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18214 73RD AVE W
S'IE111 11: _02-so
City of Edmon'd
PERMIT EXPIRES
SIDE SEWER PERMIT
Address of Construction: I t2A 4 -73rJ LTID #
—775- Di!�O, C)Co CXD
Property Tax Account Parcel No. 4
Attach copies of all access and utility easements Verified and Approved,b
Owner and/or Cont - ractor: I I- L
Co
ntractor License.#: C: L 'Building Permit'#:
Mingle Family Invasion into City *Right -of Way: 0 Yes KN* 0
Fj Multi -Family (No. of Units *R)V,CoAsiruction Permit #
E] Commercial (No. of Units Cross other "Private Property: Yes No
R Public "Attach. legal description -and copy of recorded easement.
Owner /Contractor?
Owner or contracror signatur; and acknowledgement statement:� Date
By signing f6r this permit I certify that I have read the City's public hand���
Wide Sewer Specifications, and shall complywith all City requirements outlined therein.
9 CALL DIAL -A -.DIG (1-800-425-5555) BEFORE ANY EXCAVAT 11-01—N.:.2
.2 FOR INSPECTION CALL 425-771-0220 extensio0
HOUR NOTICE REOUIRED FOR ALL INSPECTION REQUESTS
NOTE: * IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A'$45 RE-INSPECTJON FEE WILL BE CHARGED.
Job Site Ready YES NO, Date: Initial:
Partial Inspection: Date: —initial:
Partial Inspection: Date: Initial:.
FINAL INSPECTION APPROVED: Date:
it 1 0 t Initial: L�&n As -built to Street File-.
t�- PERMIT MUST.13E'P,OST.ED ON JOB. SITE
White Copy: File Green Copy: Inspedor Buff Copy. Applicant
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CITY OF EDMONDS
SIDE SEWER
AS -BUILT
ADDRESS
18214 73RD AVE W
PERMIT
NUMBER 9329
HOMEOWNER
CONTRACTOR
PERRINVILLE
04/04/01
DRAWN
ISMAEL ABILA
BY
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