17919 69TH AVE W.PDF111111 lill 11
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PR 2 7 2001
DV NO:. 94,09'
'City- of Edffio.'' I R4GdW,T-
PERMIT ENPIRES 1 0 1
SIDE SEWER PERMIT..
Address of Construction- I 1!� 6St- ft q LID #
Property Tax Account Parcel No'.
Attach copies of all access and utility easements Verified and Approved b
Owner and/or Con_trac_to'_r�,������
Contractor License #:
RP Single Family
Multi -Family (No. of Units'
Fj Commercial (No. of Units
F-1 Public
ilding Permit
..Invasion into City *Right-ofWay: El Yes P4 No'
*RW Construction Permit
Cross other "Private Property: 'El Yes. No,
**Attach legal description and copy of recorded easement,
p
r
A x Owner/Contractor p I
06er or contr c owledgement statement:
actor sign�ture and a kn 5a,te
By signing for this permit I certify that 1 have read the City's public handout entitled
ith 111 Ci
ide Sewer Specifications, and shall comply w a ty. requirements outlined therein.
..2 CALL DIAL -A -DIG (1-800-42IN-5555) BEFORE ANY EXCAVATION'R
.2 FOR INSPECTION CALL 425-771-0220 extension
.24 HOUR NOTICE REOUTRED FOR ALL INSPECTIONiREoUESTS
11, PERMIT MUST BE POSTED QN JOBSITE t�
White Copy: File Green Copy: 16sp'ector Buff Copy: Applicant
L;teinp;bldg;forms,s.spermitjig4/00
NOPCE- NO WARRAM OF ACCURACY The Informatio,,j shmun on the
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180TH ST, SW
CITY. [IF EDMONDS SIDE SEWER AS -BUILT
ADDRESS
17,919 69TH
AVE W
PERMIT
NUMBER 9409
HOMEOWNER xxxxxxxxxx
CONTRACTOR JD NEWTON
DATE 04/27/01
DRAWN ISMAEL ABILA
BY
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