17803 69TH AVE W.PDFiiiiiiiiiiii
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17803 69TH AVE W
1-,ka u.;, 0-
dmon 9441
o PERMIT NO:
fE
PERMIT EXPIRES_�, 1 01
crnr crwrD -PrlDX41T
7C.
of Constru. LTD.#
Address ction: Mo 3 eh 4 -7
Property Tax Account Parcel No. 7t
D_ 0 0 (:)P.
Attach copies of all access and utility eas�mentR Verified and Approyed by
2 *1 UaAd i��
Owner and/or Contractor:
Contractor License Building Permit
Single Family
Multi -Family (No.: of Units
Fj Commerciail (No. of Units
F� Public
3
Invasion into,City *Right -of Way: 0 Yes No
*RW Construction Permit #
Cross other"Private Property: Yes No
"Attach legal. description and copy of recorded easement.
Owner �rc'ontractor signature and acknowledgement stAtement:
By signing for this permit I certify that I have read the City's public handout entitled
Viol
Daie
ide Sewer Specifications, and shall comply with all City requirements outlined therein.
W'CALL DIALLA-DIG (1-800-425-5555) BEFORE ANY EXCAVATION t
V FOR INSPECTION CALL 425-771-0220 extension,329. 9
24 HOUR NOTICE REOUIRED. FOR ALL INSPECTION REOUESTS'
........... ......... ...........
.. .. ... . ... .........
FOR OFFICE USE ONLY
. .. ... .... ...... . . .... ..
Permit Fee Repair Fee $ issued 13
Trunk Charge $ Date Issued: n
Assessment Fee Receipt No:
City Permit Surcharge. Fee $5.00 Total Fees Paid.$
NOTE:' IF JOB SITE IS NOT READY.FOR INSPECTION WHEN -
INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED.
Job Site Ready YES NO Date: —initial:
Partial Inspection: Date.: InitiaL
Partial Inspection: -Date: Initial:
FINAL INSPECTION APPROVED: Date:. Initial: As -built to Street File:
t� PERMIT MUST BE POSTED ON. JOB SITE IM
White Copy: File Green Copy:. inspector Buff Copy:'. Applicant
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30'
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45"
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y
17,
58'
180TH ST, SW
CITY' OF EDMONDS'
SIDE SEWER
AS -BUILT
ADDRESS
17803t69TH AVE W
PERMIT
NUM13ER 9441
HOMEOWNER xxxxxxxxxx
CONTRACTOR
-RIVARD
DATE
05/21/01
DRAWN
BY
ISMAEL ABILA
0
0
I
rn
N0110E: NO WARRAMW OF ACCURACY The Information chmw 01) thtl
aftach�3,d map was cornpiledfo7 use bythc., City ot Edmcr," 1'
an,-consuftants. The Ci�, of E&ijorids do,�.-� not viarr�-. t:!.
ooh�- map, An�peiscooiei2yrcI"'-'-.
sh in(ik-y rogudliql tho, iniol C11
bv� op� lint itec', to, th., locaJon of an',
t ra&�� no, e;ds� and may cr r..:-j i.:i c:, ' *-, J
113 c" co
tb. a, tht W, d Edmcn& n�
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