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18007 72ND AVE W
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1E11T NO:
City of Edmonds. RES
PERMIT 9XPI
SIDESEWERPERMIT
Address of Construction: 19M 7 7o?Azn 7A 1/11 LH
DUD 00
Property Tax Account Parcel No..7 11 V+
Attach, copies of all access aind utility easements Verified and Approved by.
d/or Contractor: eluton
Cdntractor License Building Permit #:
XSingle Family
F� Multi -Family (No. of Units
Fj Commercial (No. of Units:
F-1-Public
Invasion into City *Right -of Way: 0 Yes kNo
*RW Construction Permit
Cross other "Private Property: El Yes'- No
'"Attach legal description and copy of'i&ecorded ement
Owner/Contractor
Owner or dontractor signature aAd VKnowledgement statement:
By signing for this permit I certify Riat I have read the City's public handout entitled
ide Sewer Specifications, and shall comply with all City requirements outlined therein.
CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION'W';
W FOR INSPECTION CALL 425-771-0220 extensi O'n-13ZW
24 HOUR NOTICE REOUIAED FOR ALL INSPECTION REOVE TS
...... FOR OFFICE USE ONLY
. .... ....... .
............
Permit Fee Repair Fee Issued By:
Trunk Charge $ Date Issued: 44 1 el 0-1
Assessment Fee Receipt No:
City Pe�mit Surcharge Fee $5.00 Total Fees Paid $
�,N.OTE: IF JOB SITE IS NOT READY FOR INSPECTION. WHEN..-''
'
INSPECTOR ARRIVES A $45 RE -INSPECTION FEEWILL BE CHARGED.
Jbb Site Ready YES NO Date: Initial:
Partial Inspection:. Date: Initial:
Partial Inspection: Date: Initial:
7
, :16, As�-builtto Street File:
.7/
FINAL INSPECTION APPROVED: Date: Initial:
_j
1; PERMIT MUST *BE;POSTED ON JOB SITE t�
White Copy: File Green Copy, Inspector Buff Copy: Applicant
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THIS IS INSIDE 61
THEIR HOME
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BACK OF THE HOUSE
CITY [IF EDMONDS SIDE SEWER AS -BUILT
ADDRESS
180.07 72ND
AVE W
PERMIT
NUMBER 9514
HOMEOWNER xxxxxxxxxx
CONTRACTOR xxxxxx
DATE
07/30/01
DRAWN
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