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18013 73RD AVE W
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City of Edmon, (ds
SIDE. SEWER PERMIT
Address of Construction:
Property Tax Account Parcel No
Attach copies of all access and utility
Owner and/or Contractor:
Contractor License #:
5�4-Single Family
11'� " -
F� Multi -Family (No. of Units
Commercial (No. of Units
Public
PERMIT. NO; 93,82
PERMIT EXPIRES 0/
1. A'. 71 '1)
&4*4� Verified. and Approved by
Iding Permit #:
Invasion . into City *Right -of Way: FI Yes
*RW Construction Permit #
Cro I ss other "Priviate Property: El Yes No
**.Aftach legal description and copy of recorded easement.
U&dW,��e�r'_/C�on�tracfor; -%4 0j
Owner or dontractor-signature and i-cknbwledgement statement: T)afe I
By signing for this permit I certify that I have read the.City's public handout entitled
ide Sewer Specifications, and shall comply With all City requirements outlined therein.
9 CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY E-XCAVATION 2
Iff FOR INSPECTION CALL 425-771-0220 extension 329 9
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REQUESTS
...... ...........
........ .. . ...
.. ..... ....
..... . ........ . . ...... FOR OFFICE USE ONLY
. . .. ...... ... . .. ...... ...
... . ............... .. 26 Issued By
Permit Fee epair Fee
Trunk Charge $ Date Issued:.'
let -
Assessment Fee Re*celpt No: 7
City Permit Surcharge Fee $5.00 Totalfe es Paid $
NOTE: IF JOB SITE IS NOT READYFOR. INSPECTION WHEN
INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED.
Job Site Ready YES - NO —Date: Ihitial:
P p
artial Inspection: Date:. Ini
Partial Inspection: -Date': Initial:
FINAL INSPECTION APPROVED: DaW Initial:- As -built to Street File: E]
15, PERMIT MUST BE POSTED ON JOB SITEt,
White Copy: File Green Copy: Inspector' Buff Copy: Applicant
L;temp;bldg;formssspennitjlg4/00
Nl()*pr.f:: �Vl Or' ACCURACY Thn Informplir', Ph -in on the
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use by l'o CiL ol Vmi- li^la
V- fr",lh 0', map, Any c, I,.
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W-7
Cleanout and 1/8 Bend
18" Deep
18013 73rd Avenue West
2 V
73rd Avenue West
---,A4" Inspection Tee and 6" Riser
5' Deep
CITY
OF EDMONDS SIDE SEWER AS -BUILT
ADDRESS
PERMIT
18013
73rd AvenuE? West
NUMBER 9382
HOMEOWNER
CONTRACTOR B&M Contractors
DATE 4-23-2001
DRAWN Jim
I
R oberts
BY