HomeMy WebLinkAbout1400 S Butler St - Engineering
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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
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7-4'477
PUBILle WORKS & R/W PERMIT
D Attached Notes
OWNER/APPLICANT
City of Port Angeles
Port Angeles, WA 98360
000/600-0000
PROJECT INFO
Work Is:
Issued: 3/05/2003
Permit No: 1370
Work Order: 0
PROPERTY LOCATION
--t7'lll1" BUTLER STREET
Lot''('f?O
Subdivision: SL 99
Parcel No:
Block:
D Long Legal
Plans Required: Start Date:
Contractor: QWEST COMMUNICATIONS
Performance Bond Required: Amount:
Proof of Insurance:
Work to Perform:
~ Install
D Repair
D Watermain
Value Work:
$0.00
II
Finish Date:
360/000-0000
$0.00
D Sanitary Sewer
D Storm Drain
~ Underground TelelElec
D Mise
PROJECT NOTES
install buried cable 240' North of 18th on Butler Street on west side
3' east of power poles on Butler Street
install buried cable 415' on south side of 18th Street east of Butler
line is 3' south of power poles I place peds at power poles for future
expansion
FEES ASSESSMENT
1.) RfW Excav:
2.) Sidewalk:
3.) Curb/Gutter:
4.) Driveway:
5.) Dwy Culvert:
6.) Street Cut:
7.) Other RfW:
8.) Fire Hydrant:
9.) Res Water Servo
10.) Comm Water Serv:
11.) Other Water Service:
12.)Water System Dev:
13.) San Sewer SFR:
14.) San Sewer MFR:
add unit 0
I I -----=;:::-:.. ,
"'rz p - ~ "
,1\ l j-~
, ----
-
$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
Receipt No:
Inspection Fee:
$0.00
RW
WATER
SANITARY
15.) Other San Sewer:
16.) Sew Tap WyelMan Tap:
17.) Sew Capl WIM Removal:
18.) Alter Repair Sewer:
19.) Storm Drain:
20.) Catch Basin per ea:
21.) Sewer System Dev:
22.) Milwaukee Dr. Sew Ass:
23.) RfW Use Perm:
24.) Admin Cost (DRA)
25.) DRA.
26.) Mise:
TOTAL FEE:
$0.00
$000
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Amount Paid:
$0.00
Balance Due:
$0.00'
DWY
STORM
DRA
OTHER
Separate Permits are required for electrical work, 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 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 perforx~
Sinnature of Contractor or Authorized Anent Date Sionature of Owner m owner is builder) Date
??~ <@I/ed g)~
PI JRI IG WORKS
Permit To Perform Work In Street Right-of-Way
APPLICA nON is hereby made to the municipality of PORr ANGELES
noted hereon and as shown on attached drawing: JOB # ~?.w'3 'i'13
to perform work as
\ ~ 1\-{ ") T
.;
'\5 I.A. "\ L Ii: V(
p~ I~IO
CHRIS CHRISTENSEN
Qwest, ENGINEER
360-452-2184 Approved:
Water Department -. Superintendent
7-o/4~7
Sewer Department - Superintendent
The estimated time for completion of the above work is W\'ft-'f. 'SO '2..00 S
~~
Date~' ~LcnJS
Contractor
Owner
.....,.-/
(check one)
THE ABOVE APPLICATION IS HEREBY GRANTED SUBJECT TO APPLICANT'S:
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 accrlle to any person
or property becallse of this installation or the maintenance thereof;
Complying with following special conditions:
3/5/?(J~9
Date
City of PORr ANGELES
BY~ZV~
I>r1nre,., eo.nmllnlc:Mlo"a, POrt Town~.nO'-J85-125/j
, Reason for reissue:
Issue: Dote:
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EMPLOYEES HAVING A NEED TO KNOW
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REMARKS:
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Notice: Not for disclosure outside of Owest and affiliates exce t under written a reement.
DESIGNED BY: l)6U.i;. \)f\V\')oi'-l JOB: '3<.W '1"\3
TELEPHONE: ?, Coo - '-\ l"1-' 2.n <{ GEO CODE: W 2."''-1 ~ z..
TAPER CODE: ' WC CLl-': P-rnNwf\0\
PLAT REF:'T ON Rio"" ';). Isse: ISS DATE: SH:
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