HomeMy WebLinkAbout1100 W 12th St - Engineering
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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 reement.
DESIGNED BY: uou..<:;, \)f\vISb/'.-l JOB: '3'2lD I> 5"'6;;-
TELEPHONE: sc"o - \.Hl-- 2.n<f GEO CODE: W 2..rc'-l ~2..
TAPER CODE: WC ClU: PT'AI'( Luf\Q)\
PLAT REF: ISSI9: ISS DATE: SH:
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PUBILle WORKS & R/W PERMIT
o Attached Notes
OWNER/APPLICANT
CITY OF PA
Issued: 3/12/2003
Permit No: 1373
Work Order: 0
PROPERTY LOCATION
1100 12TH ST W
Lot:
Subdivision:
Parcel No:
Block: 370
Port Angeles, W A 98360
000/600-0000
PROJECT INFO
Work is:
o 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 0 Sanitary Sewer 0 Mise
o Repair 0 Storm Drain
o Watermain ~ Underground Tele/Elec
PROJECT NOTES
OPEN CUT ACROSS 12/13 ALLEY EAST OF "D" STREET DIRECT BURY 1-ANMW
SOX CABLE RESTORATION BY CONTRACTOR CDF BACKFILL
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 Capl 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.) D.RA $0.00
12.)Water System Dev: $0.00 26.) Mise: $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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PIIRI Ie:: WORKS
Permit To Perform Work In Street Right-of-Way
APPLICATION is hereby made to the municipality of PORI' ANGELES . to perform work as
noted hereon and as shown on attached drawing: JOB # S~ W l; ~ S-
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Water Department -.Superintendent "',- !!.h
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CHRIS CHRISTENSEN
Qwest, ENGINEER
360-452-2184 Approved:
Sewer Department - Superintendent
The estimated time for completion of the above work is 'Yv\ If\- y , ~ 0 .
Dateb. ,\ Lo-oS ~
LOO>
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 accrue to any person
or property because of this installation or the maintenance thereof;
Complying with following special conditions:
:7/1/ID~
Date
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19
Pntl...., Commu"I~/on.. Po-r Tow".."d_J85-12S"
Reason for reissue:
Issue: Date:
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EMPLOYEES HAVING A NEED TO KHOW
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Notice: Nol for disclosure outside of Owest a.nd affllla.tes exee under wrItten 8 reement.
DESIGNED BY: \)011.(, \)11 Wio>.l JOB: ": L CU 15 s-.,,--
TELEPHONE: '.0' '-\\1-- 2.\1-<{ GEO CODE: w z.".gz.
TAPER CODE: . WC CLL/: PTY'\N WF\0\
PLAT REF: 1C'C'.oI" 1C'r':' r...T......