7019 179TH ST SW.PDFiiiiiiiiiiii
1'2 2 4
7019 179TH ST SW
City of Edmonds PERMIT NO: 9624
PERMIT EXPIRES q) I L
SIDE SEWER PERMIT
Address of Construction: q � 611MID # d9l (0
Property Tax Account Parcel No. �5-33) 000 0o6' 00
Attach copies of all access and utility easements Verified and Approved b
Owner and/or Contractor: '01 Almm-6 froyzeb e es � LL, 41,
CQntractor License -9-OBu'ilding Permit #:
C&I
Single Family
V_�
F] Multi -Family (No. of Units
Commercial (No. of Units
Public
Invasion, into City *Right -of Way: 0 Yes
*RW Construction Permit #
Cross oth er."Private Property: El Yes 5kNo
"Attach legal description and copy of recorded easement.
I
Owndpai'contractor sig'nature and acknowledgement statement:
B signing for this permit I certify that I have read the City's public handout entitled
y
JO&Side Sewer Specifications, and shall comply with all City requirements outlined therein.
(0-� 10- C>
Date
CALL DIAL -A -DIG (1-800-42__�;5555) BEFORE ANY EXCAVATION. 2
9 FOR INSPECTION CALL 425-771-0220 extension, QiaAa
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REOUESTS
.......... ....... ...................... ....... .......
FOR OFFICE USE ONLY .....
Permit Fee $ 1-140, Fee issued By:
=n afge-$ i5noe, -Date Issued:
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 WILL BE C.HARGED.
Job Site Ready YES NO Date: Initial:
Partial Inspection; Date:
Partial Inspection: Date: Initial:
FIN AL INSPECTION APPROVED: Date: Initial: As -built to Street File:
1,� PERMIT MUST BE POSTED ON JOB SITE ti-
White Copy: File Green Copy: In.tpector Buff Copy� Applicant
L;temp;bldg,forms;sspermitjlg4/00
5�5'-j
GARAGE
T
C/o
13.5'
/45*
LLJ -
z NO DIM.
oli
C/o
CI FRAME LID
179TH
ST, SW
CITY OF EDMONDS SIDE
SEWER AS -BUILT
ADDRESS
PERMIT
7019
179TH ST, SW
NUMBER 9624
HOMEOWNER
SENATORE
CONTRACTOR
DIAMOND PROP,
06/27/02
DRAWN
BY LABILA