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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
/
PUBLlc WORKS CONSTRUCTION Issued: 6/11/98 LC Permit No: 783
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
RICK ANDERSON 702 ESTES COURT _ \
618 S. PEABODY Lot: 22 ~
Port Angeles,WA98363 Block: Long Legal: ~
PR;;~~~5i~:~~~------------------------------~~~:-~:~~~~~~~_~:~_~~______________~
Work is OUTSIDE traveled road Value Work: $0.00
/ / C\\
/ / \{)
$ 0 . 0 0 ~\
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Plans Required: N/A
Contractor: OWNER
Start:
Finish:
Performance Bond Required: N/A
Proof Insurance:
Amount:
* Storm Drain
Underground Tele/Ele
* Misc
PROJECT NOTES-------------------------------------------------------------------
STM DRAIN IN UTILITY EASEMENT ON WEST SIDE OF LOT
PROJ~~::::::i:::--~~-1k%!i!i-~-~::-~~-:l{Cj-~L------------
R/W Excav: $0.00 San Sewer SFR: * $80.00
Sidewalk: $0.00 San Sewer MFR: $0.00
Curb/Gutter: $0.00 Add Unit: 0
Driveway: * $125.00 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 ~. .t Storm Drain Tap: $0.00
Res Water Serv: * $0.00 I~S~ 4'~~1 Catch Basin per ea: $0.00
5/8" -~(., Sewer System Dev: * $642.00
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 II ==============================
Oth Water Serv: * $883.00 I ?I&'5 If-c.)
Water Sys Dev: $0.00 TOTAL FEE: $1,730.00 ~
AMT PAID: 41,730.00
Work to Perform: INSTALL * Watermain
* Sanitary Sewer
Receipt No: 4120
Inspection Fee:
SANIT AR Y
$0.00
WATER
BAL DUE:
$0.00
R/W
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.
Signature of Owner (if owner is builder)
Date
CITY OF PORT ANGELES
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)
102- ~S7 ~ C-,
T~ en , fi.-..;
Sewer Foundation Framing
Permit No 72? -3
Chimney Plumbin( Fin~ewer Excav Other ~ J-I J -
7
Phone No
INSPECTION NOTES
Inspected Date 8'- ;;...'1-9 r Time
Remarks D~ I C-o """- P t e.-r:e...
]) c...J n ... 075 "'t;;. J. r y wells
I
?~
B~
RESTORATION REQUIRED
YES
NO )(
SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel D Asphalt D PCC
D Other
D Repaired by City
[] Repaired by Permittee
[] No Damage Found
Work Order #
o COMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
/')'-/-,-,-,;1':;,-_OU I
( of
; l._~ -"
APPLICATION FOR WATER
City Water Department 0 I
Port Angeles, Wash _ lP~___, 19~ <?'
I" 1
-+ <
"<_ I ~_, I
I hereby apply for water to be furni shed in accordance with rates and rules of the City
for the following premises
Name of Applicant__ L~ ~ (?O"7S~ ________________
Address--.Zt'2::_ t!::--s~s_e /.!.._ ~/g ~ ~Ahe:~-'I-
Renewal 0 New Servic~ Blk_ Lot;?~ AdrY?1//Wtl?,fl;C::.- #IS-
/ if ~ j., dy r i ) ? c; c; (" .- 'iT
Size of Service-l---A--=/3' (1'/I:}O/OMeter Number_'( - {I,? I ~___
Service Left On [J Service Left Off2- Signed________________________
~:~:l,: ~~:~-?'J"3 -~--~~5 00":; W~- "0
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVEll,
INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION
INSPECTION TYPE DATE I ACCEPTED COMMENTS
YES I NO
FOUNDATION:
FOOTINGS
WAlLS
FOUNDATION DRAINAGE
ELECTRICAL (UGHT DEn)
ROUGH-IN
PLUMBING
UNDER FLOOR / SlAB
ROUGH-IN
WATER liNE
BACK FWW / WATER
AIR SEAL
WAlLS
CEIUNG I
FRAMING
JOISTS / GIRDERS
SHEAR WAlL
WALLS / ROOF / CElUNG
DRYWAlL
T-BAR
INSULA nON
SlAB
WAlL / FLOOR / CElUNG
MECHANICAL
CHIMNEy
WOQDSTOVE / PEllET
DUCTS
PW urn.rrrns / SITE WORK (Engineerin! Division)
WATERliNE / METER
SEWER CONNECTION
SANITARY
STORM
srrn DRAINAGE / EROSION CONTROL
PARKING
OllIER
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ElECTRICAL UGHT DEPT 417-4746 ElECTRICAL
UGHT DEPT
CONSTRUCTION R. W / PW/ CONSTRUCTION R.W
ENGINEERING 417-4807 PW / ENGINEERING
ARE (MULTI-FAM. ONLY) 417-4654 FIRE DEPT
BUIWING 417-4815 BUIWING
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
GENERAL COMMENTS:
PW-II02.IS [4/96J