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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
PUBLIC WORKS CONSTRUCTION Issued: 1/08/97 TF Permit No: 599
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
CITY OF PORT ANGLESE 220 2ND ST W
321 EAST 5TH ST Lot: 5
Port Angeles,WA98362 Block: 52 Long Legal:
360/417-4807 Sub: TPA
PROJECT INFO----~---------------------~-----------------------------------------
Work is INSIDE traveled road Value Work: $0.00
Plans Required: N/A
Contractor: GENERAL CONST
Start:
Finish:
/ /
/ /
Performance Bond Required: N/A
Proof Insurance:
Amount:
$0.00
Work to Perform: REPAIR
Storm Drain
Underground Tele/Ele
* Misc SLIDE AREA
PROJECT NOTES-------------------------------------------------------------------
NO FEE PERMIT ISSUED FOR WORK IN CITY R/W FOR SLIDE REPAIR @ 2ND ST
BEHIND ARMORY SQUARE
Watermain
Sanitary Sewer
PROJECT FEES ASSESSMENT---------------------------------------------------------
R/W Excav: $0.00 San Sewer SFR: $0.00
Sidewalk: $0.00 San Sewer MFR: $0.00
Curb/Gutter: $0.00 Add Unit: 0
Driveway: $0.00 Other San Sewer: $0.00
Dwy Culvert: $0.00 Sew Tap Wye/Man Tap: $0.00
Street Cut: $0.00 Sew Cap/ W/M Removal: $0.00
Other R/W: $0.00 Alter/Repair Sewer: $0.00
Fire Hydrant: $0.00 Storm Drain Tap: $0.00
Res Water Serv: $0.00 Catch Basin per ea: $0.00
5/8" Sewer System Dev: $0.00
3/4" Milwaukee Dr. Sew Assess: $0.00
1" R/W Use Perm: $0.00
Corom Water Serv: $0.00 D.R.A.: $0.00
1" Admin Costs (D.R.A): $0.00
1 1/2" Misc: $0.00
2 ,. ==============================
Oth Water Serv: $0.00
Water Sys Dev: $0.00
TOTAL FEE:
AMT PAID:
$0.00
$0.00
Receipt No:
Inspection Fee:
RJW
SANITARY
$0.00
WATER
BAL 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 autihorized 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 performance of construction.
Sionature of Contractor or Authorized Aoent
Date
Sionature of Owner (if owner is builder)
Date