HomeMy WebLinkAbout1632 E 4th St - Engineering CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
PUBILIC WORKS & R/WPERMIT Issued: 4/17/2001 Permit No: 1140
[] Attached Notes Work Order: 0
OWNER/APPLICANT PROPERTY LOCATION
BRAD WEATHERBEE 1632 4TH ST E
201 ROBINSON RD Lot:2 Block: 183
Port Angeles, WA 98362 Subdivision: TPA
000/604-2310 Parcel No: 063000018305000 [] Long Legal
PROJECT INFO
Work is: Value Work: $0.00
Plans Required: Start Date: / / Finish Date: / /
Contractor: OWNER 206/000-0000
Performance Bond Required: Amount: $0.00
Proof of Insurance:
Work to Perform: [] Install [] Sanitary Sewer [] Misc dwy
[] Repair [] Storm Drain
[] Watermain [] Underground Tele/Elec
PROJECT NOTES
FEES ASSESSMENT
1.) RNV Excav: $45.00 15.) Other San Sewer: $0.00
2.) Sidewalk: $0.00 16.) Sew Tap Wye/Man Tap: $0.00
3.) Curb/Gutter: $0.00 17.) Sew Cap/W/M Removal: $0.00
4.) Driveway: $145.00 18.) Alter Repair Sewer: $0.00
5.) Dwy Culvert: $0.00 19.) Storm Drain: $0.00
6.) Street Cut: $230.00 20.) Catch Basin per ea: $0.00
7.) Other R/W: $0.00 21.) Sewer System Dev: $745.00
8.) Fire Hydrant: $0.00 22.) Milwaukee Dr. Sew Ass: $0.00
9.) Res Water Serv: 5/8" $640.00 23.) PJW Use Perm: $0.00
10.) Comm Water Serv: $0.00 24.) Admin Cost (D.R.A) $0.00
11 .) Other Water Service: $0.00 25.) D.R.A. $0.00
12.)Water System Dev: $1,025.00 26.) Misc: $0.00
13.) San Sewer SFR: $95.00 TOTAL FEE: $2,925.00
14.) San Sewer MFR: $0.00
add unit: 0 Amount Paid: $2,925.00
Receipt No: 6950
Inspection Fee: $0.00 ' Balance Due: $0.00
RW SANITARY WATER DWY STORM DRA OTHER
Separate Permits are required for electrical work, otJlities, private and public improvements. This permit becomes null and void if work or
construddon authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after
the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have
read and examined this application and know the same to be true and correct All provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. The granting of a permit does not presume to g ve authority to violate or cancel the
3rovisions of any state or Iqcal law regulating construction orthe performance of construction.
Signature of Contractor or Authorized A~lent Date Sicjnatura of Owner (if owner is builder) Date
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOP. BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. ITIS UNLAWFUL TO COVER,
INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.