HomeMy WebLinkAbout1229 E 2ND ST 1I
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�d PUBLIC WORKS CONSTRUCTION PERAUT 0 014 5 11
' and RIGHT-OF-WAY PEiL'�IITS
yam , City Phone: 206-457-0411, ext. 124
.%rd'L,CANTIOWNER: / y ADDRESS OF JOB:_,.
APPLICANT ADDRESS: PHONE _ _ LEGAL, OF JOB:
WORK IS 0 OUTSIDE or 0INSIDE OF TRAVELED ROAD VALUE OF WORK IS:$ (If work is outside roadway.,
and is equal co or iess than $2,000, then permit may be issued to other than licensed and bonded contractor.)
PAS REQUIRED 0 YES 0 NO CONTRACTOR:DATES FOR START & FINISH
PERFORMANCE BOND REQUIRED 0 YES 0 NO AMOUNT: $
PROOF OF INSURANCE: ❑ Work $2.000 or less: $50,000 personal injury, $100,000 per incident, $20,000 property
❑ Work over $2,000: $200,000 iersonal injury, $500,000 per incident. S100,000 property
❑ Right of Way Use: $300,000 personal injury, $300,000 per incident, $100,000 property �\
Permittee undemtands that no street may be closed to traffic unless approved by the City Engineer and Chief of Police in advance of the
closure; that th:re is a 24 hour minimum notice prior to inspection, and to call 48 hours before digging to: I-800-424-5555.
had4ed=d the pe SW6 of thi ptmY. Y is Mnbe qpW by tb .*kwl thr the C* d Pat Ah01W =d =V d u oMfi W old' "Ube Mtsd bomb+. td tb Ipplivn (xm are' U bility m m pt i), tY
for tmD'�, lou v dt p to pnstte a MWNTY. bPP_4 m =wmg u the rj_w _W1 of LW wtt atdsruln+ odor tnc terns of thi. efgliatim L d U. m" b Snmd m eavase
tbww. ud 0" ell d Mid Wbilium V• bemby --d by ds rPpbi . !
DATE:
Sim:
/
T'PE
FEE
RE 'D
PAID
TYPE _
FEE
REQ'D
PAID
RIGHT OF WAY EXCAV.
H0.00
SAN. SEWER (SFR) (61 to P/L. 6'.4'
rtd,amr)
SWLOO
__
SIDEWALJ
SEDM
SAN. SEWER (MFR) • 1.1 out
.00
Amurra Rrrsv 1.
S125.00
SAN SEWER (MFR) • ADD. UNrr
DRIVEW Y
S123.00
SAN SEWER Ort HERS • hlin-$73.DU
5
L=1
M-050
ua�
DWY CJLVFRT
Sp,Oq
SEWER TAP - BY Cr'Y NO
WYE/MANHOLETA,
0— • . mtm4ah
STRFEr cur - 0.4etonum
S211D.D)
SEWER CAPIWATER M, TER
$225.00
REMOVAL
anE3 RIGHT OF WAY WORK
$to=
ALTERATION/
$30.00
REPAIR TO SEWER
FIXE HYDRANT
DEPOSIT
S70Rh1 DRAIN TAP
$123.00
RF. `.EATER SERVICE 1' X 3/8'
15K 00
CATCH BASINS IN LOTS PER EACH
W 00
Rom. WATER SERVICE I' X 3/4.
S375.00
SECONDARY SEWER ASSESS.
S410.00 in S615 00 aa..de
WATER SERVICE ' X I'
5600.00
SEWER SYS. DEV. CHARGE
$324 00'EW'M
-RES.
I COMM. WATER SERVICE
1' - SI.000
MILWAUKEE DR. SEWER ASSESS.
$150.00 lEWM
114E 51.300
000
WATER SERVICE - On
ESTIMATE
RIGHT OF WAY USE PERMrrS
VARIES $S • S100
WATER SYS. DEV. CHARGE
$150.00
TOTAL-S
1
S
Tbb ouWfM lbs the ebms emd epplram i v and the {smuu to do .4 — dumbed to " fa the p urp- tbowe to us W01-0- Firm Pe u Sr ied .-,- io arc — of v e �1rtv.ra ........,,,.., ......
and r *a m tL- peovi k- d tb City d Pat Mpb Mu 11* Codk. ti,Nrry perrviwd bemuau .7s0 be deemed io -114, Us P,_.- of urr .ppli.bk 1- or th Cii., I:ovu.. Su- a Ftda ' Go emrerv.
COMMENTSICONDITIONS:
0 Install 0 Repair
�i�Vatermain (/
n Sanitary Sewer ��v� L ��% ✓C��� �`
❑ Storm Drain
0 Underground Telephone/Electrical
_RMIT TOTALS $_ RECE' .: H ISSUED BY: DATE. /
INSPECT-i0N FEES $ WORK ORDER
PW-0209,03 (12J931 INSPECTOR'S COPY - WHM APPLICANT'S COPY - PINK OFFICE COPY - CANARY PERWT 00 145
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
........... INSPECTION REPORT ...........
REQUEST:
13,3te � . Z 7 41 Time ' ` 10
Received by h , wA ter'='''� (phone, person)
-ocation of Work to be inspected
Name of person requesting inspection
1
Address of person requesting inspection / '•} Phone No.
Type of Inspection (circle appropriate one): Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excay. Other .
INSPECTION NOTES:
Inspected: Date Z - 2 -7 ( Time 6 d By
Remar4s;
RESTORATION REQUIRED ...... YES NO
SURFACE RESTORATION:
SURFACE TYPE: ❑ Unimproved El Gravel
❑ Repaired by City
❑ Repaired by Permittee
❑ No Damage Found
�6'�) o;ae�7I
[' jasphalt ❑ PCC ❑ Other
Wo . Order # S8
7c"OMPLETE
❑ INCOMPLETE
(Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE)
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APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
DEPARTMENT OF PUBLIC WORKS -CITY OF PORT ANGELES, WASHINGTON Permit No. DatePermt SS ed
UPI DING DIVISION j� -'">
DATE,�_�....`.
--- Applicant to fill in between heavy. lines
� �% Valuation
Building — { �L ' ! 2 `2�—
Add►ess j , CLASS OF WORK Building Permit Fee ; l�
Plan Checking Fee - $ ---
9 NAME ` l
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Moil Address �vr
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Ph. No.
O NAME—
ZAddress
City Ph. No.
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NAME^---
--
x,
Address
_city
Ph. No.
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NAME -----
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Address
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City
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license No.
Plans and
Plot Plan {
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3707A . REV 2-82
New
Demolish
-- AI!eration------------ ---- Repair
Total �$
-'� ._._.---..
Addition -"- --
Move
Treasurer's Recei o.
Use of building �! _-r'- - - --
_ - ----- �_Life
of_buiiding % -Ve
of PermitSize
_ ght•
'-
f
No. of rooms ----------------
-- No. of
Application taken b y ` r .
_Families
----------- of L_w---
No. of flooTSPE
.......
Date review completed
_Sme
- No. of BldgUse of Bldg. _
Now on lo
- iltow on Lot
..................
Total Floor Area
CATILot
coverageDATION
-Material----Sq•h-
Area of Lc,t
Width of WExterior
PiersT-
ype Construction I, II,
Footing SineHeight--
IIIIV, V
—
_
— --
- — -- FR, ? Hr, HT, N
Use Zone
-----------------
Beams
:�pacing Spun
._---_------------- ---
-- - ---
---
-
Joist 1st Ff.
�- -- —
Occupancy Group
A, E, I, H, B, 13
,
- ------
Ph. No.
------
Joist 2nd Fl.
--- -- ---- -
lJ''
_
Joist Ceiling
— _ - - -
_
7 2 34 5
- --- - -
Roof RaftersOther
- ____----- ------
Permit Numbers:
-
submitted .........
. .-
...........
Exterior Studs
- --- —�-
Plumbing
Raw
Property Line
Interior
--- — _
Sewer -
COVERING
—_— -' - -- -
-p
Exterior Walls _ _---__ Roof
-- _ - --
Interior Wafls
APPROVED �"
�_.
---------- ---------------------
-_____-_ Reroofing
Heat:16. 4Yaod Gas Oi I -
y rector of
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Dept. of Inspections
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—_ _ Electric
I hereby ack;.Uwledge that I have read this application
and state that the above is
SPECIAL and LINUSUA CONDITIONS
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correct and agree to comply with
all City Ordinances and State Laws
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71,
regulating building con-
Struetion. f
SIGNATURE OF
—
--
'a PERMITLZ % `I
PROPOSED -- ,
O0 EXISTING
LEGAL DESCRIPTION
BUILDINGS
on
•o lot No.
0
Street
Block No.
Variance or Conditional Use Permit
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