HomeMy WebLinkAbout732 E 1st St - Engineering
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PUBLIC WORKS CONSTRUCTION
and RIGHT-OF-WAY PERMITS
City Phone: 206-457-0411, exl. 124
.......CANT/OWNER.. ,?off.q !P[ . ADDRESS OF lOB, 'l ;9P- i5 /5 T
APPUCANT ADDRESS: PHONE ' LEGAL OF lOB:
WORK IS CJ OUTSIDE or CJ INSIDE OF VELED ROAD VALUE OF WORK IS:S (If worle: is outside roadway
and is equal to or less than $2,000, then permit may be issued to other than licensed and bonded contractor.)
PERMIT 00460
PLANS REQUIRED CJ YES CJ NO CONTRACTOR: DATES FOR START &. FINISH
PERFORMANCE BOND REQUIRED CJ YES CJ NO AMOUNT: S
PROOF OF INSURANCE: CJ WorIt $2,000 or leis: S50,ooo penonaJ injury, Sloo,ooo per incident, S20.ooo property
CJ Worle over $2.000: S200,OOO personal injury, S5oo,ooo per incident, Sloo.ooo propeny
CJ Right of Way Use: S3oo,ooo personal injury, S3oo,ooo per incident, Sloo,ooo propeny
Pemii.ttee UIldentlIIIda tbat DO _ may be cloaed to traffic unIeaa approved by the City Encin- and Chief of Police in advmce of the
closure; that there is a 24 bour m;n;...n... notice prior to inspection, and to Call 48 boun before digging 10: 1-800-424-5555,
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Sipd: (Lila -/ DATE: << 7/9&,
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"'" FIE 'AID TYPE FEE ,AJl)
JJOKI' OF WAY IXCAV. ......, .....- 4{)t3l- ~csraJ (," ,oM.......... .""'"
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.wourmt ',,,.11> IAlIIEWEIl ""FlU. .00, UNIT SS.ll>
IlIMlWIY .125m INIIBWD OTHEU . WiI-S1S_ ~:.so.om.._
Ma-'7SJ
DWY CULyar ......, lEWD TAP. IY ern}ll() IIU.m4JCD.O)
rru:EI' cur . ....... I2lII.OIl IEWEIl CAP/WATD MEI'D 121S.II>
OEMOVAL
onallCJHf O' WAY woo:. ......, ALTD.ATJONI 130.11>
REPAIR TO lEWD
"........... .......... STO.... DlAn'l TAP SI1S.DO
lD. WA1'D.II!KYICII. X SIr ....... CATCH 1ASUrd: Of LOTS I'D EACH ..,CD
m.WATBSBVICEI-X "..- ''''.II> tECONDAJlY SEWER ASSESS. S4I0.DO In S6".DO (IOU_ i
'''W 'y" -- , ._, -"OF '~'.CD~ I
coww. WATDID.YICE I- .II,D Ma.WAlAtEE Dl. SEWD ASSESS. IUO.oo IE'NM
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W'A1'D.ID.YICI. 0T1II!I. .......n IKJ1fl'OFWAY USE PDMrTS V,UJES U . IllX!
WATB IYS. DEV. CHAl.GE moJll/EWW . . qv,OC>
TOT"'" . -
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COMMENTS/CONDmONS:
C Inata11 CJ Repair ~
CJ Walermain ~
~~:::~ ~/t:Ud ~
CJ Uaderpouud TelephoDelE1ectrical
.JtMIT TOTALS, $ 1/) M
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RECEIPT
, t:tItf ISSUED B~
h4'~ADA"~"';7~
WORK ORDER No.
1>0460
omCE copy. CANARY PERW'r
INSPEcnON FEES $
PWoOD.OJ (l2m1
INSPIlCI'OR'S COPY , WHlI'E
Al'PLlCANT'S copy. PINK
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