HomeMy WebLinkAbout1409 S N St - Engineering
~.~l:.
...~ PUBLIC WORKS CONSTRUCTION
~ and RIGHT-OF-WAY PERMITS
~ City Phone: 206-457-0411, ext. 124
.\\'+ .. IA",a ~ "\\11
..dUCANTIOWNER: j l V'A. ~n . ADDRESS OF JOB:.....L.:::U..L....1 0D N OS T .
APPUCANT ADDRESS: PHONE ~~if; 7- LEGAL OF JOB: Ly?. l.lJeST\/I@ II ) tb:s-
WORK IS Cl OUTSIDE or Cl INSIDE OF TRAVELED ROAD VALUE OF WORK IS:S (St.... '/7 f..J. ifJ...ork is outside roadway
and is equal to or less than S2,OOO, then permit may be issued to other than licensed and bonded contractor.)
PLANS REQUIRED Cl YES Cl NO CONTRAcrOR: DATES FOR START
PERFORMANCE BOND REQUIRED Cl YES Cl NO AMOUNT: S
PROOF OF INSURANCE: Cl Work S2.000 or leSs: SSO,OOO penonal injury, SIOO,OOO per incident, S20,OOO property
Cl Worle over S2.000: S200,OOO personal injury, SSOO,OOO per incident, S 100,000 propeny
Cl Right of Way Use: S300,OOO personal injury, S300,OOO per incident, SIOO,OOO property
Permittee undentaDda that no atreet may be closed to traffic UDleaa approved by tho City Engin_ and Chief of Police in advmco of the
closure: that there is a 24 hour minimum notice prior to inspection, and to call 48 hoUlS before digging to: 1-800-424-5555..
PERMIT
00409
& FINISH
.. fIl" ~"'''''''''''Il'' ...........,.~... ..a,fI Pall ~... ..fIl" ~ _.......-u...... --- --.....-. '"-......... -'.
b _........, ...- .,....,.. ~<<iCIlIIlIftiDI........... __ d...- __....... __ tbI __ eI dlIt qlJllaum. aid u. permit or,._ .....-r '-..... ill.....
tt: ....."'..... . -.....,........,.. ..... 3) C( k,
SipecI: ~ .. ~. .~ - sf
DATE:
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.~ TYft! FEE a."." TYft! FEE ...01> PAID 'i
PAID
uaKrOF WA.Y EXCAV. ....,. >rOOD 1
....11) ~. SEWD lSfll (6' \0 PIt... 6-.1.'
,",.II)' 'AH.1EWEl A.I~\. It!_ ......,
""""'"'" SltUIO SAN IEWElIUA', ADD. UNrr ".II)
DllYEWAT IllSJlO -- J7..~ qt2 IAN &EWEI 0T1IEU. W.-I1SJlD: ~~mzsa_
101.-1",
llWY C\lI.VEKT ........ ....., lEWD TAP. IV CITY ffO 1125.m4JDQ.CD
TAP
mEEI' cur . ........ S2X1.II) SEWE1 C>>fWAn1lWETER "".II)
lEMOYfo!.
0T1IEI.1JOHT 0' WAY WOIK ....., ALTD.ATION' SJO.II)
_ErArR TO SEWn
flJJ! lIYtlOAHT DEJ'O$IT sro_J.4 OkAD'lTA" Sl'U.OO
lES. WATDIEJ.VIC1! I- X "'- ""'.II) <--" (1)
- CATC1f BASINS ~ LOTS PER EACH ....,
lES. WATEl JDV1CE I- X "..- "".II) -, i
,
aD WA .y,.. -.II) S~ SY!. ....,.... CH."O'" /,-, A~ 00 I
,
co..... WATD.ID.VICE ,- - ",coo Mo.WAUKEE CA. SEWEJl, ASSESS. IISUJ)/E'Wl4
~":-J~
WATU.ID.VJCI. 0THEIl """An _IOKTOF WAY USE PDMrTS VARIES" . 1100 .2Z~,
"ATEl JYS. DEY.CHAl.OE X ,I('~ E.E. TOTALS .
TWt-ww ..lIII...... __ ___ II ~...,......... Ita __....... ill... _lIII,...,....... ill............ E..s.....,. &.-d""" 10 U. ___ of !oN .~ ___ ill... ~
1lIli....1lD...........~...C\ty_.... ~..~ Cod.. N~ "nainM ____ nu"~ to........._ "-"_...... ....... II.... 01 IN Ci.~. C<U'IlY. S...... or F...... C-_.
COMMENTSICONDmONS:
o IllIlaIl Cl Repair
OWatermain
Cl Smituy ~
o Storm Drain
o Uuda-ground TelephoDelEIoctrical
.---
..JOOI'TOTALS S 22. ~ D
RECEIPT
d~l~ISSUEDBY: In
DATE:5./"3) 9-s
PW.0209.03 (111931
INSPI!CTOll'S COPY .. WIIlI'E APPLlCAIn"S COPY .. PINK
WORK ORDER No.
- 00406
omCE COPY .. CANARY PERMIT
INSPECI'lON FEES $