6805 180TH ST SW.PDFIII . iiiiiiiii
1252
6805 180TH ST SW
0
ADDRESS:
I "I
rd
TAX ACCOUNTIPARCEL NUMBER: 000 t 008 opi
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: Ej Conditional Waiver E] Study Required Ej Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED-
EASEMENT(S) RECORDED FOR:
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).#: 9
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED:
OTHER:
LOT:
F91-11
BLOCK:
LATEMP\DSrs\Fomis\Street File Checklist.doc
City of Edffionds
PERMIT EXPIRE
SIDE SEWER PERMIT'
Address of Construction: �aos, la<> .5 1 -.s &. *4 LID #
Property Tax Account Parcel No. :2 1 -1 -C), A
Attach copies of all access and utility easements Verified and Approved b
Owne" " nd/or Contractor:
Contractor License #: 40161-,4�S 22-y 174, 'Building Permit
KSingle Family
Fj Multi -Family (No. of Units
F-1 Commercial (No. of Units
F-1 Public
Invasion into City *Right -of Way: El Yes kNo
*RW Construction Permit
Cross other "Private Property: F] Yes No
"Attach legal description and copy of recorded easement..
Owner/Contractor
Owner or contractor signature and acknowledgement statement: Date
WBy 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,.- 425-5555) BEFORE: ANY EXCAVATION 9
2 FOR INSPECTION CALL 425-771-0220 exte n*sion 3", �3
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REQUESTS
..................
. . . ...... .. .
Issued By
TOR OFFICE USE ONLY
Permit Fee Repair Fee $
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 $45RE-INSPECTION FEE WILL BE CHARGED.
Job Site Ready YES NO Date: Initial:
Partial Inspection: Date,-- Initial:
Partial Inspection: Date:— Initial:
Initial: P L`4" As-b*uilt to Street File: E]
FINAL INSPECTION, APPROVED: Date:
t PERMIT MUST BE POSTED ON JOB SITE t�
White Copy: File Green Copy: Inspector Buff Copy: Applicant.
L-,temp;bldg,forms;sspermitjlg4/00
Siodle Se er 21 to 3" Deep
z
House
co
6
Door
25'
241
27"
Door to C-0
co
ep
leoth
Street SW
CITY
OF EDMONDS
SIDE SEWER AS BUILT
ADDRESS 6805
180th St SW
Permit Number 9388
HOMEOWNER
CONTRACTOR
K & S
DATE
6-1-01
DRAWN
BY
P, Lemcke
LID
NO. 215
NOTICE:
No warranty of accuracy.
The information shown on the attached map(s)
was compiled for use by the City of Edmonds,
its Employees and Consultants. The City of
Edmonds does not warrant the accuracy of
anything set forth on these map(s). Any person
or entity requesting a copy should conduct an
independent inquiry regarding the information
shown on the map(s), including, but not limited
to, the location of any sewer stub shown. Such
sewer stubs may or may not exist and may or
may not exist at the location shown. Neither
the City of Edmonds nor its employees or
officers shall be liable for the information given
on map(s), nor for any one representation
provided based upon said map(s).