6823 180TH ST SW.PDFiiiiiiii lill
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6823 180TH ST SW
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER: b 0 0 Co t C)
BUILDING PERMIT (NEW STRUCTURE): --- wtf�
COVENANTS (RECORDED)
CRITICAL AREAS:
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS
PLANNING DATA CHECKLIST DA'
DETERMINATION: E] Conditional Waiver E] Study Required E] Waiver
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED: —
SIDE SEWER PERMIT(S),#: q
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
OTHER:
LATEMP\DS'Ps\Fonns\Street File Checklist.doc
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r-16 r T7 A A PEF"TWO: 9290
Ly V VU ' a P-MMMU04RES 10/.
SIDE SEWER PERMIT 11-1
Address of Construction: (D LED #
Property Tax Account Parcel No. 5/aL 0C)Q 1(a / 03
Attach copies of all access and utility easements Verified and Approved b
Owner and/o it i _�Xm_;Vs
Contractor License 9.3A! &: ZD \0 Q QA L F Build.ing Permit
�Single Family
Multi -Family (No. of Units
Comm ercial (No. of Units'
Public
Invasion into City *Right -of Way: El Yes
*RW Construction. Permit
Cross other "Private Property: El Yes Fj No
"Attach legal description and copy of recorded easement.
ner or contractor si Patu're and acknowledgement statement:
signing for this permit I certify that I have read the City's public ha�dout entitled
A.,
Datj 1.
E]No '
�ide Sewer Specifications, and shall comply with all City requirements outli'n'ed therein.
y
2 CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANVEXCAVATION 9
W FOR INSPECTION CALL 425-771-022W�exten'§i'o"'�h,- "36 9
24 HOUR NOTICE, REOVIRED -FOR, ALL INSPECTION -REOUESTS.
... ........ : ... .. . . . .....
... ....... .
FOR OFFICE USE ONLY
.. .... .... .... ..... ...
Repair Fee $ Issue
Permit Fee $ d By: �;14
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 $45 RE -INSPECTION FEE WILL BE CHARGED.
Job Site Read' YES NO Date: Initial:
y
Partial Inspecbon: Date: 'Initial:
Partial Inspection:
Date: Initial:
FINAL INSIDE ",90 (n�Lk InitiaI:...@ff.._ - As-buiItt'oCf9ee0tA&e E!
t�'PERMIT MUST BE POSTED ON JOB. SITE f$
White Copy: File Green Copy: Inspector Buff Copy: Applicant
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CITY OF EDMONDS
SIDE SEWER AS BUILT
ADDRESS
6823 180th St SW
Perm1t
Number
9290
HOMEOWNER
CONTRACTOR
Gavdinier
JD Newton
DATE
3-28-2001
DRAWN
BY
P, Lemcke
LID
No. 215