18429 73RD AVE W.PDFlill 11111111
5790
18429 73RD AVE W
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PERMIT.NO:. 9230
City of Edmonds' PERMI I T EXP , IRES
SIDE SEWER PERMIT
Address of Construction: 14�42� 4.3y-d AV157'', LIIQ # R29MV E Q
Property Tax Account Parcel No. 44--�� oco czA25 NOV n 6 ?Ono
Attach copies of all access and utility easements, Verified and Approved b
PuBEie wern-K, S U L I I
Owner and/or Contractor: lst> N T�m
Contractor License#: Building Permit #:
2-`S`ingl-e Family
F� Multi -Family (No. of Units
F� Commercial (No. of Units
El Pubyb
Invasion into City *Right -of Way: F1 Yes 0-go
*RW Construction, Permit
Cross other *.*Private Property: El Yes D-90
**Attach legal de'scripti on and copy of recorded easement.
Owner/Contractbr 4/0 6
OwnetZe_r--eontrabt'b�ature and acknowledgement statement: Dat(�
By s' igning for thispermit I certify that I have read the City's public. handout entitled
Side Sewer Specifications, and shall comply with all City requirements outlined therein. Y�NWo�OD�IN -
9
W CALL DIAL -A; -DIG (1-800-425-5555) BEFORE ANY EXCAVATIONV.
W FOR INSPECTION CALL 425-771-0220 extension 329 W
24 HOUR NOTICE REOUIRED FOR ALLINS-PECTION REOUESTS'_
NOTE:. IF JOB SITE IS 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:
FINAL INSPECTION APPROVED: Date -
Initial:
-As-built to Street File:
t� PERMIT MUST BE POSTED ON JOB -.SITE T_�
White Copy: File Green Copy: Inspector Buff Copy: Applicant
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