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PERMIT NO: 9233
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PERMIT EXPIRES
PVR N41T
Address of Construction:
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Property Tax Account Parcel No. e72� C%;� &CO 3
NOV 0 6—ZUU9--
Attach copies of all access and utility easements Verified and Approved b
Owner and/or Contractor: MALINDAr R PUBLIC WORKS.01L
Contractor License Building Permit #:
2'ISingle Family Invasion in . to City Right -of Way: [:1 Yes �o
F-1 Multi -Family (No: of Units', *RW Construction' Permit
F� Commercial (No. of Units Cross other **Private Property: 0,Yes E 2'f4 o
E] Public **Attach legal description And copy of recorded easement.
Owner/Contractor A 4_�
Owner or contracto"r si�ture and acknowledgement statement: Date
By signing for this per.mit.1 certify that I have read the City's public handout -entitled
Side Sewer Specifications, and shall comply with all.City requirements outlined therein.
W. CALLDIAL-A-DiG (1'-800-425- 1 5 . 555)� BEFORE, ANY EXCAVATION 2
A 91
FOR INSPECTION CALL 425-774-0220 extenii"bn 32 It -
24 HOUR NOTICE REOUTRED FOR A L-L INSPkCTION REQUESTS
NOTE: IF JOB SITE IS-NOTREADY FOR INSPECTION WHEN,
INSPECTOR ARRIVES A $45 RE -INSPECTION F ' EE WILL BE'CHARGED.
Job Site Ready.YES NO —Date: Initial:
71
Partial Inspection:
Partial Inspection:
FINAL INSPECTION APPROVED
14
Date: Initial:
-Date: Initial:
Date: It Cj - Q\) Initial: As' -built to Street File:*
IT MUST BE POSTED ON JOB SITE,f�
iite Copy: Fil6 Gieen Copy: Inspector Buff Copy: Applicant
L;temp-,bl dgformsssperTnitj Ig4/00
The City of Edmonds
Side Sewer Drawing
NEW CONSTRUCTION [j
OWNER.............. ............................... ...................................... ....... .
JOB ADDRESS ........ C) 5- -� -3 RA Atw, WD
.............. I --- ---------- .. .................................
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PWW-000 I - 11/75 (R EV. 11/78)
CONTRACTOR .... .....
ItEPAIRS
EASEMENTNO. ............................................
LID NO . .................. ASMT. NO . . ..... .....
PERMIT NO.
.2-.3.3
LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO . ............ ....... ...............
...................................................... ....................................................................................... .......
NAMEOF ADDITION ................. --------------------------- ---------------------------------- ................
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Approved: 1. ..
- (� ............. .........
DATE .... .... - — PQ ------------ By .............................