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7112 182ND PL SW
MAR 2 3 2001
C * of Edmonds PE i` INOYISION92 2
r O '
SIDE SEWER PERMIT PERMIT EXPIRES U
-7�,,/ 2 �gz "✓ /��/ - S �/ LID #
Address of Construction: /l
Property Tax Account Parcel No.
Attach copies of all access and utility easements Verified and Approved by
Owner and/or Contractor:r2✓!ci-
Contractor License #: 6'AeZf7' Seed 52 Al Building Permit #: 200 S
Single Family
0 Multi -Family (No. of Units _)
❑ Commercial (No. of Units )
❑ Public
Invasion into City *Right -of Way: ❑ Yes LJ"No
*RW Construction Permit #
Cross other **Private Property: ❑ Yes 2-<0
**Attach legal' description and copy of recorded easement.
Owner or contractor signature and acknowledgement statement:
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:
s -
Date
9 CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EXCAVATI.ON. W
W` FOR. INSPECTION CALL 425-771-0220 extension,✓
24 HOUR NOTICE REQUIRED FOR ALL INSPECTION REQUESTS
...... .... .
FOR OFFICE USE ONLY
�....
Permit Fee $ .s Repair Fee $ Issued By: C�c���
Trunk Charge $ ._
Assessment Fee $�
City Permit Surcharge Fee / $5.00
Date Issued:
Receipt No: -7
Total Fees Paid $ si .
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR"ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED.
t, Job Site Ready YES NO Date: Initial:
Partial Inspection: Date:' Initial:
Partial Inspection: Date: Initial:
e t� P�
FINAL INSPECTION APPROVED: Date: Q ( Initia As -built to r�eet-F►le- !�
t� PERMIT MUST BE',POSTED ON JOB SITE t�-
White Copy: File Green Copy: Inspector Buff Copy:, Applicant
L;temp;bl dg;for ms;sspermitj l g4/00
..
N
HOUSE
CONC. ENTRY
3'
2'
C❑
ey
�o
34'
m
E
DEPTH = 6'
f-22' BEND
<
7' Co
2'
10'
182ND PL, S,W,
CITY OF EDMONDS SIDE SEWER AS -BUILT
ADDRESS
7112 182ND PL, S.W.
PERMIT
NUMBER 9282
HOMEOWNER
CONTRACTOR EARTH
SERVICES
DATE 3/30/01
DRAWN DANIELLE
GILBERT
BY
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).