HomeMy WebLinkAbout731 Marine Dr - Engineering
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PUBUC WORKS CONSTRUCTION PERMIT 00 15 1
and RIGHT-OF-WAY PERMITS
City Phone: 206-457-041l.,ext. 124 Jl~//7lt:ZU~a:.o.Aa~
fWk:1L1~ @DRESS OF JOB: >rDO ~ /3o-rlxA {J I l.iI ^' j
APPUCANT ADDRESS: PHONE LEGAL OF JOB:
WORK IS C OUTSIDE or C INSIDE OF TRAVELED ROAD VALUE OF WORK IS:5 (If worle is outside roadway
and is equal to or lesa than 52.000. then permit may be issued to other than licensed and bonded contractor.)
PLANS REQUIRED C YES [] NO CONTRAcrOR: DATES FOR START
PERFORMANCE BOND REQUIRED [] YES C NO AMOUNT: 5
PROOF OF INSURANCE: [] Worlt $2,000 or lea: 550,000 persoaaI injury, 5100,000 per incident. 520.000 property
C Worle over $2.000: 5200,000 personal injury, 5500,000 per incident, 5100,000 propeny
C Right of Way Use: 5300,000 personal injury, 5300,000 per incident, 5100,000 propeny
Pemiitteo IIIIdcntlIIlda that DO atnet maybe c10eed to traffic lIDI_ approved by the City Eoaineer and Chief of Police in advmco of the
closure; thai there ia a 24 hour m;n;mn'1l notice prior to inspection, and to call 48 houn before digging 10: 1-800-424-5555.
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& FINISH
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COMMENTSICONDmONS:
[] IJIIlal1 C Repair
CWaIennIin
C Saaitary Sower
C SlorIII Drain
C Und...II'......d TeJephoncIEIeclrical
JOOT TOTALS 5 -Z~ ~ RECEIPT
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ISSUED BY~ , ~./i ht;~ W TE:~~Ai
PW~.03 (111931
INSPIlCl'OR'S COPY - WHJI'E APPLICANr'S COPY - PINK
WORK ORDER No.
00,15 .
omCE copy. CANARY PERWT
INSPEcnON FEES S
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