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7024 180TH ST SW
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7 11 C. 1 16') -
PERMIT NO: 9551
City of Edmonds PERMIT EXPIRES /d
SIDE SEWER PERMIT
to -
Address of Construction: —)5)74 (sc, S I L LID #
Property Tax Account Parcel No. 10 !2A42,000 OX 00
Attach copie's of all access and utility easements Verified and Approved b
Owner and/
CZ1_
Contractor License -ky4iE�k o 14147- Building Permit
-of Way: El Yes -jSa-No
esingle Family Invasion into City *Right
Fj Multi -Family (No.. of Units
F� Commercial (No. of Units
F� Public
*RW Construction Permit #
Cross other "Private Property: El Yes XNo
"Attach legal description and copy of recorded easement.
Owner/
X=ontraclor
Owner or contractor signature and acknowledgement. statement: Date
By signing for this permit I certify that I have riead the City's public handout entitled
ide Sewer Specifications, and shall comply with all City requirements outlined therein.
2 CALL DIAL -A -DIG (1-800-42,,d-
f-5555) BEFORE ANY EXCAVATION 9
9 FOR INSPECTION CALL 4-25-771-0220 extension'lub , N
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REQUESTIS.-j
.... ........... ..........
...... ..... .. .... ....
.. ... . FOR OFFICE USE ONLY
............ .......... . ......... . . ..... . . . ......
Permit Fee Repair Fee $ Issued By:
Trunk Charge $ e—o Date Issued:
Assessment Fee $ Receipt No:2kcf
City Permit Surcharge Fee $5.00 Total Fees Paid $_35. ..-Vow
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: 10 11 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;ssperFnitjlg4/00
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61
71
C/O 1-1/2 DEEP
21
70'
180TH ST,
\\-C/O 7' DEEP
CITY OF EDMONDS SIDE SEWER AS -BUILT
ADDRESS
7024 180TH ST, SW
PERMIT
NUMBER 9551
HOMEOWNER WILCOXIN
CONTRACTOR ACORN ENTERPISE
DATE
10/01/01
DRAWN ISMAEL ABILA
BY
W) t-t�le .)Z 11 Y-)
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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).