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HomeMy WebLinkAbout1020 W Lauridsen Blvd - Engineering PUBLIC WORKS CONSTRUCTION Issued: 11/06/96 TF Permit No: 552 & R/W PERMIT Cand: Work Order: 0 OWNER/AppLICANT------~-----------------PROPERTY LOCATION------------------------ G GILBERT 1020 LAURIDSEN Y 1020 Y LAURIDSEN Lot: Port Angeles,WA9B362 Block: Long Legal: 360/000.0000 I Sub: PROJECT INFO.................................................................... Work 1S INSIDE traveled road Value Work: SO.OO Plans Required: N/A Contractor: US WEST COMMUNICATIONS Start: Finish: Performance Bond Required: N/A Proof Insurance: Amount: / / / / $0.00 Storm Drain * Underground Tele/Ele Misc PROJECT NOTES------------------------------------------------------------------- underground trenching N. side Lauridsen Blvd between Fairmount Ave & Work to Perform: Watermain Sanitary Sewer "CII St. Ext PROJECT FEES ASSESSMENT......................................................... R/W Excav: SO.OO San Sewer SFR: SO.OO Sidewalk: SO.OO San Sewer MFR: SO.OO Curb/Gutter: SO.OO Add Unit: 0 Driveway: SO.OO Other San Sewer: Dwy Culvert: SO.OO Sew Tap Wye/Man Tap: Street Cut: SO.OO Sew Cap/ Y/M Removal: Other R/W: SO.OO Alter/Repair Sewer: Fire Hydrant: SO.OO Storm Drain Tap: Res Water Serv: SO.OO Catch Basin per ea: 5/B" Sewer System Dev: 3/411 Mi lwaukee Dr. Sew Assess: 1" R/W Use Perm: O.R.A. : Admin Costs (D.R.A): Misc: Comm Water Serv: $0.00 1" 1 1/2" 2" Oth Water Serv: Water 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 60# fOOd Nd9g:rO 96-60-0r 9tH l.g~ 90Z , ~oflK14 )l.ilimR'" ar,r& NFmf;: Sllbli'N~on CUll.. Slgntltllm (Optionall ellStcm!:r may n;f,r questions to: 800-737. 0477 S~rrrif.r;W{m t/ll~ OC&f1Zli:/:~~;b ItllST;S\!,J..A llPNIR~pAIR Nil""" 0 Cf' I] son ~tr""M':l (] Add Una ~ R~P~lr;xr( 005 I] ri: ~~::.lf / :=1l~'Sl<( l':lm!, (] CBII# ' TfflIP.~rf7grll' a Y J:( N r~;:-tRgV~19ij!D!~ feG alll:'/ Cl C;onollit r!",~ Partial C Completll [] ElSW In Open Tr. PBItIal 1:1 Complete ~ Extl'nd BSW on penial conduit or open trench El (iorrrfl Rom)' rw 8NVGND (j Not RNdv r:J LLLdLJz.-T L ILl ( Add $ tIJ rlgllt It skEltelI sent to contt8ctOf I Is tln:rll ~d1tI9nl'll C\.IStomor billing? 0 V8Il z( No DllBS TQQh nCllll notifled1 )J(V08 t:J No MAPfI. caL. PAIR SfuIfdJ Wpm a_1Tid ~ Includo nllSlNt CIOU stntet WId wJro ./8ngtll u., {mil !l.G~I.oar,.. lIod4/11>o11.,...la....... ~ ~ '" u 3/..(/3 ~}f 611 " 'fiM' "'.I, Ll.fil(l'r'l.f8K. 6/vJ ~f - J I ~ S U U9H 6~'-i BURIED SERVICE W1REClJ t./ 5.6 ? 5,<1 WORK ORDER DAYI': : /0 Jrl/9f, gpNTRAC1'OR'S ACCEPTANCf: firm SlgnllttJrll TItle USWeat group dOing work Bill to: (lSWesr Communlclltlllilil Attention: Address: City: cst;): ~ 'l1~,~ Recommended: O~tb; 0 Approved by: 0:>16: I , 9{ Vi;.'; .... PEf\Mrr REQUIRED? Cl No (J \.J Re\:8lved from W,li,,\ t'i C JurI,dJctlDn ~ No. !t:Jt::1: ~. COMPLETED BY: -- CalI D;E;.:~~ 'i.j~' f;j~"'J!;;o ";6{'.;i~Ctk..~ .~ '"... - ---." .... ~...~ !;'idi.;.;.~ f:fu'lli ~ I , - ), .rLg t _[J7 dl-?f.- ~ ft- .....1..-,.. PI. 'V~0~~ J fk -P'i-v!'-l. -{2;;: .fa- ,<r/'rr _ V-...J-.,/ 10 lootoLmoilllri WoIJ. 1 ~.. . .~.Tl:.l<I~lIHljIl1llIbolUl~ In 811 deIIlIa, R IIIIlllIn8I11s OCII1lnIOlot'a Tn J