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OWNER/CONTRACTOR IS RESPONSIBLE
FOR EROSION CONTROL AND DAMAGE
ALL WORK SUBJECT
TO FIELD
INSPECTION FOR
CODE COMPLIANCE
OWNER/C
NTRACTOR RESPONSIBLE
FOR LOCA
NG ALL ON -SITE UTILITIES.
RELOCATI
N/REVISION TO ANY UTIUiI
MAY R60
IRE SEPARATE PERMIT.
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RECEIVED
e f\j MAY 21 2015
DEVELOPMENT SERVICES
COUNTER
APPROVED AS NOTED
BYE!N/1GINEERING
City of Edmonds Building Division
x PT) ov UIN P
t R My LXN
CITY OF
BUILDING
WORK
A[)DRESS �
OWNER _---/--_'�
EDMONDS
DEPARTMENT
rAPPROVED DAT:2�. OFFICIAL
PERMIT NUMB
jat-�n
APPROVED BY P NNING
ALL. WORK SUBJECT
TO FIELD
INSPECTION FOR
CODE COMPLIANCE
STREET FILE
RECEDE®
MAY 21 2015
DEVELOPMENT SERVICES
COUNTER
City of Edmonds,
SIDE SEWER PERMIT
IZEPA12, -
PERMIT NO:' 9587.
PERMIT EXPIRES -111
Address of Construction: -aeeo- S-TTT--'Sk LID #
Property Tax Account Parcel No. 66,514 ys5, (')C C' %(� H
Attach copies of all access and utility easements Verified and Approved b
Owner and/or Contractor:
Contractor License 124boIQ_7 Building Permit
gle Family
El multi -Family (No. of Units
E] Commercial (No. of Units
Invasion into City *Right -of Way: El Yes 54No
*RW Construction Permit #
Cross other **Private* Property: D'Yes [0-No,
F� Public "Attach legal description and copy of recorded easement.
Own r to)
ontractor
e) N.- j/_ ® Z.
Owner or contractor signajtre and acknowledgement statement: Date
By signing for this permit I certify that I have read the City's public handout en i ed
joide Sewer Specifications, and -shall comply with all City, requirements outlined therein.
9- CALL DIAL -A -DIG (1-800-429,-55*55) BEFORE ANY EXCAVATION 9
R FOR INSPECTION CALL 425-771-0220 extension
24 HOUR NOTICE REQUIRED FOR ALL INSPECTION REQUESTS
...... .. . ........ ... . ...
FOR OFFICE USE ONLY
..................... ...
Permit Fee $ Repair Fee' Issued By: kAk
Trunk Charge $ Date Issued:
Assessment Fee $ Receipt No:
City Permit Surcharge Fee $5.00 Total Fees Paid $
I NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A $45RE-INSPECTION FEE WILL BE CHARGED.
Job Site Ready YES NO' Date: Initial:
Partial Inspection: Date: Initial:
Partial Inspection: Date:. Initial:
FINAL INSPECTION APPROVED: Date: 3 S 101—. initial: As -built to Street File:
13, PERMIT MUST BE POSTED ON JOB SITE �-'
White Copy: File 'Green Copy: Inspector Buff Copy: Applicant'
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BROOMERE ST,
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10'
14'
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69'
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22°
16' S,
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CITY OF
EDMONDS SIDE SEWER AS
-BUILT
ADDRESS
1012 9TH
AVE, N
PERMIT
NUMBER 9587
H❑ME❑WNERXXXXXXXXXX
CONTRACTOR RESCUE ROnTER
DATE 03/15/01
BYISMAEL ABILA
4 �
CITY OF EDMONDS
J �o
890.19
;ERrrJ rr ,�X�i,4�5 �O JA��
SIDE SEWER PERMIT
PERMIT '\10- 8825
Address of Construction: �C% Z, 5/T7 UL vfo�VN UnG�S
Property Legal Description (Include all easements): m 042 7— 0-?Z=& j�70/-0?
. ol18LIC WORKS UEPI
Owner and/or Contractor: 'Kr SCCie_ R Uri, f rr
State License No. Te SGu Gj -(.f a I Building Permit No.
Single Family
❑ Multi -Family (No. of Units )
❑ Commercial
❑ Public
Invasion into City Right-of-WayK No ❑ Yes
RW Construction Permit No.
Cross other Private PropertyxNo ❑ Yes
Attach legal description and copy of recorded easement
I certify that I hW read and shall comply with all city requirements
as indicated on the back of the Permit Card.
1100r,
Date
* CALL DIAL -A -DIG (1.-800-424-5555) BEFORE ANY EXCAVATION *
OFFICE USE ONLY
* FOR INSPECTION CALL PUBLIC WORKS DEPT.
Permit Fee: 3/0, 00//,�J Issued By —`-,!
Trunk Charge: i`� �� l!� Date Issued:
Assessment Fee: Receipt No.:
Lid No.:
Partial Inspection: Date —Initial -
Comments
Reason Rejected: Date Initial
Final Inspection Approved: Date Initial'
** PERMIT MUST BE POSTED ON JOB SITE **
White Copy: File . Green Copy: Inspector Bull Copy: Applicant
Revised 3/90
The City of Edmonds
Side Sewer Drawing
OWNER
JOB ADDRESS .tD---L)).._.._. .....--...U......
11
F WW-0001-11/75 (REV.11/78)
NEW CONSTRUCTION ❑
EASEMENT NO. .......---•--.
REPAIRS LID NO . .................. . ASMT. NO. _.....-_.-_-
CONTRACTOR...........................................................................•-..-_... PERMIT NO.
LEGAL DESCRIPTION: LOT NO ....................................... BLOCK NO. ....................................
-----------------------------------------------------................... I.............. ------------------------...------------•---------------------......••----
NAME OF ADDITION ......... :...
EREATM
D1�1OMDS
EN f PLANT
Approved:
DATE ..�._..z..-....0........ V B �}
Y..............•• f�/-----------------------.-...-
APPLICATION
:.,.A' -I � � for
The Cityof Edmonds `
ixrWs P. °� .,yj SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS ❑ EASEMENT No ....................................
❑
117-00300
OWNER..........:---------------•-----•------• ---------- ............. . CONTRACTOR ........--------.........................--
.................................•---..........-•---- PERMIT No. ......................
ADDRESS .... ^l:"�.9.h
... AV2' N'..__.... LEGAL DESCRIPTION: LOT No. .
BLOCK No..-------••------
NAME OF ADDITION
0
4-0
DYE TESTED ON SEWER, 1972
Approved:
DATE................................................ By---..............................._----•--•--•------•.............