HomeMy WebLinkAbout1029 W 6th St - Engineering
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PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
PUBLIC WORKS CONSTRUCTION Issued: 9/09/96 LEH Permit No: 528
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT-----------------------_PROPERTY LOCATION-------------___________
DAVID SOMMERS 1029 6TH ST W
1029 W. 6TH STREET Lot: 13
Port Angeles,wA98363 Block: 108 Long Legal:
360/457-8597 Sub: TPA
PROJECT INFO------------________________________________________________________
Work is OUTSIDE traveled road Value Work: $0.00
Plans Required: NO
Contractor: OWNER
Start:
Finish:
Performance Bond Required: NO
Proof Insurance:
Work to Perform:
Amount:
Watermain
Sanitary Sewer
/ /
/ /
$0.00
Storm Drain
Underground Tele/Ele
* Misc DRIVEWAY
PROJECT NOTES-------------_____________~------------____________________________
Cu rZB \::x.rpt2e-sS; lOA..) eX/S T/Nf
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:
Inspection Fee:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$40.00
$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
------------------------------
------------------------------
Si nature of Contractor or Authorized A ent Date
$0.00
TOTAL FEE:
AMT PAID:
$40.00
$40.00
$0.00
BAL DUE:
-----------------------
$0.00
~.
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 ins eti~herebY certify that I have
read and examined this application and know the same to be true and correct. All provisions of laws and or . ances g verning this type of work
will be complied with whether specified herein or not. The granting of a permit do~ot presume to ' autho' to violate or cancel the
provisions of any state or local law regulating construction or the performance gt-c6nstn.lction 0 )
/ ' "-1 f .
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.....
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . INSPECTION REPORT. . . . . . . . . . .
REQUEST
Date
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)
c5:?~:::~am;ng C~imneY
Inspected Date q ,I ftJ I qv
Remarks / /~ ~ Vy
Plumbing Final Sewer Excav Other
Time
By
,
'J
RESTORATION REQUIRED . . . .. YES
NO /
1----,
i'-=.
SURFACE RESTORATION:
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DA TE)
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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DNISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
PUBLIC WORKS CONSTRUCTION Issued: 9/09/96 LEH Permit No: 528
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
DAVID SOMMERS 1029 6TH ST W
1029 W. 6TH STREET Lot: 13
Port Angeles,WA98363 Block: 108 Long Legal:
360/457-8597 Sub: TPA
PROJECT INFO-----------------------------~--------------------------------------
Work is OUTSIDE traveled road Value Work: $0.00
Plans Required: NO Start: / /
Contractor: OWNER Finish: / /
Performance Bond Required: NO Amount: $0.00
Proof Insurance:
Work to Perform:
Watermain
Sanitary Sewer
Storm Drain
Underground Tele/Ele
* Mise-DRIVEWAY
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"
I"
Comm Water Serv:
I"
1 1/2"
2"
Oth Water Serv:
Water Sys Dev:
Receipt No:
Inspection Fee:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$40.00
$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):
Mise:
$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
==============================
$40.00
$40.00
$0.00
$0.00
$0.00
$0.00
TOTAL FEE:
AMT PAID:
$0.00
BAL DUE:
Separate Permits are required for electrical work, utilities, private and public improvements. This permrt becomes null and void W work or
construction authorized is not commenced wrthin 180 days, W construction or work is suspended or abandoned for a period of 180 days after
the work as commenced, or W required inspections have not been requested wrthin 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 permrt 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.
Date
Sianature of Owner (~ owner is builder)
Date
Siqnature of Contractor or Authorized Aoent