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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
PUBILlC WORKS & R/W PERMIT
D Attached Notes
OWNER/APPLICANT
North Peninsula Home Builders
101 E 10 TH ST
Port Angeles, W A 98362
360/452-8160
PROJECT INFO
Work is
Plans Required
Contractor'
Performance Bond Required
Proof of Insurance.
Work to Perform
Issued
6/07/2001
Perm it No
Work Order'
1173
o
PROPERTY LOCATION
900 I ST S
Lot:
Subdivision
Parcel No
Block. 306
TPA
D Long Legal
Value Work.
$000
Start Date'
I I
Finish Date.
0001000-0000
I I
Amount:
$000
C8J Install
D Repair
D Watermain
C8J Sanitary Sewer
C8J Storm Drain
D Underground Tele/Elec
D Mise
PROJECT NOTES
install sanitary sewer in 9/10 alley east of "I" Street for home
home builders assoc. set 3 manholes. $300.00 inspection
$45.00 r/w $45.00 per catch basin
FEES ASSESSMENT-
1 ) R/W 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 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 $45 00
7 ) Other R/W $000 21 ) Sewer System Dev' $000
8 ) Fire Hydrant: $000 22.) Milwaukee Dr Sew Ass $000
9) Res Water Servo $000 23 ) R/W 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: inspection $300 00
13 ) San Sewer SFR $000 TOTAL FEE. $390.00
14) San Sewer MFR $000
add unit: 0 Amount Paid $390.00
Receipt No 7736
Inspection Fee $000 Balance Due. $0.00
RW SANITARY WATER OWY STORM ORA 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 Gomplied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
pro\!~ of any state\or localla-.y regulating constru1on or the performance of construction.
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-(' Sianature of Contractor or Authorized Agent ' Date Sianature of Owner (if owner is builder) Date