HomeMy WebLinkAbout1715 W 15th St - Engineering
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PUBLIC WORKS CONSTRUCTION Issued: 11/04/96 TF Permit No: 551
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY lOCATION------------------------
ANDREWS 1715 15TH ST W
1715 W 15TH Lot:
Port Angeles,WA98362 BLock: long Legal:
360/000-0000 I Sub:
PROJECT INFO--------------------------------------------------------------------
Work is OUTSIDE traveled road Value Work: $0.00
Plans Required: N/A
Contractor: US WEST COMMUNICATIONS
Start: / /
Finish: / /
Performance Bond Required: N/A
Proof Insurance:
Amount: $0.00
Watermain Storm Drain
Sanitary Sewer * Underground Tele/Ele
Mise
PROJECT NOTES- - - - - - - - - - - - - - - - - - -- - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --
Work to Perform:
south side of 14/15 alley west of IlIU
PROJECT FEES ASSESSMENT--,------------------------------------------------------
R/W Excav: SO.OO San Sewer SFR: SO.OO
Sidewall<: SO.OO San Sewer MFR: SO.OO
Curb/Gutter: SO.OO Add Unit: 0
Driveway: SO.OO Other San Sewer:
Dwy Culvert: $0.00 Sew Tap Wye/Man Tap:
Street Cut: $0.00 Sew Cap/ W/M Removal:
Other R/W: $0.00 AlterlRepair Sewer:
Fire Hydrant: $0.00 Storm Drain Tap:
Res Water Serv: $0.00 Catch Basin per ea:
5/811 Sewer System Dev:
3/411 Mi lwaukee Dr. Sew Assess:
1"
R/W Use Perm:
D.R.A. :
Admin Costs (D.R.A):
Mise:
Comm Yater Serv:
1"
1 1!211
$0_00
2"
Oth Yater Serv:
Yater Sys Dev:
$0.00
$0.00
TOTAL FEE:
AMT PAID:
Receipt No:
Inspection Fee:
$0.00
BAL DUE:
$0.00
$0.00
$0.00
$0_00
$0.00
$0.00
$0.00
$0_00
$0.00
$0.00
$0.00
$0.00
$0.00
$0_00
$0.00
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P\Jauc WORKS
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II ! NOV - 4 /996
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Permit To Perform Work In Street Right-of-Way
APPLICATION is her~by made to th~ municipality of PORT ANGElES to p~rform work as
noted hereon and as shown on attached drawing: 'B~ ~{J'}1.L w LiLL
lM1d-v1 ~ 0I:b 0fn t; Ch~~~... 39 (
(0 ~5D0l1
Approved:
Water Department - Superintendent
Sewer Department - Superintendent
The estimated time for compl~tion of the above work is
Date
I D/?;o
19 (fin
By APUwLAW;j Joy ~ll/l;t;t)
Contractor Owner
US WEST / ATTN: ..MISTY .
~'2.0 KEAN Sll\EET . GJ\RA GE
BREMERTON. \;JASHIN~ION q831~
THE ABOVE APPLICA nON IS HEREBY GRANTED SUBJECT TO APPLICANT'S:
Complying with all Municipal Ordinances;
Notifying the Street Superintendent of the time the work will start, and when it will finish;
Prosecuting the work with diligence and with due respect to all property. contracts, persons'
rights and the interests and convenience of the public:
Saving the Municipality harmless from any and all damages which may accrue to any person
or property because of this installation or the maintenance thereof:
Complying with following special conditions:
Date
19
City of SEQUIM
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91n IOOd Wd80:90 96-82-01
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State wl1-
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Subcllvish:m
Gust. Slgn~t\J'" (Optlgnull
custOmer may "t/ur qu"ll!!ons to: 800-737- 0477
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Il'!STAlIJ\TIONlREPAIR
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CQn<:'uit PI~~fd Partial 0 Complete []
asw In Op",n Tr. Partial [] Complete []
Extl'nd BSW on partiel conduit or open trunch []
Ifama flrmdy kr SNVGND {3 Not RfNldy a
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I Add $ to right If sketch sent to contra~or I
Is there "ddilional customer billing?
Oo~s Tl'cll n~~.d notified?
MAP It
eBl PAIR
If;;; Z5
[] Yes ar No
[] Yes a\ No
Sketch Worn Required. Include dllilrest cross street
Ilm:l wire length
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BURIED SERVICE WIRE .3 3.0 ( ~ ~ S
WORK ORDER OATE; /19/Z-'l/9'{..
%<;6-8
CONTRACTOR'S ACCEPTANCE
F11'11'l
Slgnetul1l
Title Datu:
USWest group doing wolk
BUI to: USW~ CommunlClltlons
Attenlian:
Address:
City: Zip:
Recommended: Date:
Approved by: Date:
,-
PERMIT REQUIRED? 1- Yes 0 No
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Received from Verbal [] ;c
Jurit<<Jiction (ih~ ND. Date: '-
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COMPlETEP BY:
Call
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100 'd
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