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PFRMIT NO: 4
UILY U1 i1iU111110114h
PERMITEXPIRES
SIDE SEWER PERMIT
Address of Construction: 10 /2�2 -. :7 72- A� LID # 2_1 S
Property Tax Account Parcel No. 01 (2 (04
-Attach copies of all util
_�.�ess and ity easements Verified and Approved by
Owner and/or
. Contractor License #: -
aSingle Family
Multi -Family (No. of Units
Commercial (No. of Units
Public
Invasion into tity'*Right-of Way: 0 Yes �KNO
*RW Construction Permit #
Cross other **Private Property: El Ye's KNO
**Attach legal description and copy of recorded easement.
Zgi -Owner/Con.tractor 4�_AAO
twIneror ntractor signature - &nd ackno`w i e-ag e- m-en-t -statement: Date
By signing for this permit I certify that I have read the City's public handout entitled
ide Sewer Specifications, and shall comply'.wit'h'all City requirements.outlined therein.
2 CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EXCAVATION.W.-
V FOR INSPECTION CALL 425-771-0220 extensionO V .1 �0!1
.24 HOUR NOTICE REQUIRED FOR ALL INSPECTION RE UE8TS
. ............
Permit Fee$ Repair Fee s
Trunk Charge $
Assessment Fee $
Cal �.j
City Permit Surcharge Fed $5.00. Total Fees Paid $ 7.
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION -WHEN
INSPECTOR ARRIVES,.A $45. RE-UNSPECTIONFEE WILL K CHARGED.
Job Site Ready YES�'.. No Date: Anitial:.
Partial Inspection: Date: Initial:
Partial Inspection: Date: Initial:
FINAL INSPECTION APPROVED: Date: Initial*- As -built to Stre e t File
t, PERMIT MUST -BE POSTED ON JOB SITE t
White Copy: File Green Copy: Inspector Buff Copy: Applicant
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CITY OF
EDMONDS
SIDE SEWER AS -BUILT
ADDRESS 10
18 9 72ND AVE, WEST
PERMIT
NUMBER 9343
HOMEOWNER N/A
CONTRACTOR AAA
EXCAVATING
DATE 4/10/01
DRAWN
DANIELLE GILBERT
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