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Home My WebLink About418 Tumwater Truck Rt - BuildingOf pORTN 11� 't ibe W3 Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Tenant nbr name Application type description Subdivision Name Property Use Property Zoning Application valuation Owner LAMB CHARLES R PO BOX 390 FORKS Permit Additional desc Permit pin number Permit Fee Issue Date Expiration Date Fee summary Charged Permit Fee :T otal Plan Check Total Grand Total T•\Policies \1102.15R [1/05] WA 983310390 RIGHT OF WAY RENEW PERMIT 113449 00 10/17/07 4/14/08 00 00 00 CITY OF PORT ANGELES PUBLIC WORKS UTILITIES DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 07 00001203 303641 418 TUMWATER TRUCK RT 06 30 00 0 0 8325 0000 GOODMAN INC PUBLIC WORKS UTILITES INDUSTRIAL LIGHT 0 Contractor OWNER DRIVEWAY /CULVT Plan Check Fee Valuation Paid Credited 00 00 00 0 0. 00 00 Date 10/17/07 Due 00 00 00 00 0 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction 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 give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date 1 CALL 417 -4807 FOR UTILITY INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, 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 COMMENTS PW UTILITIES (Engineering Division) WATERLINE METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE SITE EROSION CONTROL PARKING SIDEWALK CURB GUTTER DRIVEWAY APPROACH BACK -FLOW DEVICE T•\Policies \1102.15R 1/05] RESIDENTIAL CONSTRUCTION R.W PW/ ENGINEERING 417 -4807 FIRE 417 -4653 PLANNING DEPT 417 -4750 BUILDING 417 -4815 PERMIT INSPECTION RECORD YES 1 NO FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL DATE ACCEPTED YES I NO CONSTRUCTION R.W PW ENGINEERING I FIRE DEPT I PLANNING DEPT BUILDING Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Owner Contractor VANDER VEN NEIL 2495 CAPE GEORGE PORT TOWNSEND Qty Unit Charge Per 1 00 50 0000 ECH RIGHT OF WAY PERMIT Fee summary Signs ut re of Contractor or Abtliorized Agent l /Date T•\Policies \I102.15R [1 /05] WA 98368 CITY OF PORT ANGELES PUBLIC WORKS UTILITIES DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 06 00000346 Date 4/17/06 459704 418 TUMWATER TRUCK RT 06 30 00 0 0 -8325 0000 Tenant nbr name GOODMAN INC Application type description PUBLIC WORKS DRIVEWAY CULVERT Subdivision Name Property Use Property Zoning INDUSTRIAL LIGHT Application valuation 1 OWNER Permit CLEAR GRADE Additional desc Permit pin number 74807 Permit Fee 50 00 Plan Check Fee 00 Issue Date Valuation 0 Expiration Date 10/14/06 Charged Paid Credited Due Permit Fee Total 50 00 50 00 00 00 Plan Check Total 00 00 00 00 Grand Total 50 00 50 00 00 00 Extension 50 00 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction 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 goveming this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. Signature of Owner (if owner is builder) Date 0 6' PW UTILITIES (Engineering Division) WATERLINE METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE SITE EROSION CONTROL PARKING SIDEWALK CURB GUTTER DRIVEWAY APPROACH BACK -FLOW DEVICE T•\Policies \1102.15R [1/05) RESIDENTIAL CONSTRUCTION RW PW/ ENGINEERING 417 -4807 FIRE 417 -4653 1 PLANNING DEPT 417 -4750 1 BUILDING 417-4815 PERMIT INSPECTION RECORD CALL 417 -4807 FOR UTILITY INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, 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 YES 1 NO 1 1 1 1 1 1 1 1. 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 COMMENTS FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL DATE ACCEPTED YES 1 NO 1 .1 1 1 1 1 1 1 CONSTRUCTION R W PW ENGINEERING 1 FIRE DEPT 1 PLANNING DEPT BUILDING 1 1 1 1 1 1 1 1 1 1 Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Tenant nbr name Application type description Subdivision Name Property Use Property Zoning Application valuation Owner VANDER VEN NEIL 2495 CAPE GEORGE PORT TOWNSEND Permit Additional desc Permit pin number Permit Fee Issue Date Expiration Date Qty Unit Charge Per 1 00 Fee summary Permit Fee Total Plan Check Total Grand Total WA 98368 RIGHT OF WAY DRIVEWAY CULVERT 74831 50 00 10/14/06 50 0000 ECH RIGHT OF WAY Charged Paid CITY OF PORT ANGELES PUBLIC WORKS UTILITIES DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 06 00000346 459704 418 TUMWATER TRUCK RT 06 30 00 0 0-8325 0000 GOODMAN INC PUBLIC WORKS UTILITES INDUSTRIAL LIGHT 0 Contractor OWNER 50 00 50 00 00 00 50 00 50 00 Plan Check Fee Valuation PERMIT Credited 00 00 00 Date 4/17/06 Due Extension 50 00 00 00 00 0 0 0 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction 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 goveming this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating .construction or the performance of construction. Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date T•\Policies\ 1102.15R {1/05] CALL 417 -4807 FOR UTILITY INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. SITE EROSION CONTROL PARKING SIDEWALK CURB GUTTER DRIVEWAY APPROACH BACK -FLOW DEVICE INSPECTION TYPE DATE ACCEPTED YES 1 NO PW UTILITIES (Engineering Division) WATERLINE METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE RESIDENTIAL CONSTRUCTION R.W PW/ 417-4807 ENGINEERING FIRE 417 -4653 PLANNING DEPT 417 .4750 11 BUILDING 417-4815 T•\Policies 1102.15R {1/05] PERMIT INSPECTION RECORD KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 y 1 1 1 1 1 1 1 1 1. 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL DATE ACCEPTED YES 1 NO CONSTRUCTION R.W PW ENGINEERING FIRE DEPT 1 PLANNING DEPT BUILDING COMMENTS 1 1 1 1 1 1 1 1 1 1 Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Tenant nbr name Application type description Subdivision Name Property Use Property Zoning Application valuation Owner LAMB CHARLES R PO BOX 390 FORKS Permit Additional desc Permit pin number Permit Fee Issue Date Expiration Date Other Fees Fee summary WA 983310390 T•\Policies \1102.15R [1/05] Permit Fee Total Plan Check Total Other Fee Total Grand Total Signature of Contractor or Authorized Agent Date CITY OF PORT ANGELES PUBLIC WORKS UTILITIES DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98-3 05 00001255 147190 418 TUMWATER TRUCK R 06 30 00 0 0 8325 0000 GOODMAN SANITATION PUBLIC WORKS UTILITES INDUSTRIAL LIGHT 0 Contractor OWNER PUBLIC WORKS RES WATER SERV Date 10/23/06 67488 715 00 Plan Check Fee 00 10/23/06 Valuation 0 4/21/07 Qty Unit Charge Per 1 00 715 0000 EA PW W/M 1 SERV 5/8 METER PW WATER SYSTEM USE FEE Charged Paid Credited 715 00 715 00 00 00 00 00 1200 00 1200 00 00 1915 00 1915 00 00 Extension 715 00 1200 00 Due 00 00 00 00 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction 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 goveming this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. Signature of Owner (if owner is builder) 23 P4 Date CALL 417 -4807 FOR UTILITY INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. PW UTILITIES (Engineering Division) WATERLINE METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE SITE EROSION CONTROL PARKING SIDEWALK CURB GUTTER DRIVEWAY APPROACH BACK -FLOW DEVICE CONSTRUCTION RW PW/ ENGINEERING 417 -4807 FIRE 417 -4653 PLANNING DEPT 417 -4750 BUILDING 417 -4815 T \Policies\1 102.158 [1/05) KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE ACCEPTED YES 1 NO RESIDENTIAL 1 I 1 1 1 1 1 1 1 1 I I 1 1 1 1 1 1 1 I I 1 1 1 I I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I I 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 I 1 1 FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL DATE ACCEPTED YES 1 NO PERMIT INSPECTION RECORD 1 I 1 1 1 1 I I CONSTRUCTION RW PW ENGINEERING I FIRE DEPT. I PLANNING DEPT. I BUILDING COMMENTS 1 I 1 1 1 1 I I I I s .~ .....,;;it' CITY OF PORT ANGELES PUBLIC WORKS - UTILITIES DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 o &-34? Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER: Tenant nbr, name Application type description Subdivision Name Property Use Property Zoning Application valuation 06-00000346 Date 459704 418 TUMWATER TRUCK RT 06-30-00~O-O~8325-0000- GOODMAN INC. PUBLIC WORKS UTILITES 4/17/06 Owner Contractor 1/81M77;;r/d INDUSTRIAL LIGHT o VANDER VEN NEIL 2495 CAPE GEORGE PORT TOWNSEND OWNER WA 98368 G~M0 Permit Additional desc . Permit pin number Permit Fee Issue Date Expiration Date RIGHT OF WAY DRIVEWAY CULVERT 74831 50.00 Plan Check Fee Valuation .00 o 10/14/06 Qty Unit Charge Per 1.00 50.0000 ECH RIGHT OF WAY PERMIT Extension 50.00 Fee sununary Charged pafd Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 50.00 50.00 .00 .00 plan Check Total .00 .00 .00 .00 Grand Total 50.00 50.00 .00 .00. J)Me. 0~ %2- -7803 w~ f~ r~ Re 11dUJ.) I/V p~ 40 -r~ rk.. (2t; &\'1 ne.6T .4.fx &7L. .. 16/,} p~ ~ Separate Permits are required for electrical work, SEPA, Shoreline,ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, ff 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 goveming this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date T:\Policies\J J02.JSR (1I0S) .. CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . . . . . INSPECTION REPORT. . . REQUEST: Date Time Received by (phone, person) Location of Work to be inspected Name of person requesting inspection Address of person requesting inspection Type of Inspection (circle appropriate one): 4/8 TUf'"hW~Lk,~ ~ cod r>'I aA-... Phone No. Permit No. O~ - ~ ~~ Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other INSPECTION NOTES: Inspected: Date '1- \ ,. -DL:> Time Remarks: (1-{.1 Q~.J..J/)-j~ ...P4-t-~ rht fl~- By n~ uo ,I(!--c : bdxV RESTORATION REQUiRED...... YES NO~ N< l' uyv\.uJo..~"- T Iu.c-I<. xr ,. " -" j .- :~<,'<'H 'e/' Pit. CtA-) ve+"T \e.w Ib' f'T C ,.5'/',':) /<B"PVe,,,,,,,,lve.,,..1 Ie/I, _ '~i,... 'Poc... ~.'~ . J '+ r:," rV~ C-Ol/vet' ~;s+'''5 ...."\'I~' , r. .,.0 ~ , /).A.P.-Sto'i><.-\J-ol ~ SURFACE RESTORATION: SURFACE TYPE: D Unimproved D Gravel D Asphalt D PCC D Other D Repaired by City [] Repaired by Permittee D No Damage Found Work Order # D COMPLETE D INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) ALL CONSTRUCTIOtLTO -', FOLLOW CrD:_.BA,._~TA.r:iOA.RQs.. ..- -z"" RT CON NE TO EXISTING ~ '. - . CllLV ERT TO MATCH EXISTING. EXIS 'I \Ie __ ~- ~=.:{. XIS TIN C / <: D~IVE H MET P NO N~ ~ 7\:j --- ~ Tt::. 4, Filed for Record at the Request of: fiLED FOR. HC:C',",,' ". .~ nL~!\:J'" iHt:,::EUlIEST " +-' T ~::,:~~--,..._- . - ~'..I.-1 ,"" . ._~ ""-.. ,I,; ;~,.'r-::;~l-;:'.':~'~~~:J"- 2005 HM 16 Ph 3: I 4 ,. '-' '.' GARY R COLLEY The Law Firm of Platt Irwin Taylor, 403 South Peabody Port Angeles, WA 98362 III\!! \\\\\ II \ \11\ 1\ 11\ \\11\\1 @ 2006 1176649 Clal1am County EASEMENT Grant.cl..: ~..A3CO P:':TRO:'Et."M. I!;C. Grantee: NEIL VANDER VEN, a married man, as his separate property Legal Description: Lots 5 through 9, Block 83, Townsite of Port Angeles and Lots 13 and 14, Block 83, Townsite of Port Angeles Assessor's Property Tax Parcel Account Numbers: 0630000083370000; 0630000083350000; 0630000083250000. PARTIES 1.1 Grantor. MASCO PETROLEUM, INC. 1.2 Grantee. NEIL VANDER VEN, a married man, as his separate property. EASEMENT 2.1 Grant of Perpetual Easement. Grantor hereby grants to Grantee an easement as described herein of the type described herein for the purposes described herein. 2.2 Pllroose. The" purpose cf this ea3e~ent lS for ingress, egress and utilities. 2.3 Consideration. This easement is for good and valuable consideration consisting of Grantee's agreement to fill in an approximately 80 foot long ditch located on Lot 14 of the Grantor's below described property as it abuts the Tumwater Truck Route, extending an existing culvert and widening the opening for EASEMENT - , vend-461,agreements ORIGINAL .J the existing driveway along the southern portion of said Lot 14 as it abuts the Tumwater Truck Route for a distance of approximately 40 feet to the north and paving over the driveway extension and filled in ditch. 2.4 Benefited Propertv. This easement is to benefit the following described real property situated in the County of Clallam, State of Washington: Lots 5 through 9, Block 83, Townsite of Port Angeles. Together wi,th the Southerly 35 feet of Fourth Street abutting Lots 6, 7, 8 and 9, Block 83; and the 4th/5th alley abutting all of Lots 6, 7, 8 and 9, Block 83, Townsite of Port Angeles, lying Westerly of the Westerly right of way line of the Tumwater Truck Route. Situate in Clallam County, Washington. 2.5 Location of Easement. The location of the easement is described as follows: Because most of the burdened property is an open paved lot, no specific location for the ingress, egress and utilities easement shall be required, provided, however, the entrance onto Lot 14 shall generally be at its southern end where the driveway opening is being extended along the Tumwater Truck Route as described above and shall then extend northerly through Lot 13 and the alley adjoining to the north of Lot 13 as described below a.s the Grantor's !:urde~ed property. 2.6 Burdened Propertv. This easement is to burden the following described real property situated in the County of Clallam, State of Washington: Lots 13 and 14, Block 83, Townsite of Port Angeles, together with that portion of the alley abutting on the north side of Lots 13 and 14 as shown on the survey recorded in Volume 14 of Surveys, page 38, records of Clallam County, Washington, lying westerly of the EASEMENT. 2 vend.4S1.agreements westerly right of way of Tumwater Truck Route, situate in Clallam County, Washington. 2.7 Term of Easement. The term of this easement shall be for as long as the Grantee, Neil Vander Ven, continues to own the above described benefitted property. 2.8 Appurtenant Easement. The benefits and burdens granted and imposed by this instrument shall run with the lands described herein. q day of n'l ('veL---., 2006. DPl.TED this r..........................., : CANDIE L. OWEN ! : NOTARY PUBLIC : . . : STATE OF WASHINGTON : : My COntmlsslon Expires Mar. 5, 2009 : ~........................_.~: STATE OF WASHINGTON ) ) ss. COUNTY OF CLALLAM ) On this ~~ day of JY\Uv'\ c{~ ,2006, before me the undersigned, a Notary Public in and for the State of Washington, duly commissioned and sworn, personally appeared 'I ~\,(\.p.: C. 1\\ Co, ',/Y" ,to me known to be the :c:t\ e c.; d Sf' +- of MASCO PETROLEUM/ INC., tbe corporation that execu...ed t:he within and foregoing instrument, and acknowledged the said instrument to be the free and voluntary act and deed of said corporation for the uses and purposes therein mentioned, and on oath stated that he is authorized to execute the said instrument. WITNESS my hand and official seal hereto affixed the day and year first above written. C O_i'\ (Let. t. ((Ul/(..v",.- NOTARY PUBLIC in and for the State of Washington. 3 - -,C My Commission Expires: - ~ - 0 1 EASEMENT - 3 'Jend-481.agreements . STATE OF WASHINGTON ss. COUNTY OF CLALLAM On this Iv day of .~ , 2006, before me the undersigned, a:Notary Public in and for the State of Washington, duly commissioned and sworn, personally appeared NEIL VANDER VEN, a married man, as his separate property, known to be the individual named in and who executed the within and foregoing instrument; and he acknowledged to me that he signed the same as his free and voluntary act and deed for the uses and purposes lhere-iIi mentioned. WITNESS my hand and official seal hereto affixed the day and year first above written. ?:-;;;.2 -'?. /.Yt?/Y \\\"""'111/ ..// : /" 0-C/..0 "", 31'0' is 111II ./ ....~ '>>0........ ...., ~~/ ". '-;. NOTAR'l{' P}JBLIC in and for ~~:' ~~t.;;, ... ~ the St~e of Washington. ) ~:!:; !::: ~ 5 ::D~ My Commission Expires: / =Z. 0 Ai ~ :-<::: ~~;.. # ~ /..:tr~ ,,~O' y ~ .".:- '" ~~. "0'" ~ 'r" ......~~ ,~ '11/ }:.':) ~ \", 11"111111\\\\\ -(a -0 ") EASEMENT - 4 vend-481.agreements t,~';~ r...a .. -=-- ~ CITY OF PORT ANGELES PUBLIC WORKS - UTILITIES DIVISION 321 EAST 5TIf STREET, PORT ANGELES, W A 98362 O?-/~6S Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER: Tenant nbr, name Application type description Subdivision Name Property Use Property Zoning . . Application valuation 05-00001255 Date 147190 418 TUMWATER TRUCK RT 06-30-00-0-0-8325-0000- GOODMAN SANITATION PUBLIC WORKS UTILITES 10/23/06 INDUSTRIAL LIGHT o 1/8 TI//71 wtzZi/u It::- t:t:; 6'-000/177 ~ Owner Contractor LAMB CHARLES R PO BOX 390 FORKS OWNER WA 983310390 Permit Additional desc . Permit pin number Permit Fee Issue Date Expiration Date PUBLIC WORKS RES WATER SERV 67488 715.00 10/23/06 4/21/07 Plan Check Fee Valuation .00 o Qty Unit Charge Per 1.00 715.0000 EA PW W/M 1" SERV 5/8" METER E~ " 715.00 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~-(:i;;;~;~-- Fee summary Charged Paid Credited Due Permit Fee Total plan Check Total Other Fee Total Grand Total 715.00 .00 1200.00 1915.00 715.00 .00 ".00 .00 .00 .QO 1200.00 .00 .00 1915.00 .00 .00 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, uWilies, private and public improvements. This permit becomes null and void if work or construction 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 ifrequired 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 give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. . Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date T:\Policies\II02.15R {I/05] CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . . . INSPECTION REPORT. . . . . . . REQUEST: Date /2.- /4 -67 Time Received by 7<V (phone. person) Location of Work to be inspected I-fl B T u WI INCl.i-e r "Tt- u..c.kK-f- Name of person requesting inspection ))",ve ~k..'i :de...- Address of person requesting inspection Phone No. Type of Inspection (circle appropriate one): Permit No. OC- :SYb Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other .A,'ve.woy 1=" ""'-Q, I INSPECTION NOTES: Inspected: Date I Z -14 -07 Remarks: Time By 'Kv OK 7;)"'tl've_wa.y ]:"; !... oj , RESTORATION REQUIRED . . . . .. YES NO :-L SURFACE RESTORATION: SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC o Other o Repaired by City o Repaired by Permittee o No Damage Found Work Order # o COMPLETE o INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE)