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18035 73RD AVE W
PERMIT NO: .9338
City of El dmonds-,
PERMIT EXPIRE
SIDE SEWER PERMIT'
421
LID #
Address of Construction:- 1`0.�
Property Tax Account Parcel No. 175 �l
42
Attach copies of all access a nd utility easements Verified and Approved b
Owner and/o �cto?� kn.� T\
Contra NIS& ILN
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Building Permit
Contractor License �#Ck
Single Family Invasion into City *Right -of Way: F1 Yes RNO
F-1 Multi -Family (No. of Units *RW Construction Permit
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Fj Commercial (No. of Units Cross other "Private Property: El Yes, No
-1 r Public Attach legal description and copy of recorded easement.,
Own
ontractor
'Ir 9 ature and acknowledgement statemen
0 er or contracto si n t: Dat�.
�ni -this permit. I certif� that I have read the City's public handout entitled
y s ning for
ide Sewer Specifidations, and, A all Cit' requirementsoutlined therein.
shall comply w
y
9 CALL DIAL -A -DIG (1-800-42.5-5555) BEFORE ANY EXCAVATION iw
1W FOR INSPECTION CALL -425-771-0220 extension,
24 HOUR NOTICE REQUIRED FOR -ALL INSPECTION REOUESTS"�
. . ...... . . .....
FOR OFFICE USE ONLY
Permit Fee $ —Repair Foe $ Issued By:
Trunk Charge $ Date Issued:
Assessment Fee $ Receipt No: 17 V<:� ?z�-
City Permit Surcharge Fee
$5.00 Total Fees Paid $
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A-$45 RE -INSPECTION FEE WILLBE CHARGED.,
Job Site Ready YES NO'..-,�' Date: Initial:*
Partial Inspection: —Date: Initial,:
Partial Inspection: Date: Initial:
'.'Initial: treet File -
FINAL INSPECTION APPROVED: Date: As -built to S*
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1,� PERMIT MUST BE POSTEP ON JOB SITE t�-
While Copy: File Green Copy: Inspector. Buff Copy: Applicant
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CITY OF EDMONDS SIDE SEWER AS -BUILT
ADDRESS
18035 73RD
AVE W
PERMIT
NUMBER 9338
HOMEOWNER xxxxxxxxxx
CONTRACTOR xxxxxx
DATE
04/16/01
13RAWN
ISMA EL, ABILA
BY
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