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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
PUBLIC WORKS CONSTRUCTION Issued: 10/11/96 TF Permit No: 517
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
DONALD DUNDON 701 CURRIER COURT
701 CURRIER CT Lot: A1
Port Angeles,WA98362 Block: Long Legal:
360/452-4962 Sub: HIGHLAND ESTATES
PROJECT INFO--------------------------------------------------------------------
Work is INSIDE traveled road Value Work: $0.00
Plans Required: N/A
Contractor: LBR CONSTRUCTION
Start:
Finish:
Performance Bond Required: N/A
Proof Insurance:
Amount:
Work to Perform: INSTALL * 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"
Corom Water Serv:
1"
1 1/2"
2"
Oth Water Serv:
Water Sys Dev: *
Receipt No:
Inspection Fee:
R/W
SANITARY
$40.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$150.00
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):
Mise:
$80.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$642.00
$0.00
$0.00
$0.00
$0.00
$0.00
------------------------------
------------------------------
Date
$0.00
$0.00
$883.00
TOTAL FEE:
AMT PAID:
$1,795.00
$1,795.00
$0.00
Separate Permits are required for electrical work, utilities, private and public improvements. This permtt becomes null and void ~ work or
construction authorized is not commenced wtthin 180 days, ~ construction or work is suspended or abandoned for a period of 180 days after
tile work as commenced, or ~ required inspections have not been requested wtthin 180 days from the last inspection. I hereby certify that I have
read and examined tIlis application and know tile 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 permtt 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.
$0.00
WATER
BAL DUE:
DWY
STORM
DRA
OTHER
Si nature of Contractor or Authorized A ent
Si nature of Owner ~ owner is builder
/