HomeMy WebLinkAbout305 W Ediz Hook Rd - Engineering
PUBILle WORKS & R/W PERMIT
Attached Notes
OWNER/APPLICANT
PUGET SOUND PILOT'S ASSOC
305 W EDIZ HOOK
Port Angeles, W A 98362
000/604-77 44
PROJECT INFO
Work is
Plans Required
Contractor' R J SERVICES
Performance Bond Required
Proof of Insurance
Work to Perform
~PROPERTY LOCATION
305 EDIZ HOOK W
I Lot:
Subdivision
Parcel No
- .~---
Start Date
Amount:
Issued
I I
Permit No
Work Order'
Ediz Hook
063000000400500
Value Work.
$000
I I
Finish Date
360/457-1420
$000
G Misc
Install
Repair
SJ Watermain
U Sanitary Sewer
[] Storm Drain
D Underground Tele/Elec
PROJECT NOTES
hot tap 4 x 8 $1000.00
meter $2380.00
strainer $430.00
gaskets $8.00 valve boxes $41.32
meter box no charge total owing $3859.32
FEES ASSESSMENT----
1 ) R/W Excav'
2 ) Sidewalk.
3 ) Curb/Gutter'
4) Driveway'
5 ) Dwy Culvert:
6 ) Street Cut:
7 ) Other R/W
8 ) Fire Hydrant:
9) Res Water Servo
10) Comm Water Servo
11 ) Other Water Service.
12 )Water System Dev'
13) San Sewer SFR
14) San Sewer MFR
add unit 0
- --- -~----_.__..__._--
Receipt No
Inspection Fee $0 00
.
~1~
$000
$000
$000
$000
$000
$000
$000
$000
$000
$3,85932
$000
$000
$000
$000
Itl~lOf
15 ) Other San Sewer'
16) Sew Tap Wye/Man Tap
17 ) Sew Capl W 1M Removal
18 ) Alter Repair Sewer'
19 ) Storm Drain
20 ) Catch Basin per ea.
21 ) Sewer System Dev'
22 ) Milwaukee Dr Sew Ass.
23 ) R/W Use Perm
24 ) Admin Cost (D RA)
25 ) D RA.
26 ) Misc
TOTAL FEE
Amount Paid
Balance Due
1212
o
Block. 7
SJ Long Legal
I I
$000
$000
$000
$000
$000
$000
$000
$000
$000
$000
$000
$000
$3,859.32
$000
$3,859.32
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Request for Billing
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Light Department
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Police Department
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Actual Material Costs
Actual Vehicle Costs
Misc Costs
Billing Fee
Sales Tax
Total
Authonzing Signature
Accounting Code
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Request for Billing
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Light Department
Medic 1 Transport
Police Department
Par1c:s Department
Par1c:inglBus Improvement Area
PenCom Dispatch Services
Public Wor1c:s Department
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Misc Costs
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Accounting Code
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. , . . . . , . . . . INSPECTION REPORT. . . . , , . . . . .
REQUEST (
Date ) 1--1 --C>
.
Time
Received by
(phone, person)
Location of Work to be inspected p /" -t- D + 5'fr:c+1 J 11 ~ O/:L )-/-66 k...
Name of person requesting inspection ~ W I , L~ jC
Address of person requesting inspection II +,11 'lS-- !3 Phone No
Type of Inspection (circle appropriate one) Permit No /Z/2-
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other WA ~
INSPECTION NOTES
Inspected Date
Remarks
Time By
Jfo t-f-vco b 'I C -9 02) L-U~HY-
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RESTORATION REQUIRED
YES
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt
o Repaired by City
[] Repaired by Permittee
o No Damage Found
o Other
W~ Order # ) q 7 I
~ COMPLETE
o INCOMPLETE
OPCC
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
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COST ANALYSIS -
WORK ORDER NO
LABOR 47>2.9-1 CITY OF PORT ANGELES PERMIT NO J "2-/ ~
EQUIPMENT S"z SO PUBLIC WORKS DEPARTMENT J.. OJ 7
ACCOUNT NO
WORK ORDER REPORT ,
MATERIALS 4, t ~'1 ~-n DATE (
TAX
DIVISION
TOTAL $-i~1tf.TI , 0 DEPOSIT PAID AMT $
.R :;- 5:61? v Ie.. t=-5' ~l' ~ /' ";>.,?,
CHARGE TO - 0 BALANCE DUE $ ') ~~ 0 ,
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ADDRESS ' ' , ", -' 0 REFUND DUE $
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DESCRIPTION LOCATION r~' i ,: r 4.
SPECIAL INSTRUCTIONS
labor TOTAL MOUNLY NAT!
DATE MOUNS SIZE STOCK ON AMOUNT Ale
or DIST
EMPLOYEE QUANT. No No UNIT PN'C!
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CERTIFIED COMPLETE LA. rj/vt. ;J ~ REVIEWED ( )
'DIVISIO HEAD CITY ENGINEER
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