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7003 179TH ST SW
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City of Edmonds PERMIT NO: 9538
PERMIT EXPIRES /19,A. 2M
SIDE SEWER PERMIT C/
nstruction: 100 70 LID it E
1ECEIVED
kccount Parcel No. 4V 5J�3 1 0 0 0 0 0 9 00 AUG 2 8 200i
Attach copies of all access and utility easements , '. Verified and Approved b DIVISION
Owner and/or Contractor: A( DrA &Jer qri�,54, S / 54eoetA a DtAe- ENGINEERING
Contractor License X 0 9 XX f OP 4
Single Family
Multi -Family (No. of Units
Commercial (No. of Units
El Public
ilding Permit #: &A f __
Invasion into City *Rig4t-of Way: D Yes [2 No
*RW Construction Permit #
Cross other "Private Property: Yes RNo
**Attach legal description and copy of recorded easement.
Owner or contractor signature and acknowledgement statement:
By signing for this permit I certify that I have r'ead.the City's public��out entitled
Side Sewer Specifications, and shall comply with all City requirements outlined therein.
Date
2 CALL DIAL -A -DIG (1-80 -,-5555) BEFORE ANY EXCAVATION W.
W FOR INSPECTION CALL 425-771-0220 extensionl_33V
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REOUESTS
FOR OFFICE USE ONLY...
......... .......... ...... .
Issued By
Permit Fee ?2C), Repair Fee $
Trunk Charge $ Date Issued:
LeAssessment Fee $ Receipt No:
City Permit Surcharge Fee $5.00- Total Fees Paid $__36
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED.
Job Site Ready YES NO Date: Initial:
Partial Inspection: Date: Initial:
Pardal Inspection: Date: Initial:
FINAL INSPECTION APPROVED: Date: 0 h LQ Initial: As -built to Street File
t� PERMIT MUST BE POSTED'ON JOB SITEt,
White Copy: File Green Copy: Inspector Buff Copy: Applicant
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CITY OF
EDMONDS
SIDE SEWER
AS -BUILT
ADDRESS
7003 179TH ST
SW
PERMIT
NUMBER 9538
HOMEOWNER STEV EN
R. DUE
CONTRACTOR ACEIRN ENTERPRISES
DATE
09/07/01
DRAWN
BY
ISAMEL ABILA
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