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17805 72ND AVE W
PE11MIT NO: 9455.
C of Ecbmond S'..
ity
PERMIT EXPIRES 1,1,11,,41
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SIDE SEWER PERMIT
eoAddress of Construction: t4_� LID #
Prope rty Tax Account Parcel No.
Attach copies of all access and utility easements /2///AVerified and Approved by ........
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Owner and/01-r `Contracto�rr: Po'i n Af
Contractor License
"+�-c I
..�Single Family
F� multi -Family (No. of Units
Commercial (No. of Units
Public
Iding Permit
Invasion into City *Right -of Way: El Yes �a eo
*RW Construction Permit #
Cross other "Private Pro perty: El Yes 0
**Attach,,Iegal description and copy of recorded easement.
Owner or contractor signature and acknowledgement statement:
igning for this permit 1 certify that I have read the City's public handout entitled
By.-s
ide Sewer Specifications, and shall comply with all City requirements outlined therein.
Date
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHER-
INSPECTOR ARRIVES A $45. RE -INSPECTION FEE WILL BE CHARGED.-.
Job Site, Ready YES NO .—Date: Initial:
Initial:
Partial Inspection: Date:
Partial Inspection:. Date: Initial:
101
FINAL INSPECTION APPROVED: Date: nitiall: As -built to Street File:
t, PERMIT MUST BE., POSTED ON:,1013 SITE. t�,'
While Copy: File Green Copy: Inspector' Buff Copy: Applicant
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179TH ST, SW
CITY OF EDMONDS
SIDE SEWER AS -BUILT
ADDRESS
17805 72ND AVE W
PERMIT
NUMBER 9455
HOMEOWNER xxxxxxxxxx
CONTRACTOR PT CONST,
DATE
05/24/01
DRAWN
ISMAEL ABILA
BY
4w.'
MOLIM.
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