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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES. WA 98362
/_.
PUBLIC WORKS CONSTRUCTION Issued: 6/17/98 TF Permit No: 846
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT----------------------__PROPERTY LOCATION-------------___________
DEAN BLACK 3018 PEABODY __ S
1215 MARINE DRIVE PO BOX 93 Lot: SHP 77-12-12
MARYSVILLE, WA,WA98271 Block: Long Legal:
425/422-3745 Sub:
PROJECT INFO--------------______________________________________________________
Work is INSIDE traveled road Value Work: $0.00
Plans Required: N/A
Contractor: HORIZON EXCAVATING
Start:
Finish:
Performance Bond Required: N/A
Proof Insurance:
Amount:
Work to Perform: INSTALL
* Storm Drain
Underground Tele/Ele
Misc
NOTES-------------______________________________________________________
PROJECT
Watermain
Sanitary Sewer
/
/
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--
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$0.00 CJ\
:\)
/
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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"
Comm Water Serv:
1"
1 1/2"
2"
Oth Water Serv:
Water Sys Dev:
Receipt No:
Inspection Fee:
R/W
SANIT AR Y
$40.00
$0.00
$0.00
$0.00
$0.00
$200.00
$0.00
$0.00
$0.00
San Sewer SFR:
San Sewer MFR:
Add Unit: 0
Other San Sewer:
Sew Tap Wye/Man Tap:
Sew Cap/ WjM 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
------------------------------
------------------------------
$240.00
$240.00
BAL DUE:
-----------------------
$0.00
Signature of Contractor or Authorized Agent
$0.00
3939
TOTAL FEE:
AMT PAID:
$0.00
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 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 permit does not presume to give authority to
violate or cancel the provisions of any state or local law regulatin ns ction or the performan f construction.
. /
Date
Signature of Owner (if owner is builder)
Date
BUILDING PERMIT INSPECfION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COYER,
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 ACCEPTID COMMENTS
YES T NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE
ELECTRICAL (UGlIT DEn)
ROUGH-IN I
PLUMBING
UNDER FLOOR , SlAB
ROUGH-IN
WATER UNE
BACK FLOW' WATER
AIR SEAL
WALLS
CEIUNG I
FRAMING
JOISTS I GIRDERS
SHEAR WAll
WALLS , ROOF' CEIllNG
DRYWAll
~~
INSULATION
SIAB
WAll, FLOOR' CEIUNG
MECHANICAL
CHIMNEY
WooDSTOVE , PEllET
DUCTS
PW UTIUTIF.S , SITE WORK (Ensincering Division)
WA TERUNE , METER
SEWER CONNECTION
SANITARY
STORM
SITE DRAINAGE' EROSION CONTROL
PARKING
OlllER
FINAL INSPECTIONS REQUIRIID PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTID
YES NO
ElECTIUCAL UGHT DEPT 417-4746 ElECTIUCAL
UGHT DEPT
CONSTRUCTION R.W 'PW' CONSTRUCTION R.W
ENGINEERING 417-4807 PW , ENGINEERING
FIRE (MULTI-FAM. ONLY) 417-4654 FIRE DEPT
BUIillING 417-4815 BUIillING
GENERAL COMMENTS:
PW-II02.13 [4/96J