21601 84TH AVE W (2)1111111111111115403
21601 84TH AVE W
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CITY OF EDMONDS
RMIT s00 9134
Address of Construction: /� d 1 04- V r o
Property Legal Description (Include all easements):
VIA EDR40NCS
V./Ay :I
Owner and/or Contractor: 40
State License No. -tA L(7'rc Building Permit No. q� 7 6'
❑ Single Family Invasion into City Right -of -Way: ❑ Yes
❑ Multi -Family (No. of Units ) RW Construction Permit N .
T �ccmmercial Cross other Private Property: No ❑ Yes
�u Attach legal description and copy of recorded easement
f
I certify that I have read and shall comply with all city requirements
as indicated on the back of the Permit Card.
Date
* CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION *
I OFFICE USE ' ONLY I
* FOR INSPECTION CALL 771=9292, PUBLIC WORKS DEPT.
' 12
S-
Permit Fee:Issued By
Trunk Charge: Date Issued:
Assessment Fee: Receipt No.:
Lid No.:
ex (✓G G /T 3—/yo
Partial Inspection: S /' �� �'_Tz� wG / Date Ynitial
Commen s ep •//_ T-b �9zGc�
Reason Rejected: Date Initial
Final Inspection Approved: Date 13,00 Initial
** PERMIT MUST BE POSTED ON JOB SITE **
White Copy: File Green Copy: Inspector Buff Copy: Applicant
Revised 3190
NOTICE:
No.warranty OT aCC-- -
The .inf®rmatio
n shown on the attached
map(s) was compiled for use by the City of
Edmonds,, its Employees and Consultants.
-� �Edm.gnds does not warrant the
Thy City ®. .
c of anything set forth on these
accuracy Y
map(s). An person or entity -requesting a
Y
copy should conduct an independent
inquiry regarding the information shown on
- _fie -map(s), including, but not limited to,
the to
cation 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
emp y
-- t o- e e- s o -r o f �� i c e .r s hl- l be Va- b _I..e for t h e
informationgiven iven on this map(s), nor for
any one representation provided based
upon said map(s).
The City of Edmonds Side Sewer Drawing EASEMENT NO . ............................................t
t t
NEW CONSTRUCTION REPAIRS F-1 LID NO ................... Awn NO . ..................
OWNER ..... � ............ 5 �!:?.O./ ....... 0671.0z77 CONTRACTOR .................................................................................... PERMIT NO.
JOB ADDRESS ...... al.G.D.J ...... OY.7-94 ... 4. . J_ ...... ..................... LEGAL DESCRIPTION: LOT INO . ...................................... BLOCK NO. .................... ...............
C,
40�
1
O
'Al
a /
PWW-0001-1 1/75 (REV.1 1/78)
NAMEOF ADDITION ..................................................................................................... .................
O (Ilk,
O1
U, 5 (t
Approved: 04 3 -1d -ccA,,,d
DATE..... 3_7 /0.70 ............. By .... ...... --------------------