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18025 70TH PL W
City of E&JnLo
QT"U QUAVrD 113VDN/tlrr
44C 9 1
Address of Construction:
PERMIT NO: .94,38
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PERMIT EXPIRES
LUD #
Property Tax Account Parcel No. c5oq(.e Doo C) O� C1 0 0
Attach copies of all access and utility easements Verified and Approved b
Owner and/or Contractor: 4�CCTQP Etz�izts c-5
Contractor License #: Aco-9-p-sa -*(D-K �z 7, ding Permit #
E�rSingle Family Invasion into City *Right -of Way: E]Yes L2<No
F! Multi -Family (No. of Units r"D *RW Construction Permit
F� Commercial (No. of Units Cross..other "Private Property: El Yes 21"No
Fj Public **Attach legal description and copy of recorded easement.
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Owner/C
Owner or contractor signature and acknowledgement statement: Date J
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 EXCAVATION' W.
W FOR INSPECTIONCALL 425-771-0220* extension 329 W
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION. REQUESTS
.... . .... FOR OFFICE USE ONLY. . .......... .
.... ....... . .
Permit Fee Repair Fee .,Issued B
Trunk Charge $ Da te Issued:
Assessment Fee Receipt No:
City Permit Surcharge Fee $5.60 total Fees Paid $
NOTE IF JOB SITE IS NU READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A $45, RE-INSPECTI.ON FEE WILL BE QHARGED.
Job Site Ready.YES NO Date: Initial:
Date: Initial:
Partial Inspection:
Partial Inspection.: Date: Initial:
FINAL INSPECTION APPROVED: Date: Initial:. As -built to �treet File:
15, PERMIT MUST BE. POSTED ON JOB SITE 1,�
White Copy: File Green Copy: Inspector Buff Copy: Al3plicant
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