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7031 180TH ST SW
ADDRESS: Iwo Uj
TAX ACCOUNT/PARCEL NUMBER: WS i -,;� i ooc I con �c?
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS:
DISCRETIONARY PERMIT
DRAINAGE PLAN DA
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
DETERMINATION: E] Conditional Waiver n Study Required E] Waiver
SEWER LID FEE S: LID #:
SHORT PLAT FILE: LOT:
SIDE SEWER AS BUILT DATED: /41 N b I
SIDE SEWER PERMIT(S).#: q c5c-x-)�!If
GEOTECH REPORT DA
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED:
OTHER:
INN
BLOCK:
LATEMP\DSrs\Fortns\Street File Checklist.doc
C.
City of Edmonds
SIDE SEWER PERMIT
PERMIT NO. 952.9
PERMIT EXPIRES-&t
Address 6fConstruction: —70__,_� SCJ LID
Property Tax Account Parcel No. 00 613 In CQ I cp C)
Attach copies of all acce and ` ly eas ments Verified and Approved b
e *tl
r
(��and/or Contractor:
Contractor License #: Building Permit
XSingle Family
R Multi -Family (No. of Units
F-1 Commercial (No. of Units
Public
Invasion into City *Right -of Way: 0 Yes
*RW Construction Permit #
Cross other "Private Property: E] Yes &�Nlo
**Attach legal desc-fiption and copy of recorded easement.
10wner/ ontractor
w �6 forit
ractor signature and acknowledgement statement: Date
11
By si ning for this permit I certify that I have read the City's public handout entitled
9
--"Side Sewer Specifications, and shall comply with all City requirements outlined therein..
CALL DIAL -A -DIG (1-800-42,�_15555) BEFORE ANY EXiCAVATION 9
2 FOR INSPECTION CALL 425-771-0220 extension 13A697"�
HOUR NOTICE REQUIRED FOR ALL INSPECTION REOUESTS
FOR OFFICE USE ONLY . ... .............
.. ........ ...........
. . ..... ...
. .... .......
..... .. .........
Permit Fee $ —Repair Fee $ Issued By:
Trunk Charge $ Date Issued: 31-7
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 RE4NS PECTION FEE WILL BE CHARGED.
Job Site Ready YES NO Date: Initial:
Partial Inspection: Date: Initial:
Partial Inspection: Date: Initial:
FINAL INSPECTION APPROVED: Date: In tial* As -built to Street File:
:22-
15, PERMIT MUST BE POSTED'ON JOB SITE t�
White Copy: File Green Copy:. Inspector Buff Copy: Applicant
L-,temp;bldgforms;sspermitjlg4/00
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180th
St Sw
CITY [IF EDMONDS
SIDE SEWER AS BUILT
ADDRESS
7031 180th St SW
Permit Number
9529
HOMEOWNER
CONTRACTOR
sckocitick
DATE
4-17-2001
DRAWN
BY
P, Lemcke
LID
NO. 215
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).