HomeMy WebLinkAbout1419 W 11th St - Engineering
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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING OMS ION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
PUBILle WORKS & R/W PERMIT
o Attached Notes
OWNER/APPLICANT
Chris Repass
1419 W 11th Street
Port Angeles, W A 98363
000/600-0000
PROJECT INFO
Work is
Plans Required Start Date.
Contractor' LAKESIDE INDUSTRIES
Performance Bond Required Amount:
Proof of Insurance
Work to Perform
Issued'
6/24/2002
Permit No
Work Order'
1291
o
PROPERTY LOCATION
1419 11TH ST W
Lot: 16 & W13' It 17
Subdivision TPA
Parcel No 063000031475000
Block. 314
o Long Legal
~ Install
o Repair
o Watermain
Value Work:
1 1
Finish Date:
3601000-0000
$000
o Sanitary Sewer
o Storm Drain
o Underground Tele/Elec
~ Misc
PROJECT NOTES
asphalt planting strip no driveways standard height curb
$000
1 1
RECEIPT#9241
FEES ASSESSMENT-
1 ) R/W Excav'
2.) Sidewalk.
3 ) Curb/Gutter'
4 ) Driveway'
5 ) Dwy Culvert:
6 ) Street Cut:
7 ) Other R/W
8 ) Fire Hydrant:
9) Res Water Servo
10) Comm Water Servo
11 ) Other Water Service
12.)Water System Dev'
13 ) San Sewer SFR
14) San Sewer MFR
add unit: 0
Receipt No
Inspection Fee $0 00 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 J 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.
~.P'- (
c?U ;-, Ie
Signature of Contractor or Authorized Agent
$45 00
$000
$000
$000
$000
$000
$000
$000
$000
$000
$000
$000
$000
$000
15 ) Other San Sewer'
16) Sew Tap Wye/Man Tap
17) Sew Capl W/M Removal
18 ) Alter Repair Sewer'
19 ) Storm Drain.
20 ) Catch Basin per ea.
21 ) Sewer System Dev'
22.) Milwaukee Dr Sew Ass.
23 ) R/W Use Perm
24 ) Admin Cost (0 RA)
25 ) ORA
26 ) Misc:
$000
$000
$000
$000
$000
$000
$000
$000
$000
$000
$000
$000
TOTAL FEE.
$45.00
Amount Paid
$45 00
Date
Date
Signature of Owner (if owner is builder)
@
LAKESIDE INDUSTRIES
ACCT./ADMIN. OFFICE: P.O. BOX 7016 ISSAQUAH, WA 98027 (425) 313-2600 FAX (425) 313-2620
o
o
o
o
o
o
BOX 928
BOX 729
ABERDEEN, WA 98520
ANACORTES, WA 98221
(360) 533-0610
(360) 293-2168
(360) 736-2846
(425) 313-2600
(253) 631-3611
(360) 491-5460
"AN EQUAL OPPORTUNITY EMPLOYER"
~ LOCATION & TYPE
~ OF WORK F __ N f
R E C e, 0 BOX 576 LONGVIEW, WA 98632 (360) 423-6882
V~ Q,x 247 MONROE, WA 98272 (425) 743-1289
J U N 2 4 20~: BOX 728 PORT ANGELES, WA 98362 (360) 452-7803
?~.!) 0 :~:D~~~~J2~~~125s (503) 222-6421
~ 4- S 6 BOX 4465 VANCOUVER, WA 98662 (360) 892-5410
BOX 699 CENTRALIA, WA 98531
BOX 7016 ISSAQUAH, WA 98027
26010 180TH S.E., KENT, WA 98042
BOX 3004 LACEY, WA 98503
CONTRACTING PARTY
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DESCRIPTION
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PRICE
TOTAL PRICE
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APPROXIMATE TOTAL
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State sales tax to be added where applicable.
Total price to be based on actual quantity or measurement unless indicated above.
TERMS: Net Cash upon completion of job.
A finance charge (service charge), at current maximum allowable rate, will be imposed on any portion of your account not paid within 30 days after the
work-thru date.
SUBJECT TO GENERAL PROVISIONS ON REVERSE SIDE
YOUR SIGNATURE ON ONE COPY RETURNED TO US WILL MAKE THIS A LEGAL CONTRACT FOR THE PERFORMANCE OF THE ABOVE WORK.
RESERVING RIGHT OF LAKESIDE INDUSTRIES TO CANCEL IF UNIT PRICES INCREASE BEFORE LAKESIDE INDUSTRIES COMMENCES ACTUAL WORK
ON THE PROJECT YOUR SIGNATURE ALSO ACKNOWLEDGES RECEIPT OF OUR 'NOTICE TO CUSTOMER' STATEMENT AS PRINTED ON
REVERSE HEREOF
APPROVED BY OWNER:
LAKESIDE INDUSTRIES
WA. CONT. REG. # LAKESI*274JD
OR. CCB # 108542
ACCEPTED:
AUTHORIZED
SIGNATURE
FOR CHANGES:
BY
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BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER.
INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE
ELECTRICAL (LIGlITDEPT)
ROUGH-IN I I I
PLUMBING
UNDER FLOOR I SLAB
ROUGH-IN
WATERLINE
BACK FLOW I WATER
AIR SEAL
WALLS I
CEILING I
FRAMING
JOISTS I GIRDERS
SHEAR WALL
WALLS I ROOF I CEILING
DRYWALL
T-BAR
INSULATION
SLAB I
WALL I FLOOR I CEILING I I
MECHANICAL
CHIMNEY
WooDSTOVE I PELLET
DUCTS
PW UTILITIES I SITE WORK (Engineering Division)
WATERLINE I METER
SEWER CONNECTION
SANITARY
STORM
SITE DRAINAGE I EROSION CONTROL
PARKING
OTHER
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL LIGIIT DEPT 417-4746 ELECTRICAL
LIGIIT DEPT
CONSTRUCTION R.W I PWI CONSTRUCTION R.W
ENGINEERING 417-4807 PW I ENGINEERING
FIRE (MULTI-FAM. ONLY) 417-4654 FIRE DEFT
BUILDING 417-4815 BUILDING
GENERAL COMMENTS:
PW-II02.15 (4196]