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PERMIT NO: .9254
'City of Edmonds, . PERMIT EXPIRES- --qhblo.L
SIDE SEWER PERMIT
Address of Construction: 18S* 10 -7 7A, A LEDIt cQ\!5;-'
Property Tax Account Parcel No. Lf-7 72 s:- ia�o n�? So (Do OS
Attach copies of all access and utility ease I ments Verified and Approved by
Owner and/or Contractor:
Contractor License Building Permit.#:
Single Family
F� Multi -Family (No. of Units - . _)
F� Commercial (No. of Units
R Public
Invasion into City *Ri I ght-of Way: El Yes . 9<0
*RW Construction Permit #
Cross other "Private Property: F1 Yes 9_N�o
**Attach legal description and -copy of recorded easement.
Owner ' or, cont+ ctor signature and acknowledgement statement:
By signing. for this permit I certify that I have read the City's public handout entitled
Date
Side Sewer Specifications, and shall comply with all City requirements outlined therein..
9 CALL'DIAL-A-DIG (1-800-425-5555) BEIPORE. ANY EXC A—VAT.10
.9 FOR INSPECTION CALL .42'5-771-0220 extension-31,90,W /,(6,
24 HOUR NOTICE REOUIRED FOR. ALL INSPECTION REOUESTS,
... FOR OFFICE USE ONLY
Permit Fee $ -Repair Fee $ Issued By: Jr_�n*4, �R vo,
Trunk Charge $ Date Issued:
Assessment Fee $
city Permit Surcharge Fee $5.00--
ReceiptNo:- I(OP762
Total Fees Paid$_
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 —bate: Initial:'
Partial Inspection: —Date:—Initial:
ate
Partial Inspection: D t Initial:
FINAL INSPECTION APPROVED: Date: J—,2Q Initi a19�z W., As -built to Street File:
15, PERMITMUST BE POSTED ON JOB SITE t�
White Copy: File' Green Copy: Inspector. Buff Copy: Applicant
L;temp;bldg-,forms-,�sperTnitjlg4/00
V
EXEMPTION FROM CONTRACTOR REGISTRATION
VMMCATION FORM
. The undersigned Property owner or contractor has applied for a building permit from the
City of Edmonds and claims that he/she/it are exempt from providing contractor registration in
accordance with the provisions of RCW 18.27. The property owner, by their signature below
hereby verifies to the City of Edmonds that:
Value of work under $500.00. The aggregate contract price of labor and
materials and all other items required for the project is less than $500.00 and
is. not part of a larger operation to be undertaken on the property. The
person employed to do this work has 66t adverfised nor otherwise put
himself forward to the permittee to be a contractor or qualified* to engage in
the business of a contract. RCW l&27.090(9). -
Work performed personally on own property. The undersigned verifies
that all work done under this permit * will be done by the permittee personally
on his/her own property and that the, improvements constructed on the
property are not being undertaken with the intention and purpose of selling
the improvedproperty.
Commercial property exemption. The permittee is the owner of
commercial property and the owner's own employees will perform all
maintenance, repair and alteration work on the property. No work will be
done by contract under the permit.. RCW 18.27.090(13).
Licensed architect, engineer, electrician or plumber. All work performed
under this permit will be performed by an architect, civil or professional
engineer, licensed electrician or licensed plumber operating within the scope
of his or her license. RCW 18.27.090(14).
THE UNDERSIGNED PROPERTY OWNER HEREBY VERIFIES THAT ALL
INFORMATION PROVIDED ON THIS FORM IS TRUE AND ACCURATE TO THE BEST
OF HIS OR HER KNOWLEDGE AND ACKNOWLEDGES THAT IF ANY OF THE
INFORMATION PROVIDED ON THIS FORM IS FALSE, HE OR SHE UNDERSTANDS
THAT THE BUILDING PERMIT WILL BE immEDIATELy REVOKED AND ALL FEES
PAID FORFErrED.
Z 0o I
DATED this. day of 499--
PROPERTY OWNER/PERMITTEE
WITNESS:
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Side Sewer Drawing
4�
The Citv of Edmonds
EASEMENTNO . ............................................ ;
NEW CONSTRUCTION I-R( REPAIRS 0 LID NO . .................. ASMT. NO . ..................
-r NO.
OWNER...................................... ........ ................ - —.1 .................... CONTRACTOR ----------------------------- ------------------------------------------------------ PERMi
JOB ADDRESS -.15' . BLOCK NO . ...................................
,E 4,.). LEGAL DESCRIPI ION: LOT NO . ......................................
............ 7
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PWW-0001-1 1175 (REVA 1178)
NAMEOF ADDITION ..... ........................... : .................................................... -- -----------------------------
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Approved:
/7/ .............
DATE................. By ..................................