HomeMy WebLinkAbout704 Georgiana St - Engineering
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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DMSION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
PUBILIC WORKS & R/W PERMIT
o Attached Notes
OWNER/APPLICANT
704 Georgiana
Port Angeles, W A 98362
360/457-5733
PROJECT INFO
Work is
Plans Required
Contractor. OWNER
Performance Bond Required
Proof of Insurance
Work to Perform
Issued
6/27/2000
Perm it No
Work Order.
1074
o
PROPERTY LOCATION
704 GEORGIANA E
Lot: N 1/2 8&9
Subdivision. N R SMITH
Parcel No 063000513950000
Block: 39
o Long Legal
Start Date
Amount:
o Install
IZI Repair
o Watermain
Value Work:
/ /
Finish Date
206/000-0000
$000
o Sanitary Sewer
o Storm Drain
o Underground T ele/Elec
[8J Misc
PROJECT NOTES
replace 30' failing sidewalk and driveway apron
$000
/ /
sidewalk
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 appication and knOlN 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 not presume to give autnarity to Viblate or cancel the
""",,",OM of any slate or local law r_'ating construction orth. POolo'mane. ~co "ction. .(: I d .
. .[ c.-z:;t..~/ .' '. -.;27 d
Si nature of Contractor or Authorized A ent Date i nature of Owner if owner IS build
FEES ASSESSMENT
1 ) R/W Excav.
2.) Sidewalk
3 ) Curb/Gutter.
4 ) Driveway.
5 ) Dwy Culvert:
6 ) Street Cut:
7 ) Other R/W
8 ) Fire Hydrant:
9) Res Water Servo
10) Comm Water Servo
11 ) Other Water Service
12.)Water System Dev.
13) San Sewer SFR
14) San Sewer MFR
add unit:
Receipt No c-
Inspection Fee
$45 00
$000
$000
$0.00
$000
$000
$000
$000
$000
$000
$000
$000
$000
$000
RW
SANITARY
WATER
15 ) Other San Sewer.
16 ) Sew Tap Wye/Man Tap
17 ) Sew Cap/ W /M Removal
18 ) Alter Repair Sewer.
19 ) Storm Drain
20 ) Catch Basin per ea.
21 ) Sewer System Dev.
22.) Milwaukee Dr Sew Ass.
23 ) R/W Use Perm
24 ) Admin Cost (D RA)
25 ) D RA.
26 ) Misc.
TOTAL FEE.
Amount Paid
Balance Due
DWY
STORM
$000
$000
$000
$000
$000
$000
$000
$000
$000
$000
$000
$000
~LJ. S l?2-
$000
$45.00
DRA
OTHER