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18015 HOMEVIEW
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S PERMIT NO: 9420'
G of Edmood
ity . PERMIT EXPIRES 14hIZ91
SIDE SEWER PERMIT —1 /
Address of Construction: 110ynl�- v I L--w LID # 42 15'
Property Tax Account Parcel No. 7 7el '�Od �F- e:5�
Attach copies of all access,and utility easements Verified and Approved b
Owner
Contractor License
ilding Permit &Z4
XSingle Family Invasion -into City *Right -of Way: El Yes No
F] Multi -Family (No. of Units *RW Construction Permit #
Fj Commercial (No. of Units Cross other "Private Property: El Yes 4NO*
F-1 Public **Attach legal description and copy of recorded easement.
Owned*pnt�ractor
Owner or contraci7or signature and acknowledgement statement: Date
AjjjkBy signing for this permit I certify that I have read the City's public handout entitled
ide Sewer Specifications, and shall complywith all City requirements outlined therein.
2 CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EXCAVATION -2
9 FOR INSPECTION CALL 425-771-0220 extension:329 9
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REOUESTS
FOR OFFICE USE ONLY
Permit Fee Repair Fee $
. .. .. ..... . .
Issued By:,
Trunk Charge $ 1111A
Date Issued: A�z
If /
11
Assessment Fee &-ZA
Receipt No: 4_1V
'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.
Job Site Ready YES NO Date: Initial:.
Partial Inspection: Date: Initial:
Partial Inspection: Date: Initial:
FINAL INSPECTION APPROVED: Date: Initial: As -built to Street File:
t, PERMIT MUST BE POSTED'ON JOB SITEt/-
White Copy: File Green Copy: Inspector Buff Copy. Applicant
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180 TH ST. S,W.
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CITY OF EDMONDS
SIDE SEWER
AS
-BUILT
ADDRESS
18015 HOMEVIEW DR
PERMIT
NUMBER 9420
HOMEOWNER CHUCK GORDER
CONTRACTOR
PERRINVILLE
SEWER
DATE 05/01/01
DRAWN
BY
ISMAEL . ABILA
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