HomeMy WebLinkAbout3819 Canyon Edge Dr - Engineering
s
~~
CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
/
;",C'
,,/
.r
PUBLIC WORKS CONSTRUCTION Issued: 7/08/97 LC Permit No: 694
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
ANN KULISEC 3819 CANYON EDGE DRIVE
3819 CANYON EDGE DR Lot: 25
Port Angeles,wA98362 Block: Long Legal:
360/000-0000 Sub: CANYON EDGE
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:
Work to Perform:
Amount:
Watermain
Sanitary Sewer
/ /
/ /
$0.00
Storm Drain
Underground Tele/Ele
Misc
NOTES-------------------------------------------------------------------
PROJECT
&t>>~-LL ,t:L.-c~
It!?jpooo
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"
Corom Water Serv:
1"
1 1/2"
2"
Oth Water Serv:
Water Sys Dev:
Receipt No: 3164
Inspection Fee:
R/W
SANITARY
$0.00
$0.00
$0.00
$125.00
$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:
$0.00
WATER
BAL DUE:
DWY
STORM
DRA
OTHER
$125.00
$125.00
$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 s te or allaw gulating con truction or the performance of construction.
Si nature 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)
Sewer Foundation Framing Chimney
.5 3' 19 (}4h<r~ ~~ . LJLu-<-L/
Phone No
Permit No M<;7
Plumbing Final Sewer Excav Other dt:t-y
INSPECTION NOTES /; ~
Inspected Date I p II; zo () ()
I
Remarks
Time
By
\}J
~
~
~
#tI rf2M~ - ~/ ~
/J- (
~6 tn~ f;ft;
~
7/9"7
RESTORATION REQUIRED
YES
NO
~
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
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)