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7111 179TH ST SW
22,5'
CO 2' to Surface
4'
N
Deck
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Q
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3
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HOUSE
CO 1,5' to Surface
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1
28'
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22 Degree Bend
4'-T
D
CO 2' to Surface In Frame - Lid
ROW
12'
Edge of Pavement
179th Street SW
Sewer Main
CITY
❑E EDM❑NDS SIDE SEWER
AS BUILT
ADDRESS
Permit Number
7111
179th Street SW
9263
HOMEOWNER
CONTRACTOR
Dickerson, Linda
AAA Excavating
DATE 3-14-2001
BRAWN P, Lemcke
No 215
22.5'
AV"
b
' 4'
N
Deck
d
U
N
LL
HOUSE
CO 1.5' to Surface
7/
28'
d
A
J
�
�i 22 Degree Pend
4-
CO 2' to Surface in Frame - Lid
ROW
M Edge of Pavement
179th Street SW
Sewer Main
CITY
OF EDMONDS SIDE SEWER
AS BUILT
ADDRESS
7111
179th Street SW
Permit Number 9263
HOMEOWNER
Dickerson, Linda
CONTRACTOR
AAA Excavating
LDATE
3-14-2001
DRAWN
BY P, L e m c k e
No. 215
44C. l g9,j
City of Edmonds PERMIT NO: 9263
SIDE SEWER PERMPERMIT EXPIRES ��
Address of Construction: 7 I 1 �n LID # Z
Property Tax Account Parcel No. 5'931 tx`» Cep I CIC)
Attach copies of all access and
Owner
ity easements Verified and Approved by
Contractor License #: W hq=L L7 Ll r, 4-E;-3 C'7 Z Building Permit #;
Single Family
❑ Multi -Family (No. of Units
❑ Commercial (No. of Units )
Invasion into City *Right -of Way: ❑ Yes
*RW Construction. Permit #,
Cross other **Private Property: ❑ Yes 0No
❑ Public **Attach legal description and copy of recorded easement.
f L'i Ow r/Contractor
Owner or contractor signature and acknow6bgement statement: Date
By signing for this permit I certify that I have read the City's public handout entitled
Side Sewer Specifications, and shall comply with all City requirements outlined therein.
2 CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EXCAVATION 9
2 FOR INSPECTION CALL 425-771-0220 extension- __ V /�Z1,5'
24 HOUR NOTICE REQUIRED FOR ALL INSPECTION REQUESTS
White Copy: File Green Copy: Inspector Buff Copy: Applicant
L;temp;bldg,forms;sspermitj lg4/00
'CityOf EdmondsPERMIT NO: �26�
C. 1-6-7-
SIDE SEWER PERMIT, PERMIT EXPIRES
Address of Construction: �) I I ��' LID #
Property Tax Account Parcel No. fxpr-) C:XJ i CX7
Attach copies of all access and utility easements Verified and Approved by
Owner and/o ractor. '4A-A+
Contractor License #:k/ (I j06-L7 '�� Building Permit #;
&Single Family.
❑ Multi -Family (No. of Units._
❑ Commercial (No.. of Units )
❑ Public
Invasion into City *Right -of Way: ❑ Yes
*RW Construction Permit #
Cross other **Private Property: ❑ Yes Q No.
**Attach legal description and copy of recorded easement.
Ow r/Contractor
Owner or contractor signature and acknow a gement 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.
2 CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EXCAVATION 9
9 FOR INSPECTION CALL 425-771-0220 extension"32912
24 HOUR NOTICE REQUIRED FOR ALL INSPECTION REQUESTS
__.. _.... _.. _ _ _ ..... ...
FOR OFFICE USE ONLY
Permit Fee $ Repair Fee $ Issued By: •�.1�g ��-
Trunk Charge $ Date Issued:
t
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 CHARGED.
Job Site Ready YES N0 Date: Initial:
Partial Inspection: Date: Initial:
Partial Inspection: Date: Initial:
FINAL INSPECTION APPROVED: Date: 1 Initial:--_As-built to Street File: [�
1� PERMIT MUST BE POSTED ON JOB SITE t�
White Copy: File Green Copy: Inspector Buff Copy: Applicant
L;temp;bldg;forms;sspermitj lg4/00
r.
22,5'
CO 2' to Surface
4'
N
Deck
0
o�
)
u
C
Q
(b
L
s
CO 1.5' to Surface
O�
1
28'
J22
d
CH/
\
m
I I
4'
r
Deg ee Bend
`
CO 2' to Surface in Frame - Lid
ROW
12'
1
T
Edge of Pavement
-
179th Street SW
Sewer Main
CITY
DE EDMONDS SIDE SEWER
AS BUILT
ADDRESS
Permit Number
7111
179th Street SW
9263
HOMEOWNER
CONTRACTOR
Dickerson, Linda
AAA Excavating
DATE 3-14-2001
BRAWN P Lemcke
No. 215