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7111 182N D PL SW
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City of Edmonds PERMIT NO : 9M
SIDE SEWER PERMIT PERMIT EXPIRES��
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Address of Construction: ?&Z % Zf 2' �� LID # Z I C
Property Tax Account Parcel No. (1:0 M-21 Q?
Attach copies of all access and utility easements Verified and Approved by
Owner and/or Contractor: *r - Se et aj � �
Contractor License #: 6 :5 D SZAI 3 Building Permit #: 2AMI
❑
-( 22=
YesD'�iile Family Invasion into City Ri ht-of Way:
❑ Multi -Family (No. of Units _� *RW Construction Permit #
❑ Commercial, (No. of Units ) Cross other "Private Property: ❑ Yes. 5-No
❑ Public **Attach legal description and copy of recorded easement.
�✓ L���� e� Owne ontractor
Owner or contractor signature and acknowledgement 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
W FOR INSPECTION CALL 425-771-0220 extensior'ik32( V C=
24 HOUR NOTICE REQUIRED FOR ALL INSPECTION REQUESTS
FOR OFFICE USE ONLY
Permit Fee $ It-). Repair Fee $ Issued By:
Trunk Charge $ Date Issued: �-i�
Assessment Fee $ Receipt No: 9 7Z G�
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 NO Date: Initial:
Partial Inspection: Date: Initial:
Partial Inspection: Date: Initial:
FINAL INSPECTION APPROVED: Date: Initial: As -built to Street File: ❑
t� .PERMIT MUST BE POSTED ON JOB SITE �
White Copy: File Green Copy:. Inspector . Buff Copy:, Applicant
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HOUSE
2'
CO
32
AVERAGE DEPTH=5'
CO
12'
I
182nd Pl, S.W.
CITY OF EDM❑NDS
SIDE SEWER AS -BUILT
ADDRESS
7111 182nd Pl, S.W.
PERMIT
NUMBER 9318
HOMEOWNER N/A
CONTRACTOR Earth Services
DATE 4/3/01
DRAWN
BY
Danielle Gilbert
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).