HomeMy WebLinkAbout105 W 11th St - Engineering
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tj'"
~ and RIGHT-OF-WAY PERMITS
~ " City Phone: 206-457-0411, ext. 124
.~"uCANT/OWNER:K/qlttffW e Fe . ADDRESS OF JOB: I tJ S tv
APPUCANT ADDRESS:~I/HE-- - PHONE LEGAL OF JOB:
WORK IS 0 OUTSIDE or 0 INSIDE OF TRAVELED ROAD VALUE OF WORK 15:5 (If work is outside roadway
and is equal 10 or less than 52,000, then permit may be issued to other than licensed and bonded contractor.)
00429
PUBUC WORKS CONSTRUCTION
PERMIT
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PLANS REQUIRED 0 YES \i'1NO CONTRAcrOR: DATES FOR START & FINISH
PERFORMANCE BOND REQUIRED 0 YES 0 NO AMOUNT: 5
PROOF OF INSURANCE: 0 Work $2.000 or leSs: $50,000 persooal injury, 5100,000 per incident, 520.000 property
o Work over $2.000: 5200,000 personal injury, 5500,000 per incident, 5100,000 propeny
o Right of Way Use: $300,000 persooal injury, 5300,000 per incident, 5100,000 propeny
Permittee IIIlllentanda that no a_ may be cloaed to traffic unIeaa approved by tho City Engineer and Chief of Police in advance of the
closure: that thero is a 24 hour minimum notice prior to inspection, and to call 48 hours before digging to: 1-800-424-5555.
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Siped:~ ~-7 //~:. r2f C!)'&' DATE: 3 I~ 'iG
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...... "'''0 OF"'O Ii
TYPE FEE PAID TYPE FEE PAID
lJQHT OF WAY EXCAY. .....lD *.&0 ....lD 'I
SAI'I.~~EJtISfIU (6"""11..6"..'
...... '
~.lD' "AN. lEWD. .....FI!.'. hI \IIIil. ~,OO
.wotJTTfJt 1125.00 SAN lEWD ft.FR'. ADO. UNrr ".00
ll&IYEW A Y SI%Sm SAN lEWD. OTHDS . totil_I1SJ:U =~.amu_
W..-S730
~CUl.YBT ...... ~.w..o~.;,w~o SI1S~.CIO 12~, G?:.
snEEr cur . ....... 12lO.lD SEWD CMtwAT'D. MEJ"El .:W.lD
llEMOVAL
OTHEI,IJDHT OF WAY woax .....lD ALTDATIOHI 1lO.lD
aEPAll TO SEWn
FOO! IlYDUHT DEPOSIT SToaM DR.AIN TAP SI13.00
us. W'AT'D 1EaV1C'E I- X 511- "".00 CATCH 8ASlJIIS IN LOTS PEl'. EACH "'.00 [
lES. W'AT'D SD.V'ICI!: I- X "4- U1S.00 SECONOAA Y SEWER AS5ESS. kIO.OO irI UIHJJ co.u.x j
mWA -x ,- ~.OO S~SYS.ftEV.CHARCE 'nol.oo fEWM I
co....... WAT'D. SDVICE I' . 1I,C1OO Mn.WAUKEE DR. SE'WEl ASSESS. S130.(l)/EW'Io4
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WAT'D. SD.Y1CE. 0TIIEk EmMA"" RIOIfT OF WAY USE PERMITS VARIES U. SIOO
WAT'D. SYS. DEV. CK.UOE S7J).OD1EWM TClTAU I . /0 ~-;(f;qJ
TlliI-..i6II...u.-.-............,......u.......lIOllou.__~ ilia rot. ~""'iD.~ Eada..mul ill ~ ,""'IO"'''~ DiU. ,,__ocnaIIlMIl.u. "-1001':
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COMMENTS/CONDmONS:
O!nltall 0 Repair
CWatennain
[] Sanitary Scwor
o SlDnD Drain
o Underground TelephonelE1ectrical
JOOl" TOT Al.S $ (0 $"'. f).f) RECEWf
# 1173
ISSUED BY:
DATE:~(,
WORK ORDER No.
OFFICE copy. CANARY PERMIT 0 0 4 29
xii
INSPEcnON FEES $
PW~.03 {12l931
INSPECTOR'S COPY . WHITE
APPLICANT'S COpy. PINK