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City of Edmonds PERMIT NO: .1111
SIDE SEWER PERMIT PERMIT EXPIRE
Address of Construction: 1 (AJ LID #
Property Tax Account Parcel No. Lri-a5 (--)u c) 0 1 `3 0 C) c)
Attach copies of all access and utility easements Verified and Approved by -
Owner and/or Contractor: -D U-.$ ~'T a N L
Contractor License #: M�ZwA-ILK_S o
Ksingle Family
M Multi-Farnily (No. of Units
Commercial (No. of Units
Public'
uilding Permit #: . `-
Invasion into City *Right -of Way: 0 Yes
*RW Construction Permit #--
[?lQN0
Cross other "Private Property: El Yes �r.No
"Attach legal description and copy of recor ded easement.
Owner/Contractor I
Owner or contractor signature and acknowledgement statement: Date,
By signing for this permit I certify that I have read the City's public handout entitled
ide Sewer Specifications, and shall comply with all City requirements outlined the,rein.
2 CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EX'k,'�_ AT110N`W
V FOR INSPECTION CALL 425-771-0220 extensiopZ55"im
24, HOUR NOTICE REOUIRED FOR ALL INSPECTION REOUESTS
........ ..........
...............
...... % .-FOR OFFICE USE ONLY.
Repair Fee
......... ...
P ermit Fee Issued By:
Trunk Charge $ Date Issued: al LJU
Assessment Fee $ Receipt No:
$5.00 Total Fees Paid $
City Permit Surcharge Fee
NOTE: IF JOB SITE IS NOT READY FOR IN.SPECTION WHEN
INSPE CTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED.
Job Site. Ready YES - NO —Date:—Initial:*
Partial Inspection: Date: Initial:
Partial Inspection: Date: Initial:
Initial: As-builtto Street File:
FINAL INSPECTION APPROVED: Date:
t� PERMIT,MUST BE POSTED ON JOB SITE
White Copy: File Green Copy: Inspector Buff -Copy: Applicant
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CITY OF EDMONDS
SIDE SEWER AS -BUILT
ADDRESS
18402 72ND AVE W
PERMIT
NUMBER 9322
HOMEOWNER xxxxxxxxxx
CONTRACTOR xxxxxx
DATE 04/0.�/01
DRAWN
ISMAEL ABILA
BY
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