HomeMy WebLinkAbout1100 E Park Ave - Buildingc bnstruction.
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Application Number 07 00000729 Date 7/31/07
Application pin number 089966
Property Address 1100 E PARK AVE
ASSESSOR PARCEL NUMBER R6 30 00 0 0 0000 0000
Tenant nbr name WESTERN TELCOM INC
Application type description PUBLIC WORKS UTILITES
Subdivision Name
Property Use
Property Zoning UNKNOWN
Application valuation 0
Owner Contractor
CITY OF PORT ANGELES
PO BOX 1150
PORT ANGELES
Permit RIGHT OF WAY
Additional desc RUP 07 30
Permit pin number 105155
Permit Fee 70 00
Issue Date 7/31/07
Expiration Date 1/27/08
Qty Unit Charge Per
Fee summary Charged Paid Credited
Permit Fee Total 70 00 70 00 00 00
Plan Check Total 00 00 00 00
Grand Total 70 00 70 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. 1 hereby certify that 1 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 giv authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
T\Policies \1102.15R [1/05]
WA 983620217
BASE FEE
OWNER
re of Contractor or Authorized Agent
CITY OF PORT ANGELES
PUBLIC WORKS UTILITIES DIVISION
321 EAST 5TH STREET PORT ANGELES, WA 98362
Plan Check Fee
Valuation
Date
Due
00
0
Extension
70 00
Signature of Owner (if owner is builder) Date
CALL 417 -4807 FOR UTILITY INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER,
INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE ACCEPTED COMMENTS
PW UTILITIES (Engineering Division)
WATERLINE METER
SEWER CONNECTION
SANITARY
STORM
SITE DRAINAGE
SITE EROSION CONTROL
PARKING
SIDEWALK
CURB GUTTER
DRIVEWAY APPROACH
BACK -FLOW DEVICE
T-\Policies\ I IO2.15R 1 /05j
RESIDENTIAL
CONSTRUCTION R.W PW/
ENGINEERING 417 -4807
FIRE 417 -4653
PLANNING DEPT 417 -4750
BUILDING 417 -4815
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
DATE YES NO COMMERCIAL DATE ACCEPTED
YES I NO
PERMIT INSPECTION RECORD
YES 1 NO
CONSTRUCTION R.W
PW ENGINEERING
FIRE DEPT
I PLANNING DEPT
BUILDING
NAME OF APPLICANT NES E Z.K e ftliDA 1EL DATE JUN I 07
MAILING ADDRESS 14 101 PIQNExR WK G' STE D 1 WP' 4 05312.
PHONE NUMBER 251 k 6 401
STREET ADDRESS OF PROPOSED STREET USE 2 1 S'
DESCRIPTION OF REQUEST (Include drawings required for clarity): lif street closure is requested please site
the name of the street and limits of closure, together with the duration of closure.]
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IS THE USE TEMPORARY OR PERMANENT? rig ir4440StOr
HOW LONG WILL THE OBSTRUCTION BE IN PLACE? 1
WHAT ARE THE HOURS OF OPERATION? 2 r
HOW IT WILL. BE LIGHTED? NlA UJ4LHT
EXPLAIN THE NECESSITY TO USE THE PUBLIC STREET SIDEWALK OR PLANTING STRIP ARE THERE
ALTERNATE AREAS THAT COULD BE USE(?
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HOLD HARMLESS and INDEMNIFICATION AGREEMENT
In compliance with the Port Angeles Municipei Code, and In consideration of the issuance by the City of Port Angeles of a
Right Of Way Use Permit to the undersigned allowing the placement (Idle above described stet use or obstruction, the
undersigned for himself and for hts successors In Interest, hereby agrees to Indemnify, hold harmless, and defend the City of
Port Angeles a any dims or lawsuits for persona! injury or property damage arising out of, or in any way connected
with, U
T� rye use or obstrtadfon on the City street, sIdewalk, la strip, or ht t way
T 4 DATED t ay ofi�n 2DC� 7
14oTARy
Ft g1, C r NOTARY P BLJC for Washington,
y► 7a!1.1._ D residing at r
�a Mycommissio expires: -i
477tis psimi if epprove4 may be tanntna(er by the City of Poe withal cause and at any thnn)
fOFRRCE USE ONLYJ
Date application received 6- /Z- Ufj Fee paid
Date Cert1Etcete of Insurance per PAMC 11 12.140(8) received
Agreement to Remove Encroachment Signed and on
and recorded on
ApplicatIon re L�at�i and recommendation by City Engineer
is to deny or ro and with the foll conditions:
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1
rd by the Director of Public Works
Application
co
y IGHT OF WAY USE PERMIT
Applicant
Appwed COOP in: Appgraid. 0 Fire 0 Police 0 Street 0 Other 0 Address Pis 0
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Date
7/9
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