22908 74TH AVE W.PDF111111111111
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22908 74TH AVE W
ADDkESS:
TAX ACCOUNTIPARCEL NU`MBER:—
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: — DETERMINATION: 0 Conditional Waiver 0 Study Required F1 Waiver
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 $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S)
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DA
OTHER:
LID #:
LOT: BLOCK:
LATEMP\DST"s\Fomis\Street File Checklist.doc
PERMIT NO: 9.864
-ROW C 16ty of Edmonds 65- 10
PERMIT EXPIRES J
14 C. 1 -.9`1 SIDE SEWER PERMIT
Address of Construction: L #
arq
Property Tax Account P 1 3�"p
Attach copies of all access and �tilit�- eas�ments Verified and Approved b
Owner and/or Contractor:
Contractor License #C-:)E, Kf 3 P-1 -14 t &5&uilding Permit
ingle Family ...Invilision into City *Right -of Way: El Yes No
F! Multi -Family (No. of Units *RW Construction Permit #
E] Commercial (No. of Units Cross other "Private Property: El Yes T9,No
Public "Attach, legal description and copy of recorded easement.
PAI
Owner ritractor
Owner or contractor �ignatii'te, and acknowledgement statement: Date
ksigning for this p , ermit I certifythat.1 . have -read, -.the: City's public handout entitled
y
ide Sewer Specifications, and shall comply with all City requirements outlined therein.'
9 CALL DIAL -A -DIG (1-8.00-429-55555) BEFORE ANY EXCAVATION 9
9 FOR INSPECTiON CALL 425-771.-0220 extension
24 1961IR NOTICE'RE011REDVOR 'ALL INSPECTION REOUESTS
7
. ..........
FOR OFFICE USE ONLY
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A
Permit -Fee-$-___=..__— Repair Fee $ Issued By:
Y'
7
Trunk Charge Issued:
As Receipt No:
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City Permit Surcharge Fee Total Fees Paid,
�/IROTE". -IP4J0B'CS4ITE IS'N`0T*REA FOR INSPECTION WHEN
_" I "dT'OR ARRIVES A145'115'INSPECTION FEE WILL BE CHARGED,
NSPE
Job Sit Ready NO,* Date: Initial:
iF *7 1co X119 i��
rl I WTJ 10 61 —v>.-y71r .4 ;�; I 'cm no
Partial Inspection�BW Date: I-W44 initial; 74.
Partial Inspection: Date: Initial:
FINAL INSP . ECTION APPROVED: 'Date: OA Initial:—Iii—As'�.built to Street File: E]'
1,� PERMIT MUST BE POSTED ON JOB SITE6-
�Vhite Copy': File' Green Copy: Inspector Buff Copy: Applicant
L;temp;bldg,forms;sspennitjlg4/00
1' FROM STUB
TO 22* BEND
SEWER STUB
CONN. @
4.7' DEEP
CITY OF EDMONDS SIDE SEWER AS- BUILT I
ADDRESS HOMEOWNER
22908 74th Avenue West Carter
CONTRACTOR SCALE
NTS
DATE DRAWN P RMIT
7-14-04 13Y K. Haney NO. -
9864
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