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PERMIT NO: 91437
City 'of Edmohds
PERMIT EXPIRES 6'1
SIDE SEWER PERMIT,
Address of Construction: LID #
Property Tax Account Parcel No. 06
Attach copies of all access and utility easements -Verified and Approved b
Owner and/or Contractor:
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Contractor License 0 141A-z' 44&-� u-ildi , ng Permit #:
DrSingle Family Invasion into City *Right -of Way: El Yes .[�`No
F-1 Multi -Family (No. of Units *RW Construction Permit
(No. of Units Cross other "Private Property: El Yes Z No
"Attach legal description and copy of recorded easement.
E] Public
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Owner/G6ntractor
-Owner or contractor signature and acknowledgement 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..
W CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANYEXCAVATION W
FOR INSPECTIONfALL 425-�771'0220 extension:329 W
24 HOUR NOTICE REQUIRED FOR ALL INSPECTION REQUESTS
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A $4.5 RE -INSPECTION FEE WILL BE CHARGED,
Job Site Ready YES NO —Date:_Irlitial:
Partial Inspection: Date: Initial:
Partial, Inspection: Date: Initial:
FINAL INSPECTION APPROVED: Date- Initial: As -built to Street File:
t� PERMIT MUST BE POSTED ON JOB SITEI,�
White Copy: File Green Copy: Inspector Buff Copy: Applicant
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MIKE- NO WARRANTY OF ACCURACY The Information sho on the
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Vached map was compiied for use by the City of Edmcnd;3, iL",
ano, consultants. The City of Edmonds does not warrant th,3 v.-� of
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t1k location shown, Neither the City of Edmonds nor its employ -a -es cr
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