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18312 73RD AVE W
S. -PERMIT NO: -9,349�
City of Edmo'n*d
PERMIT EXPIRES 10
SIDE SEWER PERMIT.
Address. of Co ristruction: L111) # 7j
Properfy�Tax,kdtount Parcel No. ()()(D ()(at
ex
Attach copies of all access and utility easements Verified and Approved b
Owner and/or Contractor: Kri r) )),P S=�� cz el
Contractor License #: ? c- Rgte, 4!95 SC-L- Building Permit
Single Family Invasion into City *Rightrof Way: El Yes, No�
Multi -Family (No..of Units 4RW Construction Permit #
E] Commercial (No. of Units Crossother **Pri I vate Property:,: EI-Yes Po'
Fj Public, t*Attach legal description and copy of recorded easement.
.4� Owneetontra_ U1
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Owner or contractor signature and acknowledgement statement: Da
u
By signing for this'permit I certify that thave read the City's p blic handoutentit ed
Sewer Specifications, and sha'11 comply with all City requirements outlined thdiein.
V CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EXCAVATI
9 FOR INSPECTION CALL 425-771-0220 extension 110.Eg,
24 HOUR NOTICE REQUIRED FOR ALL INSPECTION REOUESTS
....... .... .
... .. . FOR OFFICE USE ONLY . ...........
............ ..... ... ... ....... .
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Permit Fee $ -Repair Fee $ Issued BY: P_,�, A C%.,
Trunk Charge $ Date Issued: �4 N-7 -1
Assessment F96 $ Rdceipt No* 17 3 ;;-P -2—
City Permit Surcharge Fee $5.00 Total Fees Paid $
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A $45 RE-INSPECTIONTEE WILL BE CHARGED.:,,.',
Job Site Ready YES NO. Date: Initial:
Partial Inspection: Date: Initial:.
Date: Initial:
Partial Inspection:
FINAL INSPECTION APPROVED: Date: initial:- As -built to Street.File':
1,� PERMIT MUST BEPOSTED ON JOB SITEt�-
White Copy: File Gfeen'Copy: I nsl6ctw Bu'ff Copy: Appliban't
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180TH ST, SW
CITY OF EDMONDS SIDE SEWER AS
-BUILT
ADDRESS
18312 73RD AVE W
PERMIT
NUMBER 9349
HOMEOWNER xxxxxxxxxx
CONTRACTOR xxxxx
DATE
04/16/01
DRAWN ISMAEL ABILA
BY
- MEE
4t� SdOI
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No
WARRANrlro
F AMR4Cy
"as cOmPilled for The IftbMatic-7o'..
Use
s. The City by the City of Ed,,,,'- - En the
SC, orth on the Mof Edmonds does not rJar,
sh. 'f aP. Any pe
an indep Mon or enU!y re-, Of
th a..C�Py
'd,;!:9, but not limited to, the 1 4 3 C.1
inci, "do* i"qukY regarding the lntorj',I:,j',,
I�al_ S"cp 0'�. pl.
thr —,,ersu,s ocation of 2�
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Neither the City 0 YJst and may o :r
Off 0"1 be liabi t Edmonds nor i
re.preselIjaU., � for the'nfamaUcn given an this m "s erI_,A!OY,=' or
PrDWded based Pon said map nor for c;jy 'or,,,
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