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18116 73RD AVE W
PE11 11: 9527.
C"ity of Edmonds.. 4.
PERMIT EXPIRES #x!z '2001
"C. I oz SIDE SEWER PERMIT
Address of Construction: 16 116 —7-3 Kd Ad- Y\/ e_dmr-45 KAL111) #
Property Tax Account Parcel No. 00 7_11r 000 0 760
Attach copies of all access and utility easements Verified and Approved by
00 es cfv r-
Owner and/or Contractor: Ca Ck /,To A rV-P L/ Sa t? rX�f AENwie f -,4.s 5
. I . 11 11 , . 9 1
Contractor License ks &Q,214 XA4 Building Permit #:
OV 413 /0 ZZ
XSingleFamily Jnvasion into City *Right -of Way:. E]Yes . No
,
Multi -Family (No. of Units *RW Construction Permit
Commercial'(No. of Units Cross other "Private Pro erty: Yes -No
P
F-1 Public "Attach legal description and copy of recorded. easement.
Owner/Contr*actor (0 -
�Owneror contract -or-signature and acknowledgement statement: Date
By signing for this permit I certify that I have read the City's public handout entitled
Side Sewer Specifications; and shall comply with all City requirements outlined therein.
2 CALL DIAL -A -DIG (1-800-41q'5555) BEFORE ANY EXCAYATION 2
W FOR INSPECTION CALL 425-771-0220 e'xtensiontja�
HOUR NOTICE REOUIRED FOR ALL INSPECTION REOUESTS
. .. ...... .. .. . ... .. ......... ... .... .
... . ......... .. FOR OFFICE.USE ONLY
....... ...... .....
.......... .. .. .... . ..... ......... .
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Permit Fee $ —Repair. Fee$ Issued By:
$ Date Issued:
Trunk�lpharge
Assessment Fee $ Receipt No:
City Permit Surcharge Fee $5.00 Total Fees Pal $__36
NOTE.: IF.JOB SITE IS NOT.READY FORINSPECTION WHEN
INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED.
Initial:
Job Site Ready YES. ,NO -Date:
Partial Inspection: Date: Initial:
Partial Inspection: Date: Initial:
Initial:
FINAL INSPECTION APPROVED: Dat�e. As -built to Street, File,:
t� PERMIT MUST BE P08TED ON JOB SITEI�
White Copy:. File G,.reen Copy: Inspector Buff Copy: Applicant
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CITY
OF EDMONDS SIDE SEWER AS -BUILT
ADDRESS 18116
73RD AVE
W
PERMIT 9527
NUMBER
HOMEOWNER
CONTRACTOR K & S
DATE 08/08/01
DRAWN
ISMAEL ABILA
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