18424 73RD AVE W.PDFlill 11111111
5789
18424 73RD AVE W
�,)C. I g9l
ERMIT.NO: 9436
City of Edmonds P
PERMIT EXPIRE
SIDE SEWER� PERMIT .
Address of Construction: -7 4tl-C t.J LID #
Property Tax Account Parcel-i4o. 147?�T &M .42 2 a e22r
Attach copies of all access
Owner and/
Contractor Li6e—nse #:
01S�ingle Famil�.
utility easements Verified and Approved b
r-1 Multi -Family (No. of Units
Commercial (No. of Units
F� Public
ilding Permit #:
Invasion into City *R . ight-of Way: F-1 Yes J:Ko
*RW Construction Permit #
Cross other "Private Property:, El Yes 0
"Attach legal description and -copy of recorded easement.
Owner or contractor signature and ackno w*ledgement statement:
By signinigfior this permit I certify that I have rea d the City's, public handout entitled
ide Sewer Specifications, and shall comply with all City requirements outlined therein.
Date
.9 CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EXCAVATION
V FOR INSPECTION CALL-425-771-0220 extension 329. 9
24 HOUR NOTICE REOUIREI) FOR ALL INSPECTION REQUESTS
TOR OFFICE USE ONLY .. . . ...... .. ...
................. .......
Permit Fee Repair Fee $
B ..... .... .. . .... . .... . . .. ....
Issued y J
Trunk Charge $ A1114
Date Issued:
Assessment Feel
Receipt No:
City Permit Surcharge Fee $5.00
Total Fees Paid $_195'
NOTE: IF JOB SITE.1S NOT READY FOR INSPECTION WHEN.
INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED!
Job, Site Ready YES NO Date: Initial:
Partial Inspection: Date:— Initial:
Partial Inspection: —Date: Initial:
FINAL INSPECTION APPROVED: 'Date: Initial:. As -built to Street File:. El'
f� PERMIT MUST BE POSTED ON JOB SITE t-
White Copy: File Green Copy: Inspector 'Buff Copy: Applicant
L;ternp;b1dg;forrns;ssperTnitj I g4/00