HomeMy WebLinkAbout904 S F St - Engineering
PUBILlC WORKS & R/W PERMIT
o Attached Notes
OWNER/APPLICANT
Issued:
8121/2000
Permit No:
Work Order:
1097
o
PROPERTY LOCATION
904 F ST S
Lot: 1 & EAO'OF LOT 2
Subdivision: TPA
Parcel No: 063000030400000
Block: 304
000/000-0000
PROJECT INFO
Work is:
Plans Required: Start Date:
Contractor: QWEST COMMUNICATIONS
Performance Bond Required: Amount:
Proof of Insurance:
Work to Perform:
~ Long Legal
Value Work:
$0.00
1 1
Finish Date:
3601000-0000
II
$0.00
~ Install
D Repair
D Watermain
D Sanitary Sewer
D Storm Drain
IZJ Underground TelelElec
D Misc
PROJECT NOTE!;
PUSH UNDER ALLEY BEHIND 904 "F" STS
FEES ASSESSMENT
1.) R/W Excav: $0.00 15.) Other San Sewer: $0.00
2.) Sidewalk: $0.00 16.) Sew Tap WyelMan Tap: $0.00
3.) CurblGutter: $0.00 17.) Sew Capl WIM Removal: $0.00
4.) Driveway: $0.00 18.) Alter Repair Sewer: $0.00
5.) Dwy Culvert: $0.00 19.) Storm Drain: $0.00
6.) Street Cut: $0.00 20.) Catch Basin per ea: $0.00
7.) Other R/W: $0.00 21.) Sewer System Dev: $0.00
8.) Fire Hydrant: $0.00 22.) Milwaukee Dr. Sew Ass: $0.00
9.) Res Water Serv: $0.00 23.) R/W Use Perm: $0.00
10.) Comm Water Serv: $0.00 24.) Admin Cost (DRA) $0.00
11.) Other Water Service: $0.00 25.) DRA. $0.00
12.)Water System Dev: $0.00 26.) Misc: $0.00
13.) San Sewer SFR: $0.00 TOTAL FEE: $0.00
14.) San Sewer MFR: $0.00
add unit: 0 Amount Paid: $0.00
Receipt No:
Inspection Fee: $0.00 Balance Due: $0.00
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PUBUC WORKS
Permit To Perform Work In Street Right-of-Way
APPLICA TION is hereby made to the municipality of PORT ANGE.lES to perform work as
noted hereon and as shown on attached drawing: :P uS-rl U N t) ~
,K ~L- t:Lj ~ e H I ,,-.r1:~ Cj 0 L{ I' F Vi ~-r >
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Approved:
Water Department - Superintendent
Sewer Department - Superintendent
The estimated time for completion of the above work is vl \ T M I tJ 10 b<1 y5 of 12EC.51 f'/
By (Y\~~ ~.~
3(,,0 - '-{78 "'-Lf
Contractor . woer
US WEST /ATTN: MISTY
(,,1 \ - Go')!:. Sl1\EET .15A:s:6mwT
BgEMEgluN I \t.Jf\SHINGTDN qB3~
THE ABOVE APPLICATION IS HEREBY GRANTED SUBJECT TO APPLICANT'S;
Date l1... J
\'S
..t:D, 2.000
Complying with all Municipal Ordinances;
Notifying the Street Superintendent of the time the wark will star!, 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 ta any person
or property because of this installation or the maintenance thereof;
:J /~/ / ?Pt1)
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c:k~T'L_~
City af 'Po R.;r ANG EL ES
Complying with fallowing special conditions:
Date
'13604522933
~. BSW 0"""' .om"""'. ",moo' WoCX>O JL/L 3 0 - 4 "IS u
! Wirs center_--iS 7_ Date Submit1&d R - q - aD
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TECHNICIAN PAGE: COMPLETE ONE BOX ONLY (A, B or C)
A.INSTAl.LATlON & REPAIR S. ENGINEERING C. PREPROVISIONING
Q ORJer. C) 1- Clive; () I F'ax SIc~c/1 to; FlU 1/ 1-(1(J().2'H1170
o T~3ld2-li'1.:..5.1-'fi- D Om'" # __~_-- 1. Request Drop Preburied
1. Cited lor BSW----.---~ 0 D TN_ 2_ Repon Prebury has been
2. C~ed cannot locate ENCAP .__ 0 Order CF'ed for 101l0wlng r....o"* compl"too_ - Cl
3. R~air OOS _._.________. Q 1. Over 500' (Rural) - Cl Type of prebury:
4. cR'ed tor F1-F2, alSo need BSW Q 2. Right of way or permits Q Plow CJ Open ,rench
r required JiifI'. a Condlln
: 5.1e p placad - need sketch - .?'t-
explained below ~ 3. New construction. no 3. Ou" Oatt>
6. Fdund Tamp' Same Jon--. _ 0 h.alirtes __ CJ ~=.. ~ "'"'"'' .o""l'. ~ ,., C-ao
i Olher \..ocatJon_ 0 4. No pain; - 0 F1 4. Home Roady for GndlSNI:
240 I~ne- ,_ ~. _ Q F2 Yes 0 No 0
: 0 and E AI-WAYS REQUIRED
D. CUSTOIJERName FR \', 2.E Il AcKlrellS .:1('j~J: ~
Pho~e Number 11/) ~S'7- '1,/"1 "l caR SA t'VJ E CItY fD;t- A~des
Subclivision' l.ot 1/ Block
Couhty Co. \ c.. \ , D.- v'V\ Seelion 9 Range & ~:.I Town$hip ~ Ai
E. $UBMITTED BY Name M A "-IL _ oc~ Pager 202 - 110c-Cu8lomercontllClea:
Su fVlsor~l...J)--'..A M I (() Tel..~<;?''\'l~?'''VMS4n- ~"r:;.5: pager2s;.7'iI?'f71<:Verbal~ CardQ
~KETCH . Required on ,II orders CFD't.td and DOS RII air' Fax to LRAC
C"mpleful. Info on all orders or .ketche5 Tonn/na/
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