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18303 72ND AVE W
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PERM11 10: 9,535
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City of Edmo.nds,
PERMIT EXPIRES''
J7C. SIDE SEWER PERMIT
Address of Construction: .4) 731e9-3 Z?a.4�e ;�Py LID'#
Property Tax Account Parcel No. c42,74�1�/ 7 �,M cV 434?e90
Attach copies of all access and utility easements Verified.and Approved b
Owner and/or Contractor:
7
Contractor License #: P 1 45� Building Permit &?A
�Single Family
F] Multi-Fam.ily (No. of Units
El Commercial (No. of Units
R Public
Invasion into City *Right -of Way: Yes No
*RW Construction Permit
C . ross-other "Private Property: F-1 Yes XNO
'"Attach legal description and copy of recorde'd,.easement.
`7" Owner/Contractor
Owner or contractoi signatdre and acknowledgement statement.:
By signing f6r this permit I certify that I have readthe City's public handout entitled
ide Sewer Specifications, and shall comply with all City. requirements outlined therein.
Date
9 CALL DIAL -A -DIG (1-800-421',-It5555) BEFOREANY EXCAVATION 9
9 FOR INSPECTION CALL 425-771-0220 extension-1 4j
HOUR NOTICE REOUIRED FOR ALL INSPECTION- REOUESTS
.......... . ...... . ...
'ONLY
..........
FOR OFFICE USE
.............
. . . ... .. ..... ..
Permit Fee�$� Repair Fee $ A11A. Issued By:_.)
4gm
Trunk Charge $ 1111A Date Issued:
Assessment Fee $ Receipt No:_
City Permit Surcharge Fee $5.00 Total Fees Paid $
-NOTE: IF JOB SITE IS NOT. READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A $45-RE-I N-SPECTION FEE WILL 8EICHARGED..
Job Site Ready YES -NO —Date: Initial:
Partial Inspection: Date: Initial:
Partial Inspection: Date: Initial:
FINAL INSPECTION APPROVED: Date: As -built to Street File:
19
T� PERMIT MUST BE POSTED ON JOB SITET.�
White.Copy: File Greeh'Copy: Inspector Buff Copy: Applicant,
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CITY OF EDMONDS
SIDE SEWER AS -BUILT
ADDRESS
18303 72ND
AVE W
PERMIT
NUMBER 9535
HOMEOWNER xxxxxxx
CONTRACTOR PERRINVILLE
DATE 08/16/01
DRAWN
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