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7012 179TH ST SW
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PERMIT NO: 9376.
'City of Edmonds
PERMIT EXPIRE
SIDE SEWER PERMIT,
Address of Construction: :2 Q /;L 12q,§ j,+ S4..) LED # /5
Property Tax Account Parcel No.,
Attach copies of all access and utility easements Verified and Approved b
Owner and/or Contractor: P.06GA-dLe- oe� A Z)l e___ W
Contractor License #:IJA L�Q#d- 4c 02-3 6)S Building Permr4l. < ------
Single Family Invasion into City *Right -of Way: [:1 Yes -RNo
F-1 Multi -Family (No. of Units *RW Construction Permit #
Fj Commercial (No. of Units Cross other "Private Property: El Ye's 64-No
F] Public "Attach legal description andcopy of'recorded ea'sement.
Owner/Contractor
Owner or contractor signature and Acknowledgement statement: Date
By signing for this permit I certify that I have read the City's public hand
ide Sewer Specifications, and shall comply with all City requirements outlined therein.
2 CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EXCAVATION 2
2 FOR INSPECTION CALL 425-771-0220 extension 4t4f_2 13;�6
24 HOUR NOTICE REQUIRED FOR ALL INSPECTION REOUESTS
...... ........
. ....... ..
. ..... ...... FOR OFFICE USE ONLY . . ....
. ............... ... .
a .... ...
Permit Fee $ :Ae Repair Fee $ Issued I
Trunk Charge $ Date.Issued:
Assessment Fee $ Receipt No: 17541a!?
City Permit Surcharge Fee $5.00 Total Fees Paid $
NOTE: IF JOB SITE IS. NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A $45 RE-INSPECTI.ON FEE WILL BE CHARGED.
Job Site Ready YES NO Date: Initial:
Partial Inspection: Da te: Initial:
Partial Inspection: Date: Initial:
'Initial: As-builtto Street File: Sa
FINAL INSPECTION APPROVED: Date:
t- PERMIT MUST BE. POSTED ON JOB SITE t-
White Copy: File Green Copy: Inspector Buff Copy: Applicant
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179TH ST SW
C/O
6' DEEP
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68'
oj
3'
10,
21'
CITY OF EDMONDS SIDE SEWER. AS -BUILT
ADDRESS
7012 179TH ST SW
PERMIT
NUM13ER 9376
HOMEOWNER
CONTRACTOR AAA
DATE
04/26/01
DRAWN
I BY ISMAEL ABILA
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