18021 70TH PL W.PDF111111111111
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18021 70TH PL W
1, 44'
PERMIT NO: 94,48.
'City of Ediiio'' d - §
S 01.
PERMIT EXPIRE
SIDE SEWERPERMIT.
ts.
Ad dress of Construction: L,) LID#
Property Tax Account Parcel No. 501A (a. oox� iDo (37
Attach copies of ayaccess and utility easements Verified and Approved b
Owner and/or eontrac9tor: :b5_CQjA W-WOPE!
Contractor License #: 01412_/�A. uilding Permit
E],Single Family Invasion into City *Right -of Way: El Yes CR<o
El Multi -Family (No. of Units *RW Construction Permit #
Commercial (No. of Units Cross other "Private Property: El Yes,' 2"No
Public "Attach legal description and copy of recorded, easement.
Owner/Coflt�ractor)
Owner. or contractor signature and ac,knowledgement statement: Date,
By signing for this permit I certify that.1 have read the City's'public handout entitled.
ide Sewer Specifications, and shall comply with all City requirements outlined therein.
2 CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EXCAVATIOXV
9 FOR INSPECTION CALL 425-771-0220 extension:329'9
24 HOUR NOTICE REOUIRED FOR ALL IN9PECTION REQUESTS
......... . . . . .........
FOR OFFICE USE ONLY
......... . .
Permit Fee $ Z—A-i Repair Fee Issued By: 771
U. 4Trunk Charge $ Date Issued:
Ir T(P 0
Assessment Fee $ Receipt No.
City Permit Surcharge Fee $5.00 Total Fees Paid
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES.A $4.5 RE-INSPE.CTION FEE WILL BE*CHARGE.D..
Job Site Ready�YES NO --Date: Initial:—.,
Partial Inspection: Date:. Initial:
Partial Inspection: Date: Initial:
Initial As-built.to Street File:
TINAL INSPECTION APPROVED: Date:
1,� PERMIT MUST,BE-POSTED:ON JOB Sl TE t�
White Copy: File Green Copy.' Inspector Buff Copy:. Applicant.
L;temp;bldg;.forins-,sspermitjlg4/00
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