HomeMy WebLinkAbout1132 1/2 W 17th St - Engineering
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APPLICATION flOR WATER
City Wcher Department
Port Angeles, Wash
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~ I hereby apply for water to be furni shed in accordance with rates and rules of the City
~ for the following premises
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Size of Service 1 'f-5fa ( Meter NU~-!~~O~~__
Service Left On 0 Service Left Off ~ Signed -r~ ;;~t~ ti'oo~oo 0
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~ Name of Applicant
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~ Renewal 0
Installed by
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Remarks
P~,elrl ,rJi 503'
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c! ..,. Qb APPLICATION FOR WATER
'iJ /fr." (. T City Weiter Department
.ree. 21:; 2- Port Angeles, Wash. It) /~ , 1~
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S1; I hereby apply for water to be furni shed in accordance with rates and rules of the City
\,;\ for the following premi ses
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.cor' Renewal 0 _New Service ~ BI~ Lot V
Si ze of Servi ce I ~ sta l' Meter Nu JJl f~ b:5 0 d- :3 (
Service Left On 0
Service Left Off ~ Signed.-rc:::=- I:~?-. tJ'iJtJ~6o-{J
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Installed by
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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DMSION
321 EAST 5TH STREET, PORT ANGELES, WA98362
PUBLIC WORKS CONSTRUCTION Issued: 10/25/96 LEH Permit No: 503
& R/W PERMIT Cond: X Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
HABITANT FOR HUMANITY 1132 1/2 17TH ST W
PO BOX 1957 Lot: 8
SEQUIM,WA98382 Block: 451 Long Legal:
360/683-5326 Sub: TPA
PROJECT INFO--------------------------~-----------------------------------------
, Work is INSIDE traveled road Value Work: $0.00
Plans Required: N/A Start: / /
Contractor: Finish: / /
Performance Bond Required: N/A Amount: $0.00
Proof Insurance:
* Storm Drain
* Underground Tele/Ele
* Misc
PROJECT NOTES-------------------------------------------------------------------
DEVELOPMENT REIMBURSEMENT AGREEMENT 93-03 $800.32 +5.00% ($40.01)+
5.4% (.1184035 PER DAY STARTING MARCH 10, 1994 $110.59 AS OF 9/30/96)
Work ,to Perform: INSTALL * Watermain
* Sanitary Sewer
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"
Comm Water Serv:
1"
1 1/2"
2"
Oth Water Serv:
Water Sys Dev: *
Receipt No:
Inspection Fee:
R/W
SANITARY
$40.00
$0.00
$0.00
$0.00
$40.00
$0.00
$0.00
$0.00
$550.00
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: DRA93-03
$80.00
$0.00
$0.00
$125.00
$0.00
$0.00
$0.00
$0.00
$642.00
$0.00
$0.00
$913.00
$40.01
$0.00
------------------------------
------------------------------
$0.00
$0.00
$883.00
TOTAL FEE:
AMT PAID:
$0.00
WATER
BAL DUE:
DWY
STORM
DRA
OTHER
$3,313.01
$3,313.01
$0.00
Separate Permits are required for electrical work, utilities, private and public improvements. This permtt becomes null and void ~ work or
construction authorized is not commenced within 180 days, ~ construction or work is suspended or abandoned for a period of 180 days after
the work as commenced, or ~ 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 permtt 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,
Date
Sianature of Owne;r~ owner is builder\
Date
Sionature of Contractor or Authorized Aoent