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18220 72ND AVE W
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.PIRMIT, NO: 9311
City of Edmonds
PERMIT EXPIRE
SIDE SEWER PERMIT'
Address of Construction: LID#
Property'Tax Account Parcel No.
Attach copies of all access and utility easements Verified and Approved b
Owner andJor -Contractor: Pl_r ntl� V I Ce
Contractor License y r n C, Building Permit
.��Single Family
Multi -Family (No of Uni , ts
Commercial (No. of Units
Public
Invasion into City *Right -of Way: F-1 Yes
*RW Construction Permit #
Cross other "Private Property: El Yes J2<0
"Attach legal description and copy of recorded easement.
�_f SE Owner/Contractor
Owner or contractor signature and acknowledgem6nt- statement: Date
By signing for this. permit I certify that 1, have,read the City's public handout entitled
i.de Sewer Specifications, And shall.compl Ywith A City requirement's outlined therein.
9 CALL DIAL -A -DIG (1-.800-425-,5555) BEFORE ANY EXCAVAT
V
FOR INSPECTION CALL 425-771-0220 extension�OnNkr
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REOUESTS
NOTE: IF JOB SITE IS NOTREADY.-FOR INSPECTION WHEN
IN SPECTOR ARRIVES A-$45 RE-I,NSPECTION FEE WILL BE CHARGED.
job Site'Ready YES NO Date: Initial:
partial Inspect on: Date: Initial:
partial Inspection: —Date: Initial:
FINAL INSOECTION APPROVED: Date: /&—Initial: 'AOX, As -built to Street File:.'. El
t� PERMIT MUST -BE POSTED ONJOB SITE t�'-
White Copy: File Green Copy: Inspector Buff Copy: Applicant..
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