HomeMy WebLinkAbout1312 Campbell Ave - Engineering
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CITY OF PORT ANGELES
PUBLIC WORKS - UTILITIES DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
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Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr, name
Application type description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
06-00000174 Date
842742
1312 CAMPBELL AVE
06-30-14-5-3-0530-0000-
QWEST
PUBLIC WORKS UTILITES
2/17/06
RESIDENTIAL HIGH DENSITY
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4 Ca.sw~
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Owner
Contractor
CASWELL, GARY D.
P. O. BOX 1513
SEQUIM
(360) 683-6566
WA 98382
EXCEL UTILITIES CONSTRUCTION
54 MISTY LN
PORT ANGELES WA 98362
(360) 452-1110
Permit. . . . .'.
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date .
RIGHT OF WAY
PHONE SERVICE BURIED/BORE
71456
.00
2/17/06
8/16/06
Plan Check Fee
Valuation
.00
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Fee summary Charged Paid credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total .00 .00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total .00 .00 .00 .00
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 orwork 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 state or local law regulating construction or the performance of
construction.
Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T:\Policies\1102.15R {1/05]
WAS H J N G TON, U. S. A.
~~~~i'F WAY~Si.~ IJ'ij, 'I
=
l2'ORT ~GELES.
NAME OF APPLICANT
MAILING ADDRESS
PHONE NUMBER
()/ilus-r Lt) mm14u / urr'lJ JUs.
LP~5 N. OAKi-I!';-..E Dte.
'3/d)-1{~2 - ,t.. 7/
II DATE 2;'3/0(,
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STREET ADDRESS OF PROPOSED STREET USE
1~12. ~ LAY1A;4$-EL-L Av!Z-
DESCRIPTION OF REOUEST (include drawings required for clarity): [If street closure is requested, please state the name
of the street and 'fILits of closure, ~ther with the duration Qf AcI9sure.]
'L't/tSE- S A-r-rACJIiD JJUHJ(/IJi6-.
IS THE USE TEMPORARY OR PERMANENT? fiE 'ttM A 11/ eN r
HOW LONG WILL THE OBSTRUCTION BE IN PLACE? :J,.<;;>{ k/(I~Qe's J- !f(lW,fY11.IfT" j)"R"r"6- a~T.
WHATARETHEHOURSOFOPERATION? . 1S',oo , . D ~ i:J /YI . .
HOW [T WILL BE LIGHTED? l-L 1/ i' ' 'f. I'h J IU J;iE. I Hr ~ '41.y
EXPLAIN THE NECESSITY TO USE THE PUBLIC STREET, SIDEWALK OR PLANTING STRIP. ARE THERE
ALTERNATE AREAS THAT COULD BE USED? ---..0
l::- t...L I""Oc.?IOrz... I ~t../i.. r'IIDn",€ S;;!.ev{~ TrJ 1"$/2-
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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 harmiess, and defend the City of Port Angeles against any claims or
lawsuits for-personal injury or prope~ da~age arising out of, or in any way connected with, the placement of the use or obstruction
on the City street, sldewaik, or piantlng strip. J/J7JI n 't._r.
DATEDthis~ayof. -e15l1Lf.Y ,~
,:; 'rill K e.. Lo c..kllA-Jtr
Applicant
SUBSCRIBED and sworn to befre m,e this J!L day of,:;1. 0
.OTA Y PUBLI in an< for
Washington residing at I
(This permi/, if approved, may be terminated by the City of Pori Angeles 'without cause and at any time) .
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. [OFFICE USE ONL Y]
Copies senl to:
Police
Fire
Planning _
Finance
Date:
Fee paid $ 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 application received
Certificate of Insurance per PAMC 11.12.140(B)
on N/A
Date
is to
Application approved or denied by the Director of Public Works
Dale
....................... ............__.....__...._ _h.................... ......_....._.._............ u_......._._h..._ _h...... .....- _n........__.. _.__n_n_ ..... .. ..................... ---
Copies to: Applicant 0 Fire 0 Police 0 S1reel 0 Other
N:\PWKS\L1GHTICONS\CA TE\ROWPER.wpd
o Address file 0 RUP file 0
RUP#
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Reason far reissue: Issue: Date:
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REMARKS:
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EMPLOYEES HAVING A NEED TO KNOW
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Notice: Not for. disclosure outside of Owest and affiliates exce t under written a reemant.
DESIGNED BY:. tu:.T ,JOB: 2w/. t,.2/
TELEPHONE: "!ow - "'~Z- 7t. 7/ CEO CODE: ~ 'd, YG'2..
TAPER CODE: vilC elLl: r/14/1/ullfol
PLAT REF: ISSI: I .ISS DATE: Z. .~5. ~ SH: I OF I
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