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7028 180TH ST SW
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'.Cit of Edmo ds PERMIT NO: '93-99:
y n PERMIT EXPIRES-k-"01
SIDE SEWER PERMIT
Address of Construction: 12n tpv. LID #
Property Tax Account Parcel No. 564 (9 ot)o 0 z I DO 01,0
Attach copies of all access and utility easements Verified and Approved b
Owner and/or Contractor: tj r(/4p*
,Contractor License C s�, Q ZA Building Permit
wzf�j�ingle Family
F] Multi -Family (No. of Units
Commercial (No. of Units.
F-1 Public
I
Invasion into City *Right -of Way: El Yes 4_�_No
*RW Construction Permit #
Cross other "Private Property: El Yes &�.xo
"Attach legal description and copy of recorded easement-, . '
Owner or contractor signature and a�knowledgement statement:
-&-,Py signing for this permit I certify that I ha v*e read the City's public handout entitled
Amide. Sewer Specifications and shall comnIv with all Citv reauirements outlined therein
Date
9 CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EXCAVATION 2:
.9 FORINSPECTION CALL 42-5-771-0220 extension,-�
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REOUESTS
NOTE: IF JOB SITE IS NO T 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: nitial: As -built to Street File:
'M PERMITMUST BE POSTED ON JOB SITEt,
White Copy. File Green Copy. Inspector Buff Copy� Applicant
L;temp;bldg;forms;sspennitjlg4/00
27'
C/o
2'
45*
C/o
41
25'
FRONT
67'
GARAGE
LL
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C/o C/o
14'
EP
180TH ST,
SW
CITY
OF EDMONDS SIDE SEWER AS -BUILT
ADDRESS
7028
180TH ST, SW
PERMIT
NUMBER 9399
HOMEOWNER
CONTRACTOR WALDORF
DATE 06/01/01,
DRAWN ISMAEL ABILA
BY
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CL C2
P'n
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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).