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7006 179TH ST SW
RFECEIVED
.11:�'L 3. 2001
PERMIT NO:
- An
City of Edmonds ENGGRNIRNG NVISION
PERMIT EXPIRES
SIDE SEWER PERMIT
Address of Construction: OQ& 1'7 LED
Prop.er6rf�axccotiht P'a"rp.el No. 5175
Attach copies of all access and utility easements Verified and Approved b
Owner and/or Contractor: ".5 )0)e,6 A 7k,
Contractor License#: FAlzrd ceo &ME 52� A e&IvMilding Permit#:
N,S�ingle Family
r-1 Multi -Family (No. of Units
F-1 Commercial (No. of Units
M Public
Invasion into City *Right -of Way: [_1 Yes . [91N`o`_'*
*RW Construction Permit #
Cross other "Private Property: F-1 Yes �o
"Attach legal description and copy of recorded easement.
Ownerx
Owner or contractor signature and acknowledgement statement:. Date
By signing for, this permit I certify that I have read the"(ity's public handout entitled
cifi 'a City requirements outlined therein.
ide Sewer Spe cations,arid shall comp
w"t"'
'y /
9 CALL DIAL -A -DIG (1-80/0-425-5555) BEFORE ANY EXCAVATION 9
2 FOR INSPECTION CALL 425-7471-0220 extension ��N,W
24 HOUR NOTICE REOUIRED FOR AfL INSPECTION REOUESTS
.... .. ... FOR OFFICE USE ONLY
Permit Fee Repair Fee $ Issued By:
U
Trunk Charge $ Date Issued: -9-7
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 WIl_L BE CHARGED.,
.J.0b..-Site Ready YES NO Date: initial:
-"".FiP I 'nspec
artial Inspection: Date: Initial:
n ec
I sp
Partial Inspection: Date: Initial:
F L I Sp
INAL INSPECTION APPROVED: Date: —Ila M t Initial:. W'" As -built to Street File:
'6- PERMIT MUST BE- POSTED ON JOB SITE 'M
White Copy: File Green Copy: Inspector Buff Copy: Applicant
L;temp;bldg;forms-,sspertnitjlg4/00
t
N
175TH ST, S',Wl.
5'
45*
45*
7'1
47'
-4 . 5,-121
71 71
51 4C/O
CITY OF EDMONDS SIDE SEWER AS -BUILT
ADDRESS
7006 179TH PL. S,W,
PERMIT
NUMBER 9504
HOMEOWNER xxxxxxxxxx
CONTRACTOR EARTH SERVICES
DATE
07/09/01
DRAWN
BY ISMAEL ABILA