HomeMy WebLinkAbout620 S M St - Engineering
PUBILle WORKS & R/W PERMIT
OWNER/APPLICANT D Attached Notes
Jackson
620 S "M" St
PA, WA 98363
360/457-1995
PROJECT INFO
Work is:
Issued: 10/03/2000
Permit No: 1112
Work Order: 0
PROPERTY LOCATION
620 "M" ST S
Lot:
Subdivision: EVANS
Parcel No:
Block: 1
D Long Legal
Value Work:
$0.00
. Plans Required: Start Date: 1 1 Finish Date: 1 1
Contractor: QWEST COMMUNICATIONS 3601000-0000
Performance Bond Required: Amount: $0.00
Proof of Insurance:
Work to Perform: ~ Install D Sanitary Sewer D Misc
D Repair D Storm Drain
D Watermain ~ Underground Tele/Elec
PROJECT NOTES
trench in 5/6 alley west of "M" Street
FEES ASSESSMENT
1.) RIW Excav: $0.00 15.) Other San Sewer: $0.00
2.) Sidewalk: $0.00 16.) Sew Tap Wye/Man Tap: $0.00
3.) Curb/Gutter: $0.00 17.) Sew Cap/W/M 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 RIW: $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.) RIW Use Perm: $0.00
10.) Comm Water Serv: $0.00 24.) Admin Cost (D.R.A) $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
APPLICATION is hereby made to the municipality of PORT f\NC,ElES to perform work as
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noted hereon and as shown on attached drawing:
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Approved:
Water Department - Superintendent
The estimated time for completion of the above work is ul \ T h I tJ
BY(V(~ ~~
3<.>0 - '178 - ZZ-
Contractor Owner
US WEST / ATTN: MISTY
(,,1 \ - (.,I)l:- SmEET .1)A::c,m6\.lT
. Bf\t:.I'It:.RTuN I Wf\SHINGiDN q3:)~
THE ABOVE APPLICATION IS HEREBY GRANTED SUBJECT TO APPLICANT'S:
Sewer Department - Superintendent
; 0 IY\ yS of iZEC.S /PI
Dat~'
L--L~ 7--00 0
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;
Complying with following special conditions:
Date
/~h/
I
2. ()Tt)
...pr-
~~
City of "Po R...T ANG E.L E.S
b9;za-00 .15:59
From-US WEST 635 N QAKRIDGE DR PA
+13604522933
T-251 P.OI/OJ F-923
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TB HNICIAN PAGE:
A. NSTALLATION & REPAIR... A.
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1. pedforBSW 0
2. F'ed cannot locate ENCAP _ C
3. epalr OOS., , C
4. Pad for F1-F2, alao need BSW 0
6. mp placed. need sketoh . wi
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ound Temp. Same Job 0
Other LoeB on C
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D. USTOMER Name Addresl
Ph na Numbllr 4:1') - V 9?S CBR ,,/.'1'l-19fl'i- CIIY .3
Su division Lot fI Block
Co nty Nil fP 01Wl. SecUon Ran e R h W Towoehlp '7.30 tv
E. UBMITTED B Namll r7?~ OOR .0/7 Pager poo-~"'-"'19Cuetomercontacted:
. Su BlVlsor Tel. # "''f"'l-.~p.2 VMS t/7,f'..o'L, Pa er"'''OJ~mll!J-Vlllballyll:l CllrdO
F. KETCH. Re ulred on .11 order. CFD',d and 008 RI .Ir. FIIK to LRAC
m Jete L Info on ,111 orde" Of ske'fllhe. Term/",,' eBL PR SP
L L ---E- IV feLL S hl -r
L.E F,R,I N,E,S,W 1-2+4+6.7 W,S,P,O,C Q.A,M,N 235 S,N RN C,T /a.R6
Se tlon Range 12 h W Town.hlp 7" .s () flJ
41 f Feet S () Type of WIre .91'" 8S 111/ Road XoIng
BSW Order FormlSkelch Number
Wire Center #..~.J Pate Submiltld iJ . . . -- ....
COMPUn ONE BOX ONl.Y (A, B or 0) Wooa?2 333.
B. ENGINEERING C. PREPROVlSIONINIl
F/IJt'II8tell to: Fa # f..fJO.JB'.f'fQ
o Order * 1. RequBet Drop preburled
o TN 2. Report Prebury hu been
Ordlll' CF'ed for fallowing reslana completed
,. Ovar 600' (RuraO 0 Type of prebury.
2. Right of way or pelTl1llS IJ Plow
. required IJ C Conduit
S. New conBtNctlon . no S. DUI Date
facilities IJ ~""h01l\lIeIlllllr.V'ooQoU
4. No pall'l . 0 F1 4. Home Rlady for GndfSNI:
CF2 VeeQ NoQ
D and E ALWAVS REQUIRED
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