HomeMy WebLinkAbout320 W Forest Ave - Building
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CITY OF PORT ANGELES
PUBLIC WORKS - UTILITIES DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
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Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application type description
Subdivision Name
Property Use
Property zoning . .'.
Application valuation
05-00000636 Date
524744
320 W FOREST AVE
06-30-09-5-2-3322-0000-
PUBLIC WORKS UTI LITES
7/19/05
320 U)[;rmsr/b2
o
Owner
Contractor
LO~SO
CORSO, GERALD/SUZANNE
320 FOREST AVE
PORT ANGELES WA 98362
(360) 452-4493
OWNER
0/'
.1f(}f? (~VY10aJ
Permit RIGHT OF WAY
Additional desc REMOVE TREES IN ALLEY
Permit pin number 54924
Permit Fee 50.00 plan Check Fee .00
Issue Date 7/19/05 Valuation 0
Expiration Date 1/15/06
Qty Unit Charge Per Extension
'. ~~.~ _ _ _ _ _ = ~ ~~_ _ _ _ _ _ _=~ ~~~~~ _ ~~~ _ __ ~=:~=_~~_ ~~=_ ~~~== _ __ _ _ __ _ _'___ _ _C~u. 00- ~
Fee summary Charged Paid Credited Due
Permit Fee Total
Plan Check Total
Grand Total
50.00
.00
50.00
50.00 .00
.00 .00
50.00 .00
.00
.00
.00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, 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 not
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T:\l'ollcics\1102.15R [1/05]
W ATVER AND RELEASE
the right to:
FOR AND IN CONSIDERA nON of permission from the City ofPort Angeles for
/!e/?Jol/<2 r;,e.e.s
<r cI/j Ie /'
seu/el' I, ~ e~ .
on the property located at:
3;( D Fores-C A)/e.
The undersigned, for themselves, their heirs, successors and assigns, hereby waives,
releases, and forever discharges any claims against the City of Port Angeles or its employees for
personal injuries or damages arising out of the entry onto the above referenced property for the
purpose as set forth above.
Dated this /8
day of \k; It
,2005.
A~/f/t/~.t2~ .Gn~AY
STATE OF WASHINGTON)
) ss:
COUNTY OF CLALLAM )
On this _ day of ,2005, before me, the undersigned, a Notary
Public in and for the State of Washington, duly commissioned and sworn, personally appeared
, to me known to be the individual described in and who
executed the foregoing instrument, and acknowledged to me the (s)he signed and sealed the said
instrument as his/her free and voluntary act and deed for the uses and purposes therein mentioned.
Given under my hand and official seal the day and year in this certificate first above written.
NOTARY PUBLIC in and for the State
Of Washington, residing at Port Angeles,
Washington.
NolPWKSILIGHTICONSICA TEl WAIVER. wpd
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Area Map
This map is nat in/ended fa be used as a lega! description
This mapldrUl..-ing is produced b.\> Ihl" City af Port Angeles for its ()\m use and purfXJses.
AIr.!' other IIse of/his map/drawing shall not bP the responsibility oI/hl" 0'1.1'.
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