HomeMy WebLinkAbout1539 W Lauridsen Blvd - Engineering
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CITY OF PORT ANGELES
PUBLIC WORKS - UTILITIES DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
Pin number
Property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr, name
Application description
Subdivision Name
Property Use
Property zoning . . .
Application valuation
05-00000144
.332464
NO PARCEL NUMBER
99-
Date
3/02/05
HISTORIC LINCOLN PARK RUN
PUBLIC WORKS UTILITES
CENTRAL BUSINESS DISTRICT
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Owner
Contractor
CITY OF PORT ANGELES
PO BOX 1150
PORT ANGELES WA 983620217
OWNER
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Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
RIGHT OF WAY
RUP #05-03
70.00
3/02/05
8/29/05
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Plan Check Fee
Valuation
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.00
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Qty Unit Charge Per
BASE FEE
Extension
70.00
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 70.00 70.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 70.00 70.00 .00 .00
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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.
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Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T:\Policiesll 102. 15R [1/05]
PERMIT INSPECTION RECORD
CALL 417-4807 FOR UTILITY INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL 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
YES NO
PW UTILITIES (Engineering Division)
WATERLINE I METER
SEWER CONNECTION
SANITARY
STORM
SITE DRAINAGE
SITE EROSION CONTROL
PARKING
SIDEWALK
CURB & GUTTER
DRIVEWAY APPROACH
BACK-FLOW DEVICE I I
I
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
CONSTRUCTION R. W. I PW I CONSTRUCTION - R. W.
ENGINEERING 417-4807 PW I ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
T:\Policies\1102.15R (1/05]
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i .....'ORTANGELES
.~GTON' U.S.A
CITY OF
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NAME OF APPLICANT (',(l (0 l 5t-c~ V G rlSC'1 tl DATE
MAILING ADDRESS. . PD. . ~ (I i ~<a 2- ) P()I~t ,A ,?p-c...,5
PHONE NUMBER .:::J 0 [\ - Lj lc I - 2 C1 U Lc
STREET ADDRESS OF PROPOSED STREET USE ---PJ -t?..LfC} e._"") c e ~ +t f.J...r: '/1 f (j {) rDjX_iF-. )
DESCRIPTION OF REQUEST (include drawings required for clarity): [If street closure is requested, please state the name
of the street .and limits of closure, together with the duration of closure.] J2 . '.
I.t,'""f-"_Of ~+r.ee~+"\ fov- )/"l4-{.f-'.- ~i)ILi/"'5r-'- i=Ov~ +11-<:?-. I1c,"5f-Oj-,CJ
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IS THE USE TEMPORARY OR PERMANENT?--1Gi/"/) PC)>(LLv:f
HOW LONG WILL THE OBSTRUCTION BE IN PLACE? fvl/\ f'{'_A/L 5 2 () 0 5 ) 0 : L)[~ A ,1..-[ - i z.. pM
WHAT ARE THE HOURS OF OPERA. TION?/ 0 I 00 ~ /L} - tV D6 1<..::
HOW ITWILL BE LIGHTED? Dr.i' tj I (3IJ3::
EXPLAIN THE NECESSITY TO USE THE PUBLIC STREET, SIDEWALK OR PLANTING STRIP. ARE THERE
AL'I-ERNf-TE,..,AREAS THATC~U D ~E U~D~+c_ UJ 1. /~ DJ/) +JJ~-
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HOLD HARMLESS and INDEMNIFICATION AGREEMENT
In compliance with the Port Angeles Municipal Code, and in consideration of the issuance by the City of Port Angeles of a Street Use
Permit to the undersigned allowing the placement of the above described street use or obstruction, the undersigned for himself and
for his successors in interest, hereby agrees to indemnify, hold harmless, and defend the City of Port Angeles against any claims or
lawsuits for personal injury or property damage arising out of, or in any way connected with, the placement of the use or obstruction
on the City s~H.walk, or planting strip.
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DATED this ALL day of,:..TtLnu &d3'?JY5
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Applicant
SUBSCRIBED and sworn to befor me this :k/fB'ay of ~L<LMaJ .2~c5 ,~::-
a. 6-/1...0... ---e.. ()
NO ARY PUBLIC in d for the State of
Washington residing ate:;-.:;> ~ 1M
(This permit, if approved, may be terminated by the City of Port Ange'es without c se and at any time)
Application
Date
[OFFICE USE ONL Y]
~ 'fo 12-. Prof./1 nil ~
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Date application received / / 20 ().s;-" Fee paid $ ~ -- Receipt #
Certificate pf Insurance per PAMC 11.12.140(B) Agreement to Remove Encroachment signed and
on V N/A recorded on N/A
*************
eviewed and recommendation by City Engineer
ro nd with the following conditions:
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or~ bjl the Director of Public
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Copies sent to:
Police
Fire
Planning _
Finance
Date:
Copies to: Applicant 0 Fire 0 Police 0 Street 0 Other 0 Address file 0 RUP file 0
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