HomeMy WebLinkAbout1802 W 12th St - Engineering
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CITY OF PORT ANGELES
PUBLIC WORKS . BUILDING DNISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
PUBILlC WORKS & R/W PERMIT'
D Attached Notes
OWNER/APPLICANT
1802 W 12TH
Port Angeles, WA 98363
000/604-2115
PROJECT INFO
Work is: Inside Traveled Road
Issued: 1/15/2004
Permit No:
Work Order:
1395
.0
PROPERTY LOCATiON
1802 12TH STW
Lot: 1 Block: 362
Subdivision: TPA
Parcel No: 963000036202000 [gJ Long Legal
Value Work: . $0.00
PROJECT NOTES
inslall175' burted 50 pair cable in 12/13 alley 1700 /1800 blk
at "L" Street
Plans Required: Start Date: 1 1 Finish Daie: 1 1
Contractor: QWEST COMMUNICATIONS 360/000-0000
Performance Bond Required: Amount: $0.00
Proof of Insurance:
Work to Perform: [gJ Install D Sanitary Sewer D Mise
[gJ Repair D Storm Drain
D Watermain C8J Underground Tele/Elec
--'=l-e.CLSe... ~
/)...JRI,€:: r':4-{ O}..j '(Ol.(IC..---;;"K~tf
If'
$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
Balance Due:
$0.00
OTHER
RW
SANITARY
WATER
15.) Other San Sewer:
, "",, I I" .
16.) Sew Tap Wye/Man Tap:
17.) Sew Capl W/M Removal:
18.) Alter Repair Sewer:
19.) Storm Drain:
20.) Catch Basin per ea:
21.) Sewer System Dev:
22.) Milwaukee Dr. Sew Ass:
23.) RIW Use Perm:
24.) Admin Cost (D.R.A)
25.) D.R.A.
26.) Mise:
TOTAL FEE:
Amount Paid:
DWY
STORM
DRA
$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
Separate Permits are required for electrical work, utilities, private and public improvements. This perma becomes nuU and void if work or
construction authorized is not commenced wtthin 180 days, if construction or work is suspended or abandoned for a period of 180 days after
the work as commenced, or W 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 perma does not presume to give authority to violate or cancel the
provisions of any state or local law regulating construction or the performance of construction.
Sianature of Contractor or Authorized Aaent
Date
Date
Sianature of Owner (if owner is builder)
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(M?LOYE[5 HA\!ING t. !'4(ED TO KNOW
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Notice: Not for' disclosure outaldll of Ow&st and attllates except linder wrlttBn!. BlItI1ent
DESIGNED BY: \)'ANf. flAGIO"- ID.\.ov,- JOEl:
TELEPHONE: 3100-411-7.11'1 GEO CODE: W'l.b4S2
TAPER CODE: 4~of,7.1 WC CUJ:
PlAT REF: (.101\ 1551: 15S DATE: SH:
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NORTH
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