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7023 180TH ST SW
112C. IS9"
RMIT NO: 937-4.
City of Edmoxids PE 4 Z12
PERMIT EXPIRES 60
SIDE SEWER PERMIT It, I
Address of Construction: :20-9-3 LID #
Property Tax Account Parcel No.
Attach copies of all access and utility easements Verified and Approved by
Owner and/or Contractor: Sj4 Arro C- xcA vaA��,
A7,
Contractor License #:iej,44_,o9c_ alk' od__7 41 Building Permit #:
8.,Single Family Invasion into City *Right -of Way: El Yes Qjlio
F-1 Multi -Family (No. of Units *RW Construction Permit #
R Comm"ercial (No. of Units Cross other *�*Private Property: ' El Yes -,allo -
F1 Public "Attach legal description and copy of recorded easement..
Owner or contractor signature. aid acknowledgement statement:
By signing for this permit I cerfify that I have read the City's public handout entitled
§ide Sewer Specifications, and shall comply with all City requirements outlined therein.
(a -rl
Date
W. CALL DIAL -A -DIG (1 -800-425-5555.) BEFORE ANY EXCAVATION 2
W FOR INSPECTION CALL 42.5-771-0220 ext6nsion4294ja'
24 HOUR NOTICE REOUTRED FOR ALL INSPECTION REOU. ESTS
NOTE: IF JOB SITE IS NOTREADY 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: -PL, As -built to Street File:
FINAL INSPECTION APPROVED: Date:
t� PERMIT MUST BE.POSTED ON JOB SITE t-'
White Copy:. File Green Copyi Inspector . . Buff Copy:. Applicant
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180TH ST, S,W,
CITY OF EDMONDS
SIDE SEWER AS -BUILT
ADDRESS
7023 180TH ST,
SW
PERMIT
NUMBER 9374
HOMEOWNER SIMONS
CONTRACTOR AAA EXCAVATING
DATE
06/01/01
DRAWN
BY
ISMAEL ABILA
70 QL-S IF 0 k !�'( - �;- -
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IS
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).