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IT NO: 9534'
City, of Edmonds PEI
PERMIT EXPIRE
SIDE SEWER PERMIT
LID #
Address of Construction: 7PO5.,
Property Tax Account Parcel No.
Attach copies of agAmess and utility easements Verified and Approved by
Owner and/or rktra
—W-(ZA 1EA
—A—
Contractor License #-LAn-0-�VAek 0
,Z'Sing'le Family
Multi -Family (No. of Units
Comine'rcial_(No. of Units
F1 Public
Iding Permit #: . .
Invasion into City *Right -of Way: El Yes �o
*RW Construction Permit #
Cross other "Private Property: El Ye . s 21"No
"Attach legal description and copy of recorded easement.,
ledgement statement!
Owner or contractor signature and acknow
By signing for this permit I certify that I have read the City's public handout entitled
,,jQSide Sewer Specifications, I and shall comply with afl City requirements outlined therein
q. is -of
Date
9 CALL DIAL -A -DIG (1-800-424-5555) BEFORE' ANY EXCAVATION 2
.2 FOR INSPECTIONCALL 425-771,0220 exten'sioni59.4
HOUR NOTICE REOUIRED FOR ALL INSPECTION REOefSTS.
.......................
FOR OFFICE USE ONLY
... ... . ...
Repair Fe $ Issued By:
Permit Fee $
Trunk Charge $ Date Issued:
Assessment Fee $ (::�l Receipt No:
City Permit Surcharge Fee $5.00 Total Fees Paid $--3!2
NOTE: IF JOB SITE IS NOT READY FOR. INSPECTION WHEN
INSPECTOR ARRIVES A $45 RE. -INSPECTION FEE WILL BE CHARGED.
Initial:
Job Site Ready YES NO Date:
Partial Inspection: Date: Initial:
Partial Inspection:
Date: Initial:
-built to Street
FINAL INSPECTION APPROVED: Date: Initial: As.., File:
t- PERMIT MUST BE POSTED ON JOB SITE
White Copy: File Green Copy: Inspector Buff Copy: Applicant
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179TH ST
SW
CIT Y OF
EDMONDS SIDE SEWER
AS -BUILT
ADDRESS
7005 179TH ST SW
PERMIT
NUMBER 9534
HOMEOWNER DALE
CONTRACTOR
ACORN
DATE
08/18/01
DRAWN ISMAEL ABILA
BY
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