HomeMy WebLinkAbout1040 W Lauridsen Blvd - Engineering
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PUBLI~ YYvn~0 ~vn~lKU~llUn lSSUeO: 2/2U/~~ l~ PermIt No: 808
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
GUY RICHARDSON 1040 LAURIDSEN BLVD W
1040 W LAURIDSEN BLVD Lot: 5
Port Angeles,WA98363 Block: 1 Long Legal:
360/452-3073 Sub: PENN PARK
PROJECT INFO--------------------------------------------------------------~-----
Work is INSIDE traveled road Value Work: $0.00
Storm Drain
* Underground Tele/Ele
Misc
NOTES-------------------------------------------------------------------
150 FROM HOUSE TO TERM
CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
32] EAST 5TH STREET, PORT ANGELES, WA 98362
Plans Required: N/A
Contractor: US WEST COMMUNICATIONS
Start:
Finish:
Performance Bond Required: N/A
Proof Insurance:
Amoun t :
Work to Perform: INSTALL
Watermain
Sanitary Sewer
PROJECT
PLACE
/ /
/ /
$0.00
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:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
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:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
------------------------------
------------------------------
$0.00
$0.00
TOTAL FEE:
AMT PAID:
Receipt No:
Inspection Fee:
$0.00
BAL DUE:
R/W
SANITARY
STORM
WATER
DWY
DRA
$0.00
$0.00
$0.00
OTHER
Separate Permits are required for electrical work, utilities, private and public improvements. This permit becomes null and void ~ work or
construction authorized is not commenced within 180 days, ~ construction or work is suspended or abandoned for a period of 180 days after
the work as commenced, or ~ required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have
read and examined th~ application and know the same to be true and correct All provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not The granting of a permit does not presume to give authority to violate or cancel the
provisions of any state or local law regulating construction or the performance 9f construction.
Si nature of Contractor or Authorized A ent
Date
nature of Owner ~ owner is builder
Date
'tf~. <@kd ;;V~
PUBUC WORKS
Permit To Perform Work In Street Right-of-Way
APPLICATION is hereby made to the municipality of PORT ANGELES to p~rform work as
noted hereon and as ~hown on attached drawing:, t<.bJc.~ It La rJ (;
~ 0 fl A PPR..oX 15/
<(3 -(p2.V
L- A u IZ \ b SE N
566
PlFAS€
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lBevD .
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Approved:
Water Department - Superintendent
Sewer Department - Superintep.dent
The estimated lime for completion of the above work is
BY(Y\~~ ~~
3(,,0 - '-178 -'f4Zz..
Contractor Owner
US WEST / ATTN: ..MISTY
(.,,1 \.-:- (.,-r~.. Sl1\EET .~A$mf1JT
BREMERTON I WI\5HINGTDN <18337
THE ABOVE APPLICATION IS HEREBY GRANTED SUBJECT TO APPLICANT'S:
Date
"2-) II
/
I
19'18
Complying with all Municipal Ordinances;
Notifying the Street Superintendent of the time the work will start, and when it will finish;
Prosecuting the work with diligence and with due respect to all property. contracts, persons'
rights and the interests and convenience of the public;
Saving the Municipality harmless from any and all damages which may accrue to any person
or property because ,of this installation or the maintenance thereof; u
Complying with fOllowing special conditions:
c9;f;;}
19$
~itYO( :~'~
B ~Vz .,
Date
B2/B4/1998 B8: 59 35B-.583-2557 rJ
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, Dt.f 01-- A,V 'O~~
WORK LOCA1lQ~ / W1reCenter W.26 ~r;:2-
, ~i:li1J:!~~1~~-/j~~e~~
Subdivision
..oJ ,
Cust. Signature (Option"U
'\.
:" Submitted bv,tlf#.$1/ oCl1f.~ <{Paget M~-/).-p, y
'; I\'lSTALLAYIONIRE~hIR., ,c. 01 oG/ 4 / <f
'New t:I CF IJ $011 r.e "'Iv-f-II./ / '-/
Rearrange IJ Add line 0 ' . . .
Repair CJ OOS tJ TNiI'y .r~ - 30 73
FounclT~mp OCl 'a=N' ([:2 - YS~U_
T"mporizifJd? Y __
"RE-PROVlsrONINll
Prlj Bury tJ
Conduit Placed Partial. [:J' Compl8te 0
BSW In Open Tr. Partial C1: COmplete 0
EXtoncl SSW on p"rtl31 conduit or open trencIl 0 .
Hom(1 RHdV for SNUGND t1 : Not R<Nidy 0
/ . .'
LL _ ---'- _ I -=-- (_I
( Add 8 to riollt.if sketch ~no contractor I
Is there additional customer bilUng? ': C] ve's ~NO
Does Tech need notffied7 . 0 Yes . No
MAPU ....,
eSl PAIR COLORIBP . TERMADORESS
Sketch Walk Raqulred ./nclu(/Q nearest C(O$$ $troot and
wire length
US WEST SEQlJIM
PAGE Bl
9 -020 .
BURIED SERVICE WIRE Q~ 0'10 b / '-! l if
WORK ClRDER . '. DATE: ~I :J / ~r
COIllTRA(;TOR'S ACCEPTANCe
Firm
Signature
Title Oatil:
USWest croup doing work
Bill to: USWe$t Ccmmunlc8t1O/1s
Attention: .
Address:
City: Zip:
Racommanded:
Approvad by:
Date:
Date:
PEflMI,I'tEClJ/Ri:01
Received frolil
Jurlsd/ctJM' c.. I l' Y
\Xl
COMPlETED BV:
Call
Date:
for service cOl\neetlon
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