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7023 181 ST PL SW
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.PERMIT NO: 9380
City of Edmonds PER -MIT EXPIRES - 6ZIZ� I
SIDE SEWER PERMIT
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Address of Construction: :2(),73
Property Tax Account Parcel No. /090j e�.v 19 67 A9 .
Attach copies of all access and utility easements Verified and Approved b
Owner and/or Contractor: 91.X t? L;l
Contractor Licensek 1, 44 LQ2c- Ae ().0L-7 _Building Permit
r97$ing"le Fam ily Invasion into City *Right -of Way: El Yes 9No
Multi -Family (No. of Units *RW Construction Permit #
Commercial (No. of Units Cross other "Private Property: Ej Yes o
Public "Attach legal. description and copy of recorded easement.
OwnerX�5�ntracto
Ow4r or contractor signature and acknaledgement statement: Date
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.
9 CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EXCAVATION W.
Iff FOR INSPECTION CALL 425-771-0220 extension-&*,, W
24 HOUR NOTICE REOUIRED FOR ALL INSPECTIOT� REOUESTS'
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. ... . ..... .. .... .. .. FOR OFFICE USE ONLY
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A A y
Permit Fee $ —Repair Fee $ Issued By: ig "Zz r,�r Ir
Trunk Charge $ Date Issued: z
Assessment Fee $ Receipt No: 175 /,-,717
City Permit Surcharge Fee $5.00 Total Fees Paid $
NOTE: IF JOB SITE)S 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..,
FINAL- INSPECTION APPROVED: Date: fol Initial: As-bui It to Street File: E]
1, PERMIT MUST BE POSTED ON JOB SITE15
White Copy: File Green Copy: Inspector Buff Copy: Applicant
L;temp;bldg;forms;ssperinitjlg4/00
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 accuracv 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).