HomeMy WebLinkAbout838 W 15th St - Engineering
PUBILlC WORKS & R/W PERMIT
OWNER/APPLICANT D Attached Notes
WARD DUNCOMB
838 W 15TH ST
Port Angeles, WA 98363
000/604-2944
PROJECT INFO
Work is:
Plans Required
Contractor' OWNER
Performance Bond Required
Proof of Insurance
Work to Perform:
Issued
3/19/2001
Permit No
Work Order'
1155
o
PROPERTY LOCATION
838 15TH STW
Lot:
Subdivision
Parcel No
Block: 428
TPA
D Long Legal
Value Work:
$000
Start Date
1 1
Finish Date:
2061000-0000
1 1
Amount:
$000
D Install
D Repair
o Watermain
D Sanitary Sewer
D Storm Drain
D Underground Tele/Elec
D Misc
PROJECT NOTE5--
FEES ASSESSMENT
1 ) RIW 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/M 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. $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. $45.00
14 ) San Sewer MFR $000
add unit: 0 Amount Paid $45 00
Receipt No 6956
Inspection Fee $000 Balance Due. $0.00
Date
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . .
77/;1 !tect.
I { 111
Received by
(phone, person)
REQUEST
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
;r~ % 1 ~--41
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Phone No
Permit No
Sewer Foundation Framing
Chimney Plumbing Final Sewer Excav Other
//-5-:S-
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INSPECTION NOTES
Inspected Date ~/I ~/ .:) 0
Remarks
Time
A It(
By-I / Ii
C'~~F (~
RESTORATION REQUIRED
YES
NO Y
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;0
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)