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HomeMy WebLinkAbout724 S N St - Engineering PUBUC WORKS CONSTRUCTION and RIGHT-OF-WAY PERMITS City Phone: 206-457-0411. ext. 124 .>rtUCANT/OWNER:.. /71Jc:)a..u :x!J~AD~RESS OF JOB: 1c21 ~o ..IJ'PUCANT ADDRESS: PHONE LEGAL OF JOB: WORK IS 0 OUTSIDE or 0 INSIDE OF TRAVELED ROAD VALUE OF WORK IS:S (If worle is outside roadway md is equal to or less than S2.000. theo permil may bo issued 10 other than licensed and bonded contractor.) PLANS REQUIRED 0 YES 0 NO CONTRACTOR: DATES FOR START PERFORMANCE BOND REQUIRED 0 YES 0 NO AMOUNT: S PROOF OF INSURANCE: 0 Work $2,000 or leis: S50.000 pcnonal injwy, SIoo.OOO per incideol. S20.000 property o Work over S2.000: S200.000 persol1ll injury. S5oo.000 per incidenl. SIoo,OOO property o RighI of Way Use: S3oo.000 pcrsoI1lI injury. $300,000 per incideol. $100.000 property Perniillee ~ that DO Itreet may be cloecd to traftic unless approved by the City En,m- and Chicf of Police in advau:e of the closure; that there is . 24 hour m;n;m1.m notice prior 10 inspection. and 10 call 48 hours bofor:. digging 10: 1-800-424-5555. s ~ PERMIT UUIl40 IA.) // & FINISH II .' . .,.. ......~........l.. ..................... ....a,"'...... ......"'~........,.................... lID.. ~......~. . - "". far................ .....-.......,.................... ~.... II.,................... fII.. _ioIUca__...... 01' pmaiu......., lilt.... iII.-ca- ...... .. ... .... .,... ....... - .....,. ...... .. .. ....... Sipd: x(#r('ffiJh~..,/\ ~ / .. DATE: ,-,:.:.,.,.,. .aSJ'D .~'D I nft! FEE ,"'" . TY?E FEE 'AID IJOHT O' WAY IXCAY, ...... ~EWEaCSFa) 16'10,..,..6'.4" ...... ...",. 'AN . Ill.. tiir..oo ..........,." Sl2Sm 'ANIEWD "''''.. ADO. lII<rT "'" llIMlWAY SI2S.cD lAIC I8WEI. 01HDI . ....I1SlD. ~~~ M._S'73D I t.1O.tIJ'25__ DWY ClJl.wzr H ...... IEWDT""....!..Cfr'lPfO IIUJlO4XI)JD IT1EEI' cur . ....... IDIJlO lEWD. CAPIWATD MErD. .,.,'" lEMOVAL OT1IEIUIIR' 0' WAY woaJC ...... ALTD.ATlONI 130'" "!PAra TO lEWD FlU JMlOANI' """""" STORM OkAJN T "P Sl11.00 lEI. WATI!I ID'YIC'I I- X SIr ....... ,....... ~/l/)OO CATCH' BASINS Of LOTS PEl EACH ........ lI!lI. WAT'2I. rEIVIC!'- X".. ""'" JECON'D.UY rEW'El ASSESS. 1'10.00 1ft $6U.m cuadl i ... w............. ,. - .. .....'" ...,.. ""'. G' '"'."'~ I COMM. WATDIDVICE 1-..IIp>> MD..WAUKEE OIl. SEWER ASSESS. S1.~.oo /'EWW ~":-J~ . ""Tn IDVIC'K. OTH!I. EmIolATE llOlfT OF 'flAY USE PDMrTS V.uJES SJ . Sl(l) "ATn IVI. DEY. C'KAROE ""''''IEWM Tar ALl - . ,/,V/)/l~c..- rw..... .........~~.. .,,-.......... ......__................~.................. r.-,.-..,.......... tlI h IIIlW11 01_....-.___ ill... ~ ..~..............,..Ckr.,...,................CoIk. N~,...............,....u..........____......._oI.",.......... ....IIIh Ci... C........ SlAlIIOI' F....... GG..._. COMMENTS/CONDmONS: ) / r,( / o ~~ Repair A ~ Jl (TC~ WI/77 UJ. ~rfl jU. t{! OSaDiluyScwcr /L--U L // // . 0 aStormDrain () J.. ! ) ~ JJ aUndl..l'uwudTclcphoDclElcctrical VW~ . /JLL2 JUdlTTOTALS $lAJ/)~ RECEIPT &01!/-ISSUED BYlJYiL:?fJ1/;;:;( DATE:~ INSPEcnON FEES ~ WORK ORDER No. 00448 pW~.03 (l2J931 INSPI!CroIl'S copy. WHlI'E APPUCANr'S COPY . PINK OPFICE COPY . CANARY pERl\1lT ~