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TAX ACCOUNT/PARCEL NUMBER: 49N 000 0102 COO&
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE
SHORT PLAT FILE:
SIDE SEWER AS BUILT DA
SIDE SEWER PERMIT(S).#:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DA
DETERMINATION: E] Conditional Waiver Ej Study Required 0 Waiver
LID #:
LOT: BLOCK:
L-.\TEMKDS'Ps\Foffns\Street File Checklist.doc
PERMIT NO: .9453,
City of Edmo-0-d. s .
PERMIT.EXPIRES 4/1:5// h/
)7C.79C3 SIDE SEWER PERMIT-.
1ED #
Address of Construction: 01
' vMProperty Tax Account Parcel No.
Attach copies of all access and utility easements —AM Verified and Aoprove'd b
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Owner and/or(C�*o—nitracator;
Contractor License S Q awkBuilding Permit
Ksingle Family Invasion into City'*Right-of Way: El Yes *6
Multi -Family (No. of Units *RW Construction Permit
F� Commercial (No. of Uni . ts Cro�s other **Privati� Property: El Yes 'KNO.
F] Public Attach legal description and copy of recorded easement.
0 ner�
Date:
Owner or contractor signature and ackno�vledgement� statement:
By signing for this permit I certify that thave read th e City's public handout entitled
ide Sewer Specifications, and shall comply with all City -requirements outlined therein..
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9 CALL DIAL -A -DIG (1-800-425.-5.555) BEFORE AN ' Y EXCAVATION .9
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W.FOR INSPECTIO N CALL. 425-771-0220 extensio '.329
24 HOUR NOTICE REQUIRED FOR ALL INSPECTION REOUESTS
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FOR OFFICE USE ONLY
........... .
150
Permit Fee Repair Fee $ Issued By.
Trunk Charge $ Date Issued:
Assessment Fee Receipt No:.-,...J. 741,-�,?
City Permit Surcharge Fee $5.00 Total Fees Paid $
NOTE: IF JOB SITE IS NOT READY FOR INSPECTIONWHEN.
INSPECTOR ARRIVES A $45 RE-INSPECT'ION FEE WILL. BECHARGED.
Job Site Ready YES NO Date: Initial:
Partial Insoection: Date: Initial:
Partial Inspection: Date: Initial -
,,A FINAL INSPECTION APPROVED: Date: Initial:' As -built to Street File: F-1
1,� PERMIT MUST BE PPSTED� ON JOB SITE t�
White Copy: File Green Copy: Inspector - Buff,Copy: Applicant
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73rd
Ave W
CITY OF EDMONDS
SIDE SEWER AS BU,ILT
ADDRESS
Permit Number
18225 72nd Ave West
9453
HOMEOWNER
CONTRACTOR
Perrinvilte Sewers
DATE
6-1-01
DRAWN
BY
P. Lemcke
LID
No. 215
C
N
I -
CITY OF EDMONDS SIDE SEWER AS -BUILT
PERMIT
ADDRESS 18225 72nd Ave. W. NUMBER 9453
HOMEOWNER CONTRACTOR
Perrinville Construction
DATE DRAWN Jaime Hawkins
6-19-01 1 BY