18213 73RD AVE W.PDFlill 11111111
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18213 73RD AVE W
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*RW Construction Permit
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Cross other "Private Property: El Yes e
"Attach legal description and copy of recorded easemetit.
Owner or contractor signature and acknowledgementstatement: Date.
By sigging for this permit I certify that I have read the City's public handout entitled
Oide Sewer Specifications, and shall comply with All City requirements outlined therein.
2 lll�ALL DIAL -A -DIG (1-800-41i
$;-5555) BEFORE ANY EXCAVATION.
W FOR -INSPECTION CALL 425-771-0220 extensioniala_,,W/3��`�,
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REQUESTS p.
.1,7 C. I S Tj
NIV.
nAMIT NO: 94131
City of Edmo'n'4 �1
SIDE SEWER PERMIT EXPIRE
Address of Construction: '73 Avc (.Aj LED #
Property Tax Account Parcel No. �Z2 Z a - 40 - z9 II'd - ek'2- e
Attach copies of all access and utility easements Verified and Approved by
Owner and/or ontractorc roo tzi Ile r&c)e, P 5 C3.k"\
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Contractor License r r i uilding Permit
L'Single Family Invasion into City *Right -of Way: El Yes 2rNo
R Multi -family (No. of Units
E] Commercial (No. of Units
Fj Public
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN -
INSPECTOR/�RRIVES A $45, RE -INSPECTION FEE WILL BE CHARGED.
Job Site Ready 11 YES NO, Date:-., Initial:
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Partial Inspection: 5g216 NO-T -49J.Uj?jM Date: Initial:
Partial Inspection: Date: Initial:
FINAL INSPECTION APPROVED: Date: t"I h, I. Initial: M-built to Street File:
t� PERMIT MUST BE POSTED ON JOB SITE
. WhiteCopy: File 'GreenCopy: Inspebtor Buff Copy: Applicant
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CITY. OF
EDMONDS
SIDE SEWER AS -BUILT
ADDRESS
18213 73RD AVE W
PERMIT
NUMBER 9 413
HOMEOWNER JOHN
CONTRACTOR PERRINVILLE SEWER
DATE
04/2�/011
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