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C* of Edmonds
ity PERMIT* EXPIRE
SIDE. SEWER PERMIT
Address ofConstruction:
Property Tax Account Parcel No. Wo I (a 0
Attach copies of all access and utility easements Verified and Approved by
Owner and/ . or Contractor: "F(zFtWK S7 C-
Contractor License #: P L_`9 le �e 5 C L JdWBuilding Permit
D�,Single Family
F-1 Multi -Family (No.'of Units
D Commercial (No. of Units
F� Public
Invasion into City *Right -of Way:, EI.Yes XNo
*RW Construction Permit
Cross other '"Private Pro p*erty: El Yes XNO
"Attach legal description and copy of recorded easement.
Owner or contractor sign'alure and acknowledgement statement:
By signing for this permit I certify that I have read the City's public handout entitled
Iftide Sewer Specifications, and shall comply *with all. City requirements outlined therein.
0 1
Date
W CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EXCAVATION
W FOR INSPECTION CALL 42-5-771-0220 extension.1329 W
24 HOUR NOTICE REOUIRED-FOR ALL INSPECTION REOUESTS
NOTE:. IF JOB SITE IS'NOTKIE'ADYPOR INSPE`CT1ION' HEN
'INSPECTOR ARRIVES A $45 RE-IN`SPE.QTION FEE WIL,LBE'CHARGED.
Job Site Ready YES NO
Partial Inspection: Dqt@: Initial:
1V Date: Initial:
Partial Inspection:
FINAL INSPECTION APPROVED: Date: Initial:. As-buiIt.1tb,Str'eet File: E]
f�'PERMIT MUST BEPOSTE-:D"ON JOB S11TE"'t-,
, �11
White Copy:. File Green Copy: ln�pector Buff Co�y' 4plicant
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17909 72nd Ave W
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CITY OF EDMONDS SIDE SEWER AS -BUILT
ADDRESS
PERMIT
17907 - 72nd Avenue
West
NUMBER 94"
HOMEOWNER
CONTRACTOR
Perrinville Sewers
DATE
5-16-2001
DRAWN JiM Roberts
I BY