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7008 179TH ST SW
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ERMIT NO: 9466
C of Edmonds P
ity PERMIT EXPIRES 1A
SIDE, SEWER PERMIT
Address of Construction: 7ooS 11,Ani '!S-r --;,vd LID # *2- 1&
Property Tax Account Parcel No. �5/ 0� 10 ��g
Attach copies of all access and utility easements..... Verified and Approved by
Owner and/or Contractor: =_5 !s^t-J L. Rc> S,6,-tj _151 KG: zsw--%-Z�
Contractor License #: Building Permit
g Single Family.
r-1 Multi -Family (No. of Units
r-1 Commercial (No. of Units
F� Public
Invasion into City *Right -of Way: 0 Yes fi(No'
�IRW Construction Permit
Cross other "Private Property: Yes No
x
"Attach legal descriptio n and copy of recorded easement.
Owne /Con tractor 2--A 61
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
Side Sewer Spebifications, and shall comply with all City requirements outlined therein.
2 CALL DIAL -A -DIG (1-80 0-425-5555) BEFORE ANY EXCAVATION 2,
12 FOR INSPECTION CALL 425-771-0220 extension,319 9
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REQUESTS
as
. . .. .... ...... TOR OFFICE USE ONLY..
Pe rm it Fee '07 Repair Fee $ Issued By:
Trunk Charge $ A11A Date Issued:
Assessment Fee $ ea 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 NO Date: Initial:
Partial Inspection: Date:. Initial:
Partial Inspection: Date: Initial:
Initial: As -built to Street Fil��..
FINAL INSPECTION APPROVED: Date:
T_� ERMIT MUST BE POSTED ON JOB SITEC�
White Copy: File Green.Copy: Inspector Buff Copy:. Applicant
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CITY OF EDMONDS SIDE SEWER AS -BUILT
ADDRESS PERMIT
7008 179TH ST, SW NUMBER 9456
HOMEOWNER xxxxxxxxxx CONTRACTOR BRAD MASON EXC,
DATE 06/01/01 DRAWN ISMAEL ABILA
BY
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