HomeMy WebLinkAbout410 S E St - Engineering
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CITY .OFPPRTANGELES
PUBLlCWORKS .,UTILITIES DIVISION
321 EAST5TH,STREET,:'PORT ANpELES; WA 98362.
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Application Number: . .
..Application pin number .
Property Address
ASSESSOR PARCEL NUMBER:
"Application type description
Subdivision Name
Property Use . . . \' '.
Property Zoning . .. RS?
AppliCation valuation
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GEREN JAMES/KATHRYN
. AJ.G,..S ES'T
PORT ANGELES
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, ,OWner
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Permit . . . .'.
Additional desc .
Permit pin number
Permit Fee
':tsiitie',I?ate
Expiration Date .
Feesununary .' . Charged
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Permit Fee Total .00
Plan Check Total .00
Grand Total .00
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Separate Permits ~re requirfild for electrical work, SEPA,$ho(eline; ESA, utilities, private and public improvements.-This permit~~comes
~ null and void if work or construction authorized is not cbmmEmcep witliin 180 days, if construction or work is suspended or}iibandoned
for a period of 180 daYs afterthe work as commenced,o{itrequiredinspections,have not been requested within 180.c:Uiys,fro:mthe last
inspection. 'I hereby certify. that.( have read and examined:tiii~application and know t~e same to. be'trlleanClcorrect:,'AU'provisioris,of
laws and ordinances governing this type of work will becompiied with whether specified herein orncit. The g(anting'ofap~nTiit does not
presume to give authority to violate or cancel the provisions'of' any state or, local law regulating construction 6tthe performance of
construction. .- .' '.' " ." ,
PERMIT INSPECTION RECORD
CALL 417-4807 FOR UTILITY INSPECTIONS. PLEASE PROVIDE A MINIMtJM24 HOUR NOTICE. IT IS UNLAWFUL TO COVE~,
INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE ACCEPTED COM[\1ENTS
YES I NO
PW UTILITIES (Engineering Division)
WATERLINE 1 METER
SEWER CONNECTION
SANITARY
STORM , -
SITE DRAINAGE
SITE EROSION CONTROL
PARKING
SIDEWALK
CURB & GUTTER
DRIVEWAY APPROACH
BACK-FLOW DEVICE I
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FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE : , ,
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
-. YES NO
CONSTRUCTION R.W.I PWI , CONSTRUCTION - R. W. "
ENGINEERING 417-4807 PW 1 ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT. "
BUILDING 417-4815 BUILDING
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pORTANGELES
W A 9 H I N G TON, U. S, A.
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NAME OF APPLICANT J:ID.c.h-~"'D-\-rue.k, in;tVtCO . DATE
MAILING ADDRESS ~~_\ ~ ~, ~T '~(o<sl \fJA-Pt t6'-O~'
PHONE NUMBER 5la.Q:.::J6.;;L-53~1 " '" '
STREET ~DRESS O~PRClI'()SEE !)TREETU!)_e:~O:l.. g, ~'-==C;l-- .!~tt~~~- L\{'J;!.:1'ii~"d---
DESCRIPTION OF REQUEST (include drawings required for clarity): pf street closure is requested, please state thename .
of the strest and limits of c!osur~, t~g~er with the d ratio of closure" , ' \"',,', . 'I ' ~' , "
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ISTHEUSETEMPORARYORPERMANENT?\ajv\ptrrnlU( "'''' " '
HOW LONG WILL THE Ol3STRUCTION BE IN PLACE:? ~o~ ... . \
WHATARETHEHOURSOFOPERATION?y\!A- [ 'N\ -' .)- 4\~O 1\1\-'\-' .)
HOW ITWILL BE LIGHTED? (\0 (\ 0 J . .... .... . .
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EXPLAIN THE NECESSITY TO USE THE PUBLIC STREET, SIDEWALK OR PLANTING STRIP; ARE T'HERE-
ALTERNATE AREAS THAT COULD BE USEDJ . d.. ... ... . .. ... .
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HOLD HARMLESS and INDEMNIFICATION AGREEMENT'.. . ...
In compliance with the Pert Angeles Municlpai Code, and In consldemtlon of the issuanc.6 by the City of Port Ang9les of .8 Right Of
Way Use Permit to the undarsigned allowing the placement of the above described street use or obstruction, the undersigned for.
himself and fl;)r his successors In Interest, hereby agrees to indemnify, hold harmless, and defend the City of Port Angeles agBinst
any claIms 0; lawsuits for pSf50nallnjury or property damage arising out of, or In anY way cormectedwtth, the placement of the,use'
orobstructJonontheCltystraat,sldewalk,plalllingstrlp,orrlghtfway ~'.~.'. .."'f--.. ~..' .. .~.
. DAT ~I . .. ,~y.. ....~. ,200::::>
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i ! SUBSCRIBED and swom to elhls'3f\-Ida::<31t
! Seal. '
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,2005
(OFFICE USE ONLY)
Review copies
senllo~
Police
FIre
Street.
Date:
Dale epplication received ~ ;;:-10'2 Fee paid $ -; () <;j2.R<<:eIpl#
Certificate of Insurance per PAMC 11.12.140(8) Agreement to Remove Encroachment signed sod .
on NIA recorded on N/A
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Application reviewed and recommendation by City Engineer~ ...";,, ~ate "1 ~ .
Is to delll"'ot'1l"~ and with the following conditions: ~CJ _ ';A..p . - ~~-~ ~~C-.I..
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Application approved or denied by the Director of Public Works
Date
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Approved r.ol'iiaS to: APpUcant 0 FI'l1 0 ponce 0 Street 0 Other 0 Address filo 0 RUP fila 0 RU P # c?~--- z ~ ..
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