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PUBILIC WORKS & R/W PERMIT
o Attached Notes
OWNER/APPLICANT
VERN ELKHART
104 E. 8TH STREET
Port Angeles, W A 98362
000/604-7558
PROJECT INFO
Work is.
Plans Required
Contractor' OWNER
Performance Bond Required
Proof of Insurance.
Work to Perform
Issued
9/06/2001
Permit No
Work Order'
1203
o
PROPERTY LOCATION
104 8TH ST E
Lot: 8&9
Subdivision
Parcel No
Block: 268
TPA
D Long Legal
Value Work.
$000
Start Date
I I
Finish Date
2061000-0000
I I
Amount:
$000
[SJ Install
D Repair
D Watermain
D Sanitary Sewer
D Storm Drain
D Underground Tele/Elec
[SJ Misc
dwy I curb
PROJECT NOTES
fill in ex. depressed curb
FEES ASSESSMEN"F
1 ) R/W Excav' $45 00 15 ) Other San Sewer' $000
2.) Sidewalk. $000 16) Sew Tap Wye/Man Tap $000
3 ) Curb/Gutter' $000 17 ) Sew Capl W 1M Removal $000
4 ) Driveway' $0.00 18 ) Alter Repair Sewer' $000
5 ) Dwy Culvert: $000 19 ) Storm Drain $0.00
6 ) Street Cut: $000 20 ) Catch Basin per ea. $000
7 ) Other R/W $000 21 ) Sewer System Dev' $0.00
8 ) Fire Hydrant: $000 22.) Milwaukee Dr Sew Ass $0.00
9) Res Water Servo 5/8" $0.00 23 ) R/W Use Perm $0.00
10) Comm Water Servo $000 24 ) Admin Cost (0 RA) $000
11 ) Other Water Service $000 25 ) 0 RA. $0.00
12.)Water System Dev' $000 26 ) Misc: $000
13 ) San Sewer SFR $0.00 TOTAL FEE. $45.00
14 ) San Sewer MFR: $000
add unit 0 Amount Paid $45 00
Receipt No 7308
Inspection Fee $000 Balance Due $0.00