HomeMy WebLinkAbout1040 S D St - Engineering
PUBILlC WORKS & R/W PERMIT
D Attached Notes
OWNER/APPLICANT
city of Port Angeles
Issued:
8/23/2004
Permit No:
Work Order:
1412
o
PROPERTY LOCATION
1040 0 ST S
Lot:
Subdivision:
Parcel No:
Block:
Port Angeles, WA 98360
000/600-0000
PROJECT INFO
Work is:
Plans Required: Start Date:
Contractor: QWEST COMMUNICATIONS
Performance Bond Required: Amount:
Proof of Insurance:
Work to Perform:
D Long Legal
Value Work:
$0.00
II
Finish Date:
360/000-0000
II
$0.00
[5<J Install
D Repair
D Watermain
D Sanitary Sewer
D Storm Drain
[5<J Underground Tele/Elec
D Mise
PROJECT NOTES
placement of buried service wire for customer @ 1040 South 0 Street to
include 18' push at alley
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.) 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
8-18-04; 1 :58PM;OWEST CON_ /MAINT
;253 597 5066
# 1/ 3
7850B S. Trafton
Tacoma, W A 98409
facsimile transmittal
To: City of Port Angeles Fax: 360-417-4709
From: Qwest Communications Date: 08/18/04
Re: Pages: 5
cc: Ryan Fuqua
o Urgent o For Review o Please Comment o Please Reply o Please Recycle
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Noles:
T. Funston,
Pennil applications:
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AUG 2 0 2004
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FU!UC WOFWI
Permir To Perform Work In Streel Right~f.Way
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APPLICATION is hereby made ro the municipality of PORI' ANGELEs . to perform work as
nOTed hereon and U <hown on attached drawing:
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Approved:
Water DeplUtment - Supexintendent
Sewer Deplll'tl:nent - Superintendent
The estimared time for'complerion Ofrhe above work Is JD 7)Ays A.FTER- I? Pc.~
Date
15-I8'-C)'f
By
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Phone:
2. S'3 - 47/- I~Z 'f
253-473-0788
Contractor X
Owner
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THE ABOVE APPLICATION IS HEREBY GRANTED SUBJECT TO APPI.lCANT'S:
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ComplYing wirh all Municipal Ordinances;
NotifYing rhe Street Superintendent of the time the work will sbr:, and when it will finish;
ProseCUTing rhe work WiTh cliligence and with due respect to all property, contracTS, pe(1lons'
rights and rhe .ntereslS and convenience of the PUblic;
Saving the Municipality harmleS! from any and all damag~ which rnay accrue to any person
or property because of rhis installation or rhe maintenance thereof:
Dare
COmPIYjE wlrh lllowmg special conditlohS:
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8- 1 8-04; 1: ,,",BPM; QWEST CON. /MA I NT
;253 597 5066
# 3/ 3
Qwest Job #
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This request for permit is for the placement of underground telephone service wire to
our customer at the following address: .
10 LfO
:; D
5iREEi
This work will require:
Trenching in the R/W (total footage) 1(, ,
Plowing in the R/W (total footage) R1
Push or bore 2 inch PVC or BIP under roadway (total footage) ,>> '
Push or bore 2 inch PVC or BIP under driveway (total footage) f
Push or bore 2 inch PVC or BIP under multiple driveways (total footage)
Applicant Signature/Date ...+-T_ ~... _.-:~;~/ .<
Road Number ~-.<~~-
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117 L\ qCig