HomeMy WebLinkAbout1015 W 15th St - Building CITY OF PORT ANGELES
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APP' PUBLIC WORKS UTILITIES
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number 11- 00000422 Date 5/05/11
Application pin number 012898
Property Address 1015 W 15TH ST REPORT SALES TAX
ASSESSOR PARCEL NUMBER: 06- 30- 00 -0 -4- 1380 -0000- on your state excise tax form
Tenant nbr, name QWEST
Application type description PUBLIC WORKS UTILITES to the City of Port Angeles
Subdivj_sion Name
Property Use
(Location Code 0502)
Property Zoning RS7 RESDNTL SINGLE FAMILY
Application valuation
Application desc
Plow phone service RCP #11 -12
Owner Contractor
WILSON, DEREK SARAH EXCEL UTILITIES CONSTRUCTION
1015 W 15TH ST 54 W. MISTY LN
PORT ANGELES WA 983637231 PORT ANGELES WA 98362
(360) 452 -1110
Permit RIGHT OF WAY
Additional desc RCP #11 -12
Permit pin number 185041
Permit Fee 150.00 Plan Check Fee .00
Issue Date 5 /05 /11 Valuation 0
Expiration Date 11 /01 /11
Qty Unit Charge Per Extension
1.00 150.0000 ECH PW RW CONST EXCAVTION OTHER 150.00
Special Notes and Comments
Traffic control per attached plan. Applicant responsible for
surface restoration and erosion control.
Fee summary Charged Paid Credited Due
Permit Fee Total 150.00 150.00 .00 .00 v
Plan Check Total .00 .00 .00 .00
Grand Total 150.00 150.00 .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 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 'late or cancel the provisions of any state or local law regulating construction or the performance of
construction.
Signat(C.ntractor or Authorized Agent Date Signature of Owner (if owner is builder) Date
T: Forms /Building Division /Public Works Permit
PERMIT INSPECTION RECORD
CALL 417 -4831 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
YES NO
PW UTILITIES ,''(Engineering Division)
WATERLINE METER
SEWER CONNECTION
SANITARY
STORM
SITE DRAINAGE
SITE EROSION CONTROL
PARKING
'SIDEWALK r
-CURB GUTTER
DRIVEWAY APPROACH
BACK FLOW DEVICE.
Via,
4'
t
FINAL INSPECTIONS. REQUIRED PRIOR; TO OCCUPANCY /USE
RESIDENTIAL'_ DATE IES NO COMMERCIAI DATE ACCEPTED,
CONSTRUCTION R W PW CONSTRUCTION -`R.W4
ENGINEERING:•, 417 -4807 .PW ENGINEERING
FIRE 417.4653 FIRE DEPT..
PLANNING DEPT. -417 -4750 PLANNING DEPT.
BUILDING y 4.17 ;BUILDING
4815
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T Forms /Building Division /Public Works-Permii