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18429 74TH PL W
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S �PERMITNQ:
City of Edmond.
PERMIT EXPIRES' 6 j Im
/�o C. I S),� SIDE SEWER*, PERMIT..,:
Address of Construction: LED #
Property Tax Account Parcel No.. 19�7wl- -��Oe
Attach copies of all access and utility easements Verified and Approved by
Owner and/or ContractorCA, 6,Lc jk T� s/ &0--`
'Of
Contractor License IVAL OD 6 -�C 6.�, _7 0 Z,� Building Permit.#:
-g�.Single Family Invasion'. into City'*Right-of Way: El Yes EgNo,.
F] Multi -Family (No. of Units *RW Construction Permit
Commercial (No. of Units' Cross.other *Private Property: -..El. Yes allo
F� Public "Attach.legal description and copy of recorded easement.
-Irk'
JZJ4,ee_�110_ W YA2�7 Own&/Contractor V
Owner or contractor signature and acknowledgement statement: Date
B si ning for thi s permit I certify -that 1. have read the. City's pub I i c handout entitled
ly 9
Side Sewer Specifications, and shall. comply with all.Cityrquirements outlined therein.
"ANY EXCAVATION:W�..
W CALL DIAL -A -DIG (1-800-425-5555), BEFORE
W FOR INSPECTION CALL 425-771-0220 exteinsion'�W. -01��w.
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REQUESTS-.-
. ...... . . ... .. ........ .
. . ..............
FOR OFFICE USE ONLY
Permit Fee $ :SjQ Repair Fee$ Issued BY:
Trunk Charge $ Date Issued:
Assessment Fee $ Receipt No: Z616 �P
City Permit Surcharge Fee $5.00 Total Fees Paid $
NOTE: IF JOB SITE IS. NOT READY FOR INSPECTION WHEN'
INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED.'. -
NO Date: - Initial:
Job Site Ready YES
Partial Inspection: Date: initial:'
bate: Initia
Partial Inspection: -
As -built to Street File:,
Initiak.
FINAL INSPECTION APPROVED: Date:
t, PERMIT MUSTBE POSTED, ON JOB SITE 't
White Copy: File' Green Copy: Inspector Buff Copy: Applicant
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CITY [IF
EDMONDS SIDE SEWER
AS -BUILT
ADDRESS
18429 74TH PL SW
PERMIT
NUMBER 9375
HOMEOWNER
CONTRACTOR
AAA'TAYLOR
DATE
04/26/01
DRAWN
ISMAEL ABILA
BY
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