HomeMy WebLinkAbout1703 Milwaukee Dr - Engineering
~..-~
~ PUBUC WORKS CONSTRUCTION
. and RIGHT-OF-WAY PERMITS
~ City Phone: 206-457-0411, ex!. 124
..dUCANT/OWNER: !Y\{)Y\ln 0J{l(t~"'Y~AD~RESS OF JOB: 110:5 vIA \ \ \..( ~(1l) h.('.b ," I
APPUCANT ADDRESS: PHONE LEGAL OF JOB: ~..2, 't-\ F~ CT.q (/ 0') 01 t-L
WORK IS [J OUTSIDE or [J INSIDE OF TRAVELED ROAD VALUE OF WORK IS:S (If work is outside road""
and is equal to or less than S2,OOO, then penrut may be issued to other than licensed and bonded con,ractoLI
PE~T
00391
PLANS REQUIRED [J YES [J NO CONTRACTOR:
PERFORMANCE BOND REQUIRED [J YES [J NO AMOUNT: S
PROOF OF INSURANCE: 0 Work $2,000 or leSs: $50,000 personal injury, $100,000 per incident. S20.000 property
[J Work over $2,000: S2OO,OOO personal Injury, S5OO,OOO per mCldent, Sloo,OOO propeny
[J Right of Way Use: S3oo,ooo personal injury, $300,000 per InCident, Sloo,OOO propeny
Permittee IIIldentcldI that no atnlet may be closed to lrBffic unless approved by th. City Engineer and Chief of Police in advance of the
c10SW'll; that thero is a 24 bour minimum nOllce pnor to inspection, and to call 48 hours before diggIng to: 1-800-424-5555.
DATES FOR START
& FINISH
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s~~AJ:/E~~~..- DATE: ~/;(//?}?
If TY?I! "" 1""0 P^", TYn: FEE ""n'o PAID
WKi OF WAY EXCAV. ..,'" 1-- 4/) - SAN. SEWEJI. ISFal W ll;I Ptl.. 6.... ....<Xl ,---- '6( , .
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II ~"'. SAN. SEWEll. /'Mfln. 1,1 \Ql '~<Xl
'"""'"'" 112HO SAN SEWD. tMFRI. .-.00. L'SrT ".<Xl
OlIVEWA Y SI2jJXI IAN lEWD. OTHD..S . Me-nUl'!: $O.cc5hl
M...-n>> IlD,OXlIliW_CX723 UeaI
!NY CULVEr< . _~. ....... SEWD. TAP. BY crrv 1'10 SI1J,OOtS)OO,OO I /,<L'
WYElMAl'lHOU TAP </
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nu:Er cvr . a-:...a m>.Ql / -'-" SEWn CAPfW ATER METD. n:o.oo
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OTHElIJOHr 0' WAY woax ....... ALTERATION I no.oo
RE7ArJ. TO SEWER
Flll! IfYtlOAHT OEPOSIT STORM DRAIl'l T A' IllS 00
lES. WAT'D. SDV1C"I!: I. X 511" "-'0,(1) CATCH BA.5INS fN LOTS PER EAC~ ,.,<Xl i
m.WATEJ.SDV!CEI"X )W U13.00 .- I-=,')~ SECONDA.lt.Y SE'NU. ASSESS SAl0_00 '" ~1'OOcu...ac I ~ I "',' ' .
I kES. WAT'e'tI SC'WUV'"IO' ,. Y I' '-.<Xl SEWER SYS DEY. CHARGE I SJ24.00'f\l.lM --:; --.. (j c...-L
COIo4M. WArD. SDV1CE I' - U,OXl MILWAUKEE DR. SEWER ASSESS. IJ)().OOti;WM
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WAT'D. SD.VK:E . onmR EmMA'" RIOHT Of WAY USE PERMITS VAJUE.5". Sloo
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RECEIPT
#~ISSUEDBYV~
DATE: 00{:
WORK ORDER No.
00::.181
PW.0209.03 {12m!
INSPI!C\'Ol!.'S COVY. WIlTI'E APPLICANT'S caVY - PINK OFFICE caVY. CANARY p~