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15680
7007 180TH PL SW
ADDRESS: 7- 1006
TAX ACCOUNTIPARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:
DISCR-ETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATE]
EASEMENT(S) RECORDED FOR:
PERMITS (
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
DETERMINATION: E] Conditional Waiver El Study Required E] Waiver
SEWER LID FEE S: LID
SHORT PLAT FILE: LOT:
SIDE SEWER AS BUILT DATED.
SIDE SEWER PERMIT(S).#: &�z
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
OTHER:
BLOCK:
LATEMP\DSrs\Forms\Su=t File Checklistdoc
41) C. 1,69,
City of Edmonds - PERMIT NO: 9377
PERMIT EXPIRES ei ZZ
SIDE SEWER PERMIT / f al
Address of Construction: ? 0-0 ? Jzlj LID#
Property Tax Account Parcel No.
Attach copies of all access and utility easements Verified and Approved by
Owner and/or Contractor: %I yv .6k Aw a-x c A 4404-1-
Contractor License #:W A 4- 00c-� 022 7, Building Permit 1P
Single Family
Multi -Family (No. of Units
E] Commercial (No. of Units
Public
Invasion into City *Right -of Way: El Yes 63,No
I P .
*RW Construction Permit #
Cross other "Private Property: El Yes _t_q�o
**.Attach legal description and copy of recorded easement.
Owner or contractor signature atid acknowledgement statement:
By 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.
Date
2 CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EXCAVATION 82
.9 FOR INSPECTION CALL 425-771-0220 extension
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REOUESTS
. .... .... FOR OFFICE USE ONLY
Per rn i t Fee $ Repair F ee $ Issued By: JAIII 1)
Trunk Charge $ Date Issued:
Assessment Fee $ Receipt No: 9
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 Ready YES NO Date: Initial:
Partial Inspection: Date: Initial:
Partial Inspection: Date: Initial:
Initial: s-built to Street File: E]
FINAL INSPECTION APPROVED: Date: A
P
15, PERMIT MUST BE POSTED ON JOB SITE t-
White Copy: File Green Copy: Inspector Buff Copy: Applicant
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CITY OF EDMONDS SIDE SEWER AS -BUILT
ADDRESS
7007 180TH ST
SW
PERMIT
NUMBER 9377
HOMEOWNER KATHY BAXTON
CONTRACTOR AAA EXCAVATING
DATE 04/24/01
DRAWN ISMAEL ABILA
BY
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).