7119 182ND PL SW.PDF. iiiiiiii lill
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7119 182ND PL SW
7119 — 182nd PI
a•
Cleonout (3• Deep)
4' Schedule 3034 Plastic
2•
4' Tat Tee (5' Deep)
Rher to surface
182nd Place
CITY OF EDM❑NDS
SIDE SEWER AS -BUILT
ADDRESS
PERMIT
7119 - 182nd Place
NUMBER 9390
HOMEOWNER
CONTRACTOR Earth Sciences
DATE 4-23-2001
DBRAWN
Jim Roberts
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I
CityOf EdmondsPENT NO: 939�
'n� l g9" SIDE SEWER PERMIT PERMIT EXPIRES
Address of Construction: 7// % 92 I -Ad /0� • S• LID # ✓
Property Tax Account Parcel No. !!�jz'�®�
Attach copies of all access and utility easements Verified and Approved by .--
Owner and/or .t7ntractor. �o'a7--/- S_ �/®� x
Contractor License #: Building Permit #:
Single Family
❑ Multi -Family (No. of Units
❑ Commercial (No. of Units )
❑ Public
/7.4
Invasion into City *Right -of Way: ❑ Yes G o
*RW Construction Permit #
Cross other **Private Property: ❑ Yes [ o`__
**Attach legal description and copy of recorded easement.
Owner or contractor signature and acknowledgement statement:----------J
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
Date
9 CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EXCAVATION 9
2 FOR INSPECTION CALL 425-771-0220 extension 39- 2.13:?-1
24 HOUR NOTICE REQUIRED FOR ALL INSPECTION REQUESTS
.FOR OFFICE USE ONLY
Permit Fee yz Repair Fee $ Issued By:���J
Trunk Charge $ 121Date Issued:_��A//%��/
Assessment Fee $ Receipt No:
City Permit Surcharge Fee $5.00 Total Fees Paid $ 115
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: ❑
1,� PERMIT MUST BE POSTED ON JOB SITE t-
White Copy: File Green Copy: Inspector Buff Copy: Applicant
L;temp;bl dg;forms;sspermitj Ig4/00
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).