17812 69TH AVE W.PDF111111111111
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17812 69TH AVE W
PERMIT N 0: 9260
-City of Edm ond..
PERMIT EXPIRES
WF 4— 11
C SIDE- SEWER PERMIT'.
1 7 C? A 't
Address of Construction: I e_.. _L' L/-.tf IV FF
Property Tax Account.Parcel No.
Attach copies of all access and utility easements Verified and Approved b
"ell
Owner and/ Contractor: 497-�, e4 (,Jl e, 4-i
Contractor Licensek WA4�02c. 0 .1,2 (9 Building
g Permit
Glesingle Family' Invasion- into City *Right -of Way: F� YO rVNo
F] Multi -Family (No. of Units *.RW Construction Permit,
Commercial (No. of Units Cross other **Private Property: El Yes No,
Public "Attachlegal description and copy of recorded easement.
Own Contractor .2- —ol
r or contractor signature and, acknowl gement:statement: Date
By signing for this permit I certify that I have read.the. City's public handout entitled
ide Sewer Specifications, and sh,all comply with all City requirements outlined therein.
W, CALL DIAL -A -DIG (1-800-42575555) BEFORE ANY EXCAVATION W,
W FOR INSPECTION CALL 415-771-0220 e'xt�nsiofi'3_'f9_4-AA_i'
HOUR NOTICE REOUIRED ]�OR ALL INSPECTION REQUESTS
FOR OFFICE USE ONLY .... . .
......... .
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Permit Fee $ Repair Fee $ Issued By: CA
Trunk Charge$ Date Issued: c> I
Assessment Fee $ Receipt No:
00-
City Permit Surcharge Fee $5.00 Total Fees Paid $_
NOTE: IF JOB SITE IS NOTREADY 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: 5 4 '1 Initial:_jF L-� As -built to Streetfile:
1,�.PERMIT MUST BE POSTED ON JOB SITE t-
White Copy- lnsp�ctor Buff Copy: Applicant
L;temp;bldg,forms;sspermitjlg4/00
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NOTICE: NO WARRANTY OF ACCURACY The Information shown on Ine
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attached map was comPiled for use by the City of Edmond3, jj,.- c,7!,rjcyr
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and consultants. The City of Edmonds does not
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warrant the .,-f
anything set forth on the map. Any person or entity a czpy
shculd conduci an Independent Inquiry regarding the inforrp:t jc-,,
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the map, Including, but not limited to, the location of
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any
shGVjn, Su"ch sewer stubs mayor may not e)dst and mayor z7rIc'-1'
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tb;' loCation shown, Neltherthe Cityof Edmondsnor Its
Cl
Offic—'i-s shz.,') be liable for the information given on this
map, nor fot zny orr!
reprc;sej '�acr, provided based upon said map