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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DNISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
PUBLIC WORKS CONSTRUCTION Issued: 1/28/97 LC Permit No: 605
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
CHRIS HARPER 1322 CAROLINE
1322 CAROLINE Lot: 4 & El/2 OF 5
Port Angeles,WA98360 Block: 9 Long Legal:
360/000-0000 . Sub: PSCC
PROJECT INFO------------------------------------------------------------------__
Work is N/A traveled road Value Work: $0.00
Plans Required: N/A
Contractor: DAUGAARD PLUMBING
Start:
Finish:
Performance Bond Required: N/A
Proof Insurance:
Work to Perform:
Amount:
Watermain
Sanitary Sewer
/ /
/ /
$0.00
Storm Drain
Underground Tele/Ele
Mise
NOTES-------------------------------------------------------------------
PROJECT
PROJECT FEES ASSESSMENT---------------------------------------------~-----------
R/W Excav:
Sidewalk:
Curb/Gutter:
Driveway:
Dwy Culvert:
Street Cut: *
Other R/W:
Fire Hydrant:
Res Water Serv:
5/8"
3/4"
I"
Corom Water Serv:
I"
1 1/2"
2"
Oth Water Serv:
Water Sys Dev:
Receipt No:
Inspection Fee:
R!W
SANITARY
$0.00
$0.00
$0.00
$0.00
$0.00
$200.00
$0.00
$0.00
$0.00
San Sewer SFR:
San Sewer MFR:
Add Unit: 0
Other San Sewer:
Sew Tap Wye/Man Tap:
Sew Cap/ W/M Removal:
Alter/Repair Sewer: *
Storm Drain Tap:
Catch Basin per ea:
Sewer System Dev:
Milwaukee Dr. Sew Assess:
R/W Use Perm:
D.R.A. :
Admin Costs (D.R.A):
Mise:
$0.00
$0.00
$0.00
$0.00
$0.00
$30.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
------------------------------
------------------------------
of Contractor or Authoriled A ent
Si neture of Owner ff owner is builder
$0.00
$0.00
$0.00
TOTAL FEE:
AMT PAID:
$0.00
WATER
BAL DUE:
DWY
STORM
DRA
OTHER
$230.00
$230.00
$0.00
Separate Permits are required for electrical work, ulilities, private end public improvements. This permit becomes null end void it work or
construolion euthorized is not commenced within 180 days, ff construolion or work is suspended or abandoned for e period of 180 days after
the work as commenced, or it required inspeclions have not been requested within 180 days from the last inspeolion. 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 construclion or the performance of conatruolion.
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Date
Date