HomeMy WebLinkAbout1417 S N St - Engineering
I.' ,
fJ' .' PUBLIC WORKS CONSTRUCTION
and RlGHT.OF.WAY PERMITS
~ City Phone: 206-457-0411, ext. 124
. j _ . '"' II AI '1
.......UCANT/OWNER.: j\vy\ Ue.I'y"\Y'I'\""Y'\ ADDRESS OF JOB:.-I4 \1 00 I~
APPUCANT ADDRESS: PHONE!JW..f.pQ7- LEGAL OFtOB: LI:-' \'I}e
. ~/~ '1J.'z.... L" .
WORK IS lJ OUTSIDE or lJ INSIDE OF TRAVELED ROAD V-Jt1.Ul: OF WORK IS:$ If worle is outside roadway
&lid is equal to Or lesa than $2.000, then permit may be issued to other than liceosed and bonded contractor.)
PERMIT
00407
PLANS REQUIRED lJ YES lJ NO CONTRACTOR: DATES FOR START & FINISH
PERFORMANCE BOND REQUIRED lJ YES 0 NO AMOUNT: $
PROOF OF INSURANCE: 0 Work S2,OOO or I...: $50,000 penonaI injury, Sloo,OOO per incident, 520,000 property
lJ Work over S2,OOO: S200,OOO personal injury, S5oo,OOO per incident, Sloo,OOO property
lJ Right of Way Use: S3oo,OOO personal injury, S3oo,OOO per incident, Sloo,OOO property
Permiaee undentaDda that DO ._ may be cloaed to traffic \IIIlesa approved by the City Ensineer and Chief. of Police in advaace of the
closure; that there is . 24 hour minimum notice prior to inspection, and to call 48 hours before digging to: 1-800424-5555.
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Sipd: ~ DATE: S ~ 'i, /-=
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. v ....m;; ...... FEE .- ,^'" TYPE FEE ..non 'AID I
WIlT OF WAY EXCAV. ...... SAlt.!.E'WD. ISFR) 16" ",'JL ,"&.. ...... .....- ;;rOOD
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""""'"'" 1125.(1) SAM lEWD IUn' . ADD. UNrr "...
DllYEWAY SID.IlO v"" 126 qj2.- IAN lEWD OTHEU . NiIt-IUJD; ......,.
Ma-l7S>> I =-
DWY CULyaT - IEWD.TU. .Y~ttO SI2SJD'UlDJIO
I'T'UEr cur. ~ SlIlIlJD lEWD. CAPIWATB WEJ'El SZZS...
"",,",VAL
0T1IE11JGH1' OP WA" woaK - Al.TDATIO"' ""...
REPAIR TO sewn
".. HYtlOANT DEI'OSfI' STORW DItAD'f TAP 1113.00
aD. WATI!I.I2KVIC2I- x,..- ""'... ..- /)0 CATCH IAS[J(S IN LOTS PEl. EACH ....IIl
lD. WATI!I.IERVIC!.- X 3/4- ""... i
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.... WA .y" ....... 'EWD ..... 0.... ~..GE ...-- ./ /V'2 'I (JJl I
co..... WATEJ.IDVICE I' . 11,11I) . I"om IEWN
\.M:.J~ MILWAUKEE DR. SE"!'D ASSESS.
'WATEJ.IEl.YICB. 0T1IB EmMA,", lIGHT OF WAY USE PBMm V.uJES" .1100
WATI!I.IYS. DEY. CHAJ.GE )()( .., E!2 TOTALS I ~q]!.
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COMMENTS/CONDmONS:
a 1nataIl lJ Repair
awatermaiD
a SaIIitary s-
a Storm DniIl
a Underground TelephonelElectrical
-'lOOTTOTALS S mtJ - RECEIPT
"j~1 (p ISSUED BY:
ta~ DATE:~b
WORK ORDER No,
INSPECI'ION FEllS S
PW.0209.03 (121931
INSPI!Ct'OR'S COPY . W1IlI'E
APPLlCAN1'"S copy. PINK
OFFICE copy. CANARY PERMIT 00407