HomeMy WebLinkAbout1633 W 12th St - Engineering
CITY OF PORT ANGELES /35/8
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
REQUEST~I . _ J
Date .~ 03 Time Received by (phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection Phone No
Type of Inspection (circle appropriate one) Permit No / 2-0 l/J
~
~~ Foundation Framing Chimney Plumbing@)ewer Excav Other
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INSPECTION NOTES 0 U
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Inspected Date Time By
Remarks ,"5"Cl/7 9O'-I.Jev- p~{- ~yo~e..Q' Dy
PUP/I/". !L!tJRC<:' - a J I/)- all~,,/
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RESTORATION REQUIRED
YES
NO
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
o Repaired by City
[] Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
PUBILlC WORKS & R/W PERMIT
o Attached Notes
OWNER/APPLICANT
ROGER SOVDE
364 W WASHINGTON
SEQUIM, WA 98382
000/606-3532
PROJECT INFO
Work is
Plans Required
Contractor' OWNER
Performance Bond Required
Proof of Insurance
Work to Perform
Issued
7/09/2002
Permit No
Work Order'
1296
o
PROPERTY LOCATION
1633 12TH ST W
Lot: 12
Subdivision
Parcel No
Block. 359
SURVEY V24 P2
063000035932000
D Long Legal
Value Work.
$000
Start Date.
I I
Finish Date.
206/000-0000
I I
Amount:
$000
~ Install
D Repair
~ Watermain
~ Sanitary Sewer
D Storm Drain
D Underground Tele/Elec
~ Mise
PROJECT NOTES
FEES ASSESSMENT
1 ) R/W 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 1M Removal $000
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. $0.00
7 ) Other R/W $000 21 ) Sewer System Dev' $745 00
8 ) Fire Hydrant: $000 22.) Milwaukee Dr Sew Ass $000
9) Res Water Servo 5/8" $640 00 23 ) R/W Use Perm $000
10) Comm Water Serv' $000 24 ) Admin Cost (D RA) $0.00
11 ) Other Water Service $000 25 ) D RA. $000
12.)Water System Dev' $1,025 00 26 ) Mise: $000
13) San Sewer SFR $95 00 TOTAL FEE. $2,505.00
14) San Sewer MFR $000
add unit 0 Amount Paid $2,50500
Receipt No 7464
Inspection Fee $000 Balance Due $0.00
REQUEST
Date ~-/L.J -6'C.-
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
Time
Received by
k V (phone, person)
Location of Work to be inspected I ~::5 -3 W 1:2 'I-~
Name of person requesting inspection ~tQ
Address of person requesting inspection
Type of Inspection (circle appropriate one)
Sewer Foundation Framing Chimney ~mb~ Final
Dry weLl
INSPECTION NOTES.
Inspected Date ~ po- { c;--: "(.
Remarks
Phone N06~- 3500
Permit No /3 S-/B
Sewer Excav Other I Z. 'Jd
~
Time
By
c)k
NO
T~~-rs~
Atv\
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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
IDA TE)
CITY OF PORT ANGELES v w - ;ac>ol - Z( 81
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)
Sewer Foundation Framing Chimney Plumbing
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Il{2L +(1
Phone No
Permit No J 2- q ?:;
Final Sewer Excav Other 4J 2~
INSPECTION NOTES 1/1
Inspected Date >?, ~ ~Time By
Remarks -;::1-fr>. II, ~ -eA) ,! x;;(I
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RESTORATION REQUIRED
. YES
/
NO V
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
Work Order #
~PLETE
o INCOMPLETE
o Other
:;({ i L
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
J...
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APPLICA TIQN FOR WATER
City Water Department
Port Angeles, Wash.
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I hereby apply for water to be furnished in accordance with rates and rules of the City
for the following premises
Name of Applicant --:::P;oq er SOVD€-
J(P~ 3 W lZ:~
Renewal 0
Address
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Size of Service
New Service Q-- BI~
JxS/l
Service Left On 0
Installed by
Remarks. "P'€t"~ JT~ 12q~
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