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18521 73RD AVE W
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City of Edm6hds
SIDE SEWER PERMIT
Address of Construction: hy .6
PERMIT NO: 96'38
PERMIT EXPIRES '9
I LTD
Property Tax Account Parcel No. 16 DOC) oz�5 110
Attach copies of all access and utility easements Verified. and Approved b
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Owner and/o 02 141
Contractor License L 01 V_ X_ 14� uilding Permit."k
Single Family
F] Multi -Family (No. of Units.
F] Commercial (No.,of Units
Public
1 0� "
Invasion 'Into City *Right -of Way: El Y�s M No
*RW Construction Permit #
Cross other "Private Property: 0 Yes Q,No,
**Attach legal description and'copy of recorded '6sement.
Wler or. contractof signature and acknowledgement, statern ' e ' nt:,
igning for this permit I certify that I have read the City's. public handout entitled
ide Sewer Specifications, and shall comply with all.City requirements outlined thereiin.,
9 C ALL DIAL -A -DIG (1-800-42,45555) BEFORE ANY EX
Iff FOR INSPECTION CALL - 425-771-0220 extension,13',
24 HOUR NOTICE REOUIRED FOR ALL -INSPECTION REOU
Date
CAVATION 2
FOR OFFICE USE ONLY
. .. .. .. .... .. . . . ...... .
..........
PermitFee$ Repair Fee $ Issued By:
*a "a?VECt_n')1"'j 9D. Date Issued:
Assessment Fee $ Receipt No:
City Permit Surcharge Fee $5.00 Total Fees Paid $
NOTE: IF JOB SITE IS NOT READY FOR INSPECTIONWHEN
INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED.
Job Site ReadyYES NO Date: Initial:.
Partial Inspection: Date: Initial:
Partial Inspection: Date: Initial:
Initial: 161 As -built to Street File:
FINAL INSPECTION APPROVED: Date: #I
t- PERMIT MUST. BE POSTED ON JOB SITE 1-
White Copy: File Green Copy: Inspector - Buff Copy: Applicant
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