HomeMy WebLinkAbout912 E 4th St - Engineering
PUBILle WORKS & R/W PERMIT
OWNER/APPLICANT 0 Attached Notes
Phylis Thie
Mt Pleasant Rd
Port Angeles, WA 98362
000/600-0000
PROJECT INFO
Work is:
Plans Required:
Contractor:
Performance Bond Required:
Proof of Insurance:
Work to Perform:
Issued: 10/09/2000
Permit No:
Work Order:
1114
o
PROPERTY LOCATION
912 4TH ST E
Lot:
Subdivision:
Parcel No:
Block: 176
tpa
063000176250000
D Long Legal
Value Work:
$0.00
Start Date:
1 1
Finish Date:
000/000-0000
1 1
Amount:
$0.00
D Install
[2;J Repair
D Watermain
[2;J Sanitary Sewer
D Storm Drain
D Underground Tele/Elec
D Mise
PROJECT NOTES
repair san sewer lateral to alley ..j
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/ t\t-e~..It-.-C 4~L/ ~./ j&~ /7tJ{.? ,W~.J4!?~",t.ljj~~/!.-;o.J. I
FEESASSESSMEN-.: . p1 iT ~~cU"'- 'ff'P14,
1.) R/W Excav: $45.00 15.) Other San Sewer: $0. 0
2.) Sidewalk: $0.00 16.) Sew Tap Wye/Man Tap: $0.00
3.) Curb/Gutter: $0.00 17.) Sew Capl W/M Removal: $0.00
4.) Driveway: $0.00 18.) Alter Repair Sewer: $35.00
5.) Dwy Culvert: $0.00 19.) Storm Drain: $0.00
6.) Street Cut: $230.00 20.) Catch Basin per ea: $0.00
7.) Other R/W: $0.00 21.) Sewer System Dev: $0.00
8.) Fire Hydrant: $0.00 22.) Milwaukee Dr. Sew Ass: $0.00
9.) Res Water Serv: $0.00 23.) R/W Use Perm: $0.00
10.) Comm Water Serv: $0.00 24.) Admin Cost (D.R.A) $0.00
11.) Other Water Service: $0.00 25.) D.RA $0.00
12.)Water System Dev: $0.00 26.) Mise: $0.00
13.) San Sewer SFR: $0.00
14.) San Sewer MFR: $0.00
add unit: 0
Receipt No: 6657
Inspection Fee: $0.00
TOTAL FEE:
$310.00
Amount Paid:
$310.00
Balance Due:
$0.00
t-vw-Ioo'. It-I)"
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . INSPECTION REPORT. . . . . .
REQUEST:
Date-'b - \0 -(30 Time
Received b~'-tA~
(phone, person)
~
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
!-'t~lnspection (circle appropriate one):
(se~. .. Foundation Framing Chimney Plumbing
-~~A\12.
gld-
t:::::
<-4~
-
~
(\\
.....D..
\~
Phone No.
Permit No.
Final Sewer Excav. Other
W6f--k D~% l'"lOlo
. . . . . .
L- 'G" \ t D~ t'Y\t-\ @ K-t'-\ C E ~"1\~
0 < ~ , $" s,s..
4/5 A~1
.....
R
A
c
..-
t
RESTORATION REQUIRED
YES
NO
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved OGravel ~sphalt OPCC o Other
D Repaired by City Work Order #
[] Repaired by Permittee C&1 COMPLETE 1()-I1.~ Il1ff
_, 0 No Damage Fo~nd 0 INCOMPLETE ~
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-to 5/ yee-:l- 10 117- 7 &D ~.
(Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE)
........
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. INSPECTION REPORT . . . . . .
.....
/
REQUEST: tft/U1nJ
Date ~
Time
z.~
Received by ~?--
/ /
(PhO~rS~
Location of Work to be inspected 9/;2 E <1 ~
Name of person requesting inspectio';-- /"fO~ Ht'~r-
Address of person requesting inspection Phone No.
Type of Inspection (circle appropriate one): Permit No. ///1
~ Foundation Framing Chimney Plumbing Final Sewer Excav. Other
INSPECTION NOTES:
Inspected: Date .~Jp /ZtJOO Time
Remarks: e"....-v1n le~
!
By
RESTORATION REQUIRED . . ., . .. YES Y NO
J~\
'- L
I
If) :;,
..... ~
/,
,/---
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.... .j
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SURFACE RESTORATION: f X I
SURFACE TYPE: D Unimproved D Gravel ctr Asphalt D PCC
D Other
D Repaired by City
[] Repaired by Permittee
[] No Damage Found
Work Order #
o COMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
o
o
CITY t'\1l:: ",,,,,...op r' lGELES PUBLIC WORKS DEPARTMENT
~
PERMIT ACCOUNT DOLLAR
NUMBER NUMBER AMOUNT
001. 2291000 ~
001.2392000
600.32290014 \
600.34220015
600.34220016
711.32210017
711.32210018
711.32210019 _.
711.32210020
711.32210021 ~
711.32210033
rmit 711.32240011 J~
711.34150000 -S)
711.34320000
711.34320010 ~
711.34583000
711.34895000 m
~
THE CIT~ DF PDRT ANG2LES
EOOD~}1~?581
10/09/00
?W Trans General Fnd
Uleck
ROTOROOTER 1114 145.00
~~OTD?UOTEf< Lt14 $.23D..zJO
ROTDR001'ER 1114 $35"00
~31D..;JO
GhHf
C.:l.'i:
,~:~~~~t: 'V~~i-~: . :~~~' -'...t.~{,.*~~ %' ":1?,( ~=-:"f.f_J~-:;~ :~~".
Hot Tap (watermain>
FH Install/ Meter
W/M Installation
Water System Developement Charge
Sanitary Sewer Permit
Sanita Sewer Tap/Cap or MH Tap
Sewer System Development Charge
ULlD 215 / Equivalent Service Connection Fee
754.32210029
754.34350018
754.34350024
782.34350025
FILL-IN COMPLETELY - TOTAL EACH FUND AND GRAND TOTAL
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Lost Revised Dec. 1999