17825 69TH AVE W.PDFIIIIIIIIIIII
5299
17825 69TH AVE W
PERMIT NO:
City of Edmon'ds'
PERMIT EXPIRES
4C. SIDE SEWER PERMIT
LID # d;�/ 5
Address of Construction: 6cl
Property Tax Account ParcelNo. 6- g�z
e 7 eW
Attach copies of all access and utility easements Verified and Approved b
Owner and/or ontractor- \-qz V-,
Contractor License c.,yw_x�w�C:In Building Permit
$TSingle Family
Multi -Family (No. of Units'
Commercial (No. of Units
Public
Invasion into City, *Right -of Way: E] Y�s, No
.*RW Construction Permit
Cross other "Private Property: Yes Q,.No
"AttaC4, legal description and copy of recorded easement.
OwnekCContractod
rne r contractor s;gnature and acknowledgement,statement:
ify that I have read the s,public handout entitled
By signing for this permit I cert C IfY2�
ide'Sewer Specifications, and shall comply with all City requi'r'ements outlined therein.
2 CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EXCAVATIONO
W FOR INSPECTION CALL 425-771-0220 extensi�h,;329 W
24 NOUR NOTICE RCQUIRED FOR ALL INSPECTION REQUESTS.
. . . . . . . . . . .
FOR OFFICE USE ONLY
. . ........ . ... ....
Permit Fee$ —Repair Fee $ Issued By
Trunk Charge $ &M.. Date Issued:'
Assessment Fee $ Receipt No:
City Permit Surcharge Fee $5.00 TotalFees Paid
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A $45 RE -INSPECTION FEEWILL BE CHARGED.
Job Site Ready YES NO Date: Initial:,
Partial Inspection: Date! Initial:
ti
P I
rtj I nspection- Initial:
Partial Inspection:
Date:
F NAL INSPECTION APPROVED: Date:' Initial:
INAL INSPECTION APPROV As -built to Street File:
T�PERMIT MUSTBE POSTED ON JOB'SITE T�
White Copy: File Greim Copy: Inspector Buff Copy: Applicant
L;temp;bldg;forms;�spermitjlg4/00
NOTICE- NO WARRANTY O,F ACCURACY The Inforn, ation shown on the
attached map wn compiied tor u-.,-. by the City of Edmclr;�� i'.'
ano consultants. The Ciqi of Edinuds does not viaTruil ['I-, of
anj�hiqj s�'i forth on tht; mau. Any poron or entity rcqu,�..:.j -a C--li'l
conducl, an inquiry regard.ng the lz'.! r- 1 c'l
*nc!.
b" firaK I -o location ct zny"S""'
th," r.-M, e(. to th ,I
s j ol and rnaycrr.;,.--) rcl c*�'A Lt
th Ne, tic� the City of Edmonds nor us
L. --'; b� k-bl,e foi th( intomiation givc, cn this map, nct f cr
re�t,z;.-ii�aUoa provide6 beiuu upod spald map
C/o
31
31
4
450
5
LLJ 351
2
29'
45)
cl 45*
01S u
45*
71
531
180TH ST, SW
CITY [IF EDMONDS SIDE SEWER
AS-13UILT
ADDRESS
17825 69TH AVE W
PERMIT
NUMBER 9458
HOMEOWNER
CONTRACTOR
JD NEWTON
DATE
05/25/01
DRAWN ISMAEL ABILA
BY
/ 7 9,:9,5- 0 4-
A S�
k �k (Jd&. Ahieo--,
,W-
0
In
n-M
pua
MD
w