HomeMy WebLinkAbout513 S Lincoln St - Engineering
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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, W A 98362
PUBLIC WORKS CONSTRUCTION Issued: 1/24/99 TF Permit No: 916
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
JAY KETCHUM 513 LINCOLN S
513 LINCOLN STREET Lot: 9
Port Angeles,WA98362 Block: 200 Long Legal:
360/000-0000 Sub: tpa
PROJECT INF~~~~-i~-;/~-----~~~~~~~~-~~~~----------------~~~~~-;~~~~-------$~~~~-~
-
Plans Required: N/A
Contractor: CITY OF PORT ANGELES
Start:
Finish:
/ /
/ /
~
$0.00 V'
s::-
Storm Drain ~
Underground Tele/Ele ~
Misc ~
PROJECT NOTES-------------------------------------------------------------------3
renewal of 2 water services @ 509 & 511 South Lincoln
payment is for 3rd service @ 513 South Lincoln
Performance Bond Required: N/A
Proof Insurance:
Amount:
Work to Perform: INSTALL * Watermain
Sanitary Sewer
PROJECT FEES ASSESSMENT---------------------------------------------------------
R/W Excav:
Sidewalk:
Curb/Gutter:
Driveway:
Dwy Culvert:
Street Cut:
Other R/W:
Fire Hydrant:
Res Water Serv:
* 5/8"
3/4"
1"
Comm Water Serv: *
1"
1 1/2"
2"
Oth Water Serv:
Water Sys Dev:
Receipt No: 4651
Inspection Fee:
R/W
SANIT AR Y
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
San Sewer SFR:
San Sewer MFR:
Add unit: 0
Other San Sewer:
Sew Tap Wye/Man Tap:
Sew Cap/ W/M Removal:
Alter/Repair Sewer:
Storm Drain Tap:
Catch Basin per ea:
Sewer System Dev:
Milwaukee Dr. Sew Assess:
R/W Use Perm:
D.R.A. :
Admin Costs (D.R.A):
Misc:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
------------------------------
------------------------------
i nature of Contractor or Authorized Agent
Date
$550.00
$0.00
$0.00
TOTAL FEE:
AMT PAID:
$0.00
WATER
BAL DUE:
DWY
STORM
DRA
OTHER
$550.00
$550.00
$0.00
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 pro .sions of laws and ordinances governing
this type of work will be complied with whether specified herein or not. ranting of a p it does not presume to give authority to
violate or cancel the provisions of any state or local law regulating structio or the perf ce of construction.
I~ 2>--- /
Date
ROUTING SLIP
";(d.';o Certificate of Occupancy
$47.00 Certificate/Inspection Fee
New Business .................~..
Transfer of Business location. . . 5~/5:~7 ..
Change of Ownership . . . . . . . . . . . . . . . . . . . . . .
New BUilding . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Remodel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Temporary Business ..................... .
Change of Use. . . . . . . . . . . . . .. ............
/2.. 1/2 ,03
DATE
Address of Proposed Business
.)1 ~ ~ L//VCOLIV
Applicant \1\/61 GtJ I W PfT([tfB,e5
Address Z- 32- IV '7 <tb- t::> J
rORr f7-flIG &L-.f5 j w/T- 't 52G2-
home 0/..1)7 -:558 'J
.
Phone'
business
v
Bnef description of proposed business: MeA 770 III Foe. I J'V1€ GT/ db 5
MJt?O. /2 NOON ) Tfft~I2'5Do/ IO}i~O ': 5:30 PI///}
Block
legal Descnption' lot
Current Use of Property:
ZOning Classification of Property:
Will THERE BE ANY OF THE FOllOWING?
Construction changes .... . .
Electncal changes
Mechanical (heating, cooling, stoves)
Plumbing changes
New or relocated signs
New septic tanks
New sewer service ...
AdmiSSion charged to patrons
Is this a home occupalion? ..
Excavalion of filling of lots
Work done In City nght-of-way
Is there sufficient off-street parking? .
New dnveway openings
A grading plan for site drainage
(parking lots, downspouts, etc )
Are the eXisting streets paved?
Are there eXisting Sidewalks? . ..
is there curb and gutter?
Other
~
Subdivision
THE FOllOWING Will BE REQUIRED:
PERMITS
1) BUilding
2) Plumbing
3) Electncal
4) Mechanical
5) Sewer
6) Sidewalk Installation
7) Dnveway Installalion
8) Curb Installation
9) Sidewalk obstruction
10) Water meter installation
11) Fire
12) Occupancy
13) Sign
14) Shoreline
15) Home occupation
16) Condllional use
17) Other
BUSINESS LICENSE
1) Taxi
2) Peddlers
3) 2nd Hand Dealer
4) Pawn Broker
5) Dance
6) Hotel - Motel
7) Fireworks
8) Ambulance
9) Tattoo shop
1 0) Other
I hereby apply for a Certificate of Occupancy and acknowl-
edge that I have read this application and state that the Date:
information I have supplied is correct to the best of my
knowledge. Signed:
Building Section
Public Works Department
Planning Department
Fire Department
City Clerk
P.B.I.A.
Comments / Conditions