1355 6TH PL S.PDF1355 6iH PL S
c' j ,
The City of Edmonds
APPLICATION E
ay�T FILECARD No . ..........................................
for T'
SIDE SEWER PERMIT
OUTSIDE 'CI INSIDE ❑ REPAIRS ❑ EASEMENT No . ..........................:.. ...........
L .._....... C d' R 7-
OWNER PERMIT No. ...... ...
...... �t..:.;..:... :.................... . y E.... ............................... ONTRACTOR I'V� S
f �/ STREET
HOUSE No. ...... �:...._ .....1.....:..�..f3...........` ............................... AVENUE LOT lo....�...!......:...........................................
. ........... BLOCK No ........................................................
NAME "ADD ....................... ....,.......................................... :...... ........................................................... ..................................
:...
9
Date Approved:
BACKFILL WORK ORDER ISSUED ............................................ DEPOSIT,$........................:............................. G
SEWER WORK ORDER ISSUED ................................................ DATE... .................. BY ..
PROVED
�10- 1962
lit par r
f CITY OF EDMONDS
890 19
Address of Construction
SIDE SEWER PERMIT
13 s s- (o 7N P k Ja 0-Nl
PERMIT i',"2 9006
EDMONDS
Property Legal Description (Include all „ easements): � Vr �CA�A7V_Y,-5�;V y s' �0w�i
�? C �P
Owner and/or Contractor:
State License No. L L— 1-7-
i) V R T,� �Building Permit No. FFP 6
PUBLIC WORKS D
EPl
Single Family
❑ Multi -Family (No. of Units )
❑ Commercial
❑ Public
Invasion into City Right -of -Way: No ❑ Yes
RW Construction Permit No.
Cross other Private Property: k7No ❑ Yes
Attach legal description and copy of recorded easement
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 *
OFFICE USE ONLY
* FOR INSPECTION CALL 771-3M, PUBLIC WORKS DE
oa.RS'
Permit Fee: (D U Issued By L,6L_a�
Trunk Charge:. Date Issued: 7
Assessment Fee: Receipt No.:
Lid No
Partial Inspection: Date Initial.
Comments
Reason Rejected: �� Date Initial
Final Inspection Approved: Date�9lnitial /�- li
** PERMIT MUST BE POSTED ON JOB SITE **
White Copy: File Green Copy: Inspector Buff Copy: Applicant
Revised 3 90
Side Sewer Drawing
The City of Edmonds EASEMENT NO- --------------------------------------------
NEW CONSTRUCTION ❑ REPAIRS k�— LID NO ................... .ASMT. NO. ...................
OWNER............................................................•----.......------...--............. CONTRACTOR---....--.....:-•--•---............................................................ PERMIT NO. 00. ...
/ 4-4
JOB ADDRESS ..1.3.-5 .. 1(� ..................... ................ LEGAL DESCRIPTION: LOT NO. ...................................... BLOCK NO. ......----------------......--
4
` kxi:�;ft
('onc9
PWW-0001-11/75 (REV.11178)
--------------------------------.............................. •......................................................................................... ........
NAMEOF ADDITION-------------------------------------------------------------------------------- -------------------------------------
N
All t- o. n P_ r r okT
debt
EDMORM
TREATMENT PLANT
Approved:
DATE .o�.- . . 99 .................. By .. �!.v`...//..----------........------....