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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
32\ EAST 5TH STREET, PORT ANGELES, WA 98362
PUBLIC WORKS CONSTRUCTION Issued: 11/13/96 LC Permit No: 555
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
ROBIN CASSAL 1411 16TH ST W
1411 W.16TH ST Lot: 18
Port Angeles,WA98362 Block: 434 Long Legal:
360/452-6728 Sub: TPA
PROJECT INFO--------------------------~-----------------------------------------
Work is N/A traveled road Value Work: $0.00
Plans Required: N/A
Contractor:
Performance Bond Required: N/A
Proof Insurance:
Work to Perform:
Start:
Finish:
Amount:
watermain
Sanitary Sewer
/ /
/ /
$0.00
Storm Drain
Underground Tele/Ele
Misc
NOTES-------------------------------------------------------------------
PROJECT
PROJECT FEES ASSESSMENT---------------------------------------------------------
R/W Excav:
Sidewalk:
Curb/Gutter:
Driveway:
Dwy Culvert:
Street Cut:
Other R/W:
Fire Hydrant:
Res Water Serv:
5/8"
3/4"
1"
Comm Water Serv:
1"
1 1/2"
2"
Oth Water Serv:
Water Sys Dev:
$0.00
$0.00
$0.00
r $~~:~~
.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Receipt No:
Inspection Fee:
$0.00
WATER
R!W
SANITARY
San Sewer SFR:
San Sewer MFR:
Add unit: 0
Other San Sewer:
Sew Tap Wye/Man Tap:
Sew Cap/ W/M Removal:
Alter/Repair Sewer:
Storm Drain Tap:
Catch Basin per ea:
Sewer System Dev:
Milwaukee Dr. Sew Assess:
R/W Use Perm:
D.R.A. :
Admin Costs (D.R.A):
Misc:
$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
------------------------------
------------------------------
TOTAL FEE:
AMT PAID:
BAL DUE:
DWY
STORM
DRA
OTHER
$40.00
$40.00
$0.00
Separate Permits are required for electrical work, utilities, private and public improvements. This perm~ becomes null and void ~ work or
construction authorized is not commenced ~hin 180 days, ~ construction or work is suspended or abandoned for a period of 180 days after
the work as commenced, or ~ required inspections have not been requested ~hin 180 days from the last inspection. I hereby certify that I have
read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. The granting of a perm~ does not presume to give authority to violate or cancel the
provisions of any state or local law regulating construction or the performance of construction.
Sinnature of Contractor or Authorized Aoent
Date
Sianature of Owner m owner is builder\
Date