HomeMy WebLinkAbout2122 Lindberg Rd - Engineering
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PUBLIC WORKS - BUILDING DNISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
PUBLIC WORKS CONSTRUCTION Issued: '? /.itJ/ tf? Permit No: 51/
& R/W PERMIT Cond: Work Order: 0
OWNERiAPPLICANT------------------------PROPERTY LOCATION~-----------------------
HELEN COOPER /,. _/i-,~ (2122 LINDBERG ~
~ 1 A q. ~ ,1'11 STREET Z/2-Z- L-I F;UK1 '-------I.ot.: _
Port Angeles, WA 98363 Block: Long Legal:
360/457-7077 Sub:
PROJECT INFO---------------------------------------------~----------------------
Work is N/A traveled Road Value Work: $0.00
Plans Required: N/A
Contractor: OWNER
Start:
Finish:
Performance Bond Required: N/A
Proof of
Insurance:
Amount: .
/ /
/ /
$0.00
Storm Drain
Underground Tele/Ele
Misc
PROJECT NOTES-------------------------------------------------------------------
drop in meter existing box west of driveway
Work to be
Performed:
INSTALL
* Watermain
Sanitary Sewer
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:
Receipt No:
Inspection Fee:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$125.00
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):
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
------------------------------
------------------------------
$125.00
$125.00
$0.00
$0.00
$0.00
$0.00
02115
$0.00
TOTAL FEE:
AMT PAID:
BAL DUE:
Separate Permits are required for electrical work, utilities, private and pUblic improvements. This permit becomes nuil and void ~ work or
construction authorized is not commenced within 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 within 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
wiil be complied with whether specified herein or not The granting of a permit 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.
Date
Sianature of Owner m owner is builder)
Date
Sianature of Contractor or Authorized Aaent