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18105 72ND AVE W
, R C. I 'S') -
PERMIT NO: 9454
C i6ty -of Edmonds''
SIDE SEWER PERMIT' PERMIT EXPIRES-4h*-/
Address of Construction
Property Tax Account P;
Attach copies of all access and utility easeme
Owner an d/or Contractor: 1,pl-reA.4 C Q_ 6
Contractor License #: �,W
ksingle Family
Multi -Family (No. of Units
E] Commercial (No. of Units
Public
Verified and Approved b
3t
ilding Permit
. Invasion into City *Right -of Way: 0 Yes XN 0
*RW Construction Permit #
Cross other "Private Property: ' El Yesi J�Ko
"Attach legal description and copy of recorded easement.
Owner or contractor signature and acknowledgement statement:
By signing for this permit I certify that I have read the City's public handout ent ' itled
ide Sewer Specifications, and shall comply with all City requirements outlined therein
5--
Date
2 CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EXCAVATION..2
.2 FOR INSPECTION CALL 425-771-0220 extension:329. 2
24 HOUR NOTICE REQUIRED FOR ALL INSPECTION REOUESTS
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:
Pardal Inspection:
Partial InSDeCtion:
Date: Initial:
Date: Initial:
FINAL INSPECTION APPROVED: Date: 1U I -: Initial: LI(4-. . As-buill
1,� PERMIT MUST BE POSTED ON JOB SITE t-
White Copy: File.- Green Copy: Inspector Buff Copy: Applicant
L;tcmp;bld&,forms;sspertnitjlg4/00
to Street File:.
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15'
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z 3' 41'
4
3
17'
87C/o
8' DEEP
27' 26'
181ST PL SW
CITY OF EDMONDS SIDE SEWER
AS -BUILT
'ADDRESS
18105 72ND AVE' W
PERMIT
NUMBER 9454
HOMEOWNER xxxxxxxxxx
CONTRACTOR
TERRY
GROSS
DATE
05/24/01
DRAWN
ISMAEL ABILA
BY
M�l
IFE,
I'Mom
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