HomeMy WebLinkAbout1734 E 5th St - Engineering
s
~~
CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
/'
PUBILle WORKS & R/W PERMIT
D Attached Notes
OWNER/APPLICANT
BEN SWEDSDET
1734 E.5TH ST
Port Angeles, W A 98362
000/606-3771
PROJECT INFO
Work is
Plans Required
Contractor'
Performance Bond Required
Proof of Insurance
Work to Perform
Issued
6/19/2000
Permit No
Work Order'
1071
o
PROPERTY LOCATION
1734 5TH ST E
Lot: 7,8
Subdivision
Parcel No
Block, 185
TPA
D Long Legal
Value Work.
$000
Start Date
Finish Date
0001000-0000
1 1
1 1
Amount:
$000
D Misc
D Install
D Repair
D Watermain
D Sanitary Sewer
D Storm Drain
D Underground Tele/Elec
PROJECT NOTES
cap sewer for demo
FEES ASSESSMENT
1 ) RIW Excav' $000 15 ) Other San Sewer' $000
2.) Sidewalk. $000 16) Sew Tap Wye/Man Tap $000
3 ) Curb/Gutter' $000 17) Sew Capl W/M Removal $260 00
4 ) Driveway' $000 18 ) Alter Repair Sewer' $000
5 ) Dwy Culvert: $000 19 ) Storm Drain $000
6 ) Street Cut: $000 20) Catch Basin per ea. $000
7 ) Other RIW $000 21 ) Sewer System Dev' $000
8 ) Fire Hydrant: $000 22.) Milwaukee Dr Sew Ass $000
9) Res Water Servo $000 23 ) RIW Use Perm $000
10) Comm Water Servo $000 24 ) Admin Cost (0 RA) $000
11 ) Other Water Service $000 25 ) 0 RA. $000
12.)Water System Dev' $000 26) Misc $000
13 ) San Sewer SFR $000 TOTAL FEE. $260.00
14 ) San Sewer MFR $000
add unit: 0 Amount Paid $260 00
Receipt No
Inspection Fee $000 Balance Due $0.00
RW SANITARY 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 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.
-kt:u~ .r La
Sicnature of Contractor or Authorized Acent Date Sicnature of Owner (if owner is builder! Date {, "1" - t:' ()
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . .
OW ID;;I..">;. - /
. . . . .
REQUEST
Date (f5 (; 7- C';- -(} 2J Time ~.~30 -Hit t Received by
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type.D.\ Inspection (circle appropriate one)
(Sewer Foundation Framing Chimney Plumbing
/ '7-3 L/ ~ L::::
J/ ( ) Ie L-C rt/;)
.s^fil J-/
Phone No
Permit No
/071
I
'-
Final Sewer Excav Other
IJ () +f / & 3 ~
(
P I ~(
I
I
4 \
~
j
-r:- y:?' ,
,
o' ,
~ J -. ,/
(I " --. '----~~ --
r-----.---------.------------ ~- t-~~ d
I '1-; \ ) 1 cLe.Rf
I
i
I (15 ~~ i
; \
t: ~-t- tt
'':J--
RESTORATION REQUIRED
YES
NO >Z.
SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel D Asphalt D PCC
o Other
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
Work Order #
o COMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)