. ~;z CITY OF PORT ANGELES PERMIT NO.
EQUIPMENT 979. ;1.t> PUBLIC WORKS DEPARTMENT ACCOUNT NO.
/5()fo.O/ WORK ORDER REPORT
MATERIALS Wtl/UcV DATE
TAX
$ 'iJO~().1 ~ DIVI ION
TOTAL -;1/1-12-~
. 0 DEPOSIT PAID AMT. S
CHARGE TO 0 . BALANCE DUE S
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ADDRESS 0 REFUND DUE S
DESCRIPTION' LOCATION'
SPECIAL INSTRUCTIONS. - s+-; VV\ c.. + c.. O",l'l 40 gf) +- 3/./2
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