HomeMy WebLinkAbout121 E 2nd 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: 6/28/99 TF Permit No: 969
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
JOHN RICKENBACHER 121 2ND ST E
126 W. 5TH ST Lot: 15 & PORTION OF 16
Port Angeles,WA98362 Block: 31 Long Legal:
360/457-0467 Sub: NR SMITH
PROJECT INFO---------------------------_________________________________________
, Work is N/A traveled road Value Work: $0.00
Plans Required: N/A
Contractor: CITY OF PORT ANGELES
Start:
Finish:
Performance Bond Required: N/A
Proof Insurance:
Amount:
Work to Perform: INSTALL * Watermain
Sanitary Sewer
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$0.00
Storm Drain
Underground Tele/Ele
Misc
NOTES---------------------------________________________________________
PROJECT
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"
Corom Water Serv: *
1"
1 1/2"
2"
Oth Water Serv:
Water Sys Dev:
Receipt No: 5194
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
$0.00
$0.00
------------------------------
------------------------------
Signature of Contractor or Authorized Agent
Date
$1,200.00
TOTAL FEE:
AMT PAID:
$1,200.00
$1,200.00
BAL DUE:
-----------------------
$0.00
$0.00
WATER
DWY
STORM
DRA
OTHER
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 . ns of laws and ordinances governing
this type'of work will be complied with whether specified herein or not. The gra g of pe oes not presume to give authority to
violate or cancel the provisions of any state or local law regulating construe' e erf e of construction.
Date
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CITY OF PORT ANGELES
DEPARTMENT O.F PUBLIC WORKS
. . . . INSPECTION REPORT. . . . . .
/
REQU~~: ~ _ a ,
Date / I l
Time
Received by
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
Sewer Foundation Framing Chimney Plumbing Final
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Phone No. ~
Permit No. t'A(~7/;' ---
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Sewer Excav. Other ~f1I
Inspected: Date
Remarks:
By
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INSPECTION NOTES:
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RESTORATION REQUIRED. . . . .. YES
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SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved DGravel
o Repaired by City
[] Repaired by Permittee
o No Damage Found
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Work Order # 1 yo ::;
\'Qr COMPLETE
Vo INCOMPLETE
o Other
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STREET SUPERINTENDENT
(DATE)
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