18012 72ND AVE W.PDF5661
18012 72ND AVE W
ADDRESS:
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TAX ACCOUNT/PARCEL NUMBER: 11,11q.1 6 000 60 Q
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS: DETERMINATION: 0 Conditional Waiver [—] Study Required E] Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE LID #:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S).#:
GEOTECH REPORT DA
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
BLOCK:
L-.\TEMP\DSrs\Fom,s\Street File Checklist.doe
V1.
RECEIVED
C,ity of Edmond-s2l NO: 291
ENGINEERINFEFUMT EXPIRES Qf /01
"'Ic 791) SIDE SEWER PERMIT.
Address of 'Construction: # ZIS
Property Tax Account Parcel No. :2 00
Attach copies of all access and utility easements Verified and Approved by
Owner and/or Contractor-,_)C6�,e, )t
Contractor License#: Building Permit
-of Way: .0 Y No
'VSingle Family Invasion into City Right
MultirFamily (No. of Units .*RW Construction Permit*
Fj Cornmercial (No. of Units Cross other "Private Property: El Yes F(No
Fj Public **Attach legal descriptiona.n d copy of recorded easement.
Owne
yfz�;� . Z,
4ac— --------- I- I �:.k_
b.36 rorcontra tor signature and knowledgement-statement: DaW, T`
B si ning for this permit I certify that I ha�,e read- the City's public ha'n"'dout entitled
y t
ide Sewer Specifications, and shall comply with all,City req*uirements outlined therein.
U'CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EXCAVATION.�11;14�,
R FOR INSPECTION iiCALL 425-771 0220 extension"
24 HOUR NOTICE REOUIRED FOR ALL INSPECT-16N REQUitSTS
............ ...
...... .. ... ... .. ....
... FOR OFFICE USE ONLY
.... . . . ....
-Permit Fee Repair Fee $ Issued B :,k'L�Ck.
y
Trunk Charge $ Date Issued:
Assessment Fee $ 7—t
Receipt No.
City Permit Surcharge Fee .$5.00 Total Fees Paid
NOTE: -IF JOB SITE IS NOT READY FORINSPECTION WHEN
INSPECTOR ARRIVESA $45 RE. -INSPECTION FEE WILL BE CHARGEP'-.-:
Initial:.
Job Site Ready YES NO _Date,,
Partial Inspection: Date: Initial:
Partial Inspection: Date. Initial:
0
FINAL INSPECTION APPROVED: Date: Oil,, v Initial. As -built tottreet File - El
t- PERMIT MUST BEPOSTED ON- J.
JOB.$ITEf,�'.
Uff.0 11
While Copy: File �Green Copy: Inspector .,B opy. App)cant
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Deck
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House
6 7'
NOTICE, NO VJAMWrilf Or- ACCURACY The Information shmn on the
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7 2 r) ol
Ave West
CITY OF EDMONDS
SIDE SEWER AS BUILT
ADDRESS
Permit Number
18012 72nd Ave W
9291
HOMEOWNER
CONTRACTOR
Shelton, Roger
James Newton
DATE
3-30-2001 —FB
DR�AWN
Y
P, Lemcke
LID
No. 215