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18017 72ND AVE W
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ADDRESS: 2--�Q MA
TAX ACCOUNTIPARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DA
PARKING AGREEMENTS DA
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE
SHORTPLAT
SIDE SEWER AS BUILT DA
SIDE SEWER PERmr.r(s) #: V/9/7
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED:
DETERMINATION: E] Conditional Waiver n Study Required 0 Waiver
LID #:
LOT: BLOCK:
LATEMP\DS'PsXForms\Su=t File Checklist.doc
,I)C. 1%9-
'RECEIN&
MNAMT NO: 9292
City of Edmond AIN I?x . pit - 611k)l
RES—
SIDE SEWER PERMIT
Address of Construction: I eon P�vel. Uj LID #
Property Tax Account Parcel No:. 172.7 OYZ 0�7 00
Attach copies of all access and utility easements Verified and Approved b
Owner and/or Contractor:
Contractor License #: Building'Permit
Single Family
F] Multi -Family (No. of Units
-E] Commercial (No. of Units
Fj Public
Invasion intoCity *Right -of Way: El Yes tRN.o
*RW Construction Permit #
Cross other "Private Property: El Yes &�No
"Attach legal description'and copy of recorded easement..
U_ Y— OwneAContractor I -:54K6,0�61
11 er or c ntracto.r . signaiurer Tnd acknowledgem,ent statement: Date
B signing for this permit I certify that I have read the City's public handout entitled
kide Sewer Specifications, and,�shall comply with all City requirements outlined therein.
2 CALL DIAL -A -DIG (1-800-425-5555) BEFORE,,. -ANY EXCAVATIONU`
.2 FOR -INSPECTION CALL 425-771-0220 extensi6n"`26
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REOVESTS
.... . ...... .
FOR OFFI.CE USE ONLY . ......
Permit Fee $ "Rep . air Fee Issued l3y:._�4_y-c,,_
Trunk Charge $ Datelssued: 1-2, 1! f 0
-2
Assessment Fee $ Receipt No: 17-Z -�Q
City Permit Surcharge Fee $5.00 Total Fees Paid $ 7?,
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:.L4j�/-0``1, Initial: As -built to Street File:
io
CURACY. The Information ghown on the
NOTICE: NO I�IAI=6017 AC 1, 11,
1 Jas for use by the City 01 Edmcr.�'
gachad map
andconsultants, The City of Edmonds does not viarrant
Any PersOn 01
anything set forth on the map.
co- inqui�y regud ng tho MR-
nduct ari lnd�-,
b tt" limited to, the localkn 01 zl�) c
the rnao, inc�sud'ng, U't'n,
Sucil sju�s may ormalf ncic)dst and may 01 r,-.-.1
Neither the City ( )f Edmonds riot Its V',. !V��:'�,
0%c:,rs E�;jp e in" fmation given 011 thic map, not for my
�jj be liable for th io
representetion pro%Aded bw-;ed upoa said map
60' 23'
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CITY OF EDMONDS. SIDE SEWER AS
-BUILT
ADDRESS
18017 72ND AVE W
PERMIT
NUMBER) 29 2
HOMEOWNER xxxxxxx
CONTRACTOR JD
NEWTON
DATE 04/06/01
DRAWN
ISMAEL ABILA
BY