HomeMy WebLinkAbout136 E 11th St - Engineering
. /
. f,.8....~/, PUBLIC WORKS CONSTRUCTION
and RIGHT-OF-WAY PERMITS
~, City Phone: 206-457-0411. ex!, 124
.';r1'.ICANT/OWNER: tft-jV Lt/I7~ . ADDRESS OF JOB: /..3k,E / /7a.
APPUCANT ADDRESS: PHONE LEGAL OF JOB: LT I /iJ-/K 63 B
/
WORK IS Cl OUTSIDE or Cl INSIDE OF TRA VELED ROAD VALUE OF WORK IS:$ (If work is outside roadwav
and is equal to or less than $2.000. then permit may be issued to other than licensed and bonded contrac,or.)
PERMIT
00228
PLANS REQUIRED Cl YES Cl NO CONTRACTOR: DATES FOR START & FINISH
PERFORMANCE BOND REQUIRED Cl YES Cl NO AMOUNT: $
PROOF OF INSURANCE: Cl Work $2.000 or leSs: $50,000 persocaJ injury, Sloo,OOO per incident, S20.000 propeny
Cl Work over $2.000: $200,000 persocaJ injury. S5oo,OOO per incident. S 100.000 propeny
Cl Right of Way Use: $300,000 persocaJ injury, S3oo,OOO per incident. Sloo,OOO propeny
Permittee UIldentaDda that no .- may be closed to traffic W1ieas .pproved by th. City Ellginoer and Chief of Police in advance of the
closure: thsi thero i. a 24 hour minimum notice prior to inspection. and to call 48 hours before digging to: 1-800-424-5555.
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WIlT OF WAY EXCA,Y,
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II ""M' SAN. SEWER 1UF11.l. 1,1 WliI ....,
oW<JUm1 112:1.00 SAN SEWD lMf1l.1 . ADD. UNIT U..,
" DlNEWA Y $125m /l.IlI..., I N;;(f '.111:. . OTHEU . Mia-sn.CO:. 5O.D:lSltl I
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DWY ctlLyar ..... V V ;r( C7V' I r~ T":to~T~~O SIU,a)lSXO.OJ
mar C\1T, '-- ".,"" ....-- ljf. ~~ -",;;"-- -SEWn CAPIWATER METER $213.00 I
REMOVAL
onca IJCJKT 0' WAY WOIX ..."" ALTER.ATlONI SJO."
REJlAra TO SEWD.
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sroalo( ORAllr' TAP
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RD. WAT'D. SDVIC! 1- X SIll-
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CATCH BASINS tH Lon: PEIl. EACH
$M3,OO
lEI. WAT'D. SElVlC! '" X 314"
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SECONO......Y SE:"Na ASSESS.
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SEWER SYS. OEV. CHAIl,CiE
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Mn.WAUKEE OR. SEWn ASSESS.
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RIOKT OF WAY USE PERMITS
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# .j?3J:sSUEDB~_fK/?f~_
DATE:~.
INSPECTION FEES,S
WORK ORDER No,
PW.0209.03 . (1%1931
INSPECTOR'S COPY. WHITE APPLICANT'S COPY. PINK OFFICE COPY. CANARY PERl\1lT
00228