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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST STII STREET, PORT ANGELES, WA 98362
/
PUBLIC WORKS CONSTRUCTION Issued: 11/18/96 TF Permit No: 560
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION--------------__________
CITY OF PA 1602 L ST S
321 E 5TH ST Lot: SUBURBAN LOTS 117 & 118
Port Angeles,wA98362 Block: Long Legal:
360/457-0411 Sub:
PROJECT INFO-------------_______________________________________________________
Work is N/A traveled road Value Work: $0.00
Plans Required: N/A Start: / / ~
Contractor: OWNER f<. J S:.V C-...- Finish: / / ~
Performance Bond Required: N/A Amount: $0.00 'JJ
Proof Insurance:
Work to Perform:
Watermain
* Sanitary Sewer
~
Storm Drain
Underground Tele/Ele
Misc
PROJECT NOTES------------_____________________________________________~---------
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;=V'Dy--yt 1V4~ 1S?t:A Ef )l\,l'--tv 0D (Lln~ ~~__
PROJECT FEES ASSESSMENT-----------______________________________________________
R/W Excav: $0.00 San Sewer SFR: $0.00
Sidewalk: $0.00 San Sewer MFR: $0.00
Curb/Gutter: $0.00 Add Unit: 0
Driveway: $0.00 Other San Sewer: $0.00
Dwy Culvert: $0.00 Sew Tap Wye/Man Tap: $0.00
Street Cut: $0.00 Sew Cap/ W/M Removal: $0.00
Other R/W: $0.00 Alter/Repair Sewer: $0.00
Fire Hydrant: $0.00 Storm Drain Tap: $0.00
Res Water Serv: $0.00 Catch Basin per ea: $0.00
5/8" Sewer System Dev: $0.00
3/4" Milwaukee Dr. Sew Assess: $0.00
1" R/W Use Perm: $0.00
Comm Water Serv: $0.00 D.R.A.: $0.00
1" Admin Costs (D.R.A): $0.00
1 1/2" Misc: $0.00
2" ==============================
Oth Water Serv: $0.00
Water Sys Dev: $0.00
~
Receipt No:
Inspection Fee:
TOTAL FEE:
AMT PAID:
$0.00
$0.00
R/W
SANITARY
$0.00
WATER
-----------------------
BAL DUE:
$0.00
DWY
STORM
DRA
OTHER
Separate Permits are required for electrical work, utilities, private and public improvements. This permit becomes null and void if work or
construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after
the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have
read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any state or local law regulating construction or the performance of construction.
Si nature of Owner if owner is builder
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PUBLIC WORKS CONSTRUCTION
& R/W PERMIT
OWNER/APPLICANT----
CITY OF PA
321 E 5TH ST
Port Angeles,WA98362
360/457-0411
PROJECT INFO-------
Work is OUTSIDE traveled road
Issued 9/18/96 TF
Cond
Permit No
Work Order
-- PROPERTY
1602
c$?
Lot
Block
Sub
LOCATION ---- ----- -_______
L ST S
SUBURBAN LOTS 117 & 118
Long Legal
Value Work
--------------------------------------
$0 00
Plans Required N/A
Contractor
Start
Fini sh
Performance Bond Required N/A
Proof Insurance
Amount
Work to Perform
Watermain
* Sanitary Sewer
Storm Drain
Underground Tele/Ele
Misc
PROJECT NOTES----
/ /
/ /
$0 00
-------- -- -------- ---- ----- --- ---------
sanitary sewer llne connect into existing MH @ 18th St for Volunteer
baseball park no fee per GK
approx 485' 6" pvc line
PROJECT FEES ASSESSMENT-- ----_____
R/W Excav $0 00
Sidewalk $0 00
Curb/Gutter $0 00
Driveway $0 00
Dwy Culvert $0 00
Street Cut $0 00
Other R/W $0 00
Fire Hydrant $0 00
Res Water Serv $0 00
5/8"
3/4"
1"
Comm Water Serv
---- --- ------------- --------------------
San Sewer SFR *
San Sewer MFR
Add Unit 0
Other San Sewer
Sew Tap Wye/Man Tap
Sew Cap/ W/M Removal
Alter/Repair Sewer
Storm Draln 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
1"
1 1/2"
2"
$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
------------------------------
------------------------------
Oth Water Serv
Water Sys Dev
TOTAL FEE
AMT PAID
Receipt No
Inspection Fee
$0 00
BAL DUE
$0 00
$0 00
$0 00
$~
~;;;o.>
CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
PUBLIC WORKS CONSTRUCTION Issued: 11/18/96 TF Permit No: 560
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
CITY OF PA 1602 L ST S
321 E 5TH ST Lot: SUBURBAN LOTS 117 & 118
Port Angeles,WA98362 Block: Long Legal:
360/457-0411 Sub:
PROJECT INFO-------------------------~~-----------------------------------------
Work is N/A traveled road Value Work: $0.00
Plans Required: N/A Start: / /
Contractor: OWNER Finish: / /
Performance Bond Required: N/A Amount: $0.00
Proof Insurance:
Work to Perform:
Watermain
* Sanitary Sewer
storm Drain
Underground Tele/Ele
Misc
NOTES-------------------------------------------------------------------
PROJECT
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:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$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/ W/M 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
$0.00
TOTAL FEE:
AMT PAID:
Receipt No:
Inspection Fee:
$0.00
WATER
BAL DUE:
R/W
SANITARY
DWY
STORM
DRA
OTHER
$0.00
$0.00
$0.00
Separate Permits are required for electrical work, utilities, private and public improvements. This perm~ becomes null and void if work or
construction authorized is not commenced ~hin 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 ~hin 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 perm~ 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.
Sinnature of Owner (if owner is builderl
Date
Sianature of Contractor or Authorized Aqent
Date