22219 76TH AVE W.PDFIIIIIIIIIIII
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22219 76TH AVE W
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.PERMIT NO: i �0, "',
PERMIT EXPII�Xs
Address of Construction: ti-) L&A" W flUD #
Property Tax Account Parcel No.
Attach copies of all access and utility easements, Verified and Approved b
Owner and/or Contractor:
Contractor License Re:�,Lug*0910,7 lh-lng, B . uilding Permit
El Single Family Inva N into City *Right -of Way: El Yes. KN 0
P);�-Ivttilti-Family l(No. of Units *RW Construction Permit
Commercial (No.. of Units Cross other ."Private Property: El Yes IR No
Fj Public **Attach legal description and copy of recorded easement.
Owner4ntra�cfo
Owner or contractor'signature and acknowledgement statement: f Date'
By signing for this permit I certify that I have read the City's public handout entitled
ide Sewer Specifications, and shall comply with all City req6irements outlined therein.
y
9 CALL DIAL -A -DIG (1-8004ZY-5555) BEFORE ANY EXCAVATION 2
W 'FOR INSPECTION CALL.425-771-0220 extension
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REQUESTS
Repair Fee $ Issued'13y:
FOR OFFICE USE ONLY
Permit Fee$
TO Date Issued:
Assessment Fee $ Receipt No:
City Permit Surcharge Fee, -$5-00-1_q, To6l Fee's Paid$_
NOTE: I.F JOB -SITE IS'NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED.
Date:-
Jo'b Site Ready YES NO* Initial:
Partial Inspection: Date: Initial:
Partial Inspection: Date: Initial:
is FINAL INSP*ECTION APPROVED: . Date: .-316,10tlo Init I ial:,--ZP At -built to Street F!17AAZ� r—*
oil . _0112306
City, of.Edinonds
SIDE SEWER PERMIT
-POSTED ON JOB SITE1/-
�,PERMIT MUST BE
White Co File
py: Green Copy: Inspector Buff Copy: Applicant
L;temp;bldg;forms,ssperTnitjlg4/00