HomeMy WebLinkAbout1120 Caroline St - Engineering
PUB/LlC WORKS & R/W PERM/T
D Attached Notes
OWNER/APPLICANT
NOEL FULLER
1120 CAROLINE
Port Angeles. W A 98362
000/600-0000
PROJECT INFO
Work is
Plans Required
Contractor'
Performance Bond Required
Proof of Insurance
Work to Perform
Issued
1 0/08/2002
Permit No
Work Order'
1311
o
PROPERTY LOCATION
1120 CAROLINE
Lot: 5
Subdivision
Parcel No
Block. 1
HART & COOK
063000810110000
~ Long Legal
Value Work,
$000
Start Date
/ /
Finish Date
000/000-0000
/ /
Amount:
$000
D Install
D Repair
D Watermain
D Sanitary Sewer
D Storm Drain
D Underground Tele/Elec
D Misc
PROJECT NOTES
sanitary sewer reconnect at alley connection must be inspected all
line from alley to new structure. (pvc) any bends greater than 45
will require a do.
FEES ASSESSMENT
1 ) R/W Excav' $000 15 ) Other San Sewer' $000
2 ) Sidewalk. $000 16) Sew Tap Wye/Man Tap $000
3 ) Curb/Gutter' $000 17 ) Sew Cap/ W /M Removal $000
4 ) Driveway' $000 18 ) Alter Repair Sewer' $35 00
5 ) Dwy Culvert: $000 19 ) Storm Drain $000
6 ) Street Cut: $000 20 ) Catch Basin per ea. $000
7 ) Other R/W $000 21 ) Sewer System Dev' $000
8 ) Fire Hydrant: $000 22 ) Milwaukee Dr Sew Ass. $000
9) Res Water Serv' $000 23 ) R/W Use Perm $000
10) Comm Water Serv' $000 24 ) Admin Cost (D RA) $000
11 ) Other Water Service $000 25 ) D RA. $000
12.)Water System Dev' $000 26 ) Misc: $000
13 ) San Sewer SFR $000 TOTAL FEE $0.00
14) San Sewer MFR: $000
add unit 0 Amount Paid $35 00
Receipt No
Inspection Fee $000 Balance Due $0.00
P.\?;(
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
REQUEST
Date
g> ~ 6 -O"L---
Time
Received by
(phone, person)
,.
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
~Inspection (circle appropriate one)
/'/
Sewer Foundation Framing Chimney Plumbing
J I J-O (' 61 '<6 [ .\ e.-
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Phone No
Permit No
Final Sewer Excav Other
13/ J
Inspected
Remarks
INSPECTION NOTES
~~~g-02--
Date
Time / 2 " '-J -S-
By'__ A..-An-
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RESTORATION REQUIRED
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YES
NO
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SURFACE RE TORA TION
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
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)