HomeMy WebLinkAbout902 1/2 Bryson Ave - Engineering
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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
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PUBLIC WORKS CONSTRUCTION Issued: 9/07/99 LC Permit No: 800
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION----------------~-------
T.S. MILLS 902 1/2 BRYSON
23 TERRY MILLS RD Lot: 4,5
Port Angeles,WA98362 Block: Long Legal:
360/452-5140 Sub: DANN'S PARK ADD
PROJECT INFO--------------------------------------------------------------------
Work is N/A traveled road Value Work: $0.00
Plans Required: N/A
Contractor:
start:
Finish:
Performance Bond Required: N/A
Proof Insurance:
Amount:
Work to Perform: INSTALL * Watermain
* Sanitary Sewer
Storm Drain
Underground Tele/Ele
* Misc
NOTES-----------------------------------------------------------------
PROJECT
/
/
~
/ '=:J
$0. 00 ~
~
~
~
/
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"
I"
Corom Water Serv:
1"
1 1/2"
2"
Oth Water Serv:
Water Sys Dev: *
Receipt No: 5120
Inspection Fee:
R/W
SANIT AR Y
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$125.00
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
$642.00
$0.00
$0.00
$0.00
$0.00
$0.00
------------------------------
------------------------------
Signature of Contractor or Authorized Agent
Date
$0.00
$0.00
$883.00
TOTAL FEE:
AMT PAID:
$0.00
BAL DUE:
$1,650.00
$1,650.00
$0.00
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 th erformance of construction.
WATER
DWY
STORM
DRA
OTHER
Date
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. INSPECTION REPORT. .
-r-- Time
I ~ l. -2)
, L --~. Received by
/-~ ----
"- -'
'c...: (phone, person)
REQUEST
Date
)/ :
I
/ -..,
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
Sewer Foundation Framing Chimney
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INSPECTION NOTES
Phone No
it No
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Inspected Date Time
Remarks
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By
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RESTORATION REQUIRED
YES
NO
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,
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt
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OPCC
o Other
D Repaired by City
[] Repaired by Permittee
[] No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)