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17804 69TH AVE W
NOTICE- NO WARRANTY OF ACCURACY The informz*?, G1 ths
aqn.;,.,;d mep vjac campi I eu, fo,� utze by the City of Ed in', i.
co:ic:j!�anits. The C14 of Edmonds dm3 not viai'sc- t" 'j,
jortl oj; the. map. Any person or eMQy rc�*-
c , 1nd,6pr:,.,&xu inquiry regarding the in'lo. c.]
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th-� biA, no'l limited to, the location of zl-,� c�--
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stu')s meyoT may not e)dst and may Orr, '-'j 9c, c:" :1 -1
thz lot'atioll ci*it'."j'l, Neitiieer the City of Edmonds ncr itG
liable for the infoi-rination given On this map, nor fcf L7�'i Gr'
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17804 69th Avenue West
L
Cteanout (2' Deep)
15' -47
4" Schedule 3034 Mello
24' 1
Stub (4- D"p)
Rleer to surface
69th Avenue West
CITY
[IF EDMONDS SIDE SEWER AS-BU ILT
ADDRESS
PERMIT
17804-69th
Avenue West
NUMBER 9342
HOMEOWNER
CONTRACTOR At Titus
DATE 4-24-2001
DRAWN Jim Roberts
BY
"'0C. I S9�
1111 NO: 9342
City of Edmonds PERMIT EXPIRE
SIDE SEWER PERMIT
Address of Construction:/ 17e 4 q 6 9 -�'h Ilt-e- LID # 11S
Property Tax Account Parcel No. 4Le�lf z e4:� - �W9 _42a
Attach copies of all access and utility easements X� Verified and Approved by
Owner and/or Contractor: Iq L 7/
Contractor License Ad�� wol —Building Permit
CKSingle Family
F� Multi -Family (No. of Units
F� Commercial (No. of Units
El Public
Invasion into City *Right -of Way: El Yes , KNO
*RW Construction Permit #
Cross other **Private Property: Ej Yes, P<N6
"Attach legal description and copy of recorded easement.
Owner/Contractor
Owner or contractor signature and acknowledgement statemenc Date
T
By signing for this permit I certify that I have read the City's public handout entitled
e,
ide Sewer Specifications, and shall comply with all City requirements outlined ther in,
W CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EXCAVATION W
W FOR INSPECTION CALL 425-771-0220 extension`l'�
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REOUESTS
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: El
t� PERMIT MUST. BE POSTED ON JOB SITE f�
White Copy: File Green Copy: 1 Inspector Buff Copy: Applicant
L;temp;bldg;fonns,sspermitjlg4/00