HomeMy WebLinkAboutBent Cedars Way - Engineering
s....~
~, ~ PUBLIC WORKS CONSTRUCTION
and RIGHT-OF-WAY PERMITS
~ City Phone: 206-457-041 ~ext. 124 I . W~~
. /J--J:. rc e- d..01-S I 01 .
.....iLICANT/OWNER: Jo H 14. k ~ 'f ADDRESS OF JOB: !h T A.t.,tj~ I e, ~C1 l E~-::; I D-F. )
APPUCANT ADDRESS: PHONE LEGAL OF JOB:
WORK IS 0 OUTSIDE or CIINSIDE OF TRAVELED ROAD VALUE OF WORK IS:$ (If work is outside roadway
md is equal to or less than $2,000, then permit may be issued to other than licensed and bonded contraclor.)
PLANS REQUIRED CI YES CI NO CONTRACTOR: DATES FOR START & FINISH
PERFORMANCE BOND REQUIRED 0 YES 0 NO AMOUNT: $
PROOF OF INSURANCE: CI Worle $2,000 or leis: $50,000 personal injury, $100,000 per incident, $20,000 property
o Worle over $2,000: $200,000 personal injury, $500,000 per incident, $100,000 property
o Right of Way Use: $300,000 personal injury, $300,000 per incident, $100,000 property
Permillee IIIIdentanda ttw DO street may be closed to traffic unless spproved by tho City Engineer and Chiof of Police in advance of the
closure; that thoro is a 24 hour minimum notico prior to inspection, and to csll 48 hours before digging to: 1-800-424-5555,
VV"JU
PERMIT
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............ _........10...- arprapeny, ~orCllCllMftr&.lbI,.......... fIlldf wort;\lrdgtU_ wdoftba ~nN ollllll applar.ioll &ad w permit Of permiu wbk.tIlmJ' be ~ iII..~
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Sipd: (/...n /.. , ~ A L..
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COMMENTS/CONDmONS: _ I . I L.. ----r- $1 D6 OF
o InsIaI.I 0 Repair UlJdf?nl/'CLP7d- ~e-c- -r-re/7(!r; ""''''"''-I
DWa/ormain (It'J ftn'1f2lf'S. (EftCEZ- t7T/L/TY c?onsy-:)
[] Sanitary Sower
[] Storm Drain
[] Uodorground TolophooolEloclricsl
1tJ.E2-- RECEIPT
.. : 'tYPE," :.: FEE ~<n'o PAID
lJOHT OF WAY EXCAV. ....co c.- d/) -
"".'"
lMlUl'ml 112$.00
llllMiW A Y slum
OWl' CULV>1T ........ ....co
mEEt' cur. ........ DOIl.co
0T1IEI.1IGKI' OF WAY WORK S<<I.oo
FIlE HYnI.AHT DEPOSIT
aD. WATD.IO.VICE I" X "'''' $5".00
lEI. W"Tn sD.V1CE I" X 314" ,,,,.00
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CQWW. WATD.IEIl.VICE
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WATEJ.ID.VIC'Il. OTHEI.
W"TEJ. m. DEV. CH.UOE
EmMAY1!
f7J:).OOIEWJo4
JtMIT TOTALS $
INSPECTION FEEs $
DATE:
I TYl'E I FEE I
~';:IEWER. (SFk) (6" 10 M.. 6..... ....co
SAN. SEWER tUfa" 11I...w ......
SAN.sEWER lMFRI. ADD. UNIT "...
IAN SEWER 0THE1S . MlD-S7S.00; 1O.oo.s1"
Ma-S750 100 CIOCltli1O.tm3 p-
IEWER TAP. IY CITY NO SI1S.co.u:lO.oo
W'YEIMAIlffOtE TAP
SEWER CAPIWATD. METa S215.OO
lDfOVAL
ALTEJlATlOflIl "".co
REPAIR TO lEWD.
ST'OkM DIlA~ TAP 112j,OO
CATCH BASlJ'lS rN LOTS P9- EACH ......
SECO/'iO,UY SEWER. ASSESS. S410.CI:IIn$6U.OOau..idc
SEWER SVS. ~. CHAROE . n14.OO IEWM
MD.WAUKEE OIl. SEWEll ASSESS. IUO,<Xl /EWM
llOKT OF WAY USE PEIlMrrs VAAJE3 U. 1100
TaT ALS
4/1 51 '1 (A
REQ'O I
PAID
# Iff!; ISSUED Dr: f~
DATE:1J~"k
WORK ORDER No,
00436
pw.0209.m (\2193)
INSPECTOR'S COPY, WHITE APPUCANT'S COPY, PINK OFFICE COPY, CANARY PERMIT