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17811 69TH AVE W
W.
RECP.
APR - 2 7.2001
."TERMIT NO: 9:411
City' -of Edhldflas -
PERMIT EXPIRES
12C. SIDE SEWER PERMIT.
Address of . Construction: 6CVt� �AV44'. I k-s-'j LID #
Property Tax Account Parcel No. -Q� o C.00 0
Attach copies of all access and utility easements Verified and Approved b
.Owner and/or Contractor:
Contractor License #: jp� r8 I- C) Wbo I L E', Building Permit
Single Family into City *Right -of Way: El Yes
Invasion DNo
0 Multi -Family (No. of ]Units
Commercial (No. o its
Public
*RW Construction Permit
Cross other "Private Property: E] Yes BD No'
"Attach legal description and Popy of recorded easement,,
A K-L-14 N S,/ A IIJ -ATAA Owne ontractor
bkn6-or -contractor signat4re and acknowledgement statement: Date.
By si ning for this pe#t I certify that I have read the City's public handout entitled
-and shal I co
fi
ide -Sewer Speci icati.ons, mply with,411., City requirements outlined therein.
0-4�0� 555) BEFORE ANY EXCAVATION.�W
CALL DIAL-A-D1q,(1-80 ,#.s
.9 FOR INSPECTION CALL 425-771-0220 extensionV-*WA3Z6--_,'
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REQUESTS
................
FOR OFFICE USE ONLY
Permit Fee $ Aj Repair Fee' $ Issued By.
V
Trunk Charge $ Date IssuedL V 0
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.
a
Job SiteReady YES 'NO _-.bate: Initi, I: —
Partial Inspection: Date: Initial:
Partial Inspection: Date*.' Initial:
FINAL INSPECTION APPROVED: Date: Initial: -As-built to Street File.:-
. 1 �5, 1 U
t, PERMIT MUST BE POSTED: ON JO&SITE* t�
White Copy: File Green Copy: Inspector Buff Copy: Applicant
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NOTICE: NO WARRAMY OF CCURACY The Information sho wn on the
attached Map WaS, compiled fo; use by the City of Edmonds, it's
and consul t emp':.re-ls
'tants. 71he City Of I dmonds does not warrant the
an�lhlnq set forth on the map Any person or entity requw,'-�. a c-;y
slhculd conduct an independent nquiry regarding the Informaticn. , I
th., map, including, but not IlInded to the lee
shcvjn. Such sevier stubs mayor may not e)dst and mayor r,-,j nc!
the location shown, Neither the City of Edmonds ner lt3 c�-.' C t
officars shall be, liable for the Infon-nation given 01, this map, ncr f' cl
representakin provided based upon said map
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