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Q ........-.- .... ..'........ . . .....;,....,... .... . j$:I;t~ , ." l (), . ..- :::::::::::::;:;..:::i'::::::::::::::: . I ..... ---If........ ,,' .. ....... . ~' ,,' . N ,.. - ;::::;::::::;.;.:.;.;. ;:::'.;:;:;1:;:. ...... __.' . . . .. ....,..... . .t.... , . " , 1,,\ , , <::::;:;:::::;:::;:'.. ::;<:::;:~:;:: ,.' ,. ,,~Ul c::::~ ( .. .._................:;~............... " . ::l) 3:: _ ............... . ...;................. LINCOLN ~~ ~~ t)~ bt~~... ~.~ '..~ii ~. ~ . . 1: in -. ......,............. o,Jo '\ ,). ~ ~ . .~, . . T'=" .................'... ~ '\ - t -- () ~ ,/!~ _. ~t-_.__ :}j1jlt/ '. STREET ~ ~, .. 'Il5... .;'...-:.;.;.;.;.:';.;.;.;.; I ~ ;ij ,,~_ ;-- {,f.,t:=::::: :-:.;-:.;.;.:-:.;:..;~::~ . ' ~ L.. -. =.0;-----., + I .J i ~. ~-~ ~, " ~:3 .:.;.;.:.;.;.;.;.;.;.;.;.:.; .-...-.-- '--. · g ;. - j )fjf?:~?t: · \ ;:fY::' ~ .. . .. .. '" .. .. . u ~ I'jf~ t t. '~f~~', . 1\.) ,'1 ~ ~~ ~" Q (j; I~ .' k ~~ ". : ',,:,' i CL^RK'~;;&. ;ATION LID NO. 203."P~~: iMi iIlLa"~:df-\si 0' )~ ~. ". .f" ..;"e:';' n r , urveyors . E- .1 PL '.,_.,.3 'C-= . '. .,'n " ~ ' . AN " . :~\.;...\; .. onstructlnn Coordi ' , . . . ~ ~. - - ~':~ . ,'.' - . . , ~ , ... ---~- o ---- - - - DENOTES r .. .. .. .. .. .. 'j ............... ............... .......'..,....'.',...,...... " """""-' .,..'......,....',..'..,...' . . . . ~ . DENOTES, N' ..". I I' I II P I '01 I," I ~ . ,,,,, " APPLICATION FOR PERMIT PEHNj'j' N~ 0858 ')\'I:; u, A t1ft~(:lln ~ 4 IJ I (o_<L/ (' n:;.'I_clOB ^or)HESS_.~2..2..7 LL LI J 1(' D U',l I IJ"_J,~: 2.. BI'(JU:_J" SUllDIVJSlO~ TI_I= (Print Name) :=>)u S"'Y'li'~h herehy mal'es applicalioll fur thc 1"11,,..II:g; O ~ ~ lIiqhL-of-l,tfay cOllstructionpermiL ~ubjt.'Cl to tyIovi~~ion~ . RIGHT-OF-WAY CONSTRUCTION reil11irod by nrdInance 2166 as "m~nde,l ~mj thf'l"Jnlciral ., Lod0 Dr other Lit.y of Port Annp}p..;, nrrhn,:mcf' J.\~,\;kltk to bf' u.nplf'l",j IJ, (dotf') 2.('(;t~ation of uJorv: (,1uV:'l(l' _ lnsldc_ ltavnled loarJw'JY (If witllin trav(~lC'd toadwny, COInplfJlr: itrml~i ~~f II !. ti) <1'L?J\lalue of welk to h.' pl'rf!;;r.-,(>rl (If'ovor $2,OUO, complete items 3t II " 5)(lf under $?OOO, complet.e 'He'll 6) 3..\;ocCoiit.rndor name OR IPUIl!.l C II'OR~S DEI'T, \ 4.':II~Ptlr tori'1ancp Hond IIM,((',t. \'DR~ OkllER 1'",. 5.;;~~toof of in':-,uFlf1CC' # :1i~~i!lr" ~2,lJ(A.I "nt1 Ie','.: 1.',11,0110 perCiOl,,,1 InjUlY, $100,000 per incident., $20,000 pluperty I~~fk $2,OOS and m01e: 1,~'r)(],O(JO pOl:;onnl InjulY, $500,000 per incident, $100,000 properly 5~" lIlll-MUoe uno:lersl3ndc, lhill no ztrect may be dO!3ed to"trafflc unless approved by the City [nyinnet "nd Chief of .~: ~. Ollce <)fld IlDlificill.iOII~. ljivf!n to lhf~ Chief of Fire Dep<irtmpnl 't;~\~,:.:;::'~ lfIilV be cl...'l',(!d to lraff ic from la , -(Slrl!d) City ~En\Jin"f!r ____ Chl,,1 of P911Ct' Fire Chief o WATCR MAIN ~'!"\lice 0 Installation 0 Rppelr 0 InspC'cl lOll 1'C'c.....,...~ [J SANIIARY 5["L,I ,,,'rvlce 0 ] rd.11i latim [J Repair 0 Illspec I I UIl Fee........, $ o 1.,JOflMSflillll "lviLt' 0 In',LaJlnlinr; 0 f!"pair 0 lnsppcliiln Fel'.........$ o ]'L[VI5IL,rJ ,:r!i'Ll Iw,L,j'l:JLlon 0 Pelp,,}r 0 Olhl'r Inspecl inn F('I',..$ o 1LLLPHDrJL l!tJU! h{,HU!/:: l1;iL It!~,Ld LIt.ioll 0 f-Iepnit 0 o 1I'It.llvPOII In',l;1I1.111,,,, 0 HI'f",i! 0 1llspf'llloll SIlI'lol,t1....S_______ J\C'rIVl TY \OIJ::; I>I-:II~IIT i(1~SIORATION TOTAl. P('rmlllH'flt Su, fil'" I." ,".II i,,,,,,.. r=-="-i $'lO.1111 S'lOO.OO $:no.oo $ GrHvel Sul'focc' 1-:>."",;11;"".......1 IlIl.liO lC,O.OO WO.OO 1\on -travl' le(l sur I a( p r'" ;"'01' ''''', ~---J :O,OIJ I 'il). O() lBO.on Np\, (Om rete w;lll, "".1,1 i 'I "';'" _____j ',II.IHI -0- 'iO.110 Cf.HlrfPlP walk. curb l~j i:lll t er TllR\()vlll and/or rf'pL" 1""l'llt.... j(l.()O -0- ',1),00 fJr1Vl'WlIV eulvNt ill~I.J: liIt iOIl...1 I 10,(lIl -0- 30.00 Ddvcwn\' JnsLallnlillll...........1 I 'iO.OO l'iO.OO ZOU.OO , R"SI(,!'iIl io'! ~uhl()lill t SulJ:l,;iltal $ i~;''''~~ .,,~ ,_ '..". ~ .,~ [-'J SEWER. SeuJer j,".!rmit 5ut)j(~cl Lo provi~ions n~quired by Ordinance 21fJO . . ilS .Jm!mded nnd lhf' Mu!1ici{Jal Coele or othP.f City of Port AnrY:\Ef, ordin;:mce ,,- .' -"""" A, Sing/(' lami Iy resid(~Kc,............... Srdf) B. !-lllti-fauil\' re'sidellrl'........,........ $7j.ln for first dl",ll;nr, IInll ;md (!)'l'lt.X, f111h i-lUlil, al>\! IIIn,Is, 5o-,.ln for aleh uddili(~,tl ulllt lrailpr 8. nutD Cllurts, ,,"'Icls) C, Other sl ruclurcs......,....",.,.".... ~nJlJ'i '~j. fl. of g!'wnd lIrm r or IlK' Ii rsl (Ibwls, office hldgs., "tom-;, Im,lff) sq. ft. alld W.m25 sq. ft. for chunlK's, :~iI(X))s, hlSpl!.lIs, l'Clrllu~l('r In f'X(('SS of l(J'),crn sq. ft. ilHlllstrinl/Ulif1l"Ti,II "1"f~S,; 1" ;:ddili"ll, $'j,IX) for mcl1lh,~lling lJniL ,,,,,jJill,,d Ikn'l,llh, "iUl a n\lllinRm fce of $T,.i n ,,,.1 " Ill" il11\1" f('(' of $7'jO.m D, AltPrilll'>>l, '('1<111', (';Ii' "I (~xist.ilJ~t sidp f;P\\t'r.................... :;;2,,0) E. AJdit iona] din,"! (l)!lll('("~ ion:;, ," n'c(~IfJf'Cl inf!s. . .. . ... .. . . : . . . . . . . . . /" . . , \ 1I " ".': Jill t l.ll c 11.111 'I: I lOll', "Ix )\'f' I. InH,tl hl~ !Ill! "I 'ill lil I,,:, "l', '" ( kJ',' .,J,/ S. Ie 1;;1 ~ J /' I: 1 P f::.-.J 0'" , ,;llInli1r "'[('1'('('1",,1'.;.................. SI >,IlII"r "'''I /!-! '- .1 H...()N... " . '-ri<"'7-??i:::J ?C-:1I'nuT "1""'"'''' fI1/PL' UMBING' IYI'L Mlil ',ill. 1I1 1'11'1 ~ .::J "4-:/',..':> ('- 0"0 1l..:J . rJl/l11tH'f nr ri)'!.ure~~..""""".""'~"".'..""'..""."*I"f" $ / ,-) ~ (P~':\r qprrnit. fq:> 1,~:.~)[1 !:,lw', 1,/,11{) OPT f1x!tlrr~) u? ,.,.'.1 ~~I~tJ~~I~:,tt~ltAI;I~,.~~"tJ:I:}':r~ftlt:'i ,Q/" \~/tl'~:~f':l:f. ::.rlll~y:"I1:t~;~:1 "_,:;r:lllb;,: .~::,~\I~!l:;fl~rntll:t~~I'I~t;~ :J('rm i t t.ottll...... __ t~nt trOfll ah, llllblllty "t 'l'l<pr,r,IIII'IIt,. for /In, IHfl<!rr,t. !Ill tit dlllt.-'lj(l" In f'l!flWI1!l lit f,Il,. Hps!nt'ot inn LoIn!. /}'l"J ..trt,. "Jl"I'''fdUk 01 11l1i/lIlnk IU "'" p"oll!'~'1' ''''''fit flr " .f'l~ u/l'lt'n~~,'" un!!", tt,,. 'f/lIo,. } (. ~_ of .!.ill Itlplltlltlnn And ft." r"'lI"l (II p'rtH} ...t,l{h 11>11 ,to .rAIlIl'd Itl 1f""f'''''I1U' thf'fi'IU, .nd 'I'()'I'AL.."".......,....,...... $ ,.J lh.! Jln tlf u.1t 11Ib-ltltlu Il" ,?,H'!:.I--'~l",j tJ, th" IltIl7'''--i I' 'N 0'(') / 1.:.: . ~ .... r \PCC'lpl 10. .X (<"_1 Sq'"f'i1 (-:1-_..6': ') l...- T('I('pholll.' No, ~ ,I /J 1I,1I11111{ Arldn's ____>___ _. /' /-/ "" ..'""" .." "., ..', ...., ."...... " ,..'... "..,,, "... 24 HOUR lll"IMUM NOTICE · .-1- ~::.~:"~, f;:~:.:~~j .~:I::: ,'," II':" t:,.;~ ;: ~::"'~t::';::' ':,l:t'~~~:;" l"j~~: m ri I ~s llf.'d ")b'~I_.1 JI.~.;{ "V:-l- :;';.~,"~:;::::: ::: .~:;~:: ,::.'::,,"::,:.:' '.',.:" .:'::'::, ',:' ,';:' REQUIRED PRIOR TO p" 1(' / '7 - <;- - x'V ~~:,:'::,,'''''''''' ., ... ..",..". ",' ". .... .... .' , ...., SERVICE OR INSPECTION 1>~;~~~*~**~~~~~~~~~~~.: ~~~.:.~.:~:'~~.~~?~~~~~~1~?;~~*~{?~{**~~~**~*~*~*1~'~*~**~*~*~~~~~}~~?~}~~~~** FIlii""" - COSI nf rl'l'"i, (fr"", Imrk "rd,'r... $ \~"rI( Orrlpr ~". "PhS "HIOI/fll djlptJ~it{'d............. 1, UC'tllfld iJlllt:1lllt dw' p('rIlFittf.t'~...... $ \~nrrHlll N(J. ,\d<1 i t j HlIII I '''''<.>Hilt ." ~,-"'- - 1'1 No. IflSI'JTroR'S COPY -. "Iii I" t\I'i'!.!r:.\:;T':.; (OJ'Y - pillk OJ';:I(:I-: ml')' _ , I ,;~ . ;~~;~::~;; APPLICATION FOR PERMIT PEH~n T N~ 0864 /'" rji'n;EH _:~;J I) ':J tf! 74 JOB ADDRESS '221- I'J, Lr AI,'", /'\1 LOT BLOCK ). . SUBDIVISION St.-T{)VN t.""'.:.L' fl I ~ '; { ~ -.-\ (Print Name) , 'ij.;:~~~~,K;':" herehy makes application for Ihe fl.Jllowill~: o RIGHT-OF-WAY CONb I KUCTION 'Ughl.~of -w'ay construction termi t. ~t1b j['cl to pr(Jvl~~ i on~, required by Ordinan::e 215 as amendl;J ond the fllunlcip,11 Lmie Dr ot.hr.?r Cit" of Purt Anneles orMll~~nc(' I. Work::l;Q-.m. Clll1~Jletc<J hy ,(date) 2. Locatian'"Of war'" OutsiOl'__ lnslde_ traveled;:,~\)atlw.y \1I within traveled toadway, complete items 3, 4 & 5) Value o(''''''r. to be fJ"rlor",,;'1 (H O\ll!lt, $2,000, complete items 3, /, & 5)(lf under $2,000, C(y11ple',e 'llr~ -,' it~.' '. "!'c.,.", 'v,')l'~ ,. ''''''!lJI!!' 0_ OR \ I~ B 1.1 C . BO"" ." I. PT. \ 4. Perfotiluinee Bond Amount WORK ORDI',R 5. proor~~t'l.nsul once . # Worl(;),~~'OOo &n1 Ie,,',: iSO,OCJO personal In}Ury, $100.000 per incident, $20,000 property Worjt:.~~txio am! more: $70fJ.';i)0 personal injury, $500,000 per incident, $100,000 pn,pnrly 6. ?ermltlllt'tJmrersto"us that 1\0 r,treet moy be clo!3elLto traffic unless approved by the City Cngim!er and Chief of Poli.Cli:'1i\'ld nolH Ic"tions ql""o Lo the Chluf of fira~Oepartment ';it)'{ , may be closed to -,harf Ie from lo ,~~~;(5tre"t) . ,,';'#r ",1' CHy lng,L:iirbr Cllief of Pollee fi I e Uricf o ~Aftl1l'\AJN Service 0 Inst.allatiotl 0 Repair 0 lnspecLiun Fee........ ,S 0 Ml'llT Arn ,HiU1 Ser ,lice 0 lnstollotlon 0 r~l]pair 0 111 s !'pc Lion F ce. . . . . . . . . S 0 5iOfll'l jlWlH ~JP r \.' i Cf; 0 lnr;lallat.lon 0 fkp"lr 0 IIISI)('cl iOIl FI!I'..,......S 0 'itLEVI~,[UtJ CPLlLf Jnstallation 0 H~pCJl r 0 OllH!r lnspl'cLioll Fl'I'...S 0 TtLtr~ Imll UNDEi '[,llfJUrJD It)I, JnslallaUon 0 nepal r 0 0 UTIU n f'ULt 1I\c,tal1~Uon 0 Hep;)l r 0 Illspeclioll SllbIOI;II....S I,CTIVI'l'Y :lUES "F,"tIIT HESTORATION TOTAL J:l'fmilIlf'lll ;';"1 I;"," LXI ,,~..IIO".... f=- I ~,10. ()n t'lO(J. (J(J $TJO.(JO $ (,rall,1 SlIr/a'" LXI ;I\'al'oll,...... '\().I)() I ~JO.OO 11\0.00 Hon-t rnvel(ld slIrfill (, <,'Xl ,I\'<I! ;1)11. I ",!).I)!) I c,{j.OO IHO.OO Nt,... l'(1I1( rl'll' \;'nlk illslill iill ;"11,,\ I 'iO.OO -[)- :iO.OO CUll, rete w[llk, Cllrh Ii >,,'11 c('" ')(). (10 H'mnvnl antl/ or l'l'jl 1;1f <''''l'nl , . . . 'jQ,OO -0- Drlv!!wri{r;ulv<,rt ;IIHlnll;,,;,,",..1 I 3ll.00 -[)- '10.00 Dr I vcwayi milil11 OJ I ; on. . . . . . , . . . . I :iO.OO l'iO.OO 20n.oO -- f(('sl nrilll on Subl 01 iJ I $ Permit SubtoLul $ ",'_., d' , 5ewer;j$~imit ~~~j~>Ct 'to:rwo~l~~$r"'l~ited by.iJ;Ji;:,ah~~' ;!f~o" ."'p ,I SEWER : as amended and th~ Municipal Code or other City of Part Angeler, omlnance "'." . Sll1!\le ranlly n'sid,Rl'................ So7'i.m ;\. B. !'\ll ll-f rmi 1v ll'Siti" ,<f'. .. .. .. .. .. .. .... '\.75,( (l for f i l'Ht 'j-",' ~ I ill\'. \,n it ,;\<,,<1 (l)lp!('X. nllit i-wdt. ill<I!lnnlls, S'i.fD flJ!' i'illh [,Idlt i(~,,! unit. lralJ("r & iluto eoerts, "nlels) C. fXlK'r lilnxturl'S....................... ~J.(XJ'i iiI}. ft. of gl'wlld arm for llll' first (Iblel:l, oJf if e bldgs., sl "I t';; , lCO,(XJ) !-',q, fl. m~1 W.rJJ2'i sq. fl. fnr dRlrches, g-lxn1s, l"spi t}lls, rmnilldt'r 1n ('xce,," of 1000,frf) S(j. fl. ilxlllstrial/nmrx:r,lill hldgs.) Tn ",Idi! ion, S'i.Cll for (>;K-h c1\;dTing unil Clllll>illnl Ihcn'Wllh, WIUl [J mininun fee of $7:,.IIJ nncl n InIximm f('(' of So7::J:).(XJ I), Altc.'r;,l\ il/n, n'pnir, Gip Cll t'\i:.;t illg :.;ilh' :;(,'\..1'1'.................... ~Lr),(J) E. ^,,"l' J,ntl dill~1 'l~lII" I;,,,,;, n'f(}flol'cl jfJfb.................. ........ ~--imr.> ,IS illit i;ll ("(lfllJ{'{.t jOlls illxw(' F, Ill' LII};ll iOll l}f ('<itch !n:~i(t<"; III simi tar 1 lI!.<"lT('pt ur:), ................. )1 ),OJ I"" Illlit S J2r PLUMBING : IVI'I 11'1[' ',jlL Of jJjPL sl!j-.t-~.".11 Nul'''!)''! {Jf fl."lu[cr:.....,. .f....f..'.'....,.........'...75.~.I...... $ "3 ~ "-~ (!J:l',ir__ '1prrnit fpl> f;,1"nrJ 0111'--\ ,~?{)O [jf>f fi,;d;l!!e) X "2.., f\. """",I'fnt::>1 h\ torUIul'tltlllJn (\1 1/"1,. ",.,Ilt!nl! of thlt ~'trll'l1. It \. IvrthfOt ..,r,.(Or! bt tIll" IIppllrllnt I hilt thl' Perm 1 l tolnl...... ell, I'lf tvtt Al"f'l,,\ .11':1 flllJ Cll Ht tJfflff'rl M f'!!t..I'l . lIfltdl b,. ,......,.d ,,,ur,IBIJ tI, tl,,, "l,pli- t81ll frOG ."', lubl1lt, M rt>llpOr,lI .1111, 1M !In, 1l/.:(df"1':, Iou O~ (lit'"'''!!'' to p~noTII or r,lO- Rl'SlornL lOll loud. put" hllH~11101l .), t'f\jtl1t... jJ ht pt,.'lut.. r~.t of "", .t,r~ \Jflrlt't1u\pn uni1" IIlf' If'fllI! TOTAL........,...~......,. . $ -\ :) ~ '\ fjl lhlt ."I,1If'li<1tl hnd tM; I" It Of .-11"'" h ~f"i"I'<1 Ifl rl'llopMU thflrto, .tld -- Ih.. 011 01 .", ".bllI"" ,I, ''''.'' II" U HI'('t'i pI No, J ~ r..- Slglll.d _.---'__ ---1~Y_-- - 'I'l'leph"IJ(' 1\0, 11" i II I'g Add "l'~,S , ,- ,... If'H/UI ,,'.' t.... ft'., ..~*" ..,-,.." II f,.not ,...... h ,. 24 HOUR MINIMUM NOTICE I SSIll'd I,v \~ I~' ",,, A.._" l., .. #--./ /.. P.. ,., I .. " .' " '" "I!'" f"" I.." ~'.,' ",."." ""1'" ,. /I, H'.' ,l fl. '1'."'" "'"'''' ,. u.' REQUIRED PRIOR TO /')-//f.l!'il';- .. :~'1.;!'l:;::;~~. ::: ~J"~"":I'" ,~',.:~:,}';:::..;;J', .,".\:' ":~::'::, ~~. ,~~:~ IlIlI(' Ill. ,fit "~".,,,~I ,,/ ." fll"'HU 'to ,I ".. I HI. lU" .t 1..,,1 SERVICE OR INSPECTION l.""I~'" *?~}~~~?;~~~,~~{~{~~~~; ~~~~;:~:;;:}~~*~1~{e~~~~~~~;~?***{~~**~*~~~~~~*~~,~*~~~*~~~~,~}~~~~~*~~~** FIIl;""" - r:",n "I "'1"'" (Ir"", \""11< ",d,', ".1, \I'ol'k Ord('r ~'" I,Phl1 "Will/II' I)I'I)IJ." II ,'d. . . . . . . . . . . . . j. Rtlf l.1lt! d!Hl/l!!l! till!' ;Jf'r nli 1 t ('('. . .-. . . . S Nfl. "old i I i ,fila I ;lflll/;lIJ1 ",It" r: i I\'. . . . . . . . I. Nfl. ,\I'I'Ll r:.\~T'~; r:i)j,y, - m;:lCl ~..~~- -'"_.._-~,- ,-"~--~.., ---,~--- ~'. ~~ ~~~1 ., - \ APPLI,CA TION PERMIT PERMIT N~ OH22 ~I _JOB ADDRESS -7,.12 4-~~' O'..mEH ct LOT -- 81 '.JeK I lI('rrby mak~~~:;~1r ~l:~~:~~e~ (PrInt Name.') m. ' "\,,HtgI1\-,{)1 -""y CO'!structi.on permit sUbj,'ct to !,tovi'iioos RIGHT -OF-W A Y CONSTRUCTION :1.; reoullf!,1 by Ord~nance 2]fifj as ~"'endelj ~nd thf' f".unlclpai > ",,{.;. , .,~'" Corln r)f othpr CIty of Port Ann~1f?~ O[r:ilf1arv:p 1, \lIorli.4~'_Jit.omplet"() Dy ('late) 2.. lOClli'ioi1~wrk' Outsiae_ Insloe_ traveled"roadway (IF within traveled road",ay, con'plE'te itC'llS 3, 4 & 5) vallli';bl!; ~~k to Le pcrfo'~ed '~" (If over $2.000, cOfnplNe items 3, 4 & 5)(lf under $Z,Ooo, complete itt!iil~~ ,,,;;,., J. ~- OR I PUBLT': '''m" 1;ln'l I,. oet(:t:i_.ri'ono Arrounl \~K OIWr',R '. # hC'(: S, Pro~'~ 'I'" ranGe , , , " )" lllo~' 'ff' ,(:and less. $50.000 personal i~'Jury. $100,000 ~~ lnCldent, $20,000 properly worli:~ii :ootrllnd more. $200,lJ[j(J persOt;al Injury, $500,000 '(Jer Incl(j"nt, !,lOO,OOO properly fj, Pl!tmftt~'l'fJilder~ta,'d~ thal no ',tnmt may be c1o~ed 1.0 traffic unles," approved by the City [r"oline"r and Chier or polii;f,~Ij,;!lOtif!r3t.i\)n5 fJl,,0O to t.he Chief of fir" Oepart:'"t .,~~i1jf,.l", may be clnoe,) to traffi~, from lo ";"&!~tteet ) i"lr'. CJ t y fnil1 '.:',i;V Uli d of Poli ce Fire Chier I: II )( o .. blAltlt"MAlN Service ~la In:,talialion nepalr 0 lnspection Fce.,.......$ OSANHARY S[W~" r;r;yvict: lTl?,lallatiurl 0 Repai r 0 InspC'( t i,," Fl'l'......". S o 'sro/ifll $fJlilfi SOl "leI' 0 :Il~)lzd lati~)fl 0 RI~;lni r 0 ! IISlll'( I i Oil 1:(>",........ ':> o 'TtltVfSlON (AU, !w,t"I]"tio(, 0 Ilrp,,j r 0 Other I IISp(,(' I 1011 h'I'...$ o lr.(EPim UNOI m,rWIJNOIM, !nsL:tllaUon 0 Rep3 j r 0 DCUl~1TY POLE lI."t,llation 0 Rcpni t 0 lnspecti(JI] SUhtClII1I....:; ACTIVITY .. ..-."'..--. ~(j II'S f'EK~IIT In:STO!IATION TOTAL I>r'rm{jnenl",~urfil( ,. Ex( 'f\';tl i,,,,,.,. r==~ qO,Of) q()f).[)O j,'l'lO.O[) $ (;l'l1veL"Sul'lIlt:(. h(il\';'i j"".,.,...f----- ',11,110 1',1).00 1,':0.00 Non-lrnvclNl surl!l((' (''.'iI\",' "Ii, ____'_ ",(1.1111 IC,O.OO IHO.O(J N(\" f'onCrel'e'Io'illk IIISlilllill ",,1..1 _ I ',(1.1)1) _(1_ c,O.O(J LOrl( rl't,n~!ilk, (/lrl, /: gt'll ('t ~ J l'"m(J\'~,ti~~lld/l)r '''I'; !l(('II" '11 I .... __ :O.Of) ,()- ',0.00 lll'J\'t'wnY'll'UJ,Vl'lllnS!,"I,",,,,,,,. I lO.()(} -(j.. :1<1.0(1 l)rlvCWllj"li'l.Ifltll! Jal ion.....,.....1 I ,0.00 I c,O.OO 10r),(J() ";';~t~:i.t;~:," , Rl'stor," ion Suhtotnl $ - Perml l Subtntl.\~, $__ .x~~;:,~.~,:,.:,~:'>l:' : ."t '~S:.:,-'--: , j:',< - _ ;~; __ ' . ^ ~ . "-\-.;,}:'\!")':' ,",0'.' ","'.., ,';, ,,' 0 SE'lVER' S"",er perlrit subject to prr"Jlsions "tf''1uit!!d by Ordinance 2100 " as ,lr!lr:'PrJf:rJ i!nd thD f"lllniclpo1J Code or other City of Port ^nIJulr?!; ClHllnanr:e .,,,., ,\, Single'rttnily;ii~..;idpln'""", .,...... $r>Jn !~. ~hdtj.filiillj:n'S';dlwe................. $7',.111 rur first d\,ellJl1g 1II1.t mxl (L\IpteJl, l1'ulti-lInii, alxlrtnnlts, $',.(f) fur eeh "dditJpn.t1 IInil t m! Icr & 'uuto (CR,rt S, nnt l'h) C, OthC'r sth;::tunos..,.............,...... SI,.rrr, sq. ft. nf gmmd <lint for t.lx' first (I\,!c!s. officc. I"d"s., slorc',", 11l1,(Jr) ~I. ft. and $0.0)2, sq. ft. fur dlurd)(.'S. sr:-hrnl ~;t hnspi tnls, I","i"d,'r in coxn's,'; ", IOl.rrn "'I. ft. indust r;nl/nm:r'r< ;,11 bldgs.) I" "ltI;1 ;",, .~,').lft fUI ("ell d\,{'ll ing IInlt 11",1>;'",III.'rl";III, willi il mlnillnlll fce of . $7').111 ,n.1 " IlltXinllll rt'C' or $7'1).00 . cO , ~ D. AI tCOntl i('l~ r"l" I I, Cilp ur . . D ~ H- G=> A-\ . \ 4S0, 01) ex,s( In)~ sid" "",pr.................... .$2'),ll) \ ~ ,-, E. Addill<ml (lin" (rKlIl{\"lt"'s, C:O-::-~-t, ~<- u.)d7(Q';;:-,0 \ 2.06 . C:n rt\.'fXII!t.1".t ion...,.......................... S:Jrlr' <IS il1il illl (orlllfTt hIllS nbovC' . F. lnsl.nIIIlIHn, ", (<11(11 loslns u, '\:.::G"~\('j.(:.?-.l+--n ~ t::>y V"['O~(tJ ~ Himllar illle.I'('(.plor';..........."..,.. Slc,.ln I'" IIIlil ( O~ ~ te3.03 '.".hJ".,1 :,1 0 PLUMBING: IYPl I\NU ~lI! UI IJJ!'[ NUl1lt!I't' 11/ r I "tUI'P~,;. . . . . . . f . , . . . . . f.' . . . . .. .. . . . . , , . .... \ .. ... .. ..... . . .... .. $ (Hw,jr: [Jf,tftdt il:e 1,~.UIJ lilll'-, 1-/.IHl !lPf f i.tuff> "f,.,d',l J~ cctlthh,.tjtfl'\ M If' ,fIW\ln, "r thh rHll-lf. f1 I. f,.nt,'" 1l,lI'tI<'1 t.t th.. IlHIlfl'lnl lh't Ih.. ""nllit 10(111..... . fU, hI fMt !fI!j.#:I,.t. ."t' 10"" t-f 1111 qUill". H ""'t'i'"... "',illl r,.- """,,-1 1'''Frr>h....l! I"~ 1t.1' 111'$111- l4n~ troA '''1 I.lfll:>Ill1t Ilr ,,..,,,,,..,,-lhilJl, '(It II'" Ilflld"tll, Iv~' M rill"'''''' If> "I""'''r>lI l,r rrll- I~ (,~.; I {j rill j fill Inllll. ,."11'1 t,"t"."H.. ,jf l)lr..Itu.~ ,." tht' pt."la-..t.. ,..",,\1 r,f 'HI' ""I> IP"I#-I'''.'''' tI."I.., II... !""'1Ii , flf HIt. llrttl'1i!tifJI\ ,."" tt<,.. ~"'''11 llf ".'.1111 ..\j I d.. -'11, ... 1'''f1I.." In '.'I.rm,,' th,.rclll, "'tl4 .J'(rrAL........... *. . ......;,...,.., $ ''', """"".." "".~... ".... · -"" "'''''''. ." "", '" p' N". '>N""" --,,' _-.LZ/f::'dA:?zu:r- ,,,"",",,,,,, N". /0..::r r fIlii Illig Adrlu'h"_ _ ~ 1'_}l( t",. "'111,,, P,.. ,*'. .,,~.. ...., "ll"o" I' .,.',.. to" " " .., I ,~". -(';." ....., ....."....,.. ............. ... ..."..... .... 24 HOUR MINIMJM NOTICE I "",." ,,~ ~ ::::",,:t~:~;::.,:;, ;:.:: '," :~";,::,:.':_"';,"::;' ::.:".;';.:',:':'. REQUIRED PRIOR TO ' , , . - -- ,_ .1 tMI t.,.I,., "/,I h'*'~1 ""'ll'_ t.J",/kl.. .'.11 M ,...... l~ I..., Ihlt t, ~ ~'"') I.!.::.::.,~'''''''''.' .., ",",," .., " ... ,,,' '"'''' , "'" SERVICE OR INSPECTION ??;:.-:~, ':;>}~::';; .:~,;; ~ : ~.~ ~~, ~ 'l-:.;;i? ~~..;-; ; ,,~ ~,;;. .:..,:. ";. -: :_': .: ,~ .: : :' ':' ~ .:": ~ : ,~ ~,~.: ~,,~,~. ~_~, -:";:',~,;::~ ~':;"/ -:' :;?,~,~.,~ <,;:.:~ '~":'~~ :~.-:' : ~. :.:.:,.: :. ,:.,~.: ~*,}-:-, ,.' Illil/l/ f' - ('{'hl "I '''lilli, ( I f tllll h'l 1 1"1< (I! dl'l . . . ",nrk Oldl'r ~'" I,{,~s :I/IJflllllf d(>'l(J~! II-d. . , . . . . . . . . . . - t<pf dflll dJl!!Hllil 11111' 11111r1lil It,(..., I, I i "It,d i!r!llllllll d II<' ( I..'llil,' ~"""1i"r'LlO~ ~II ij"_llIili*W"IL''r~!l''~'_Jt''j.u-iPW.ijjf~ JnJI1JI I;J:'~~~"~:r~'.i'~f.'1"_";~"~':;IZ:'~''tt~J~tl'''I.'.'UJ1l1'&I''WJ j' ~,t1 nrrr_~1n1li_~ljjjlll"I'l . '~'*J!!r..~;c^;~: .....f.'. ..eR :~'~;iil /,''4: ,~~_ tv.';;'" ~ to"r'.4~ APPLICATION FOR PERMIT PER~\I T N~ 0942 ~o~~ . (<'! I .(; "', .f '" .",,*!!i 1 L, 0U'J~J,) ~~ O'dN EH b.,\.. y..,.1,'~-' t.\l~ Jon IIDDHESS )/7 f\..\j L...! ___ '~~4~;' ,'--' '_1111, I LOT BLOCK SUBDIVISION ,06~'" (Print Name )-++C:l,,~"''''i\;;~n'hy mtlkes 01'1'1 iffl! ion for lhe following: ""L Ie wo"~ o RIGHT-OF-WAY CONSTRUCTION HigtJt,,"of -way const.ruction permit sut)jPct to provisions requIred by Ordinance 21G6 as nmended one.! tho Mutllcip31 Cnd" nf nU1Pt r:it'l of Port. Anqrolp',\ or-din.mef' , , 1. J!II!iI!!t.tI be Lw'plelf'rJ 0,/ (uale) 2.,:~Q{;~!on of ",ork: Out5ide..K- I"side lraveled'J.~ad",ay (if within traveled roadway. complete items 3, 4 & 5) ~V';11~ Of war\( to be performed ','I';' - (If o;;;;~ $2,000, comolele items 3, 4 & 5)(If under $2,000, complete '~;:;'O' ",. CA" ,.,-6, P A. ~.:A~ A1 \ 1iJ! I "'IIJI.IC .'''''' liEI'Ll It.~.fletformance Bond flmount \~OI~K OIWI.R 5, ;:':,l.l,l'COf of i nsurar1ce # ,)J:~~ $2.000 and le55' $',0.000 personal injUry, $lOO,;~oo per incident, $20.000 property C;:I'Mk $2,000 and more' $100.000 personal injury. $500,000 per incident. $100,000 property 5;5't:!bhnitten unclerc-tande; Ulat no street may be' clo[ied'E.o;l.rafflc unless approved by the Lity Engineer and Chief of _~(;e and noli! leation', OIive,:;;~o the Chi", of Fir~:D~porlment .51",.~,.,t " may be clo[ied to traffic from to ~f;, (Street) . City fnglr,uer Chief of Police fi re Chief 0 IMIlER MflJt, ~Jcrvlce 0 Installation 0 Repal r 0 Inspect lOll Fee.,.......$ ,0 5NH I fin V SlWUl Sl'tvice 0 Inc-tallalion 0 Repair 0 Illspecliull Fce,.,......$ 0 STORM S::Il.lU1 S~?rvice 0 Installation 0 Repa I r 0 IllspeclIon Fee...."...$ 0 llLLVISlmJ CPOll Inslallation 0 Repair 0 OLlwr T Ilspec lion Fee... $ 0 lLLI.r-IEl~IL IjtKJrHLHO!)'mlrJC In,,ta 1 Lillon 0 Repair 0 0 UllLlIY POLL 1'",l:illat.]lIn 0 Ru""i r 0 Illspeclloll Sllhlutnl....$ /\C1'IVITY 0:0TI:S PERNIT RESTORATION TOTAL P('rmfllWIlI Surf:!,,' FXC'I\';\lloll,...! I $30,00 $300.00 $330.00 $ (;rnvo) Surl,,,c' Fx'av:!llull..,..,.1 '\0.00 1')0.00 11)0,00 N(')n~lrHv{'lt\d Stlrfil(,(' t'\f ;I\'nf iql,.1 ~.().OO 1')0.01) IHO.OO Ne\! 'tunl rei" Will k iIlSl"ll"II(JII..I~x \401 50.00 -0- 50.UO ;.J I {_ A-A ConcTl'1P \-'111<, curh I', i,lIll('r I I ----, temfJvi11 "nd/uI r"pl;,,"mcnl....14xldD, ~b.no -0- c,n.oo -1l,L- C.ihf Dr.i\'cway ('Ul\'(\1 t I n:Hallnt iOIl...! I 30,00 -0- Dr Illsl Il II III i (In. .. . . . .. . . . I I 50.00 J5,J),: 00 Hl'stornll on';~:lhloln I $ Stfht~Jt " ,~. "'.~I" - ,7.,%.0 SEWER: Sewer permit subject to provisions required by Ordinance 2160 as amended and the fllunicipal Code or other City of Port A!;lge.l.e.s.c.ordlnanw " "", '-' A. Single fani Iy residence................ $7.5.CO :ti,'!'it:, '- B, Hllti-fani ly residence................. $7.5.m for first d\~J1jng unit and (1AIplex. mil i-unit, nparlnn1ts. $5.(0 for C'flCh mlditkm] unit troller & aulo CO\lrts, rTl'ilels) C. O:l1er sl f1K lures....................... $O.WS sq. ft. of gnxlnd arm for lhl' first (Ibtpls, offlre hl,:gs.. ~;t un~, IfXJ,rm f'l. It, nnd $o.ems sq. ft. for chtrcllt"" RII<xJI:;, hospitals. !tlInindl'r in I'Xl'l'SS of IlXl.CX,O S<J. ft. ilXlllst rial/comerc inl hlrlgs.) III n<ldll I..~. $S.CD for edch dwelling IInit clll~Jin"llhl'rc',lIh, 'WIth fl mininun fee of $7",.(1) alKl a IIl1X Imln f c~_' of $7'Yl.CD Il. Allp!,,1 i'ffl. rqnll', 'ill' "I ('xisl'ng sid" S<.'....r....,.......,....... $25.IXJ E. Add I f 1...11 rI i I'C' I n<uI<< I I,n>, rpn.mpc! iOI'L\{.*........................ ~~I:lr' us illit inl CTXlItfTliOllS nlxlve F. Inslilllnf 1,,1 of f!ll' Ii 1",,;,,<; ,,' sind 1111' illl ('f( ('pin'"};.................. ;,1',.(1.) 1"1' IInll $ t '-. .~" nl "I 0 Pl....UMBING : IfI'l fiNO SILL Of f1l1'l N\'nh(hi1~r r. f !J~;~ff.S; l:f~' ii:ilO" ~l;,~. ~l? :,;rl' ;l~;' r i ;i.;,;;!)."...,........ $ I I \ \ k . '.., 'M'..,t '.1 In to:Mtd",..ltnn tJf ft.P ,HIM!III ~f ,t.I, pl'tllllt, 11 It hUh", .f;'....d b, Ht'" 'PI,ttOlnt thAt ttlt> Perm i I lot n 1. . . . . . CUr f1' I'l1H '-Ilk"lu "'id .flr or 11. flll,"fol. t1t ""'I,lr.,,,,,. alHIlI b.. 'It~fld hll'tll'lt'lill ii, tht> tlrpll- 'M,l hue all' J.ft~llll, I" '."'I'""ji.lt,dl't f'" .Ill lluldl'M, lo-u PI dlt/l!lljt" to f'f'tI'H'JIlll' or po- I?f'~; I or ill i Oil t ot<l I . 1'''11" h;llf'lIt"l\j'J :', "",,'Ilr,. alii 1ft. 1"..1\""1' ,,,,,d, vI IIn, "nJJ, l.lr>dtflllo~f'f1 \lId", Ih,. It-1m'! TOTAL., ., ...., .. . .., .,.. ..,. $-1JI e.- n' It-It aN,llr,ll'l" ""f Itlt f'u"lI fl' 1'('1"'11' "hlth "'" be '''01''15 In fl'll.f'onu thfiffltfll lhd Ih.~ ,11 01 ."Id 114t.IJltlu lilt' t,eft!" fl~~'I"I'.("1 \", (h" lIf\pltcatlt. I~('c f' il'l Nu. I Slgllt'd _G....:l ~ '..J.J~'t',,,,_.hl!D 17._____ 'j'('IPl'llIlltt' No. ~I'IIII III', Add rt"l:, - -- ---- t~ll .",,11", .~.' 1M ,~'" H".' '11'''''' 10 "'hlot ,....,It IA 1ft 24 HOUR MINIMUM NOTICE I HS\lPf! ,,,. ...,/1 ".",lH .~ .., 1M !~. "'f .. ,...... .. ,,,", f"ll'."'" 1.,1, t""lI U t""U ....If'. ,. 'H I"" ,,' ,.'. .......... .....'...H l~ ,to< ..If .,,1 "'1_ .., .... !I" .. .... t""'-~" .f 110 ,..,. ~I '''' h" REQUIRED PRIOR TO Ildtt' d t.., ,.,.1... ... ...... 1 ,.,....., ..,,~,',. ".!! ... I.n.; H ,,'._ ".. 0.. ,..'...,.... ...1 1'1 'n:l'''h ... .1 "dO (''I_ t,." .. t ft.,1 SERYICE OR INSPECTION (",,,,_., 6?~?~G~?,~?~~~~~?~~~~~~~~~: F 1111111('/' - ;Nt;J-.-:";\:i No, INSI'!':CTOIi'S COI'\' .. \,1,'1 f' ,\I'I",ICi\NT'~; CO!'\' - plltk OF;.'I U: ------- ,~ jl- I '.'~',., APPLlC'ATION FOR PERMIT PC"""T N! Oilal I l/......,~~<"". I ~........, I l ~-~ OW"EHL:~ ,eL p, "', Jon AOOHES" 2zZ ~. L,;'r., In ,>- '",'"~ lJ)1' BLOCK / SUBD]VISION TLc ..~~., (Print Name-)' .;"" ,hprebv mUKes appl iCilliu!I tor lile followilJ2' ~{lcwOp " y' I'\:/l HifJ',t-ot -way construction permit wbject to illovisioos ~ RIGHT -OF-WAY CONSTRUCTION i,~(~~i~~d "~~I'~r~\r;.~n;,~ ~~~~ ~;'l~.7:,~d~~cj~~~r!::~e l'Iunlcipa1 .. . J, W"r" tr, i,' '-''''lJleted by 2../2.., / A::.- (dat") ~, L0",,~jV ',' wOlk, Out5ide---": ln~.Ide",-- trave, "loadway (if within traveled roodwoy, complpt" it"",s 3, 1/ ! S) 'h].,,: cf _'ork to be performed" (If over $2,000, complete Hems 3, 4 & 5)(If under $2,080, cOl1'p1ete "r-'i J..' f 3. :':;':'1,;,'0" n"!Illr'. ~ '::;>~''SCuJd'' d,\,1. OR J PUBLIC II'()RKS DEPT. I 1/, 1'<"'1" ",",' .' Oorld ^'''fJunt .",:. WORK OIWER 5, i'IoOf 01 j "soranee # 3 I '1 (") \;hf" 1,;.' and II'S,.: $50,000 peUC!Q<lllnjury, $100,000 per incidCllt, $20,[JOO i"llpr.rty f",S11.l-~1 ;::<1" C6 uhrk ;';;,:.c,'J and mOle: $200,000 petsiiiial injury, $500,000 per incident, $100,000 prorerty Sw C('l~ ,I L.j-...~.,l.., 5" b, "",,,j '-"" 'InderEtands that no streetJnay be closed to traffic unless approved by the Cily [nqineer and Chief of "nl : co' ,','1 notH icatiOt1$ 9i~?~ ,~~4~,r!:hlef of r; re lJepartment "("':;"~r:~e clo"ed to trul fie from to {'jtr('el.,~A '~,,'~r~~~~:: Ci'.y I "'!I '"., :' " ':':<~~(.chief of Police f ire Chief o .,:,\;1 ";i,jlj :;"Ivi"" 0 Inc.t.nIlatiOIl 0 Repair 0 I ""pt'rl iOf! F(.e.........$ o ',W:lli..,y c(\;IIY ~ervlce 0 11I5t,dJ,'lion 0 Repair 0 I"spection Fel..........$ o "';liP S"rvice 0 Installation 0 Repair 0 Inspection Fce.........$ o :"i,;-.rul, UB"E installation 0 Repair 0 Other Jngpcclion FC'c..,$ o )I U, '"ijl 11MlLRCROU1JOING Inc:taIlalion 0 Repair 0 o 11111 Iii j'U:e 1II'./.allaliol1 0 rtf!p~Jt 0 If!lipecllof! SlIhlol'lI....$ ~ -~-" - .6.fTIVTTY i'\lrll:S I'J-:R~IfT RISf'()f:ATWN TOTAL l','If""'''"1 ';1! ""' Lx, i1I'i11 1011.... r-=-- 1 $30,00 $300.00 $JJn.oo $ (;r;l\'I.j :,,": ,/I" hi .I1i11 i Uf!.......1 1 :\0,00 I SO.OO lIJO.OO ~;..n-lr"\'I'I"d ~IIIrll(f' 'O:;II1\';lll..n'r I :~O.()O ISO.no tHO.OO S"Io '''II' ,,'I., Io!llk ,"~IIIII..I 1,,".. I ',1/.00 _0_ SO.OO CO"' , "I" 10" II<. (lIl [, t; l~ III I C'r I rt'IIJ"'"I ",,<Iior r"ldllC('IIJl'tll....i SO.OO _0_ 50.00 /)1' i Vf'Io'i11 "IIII'rl l"gIilllfltion.../ J 30.00 -D- lD.OO lJr I \(010'''1' ,,,',Iilllnl ;"n...,...,....'1 50,0(1 j'jI).OO 200,00 !iesl oral j nn Subl Ilta I $' _ Penn It Subtotn J $ __ Sewer p~~"'it subject to prO\lb~s;'.r~quired ~i:Jttlfnal1Ce 2160" ._".... , as a!llentraa and the l'Iunic{pal Code or othr - City of Port A119101es ordinance '''' ," , ""~.""" ~fid,' I.',:;[r !'I'sld","c................ $7S,(f) Hlfli-I..I;';; '('Sfd(wf'.................. $7S.lfl I'll/' first (!I,pIling IUd/. ,lIwl _ (1\11.1"" ':;,1, 1,,,,,11. i11<1llnH't,"" $').llJ for (neh nddili,nnl 11I.11 t rili If'r t~ Jl~"l (f)U:" :-), n-JJtpl~) C, otl,'r -I,," I 1I1'1'S....,..,............... .)(J.(fj'i sq. 1'1.. of ground aren for IlK' flrgl (Ii)I('I,.,. ..I' ;1 p hId~:s., sl orcs , Im.frO sq. It, UlKI $O.(Xfn sq. 1'1.. for _ ehllnl,"" '.I,,,ls, f>lspllJ1J!;, fWr!im!t'r ill execs;; of ](XJ,UfJ sq. ft. Inrlll"I 1'1;11 !"I!TTrrcinJ hid;:!';.) In ndditi<nl, $').C() for CYlch dlo1:'Iling IInit ('mhl!l('l:lthe't'Wlth, ',fth a minlnnm fee of S7S,ln and II nminun ft'(' of STiJ.m D. :\11('1'<11 ilJ(l, 1('1011', (<lp cl/ ,,'xis: iltg ,<';jl!f' :~('\~t'l ............ +....... $L).f1) E. Addit jun.il d i t"f,- I (fJlllIC'C[ kn<...;, fT'COft/lfl I i'J::~............... *.......... S'I!If> [lS init in] COf1JJ(.'ct ions nlx)\'p F. I rJ<...;t; 11 Lll ifl!! qf (dldl l.\!sins 'll ',Irlll." 1111"',,'1'1..',.,.................. $1'dO I('f unit. $ , ~"~",""\ o PLUMBING: $ -- -' '"''''',''' I. '"'''',,,",,' ,r ", 0""". " "" ,,,.It. It (. I",,,,. ."", b, !h. ".11..". 'ho! .h. I'('rm j I t 01 ,tl tilt I'll PM! h,'f'l"~ ""'1 Ml (,j It. rtlrl(N. or I"llif"o,~rr ..~...Il I.,. AII"lI'd hr"~th:u~ b, thr (lppH.. < f ...... ..." ,,,~ lO, ''''"'''' " """"'"'''''' loe '" '''''''', to.. or ,......0 ,...." 0' .,.. !I"SI ofnlloll tol;j I. J:!/c "tllt. h""'''f'jf,,,.)I ""'fl"If.U ft." rtt>llll'."l,. '''fI,dt of 1111)' "nr. \j1'1~t'r1t1'f'11 undrr ~ht ll'IIft\ 01 !h,. '1'1-"'" '0" , " ",' ''',," 0' ,"'il. .,,,,h '" b, ,".1" ,. ...,..,. ""......, TOTAl..,..,....".,."..."., $ 1-J r. that _II of tAl" llM'jJllIH IIII' t'f'tt'b, IUlJt'f'd b, It., "f'Plltftr,l. I' ' N '?> "0'("1'10, ~;igll"<I --.J..- {~Od<1C i:-<t~...... T('I"phof!e No. ,'I., i 1'"1' '\d<l, , '," ;::::::::::1:::':',": .':'.:,::::Y;;'::';:::~:::::t:::;:::';':;:;:,,:,,:~ 24 HOUR MINIMUM NOTICE I ,;sll"1I ::;"'.",;:,, :. ",: ,:.";,.";;::,,'::. ';'..:;'.;'::'::, ::-:.:' REQUIRED PRIOR TO lJilll' ;;::,::;," "., 0"" "" ...., II- ,.", "",.. ,'.." SERVICE OR INSPECTION C~~~{{~~:::: .:: )~)~~~~~~~*;??~~?~~~~~~~?~~?}*~~****I**'~ Fi ""'"'' I" I "I "'1"" I (f 1"") w.lt'L '" J",.., ~ 1"01'1< Order 1\", I I ,!llH 11IIl! Ifl'lll )~; j t I.d . . . . . . . . . . . " 1, ,', !,,,,d ""'''1I11! <I"" 1",'''1111''''.......1, No, ,\,ld,II","1 d,"'I:ll)'........ -- 'pi 1\", '&~ APPLICA TION FOR PERMIT I'I';H~\ 1'1' ,"',*~3' ~.. - ',",' IjJ. JOB MDHESiZ'"2.. 2'''1~ Oi'IN EH "LV", ~ It& . .... 111I ,- .~.., F .s:l-itrir;,"';rL~4<!#J,~ -:-'-/~~ ,-",- ~ ,- ~!!""''''' ,. '#' /~,_~~-r ,'I' At< oj..'P (Pri11t N'.lfne~~A. :'-//rf~~(Jr!:hY filuJ,es "1',,1 i'ill iOll tur "tIC wOf> ,0 RIGHT-OF-WAY CONS,TRUCTION Hi0ht~ot",way 'CGrl~,lrlJCliond)(.!Imil ~ubject ~f) PLm.:i~,1ions req\Jlred by Ordinance 21b as nrnendpcJ and tht:' Murlicipal Lr:!r1r or ot.hnr City of Prnt nnf)r>les nr1in:H\U! Work to bp ',o"I,letl!rJ by ~ 'I X' \ (d3te) lncatioll 01 lJ/(J!i-': (JutsicJO'---: 'nsrJ ;!~:"~~'':,\jfl~tli\Jeled roadway {If htithin tra-vnlod roadway, complete it.ems 3. Ji & 5) Val",: of war>- I,.J ,,(, l.1Cf1nrm",J ',"'I.} (11 over $2,000, complete It"",s 3. Ii & ")(If under $I,UI1U, complete i ten fj) rontr,ct.or ,,,,,., OR 1I'1l1\1.IC hTWKS DEPT. \ Performance 8()',~ Ai'lO'.Jnt WORK O!WER ProQf of h,.llr.1f\Ce n "/ (p7; Ijork ~t',lJUf) ,rr,'1 les~,' 1,',11,0[,0 person"l injury, $100,000 per incident, $20,080 property IVDrY V,IJOiJ ;",<1 more' 1.200,000 pers':lnnl IMjury, lUlll,OOO per IncirJent, $100,000 propf"lty Per"1:1U.Pf! I.Jn!j"l",tnnd~ that no 5tf(~et may'be"closed t,o t.raffic unlc:.s approved by the CiLy Ent]ineer and Chief of Pnl',c" ,,,,cj n,,!i!i::Jt1on':, 'Jive>n t.o the Chief of firt' Department may be closed t.o traff ic from to (SlUf.t 1 t ,-,,)j IH'pf Chief of Pol i to FIre ChIef 0 lJt\TlH Mfdl! S!~I \ticc 0 InstalloLlon 0 Pepalr Lg--/ Inspecli"ll Fpe. . . ...... $ 0 SA."JI 1 MH ':;~.WU~ Senllee 0 Inslallation 0 Repai r 0 Inspecti(lI1 Fee........ .$ 0 r\liFif'li :) ~}~rvice 0 InstalloLion 0 Repai r 0 I nsper L i Oll Fee,....... .$ 0 lLlL'JLJ U'[ll., Installation 0 Hepair 0 OCher insp,>c Lion Fee, . . $ 0 Ll.l~H[1:11 f IDlhGf1DlJrJD J NG Inst.allation 0 f1epair 0 0 uTILIfY W,t.[ lnst.allation 0 f1epair 0 1 nsper Lion Subt oLa! , . , . $ },C1'1 VITY NOTES I'FRmT RESTORATI OeJ TOTAL i'Pr-r.1,1IH'lll ~"lj r: H P I ,,' ;1\', \l i "1\ , . , . 1 I S'l0. 00 $ :JOO. 00 $3'.10.00 $ (;r ;f\"(' I ~!jl f;J( ! I. Xl d\'!ll j on. . f .. . . I I 'm.no i50.0() iiiO.OO ~nJ1-1 r:l\.,'ll'd ';111" I ill f' I'\f d\'nl ; Illl. I I m.oo i ',0.00 IBO,OO Nf'v,' {Il!}' r ('1 (' '~,' I J k ",~I"I 1.\1 ;""..1 1 ",0.1I11 -0- 'j(J.OO (OlH"':/' ,,'nlk, "1,1 f. ~:lIllr'r I I rt'lTllJv,l1 i!lld/,jf npJ,J(('mclll ,.;. ')0.00 -()- 50.00 f)rl\','",,\' (lIll""l l"stiIIIntlol~".' I 'JO , 00 -0- 10,00 Dl'iv""il\' j"", "1 1;li Ion.....,......! I ,D.OO J ')(1. on 200.CO I:"stofnl Ion :,uhtoCnl $ -- l'erfllit SubLotil' $ ., "" ..., '''''',...,..,...... '" ' , ..... SEWER : JOI>Ier pe'n~t,,"ub~~"to plOVlsi()llS 'r3,,~herJ iJj?OrdIllance 2;60 as amended ri"d Lhe Municipal COlle or oUmr Ut.y of Po,!, Angelc', tlfdinnnce A. Sing!I' fer:;llI' r"side'fl(('................ $75.CfJ Jl, ~hllti-j;r.l1l\' )'I>sl:l(1]1'(>................. $75.(lJ I,,, first d\ootCIling unit ('Alp],:;,:. filii i 1-lIn i t t npQrll1l.'l1t s. $5.m for mrch mlditionn! unit trni !er f.t ;11111) clIllI.ls. ffJllf'ls) C. fn 1,,1' ',' nx III' ''S.. .. .. .. .... .. . .. ...... SO.ut, sq. ft. 01 gnxuul nrm for II., I; I st IIb!('ls. offi(e' bld~",., ',lore's, IW,!Xll sq, ft. ond SO.em5 "'1. ft. for (hurt lj{'~, ~ !,l,ds, !itJspitnl~.;. rennind('r in excess of HX),UrJ sq. ft. i..I'.I,.;1I i;ll/,":nen iid Iddgs.) In nddit.lI~l, $5.CO for eorl, .h.el1ing uni!. ((ll1l>im,<1 thcr(""dt.h, wi.t.h a minlnnrn fce of ~T).m ,\I~I 11 IITlxin.rn Ice of $TD.m Il. ^It(.tnt ion, P'IOII t / ilp III ~./(7 ...... .~,r/ / /1 /,).-'J"U:..L-t/L./ /~_' f'xisting ship SI~t'r........ f........... S21J.CO E. "ddili,~,rl dillyt""",,'i(n<<, /U ~ .AJ..ZZ.LVL f(,(,(JlHIt'(ti(lfl~.......................... ~1ffi"""1. ;lS illiti81 cormo:tions nl,n\'e 1'. lnsLlll;H if~] of Ctl~( h ln~ins or simil;lt' iflll'tll'p{('!~~"""",,,,,,,,,, SI'j,IlII(.'r unit $ (" t~i.+- nf ,~ 1 0 PlUMBING: TYP[ ArJD JUt Uf P j Pl tJllmop[' of fi.>f,tur(~s......... ... ...........,.. ..... .... ........f. ... $ (/l:1',ir ,!lI'rrnit. (PI" 11.Lnn 111'./'1':; 't,?lln Of~1' f!Yt.lIfP) ":\'ht nr ~> t 11'1 HHll1ll"rtotlM' ".f 11-.. 't..~llf'l I'd fUli rf'rl'!lt. 11 it f<jrtl'>..r It"..fol! h fhl" ~tf'Hraht thJlt tll. Ppnnit t ntn I"..., ('H, 1'" r-,>>I '..,"I... ..~' " . ..' d, ,,", .,. t., _,,1<.,.... ."1$11 to... "...." .......I~"'lI.' .".. _l'ytJ" t""t hllllll 11I1" l1..bllllt .., '."I""Ht>1l11, 111' lint 1'1I'''1''1'11. l.... Cor d~ .."i' tl1 """,t1t\. Qr 1'10" Rf'lil 0)'111 f On Lot" I . ,,.,,,. h!lf'~"H'. -1' vff",r'jll' -It {t,.. tnulJlatt 'f'.tvll 01 .n~ ",""rl ulld..nltl"n Uf."'" lh~ trttl; TOTAl.. ',' . , ., . , " . , . . , .. ... ., $ fit tPlI. "Hllt.IIOIl &f\O ,..,. l'I""lt or 1'u*H. ...hid} .11' t..- tt"lIhd 11\ tf"rpI'lU th.,.to, .nd "" .11"1 ..., ""'1"'~)""" '?;:' ,.."."~"''''".. Rpc(' i pI. Nu. " ~ (. /~ ~~ c:. - //A.)' Slgl"'d",,,~_ ,4:....:~.J~t./_.:. %.' TC'I('phollP No, H,\ \ \ ",,: \\\1111" . .# Tt..' "",II.. I".' '" .' .. ..... .!I.I't., If ,..qH tfl'l'lU l~ f~ l'4fHIt'<1 ~~/ ". ."" ~..,,>>, I' .., !" ." 'k't .. I' ,..' ,. ,,,, '!lll'.' h. t..., t Ir ~,,,,,''1-(..'''-(4 t .." lO ,...... f,' . , " ," ..... ., ,~, _,'.nul ,"",fIU: .~ ,o,. ...r .>, ,,"'-.' .'f .' '., , ".,",,,.-, ,,' "-# .M,. H t'" t", \)"1(' or ',,, j,.'!.. .'" '" I'.' ".' I",.'H, .'fll ... htn- H "t' ,,., ". "0 '.. '.' .', tl' ,"',. la. d 11..- '''t, l.u"" ,...., f...,....." C.,~.:.: : <.~':. :~. :..-:.:.: . : : ~ :. .;,,;;.:. ,;,'::-:'~,;; i': ':' ,:.;:..~;:;*,:,*~.-:,.~ I: i !l" r it I' ~- c: I j' , ! ,,' !1'ILI!r (11"11I Imtk (I r fl,. r . . . S h'", k Orti"r Nu. - 1(,. llllllllnl f!f>IHJS it ,.d. . . . . . . ., , . . . -:. 1-:1,1 !uld ,Itrlllllfll <1',,' I'prrrd I I Pft. . . . . , . :), Wnr f/lnt l\rlll!1 jllll'l! 11 !iiI Hill I <II'" f: i I y,.. , " ., ~. H(., ei pi IN"I'I':r:'lil!<"'; hWY" It' pi -------.--- - ----"~~~_._._- -----~~".---, ---.------- _.~~-""'...,,~-- _._.-.--,,~,~~ -~-- -------.._--~--- -- -_.,,_._~ ._----_..-._-._-,~---_..-~.~~_._.,~-----"~~- COST ANALYSIS SEOUENCE NO. LABOR CITY OF PORT ANGELES STREET 4000 PUBLIC WORKS DEPARTMENT WATER 7000 EQUIPMENT WORK ORDER REPORT WORK ORDER NO 3190 MATERIALS . TAX S ElU I! R ;VI)~ Iff T ACCOUNT NO, c: 13/0 1$ DIVISION PERMIT NO, () '1.j-/ TOTAL CHARGE TO ~!1:('t"f- Ptt>T , I {~/J" Kt1 J oC I< e f?.. PREPARED BY ADDR E55 CO K P Y J:l P::. D 2-Z7-:?S.- IDATEl I DESCRIPTION' S /tJRJv1 !;Elt/EJ<:. I LOCATION' . 121-1 ; led. {' ,)111(10/11 SPECIAL INSTRUCTIONS '.J.. /( sf;; 1/1:D /J1!t<j z: V .. C It Ie/; .b II f i;1 cJ// S/C/J CO/C./Jerr:.. labor DATE 12 I I I TOTAL I I HOU~lY UT[ I ?; HO.~RS SIZE STO::K O~ A~OUNT Ale EMPLOYEE' :'"~~' I ": " I '"" ..", : "" JlrH '-I , i De c.. I 'f' I I I I I I I I , I I I I , I I I I I I I I , I I I I , I , I I , , I , I I I i I I I I I I I I , I I I I I I I I , I I I I I , I I , I , , I , I I i I , equipment No n L5 CBJE.I.l.QtL__ W'z., r=: LI. --...-- Z N AL a: nr~CR'PT1()N ::> tli a: c;j f- ::> 0 f- (j) 0 U 0 -1 -- l==~~ ~~- =1~ i; ..~~-I-t-t-I-+-I---t--j I G "'I , I I , I I I I ,- :i! gl I I I I I I I , I I I I I I I I I I I I I I I CERTIFiED COMPLETE WR / DIVISION Ptn Print, Inc, "~h :";,1'\\,> ~':-';);if&1Fh::,t:1Jt~H~\'t'{.\jA~,;<;~' , ,.~ : ~;i , _ '"" i . ~~~.:o:.""'-.'''''liltlii''''~'IIi.d&lI.II!lIlliIl!IIl_iIIIll\!lll'~llIlt.l\I'\'''..~__