HomeMy WebLinkAbout717 W 6th St - Engineering
S PUBLIC WORKS CONSTRUCTION
_ and RIGHT-OF-WAY PERMITS
~ City Phone: 206-457-0411, ext. 124
. -tft
...dUCANr/0WNER1.i.PA7 JJt/n76; . ADDRESS OF JOB: 1 / ~ tV {;;
APPUCANr ADDRESS: PHONE LEGAL OF JOB:
WORK IS 0 OUTSIDE or 0 INSIDE OF TRAVELED ROAD VALUE OF WORK IS:S (If work is outside roadway
and is equal to or less than S2,OOO, then permit may be issued 10 other than licensed and bonded contraClor.)
PLANS REQUIRED 0 YES 0 NO CONTRACTOR:W:OZ 80 DATES FOR START
PERFORMANCE BOND REQUIRED 0 YES 0 NO AMO : S 7-74~
PROOF OF INSURANCE: 0 Worle S2,OOO or leSs: SSO,OOO personal injury, Sloo,OOO per incident, S20.000 propeny
o Worle over S2,OOO: S2OO,OOO personal injury, SSoo,OOO per incident, Sloo,OOO propeny
o Right of Way Use: S3OO,OOO personal injury, S3oo,OOO per incident, Sloo,OOO propeny
Permilleo undemmda that no ._ may be closed to traffic unleaa approved by tho City Engineer and Chief of Polico in advance of the
closure; that there is a 24 hour minimum notice prior to inspection, and to call 48 bours before digging 10: 1-800-424-5555,
PERMIT
VV'iGO
& FINISH
k .. . ~"~fIl"'''-'II.II............,........._..ae,fIII''ADIIIII_.,cllIlIam-._~ItaD..............~..~",.,.........,.....-wrr
b'.,~.. .~...... or""""""',...... ~.Ibt......... -* dill)' wmt1nMu.......U. M'nN dlbillPJNicatica..,; IN permit Of petnll...mctl~ t. &..-d m ~
~ ._.ucl-.id ~_...,..... ~ ~ ~
Sipd: ./J , ~A - rff// . DATE:
.-'7 , . .
... .:;.0 ..... . .....0 ""'0 Ii
nP! m! 'AID TYVE FEE 'AlO
UiHT OF WAY EXCAV. d /) {!!2- S.\I\l. SEWEI. (SFll {6" 10 M... 6-&" ..."., -- ?o!!E- !
..,,,.,
~ -.
-.w: ~"'. SAJ\I. SEWD. (MFR'. 1,,!miI un.1Il
<MJIITTn S115m SAN SE"ND IUFRI. ADO. UNrr "'"
D&MWAY nzs.m SAN lEWD 0'nID.S . J,t1D-J7HD;. SO..coshl
Ma-I7:1O 100 lXQIr.1O.o:ns p.a:M
"""ClJI.~ ___" ""'" SEWD. T~. IV CrTY 1'10 111S..llOISJlXlm
WYP./MANHOLE TAl
mEEt' cur . ........ S2lO'" --- 7' /) /l qa.. SEWD CMfWATEJI. MErD 1%15.00
lEMOVAL
OTHD lJOHI' 0' WAY WORK ""'" . SJO.oo
ALTERATION'
~EJI'ArJ. TO SEWn
FlU HY1lOAHT OE>OSIT STO~M DRAIN TAP IllS.OO I
RD. WAT'D SEltVJC"E I- X "'- ""'''' CATCH BASINS IN LOTS PEIl EACH ..,1Il
RD. WAT'EI. SBVJC"E I" X )1'- ""'" SEC'ONDAAY SEWn ASSESS. 1-410.00 in UlU.OO ~o::II: Ii
RES. WA1'D. ""VICE " X " '-.1Il SEW'DSYS.DEV.CHAROE U2'.OOfEWlro4 !i
;
COMM. WAT'D SDVICE I". U,aJO MD..WAUKEE DR. SEWEJ. ASSESS. UXl.oo~
~~:"J~
~!~ SEJt.V1CE. 0T1ID.. EmMA'" llOHT OF WAY USE PERMrrS VAFUES 1'.1100
WAT'D SYS. DEV. CHAl.OE mo.co IEWM TOTALS . I I
T'bif-"- u.a......___ ~ ..,..-..z. ..-_1Io ilia __ ~ .alar.....,...--..... ~ E.dI"rmfI.. ~.~ 10 II'&"~ olu.. .~____..z. "-1_
_~_..~eI"Clr)''''PaltAllp'-M\DQp&ICcd.. N<llhina ..rmit.........w.u., a..r.d\O_rna.Ihf~_o(""'" .w1ic-bllll.... 011,/-. e,,'<. C_... Slalll Ot F..... c;.,...,...."....
COMMENTS/CONDITIONS:
Cl Inalall 0 Repair
OWIlermIin
o Saaituy Sewer
Cl Storm Drain
o UodergrouDd TelephODelEloctrica1 0
.cIOOTTOTALS $ ~JtI)~CEm
PW~09.03 1121931
lNSPECI'OR'S COPY . WIITl'E
#/1Y~SSUEDBy\f~ DATE~
WORK ORDER No.
APPUCAm"S COPY. PINK OFFICE COPY. CANAAY PERMIT 0 0 4 28
INSPECTION FEES $
~