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18107 73RD AVE W
ADDRESS: o 0 Uj -
TAX ACCOUISIT/PARCEL NUMBER: 000 OqS 0(p 0,;�,
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS:
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (OTHER):
PLANNING DATA CHECKLIST DA
SCALED PLOT PLAN DATED:
SEWER LID FEE S:
SHORTPLAT
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S).#: q L4 /!5
GEOTECH REPORT DA
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED:
OTHER:
DETERMINATION: E] Conditional Waiver E] Study Required [j Waiver
LID #:
LOT: BLOCK:
LATEMP\DSrs\Forms\.Street File Checklist.doc
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941HRMIT NO:. 94,15.
City of Edmmo, 0.
)T.EXPIRES (a
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SIDE SEWER PERMIT
Address of Construction: LID # a 15
Property Tax Account Parcel No. 1/41--+5 000 04S 00 OZZ
Attach copies of all access and utility easemenis —4111-Verified and Approved b
r17)
Owner and/or Contractor: J 0,4-'
Contractor License L)AI-o'D C, �*r 12 7_� Building Permit
.,��ingle Family Invasion into City *Right -of Way: El Yes ..59-No
Fj Multi -Family (No. of Units *RW Construction Permit #
Commercial (No. of Units Cross other "Private Property: El Yes [�No
F� Public **Attach legal description and copy of recorded easement.
D-47191 P-4-4 P Owner/Contractor
O14n_ero`r', �ontr_a�cit`or s1`g%n"ature and ackQwledgement statement: Date
O�Bl y signing for this permit I certify that I have read the City's public handout entitled
ide Sewer Specifications, and shall comply with all City requirements outlined therein.
9 CALL DIAL-A-DIG.(1-800-425,,,4'5555) BEFORE ANY EXCAVATION.
Iff FOR INSPECTION CALL'425-771-0220 extension 32ARK1,
24 HOUR NOTICE REOUTRED FOR ALL IN.SPECTION REOUESTS
................... .
. .. . ............
FOR OFFICE USE ONLY
. . . ...........
Permit Fee Re!j�iFeei:�W Issued By:
, r I tV
Trunk Charge $ Date Issued:
Assessment Fee Receipt No:
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 FEEWILL BE ' CHARGED.'�
Job Site Ready YES NO' Date: Initial:
Partial Inspection: Date: Initial:
Partial Inspection: Date; Initial:
FINAL INSPECTION APPROVED' Dat fniti�l�tOff. As -built to Street File:,
1,� PERMIT, MUST BE-PO,STED.ON JOB SITE. t-
White.Copy: RIP Green Copy:, Inspector Buff,Copy: Applicant
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CITY
[IF
EDMONDS
SIDE SEWER
AS BUILT
ADDRESS
Permit Number
18107
73rd Ave W
9415
HOMEOWNER
CONTRACTOR
DATE
4-17-2001
DRAWN
BY
R Lemcke
LID
NO. 215