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18403 72ND AVE W
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PEIMIT NO:'
City of Edmonds
PERMIT EXPIRES
SIDE SEWER PERMIT
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Address ofConstruction: 4k) LuD# AN D 2)
Property. Tax'Account Parcel No. 'i - j5;1.1
Attach copies of all access and utility easements Verified and Approved by
Owner and/or Contractor:
Contractor License BuildingPermit#- AAA..,
%.1 1 pf A- IN
A�r`Single Family
Multi -Family (No. of Units
Commercial (No. of Units
Public
Invasion into City *Right -of Way: r_1 Yes 59.No
*RW- Construction Permit
Cross other **Private Property: E] Yes [;IW
.0
"Attach legal description and copy of recorded easement.
Owner or contractor signature and, acknowledgement- statement:
By signing for this permit I certify that I have read the City's public handout ent ' itled
ide Sewer Specifications, and shall comply with'all City requirements outlined therein.
Date
2 CALL DIAL -A -DIG (1 800-42,4,5555) BEFOREANY EXCAVATION W
R FOR INSPECTION CALL 425-771-0220 extension.13TGW
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REOUESTS.
NOTE: IF JOB SITE IS NOT READY -FOR INSPECTION WHEN,
INSPECTOR ARRIVESA $45 REANSPECTION FEE WILL BE CHAR';G'ED-.
Job Site Ready YES NO —Date: Initial:
Partial Inspection: Date: Initial:
Partial Inspection- Date:' Initial:
.FINAL INSPECTION APPROVED: Date: 121/02.r-Initial As-builtto Street File:
PERMIT MUST BEPOSTED ON JOB SITEtj-
White Copy: File Green Copy:, Inspector Buff Copy: Applicant
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CITY OF EDMONDS SIDE SEWER AS -BUILT
ADDRESS PERMIT
18403 72ND AVE W NUMBER 9603
HOMEOWNER HOWARD JOHNSON I CONTRACTOR ACORN
DATE 04/12/02 DRAWN ISMAEL ABILA
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DATE SENT
BOND RELEASE FORM
CITY OF EDMONDS
TO: ENGINEERING DIVISION
PLANNING DIVISION
FROM: CONNI CURTIS, ADMINISTRATIVE ASSISTANT
6
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IDENTIFICATION NUMBER (Plat, ADB, Permit)
PROJECT ADDRESS
DEVELOPER1CONTRACTOR /C&L�L IWO
TYPE OF BOND TO BE RELEASED
DATE BOND POSTED 6� 4�20 BOND EXPIRES
Please field -inspect the release of the subject bond. If there are outstanding
requirements, please note in the space provided. Failure to respond by the expiration
date constitute's approval by your division and automatic release of the bond.
1 .
9
3.
BOND APPROVED FOR RELEASE DATED
Signature
BOND NOT APPROVED (SEE OUTSTANDING REQUIREMENTS)
WORK TO BE COMPLETED WITHIN
Copy to File
Copy to Developer/Contractor
DATED
DAYS. SUSPENDED TO: _/ _/ _.
DAMy Dooffrients\Engnmg\BONDSTORMS\BNDRLSFM.DOC