HomeMy WebLinkAbout720 S N St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
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Application Number
pin number
Property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr, name
Application description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
04-00000139 Date
.882316
720 S N ST
06-30-00-4-8-0130-0000-
WAVE BROADBAND
PUBLIC WORKS UTILITES
2/19/04
720 S /tL /)
RS9 RESDNTL SINGLE FAMILY
o
Owner
Contractor
KEDISH ,STEWART AND MARGIE
P.O. BOX 507
PORT ANGELES WA 98362
(360) 457-5005
OWNER
Permit RIGHT OF WAY
Additional desc RIGHT OF WAY USE 04-03
Permit Fee 60.00 Plan Check Fee .00
Issue Date 2/19/04 Valuation 0
Expiration Date 8/17/04
Qty Unit Charge Per Extension
BASE FEE 60.00
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 60.00 60.00 .00 .00
-\Pl~J'!.-Check Total .00 .00 .00 .00
Grand Total 60.00 60.00 .00 .00
F-41- CfJ P'1 To
0\-6608
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Separate Permits are required for electrical work, SEPA, Shoreline, ESA, 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 provisiDns 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 the performance of
construction.
Date
Date
Signature of Contractor or Authorized Agent
Signature of Owner (if owner is builder)
T:\PLANNJNG\FORMS\1102.15 [11/14/2003]
WAS H I N G TON, U. S. A.
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81Glfl1 OF WAY USE.o""ji"""
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FORTANGELHS
CITYOF
NAME OF APPLICANT
MAILING ADDRESS
PHONE NUMBER
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);25 r_ 1St
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STREET ADDRESS OF PROPOSED STREET USE "} 2 Ci
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IS THE USE TEMPORARY OR PERMANENT?
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HOW LONG WILL THE OBSTRUCTION BE IN PLACE?
'I/;;;A.. ARE THE HOURS OF OPERATION? ..-'
HOW IT WILL BE LIGHTED?
EXPLAIN THE NECESSITY TO USE THE PUBLIC STREET, SIDEWALK OR PLANTING STRIP. ARE THERE
ALTERNATE AREAS THAT COULD BE USED?
HOLD HARMLESS and INDEMNIFICATION AGREEMENT
In compliance with the Port Angeles Municipal Code, and in consideration of the issuance by the City of Port Angeles of a Street Use
Permit to the undersigned allowing the placement of the above described street use or obstruction, the undersigned for himself and
for his successors in interest, hereby agrees to indemnify, hold harmless, and defend the City of Port Angeles against any claims or
lawsuits for personal injury or property damage arising out of, or in any way connected with. the placement of the use or obstruction
on the City stre~h\~RflYfiJlk. or planting strip.
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App lcant
SUBSCRIBED and swom to before me this ndayof'Hc.-Jf-,.,(?1J~'-l .200*
GO:o\~01~Y \'~"t\ttJ'\
NOTARY PUB C In and or e State of
Washington residing at' .,=::>r, 1iL'T' ~Eo1:-.l:Eo '"
(This penni!, if approved, may be tenninated by the City of Port Angeles without cause and at any time)
day of
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[OFFICE USE ONL Y]
Copies sent to:
Police
Fire _
Planning _
Finance
Date:
Date application received "l/~; /O~
Certificate of Insurance per PA C 11.12. 40(B)
on N/A
~
Fee paid $ Ui)-Receipt#
Agreement to Remove Encroachment signed and
recorded on N[A
*************
Application reviewed and recommendation by City Engineer
deny or approve and with the following conditions:
Date
is to
Application approved or denied by the Director of Public Works
Date
...............nn.........................................................................n.nn.nn....nn.......l.....................................n.n........................................................n...........
Copies to: Applicanl 0 Fire 0 Police 0 Street 0 Othel
o Address file 0 RUP file 0
RUP#
o4-~:s
Area
Address 7;20 5 A/
City Por+ 1th9 eJC\. <;
Subdivision
Repair )2(
Cust. Name
Northland AeeL # 0330 )()
I Complete
By
Footage
Show nea'res( cross street .
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Due Date
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Notes, instructions
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Indicate North
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