406 2ND AVE N.PDFIIIIIIIIIIII
4794
406 2ND AVE N
SIDE SEWER PERMIT.,
��,Pllll NO:
City of Edmonds.
PERMIT EXPIRES
Address of Construction:' 4 Vf'? LID #
V
Property Tax Account Parcel No. cxp on to
Attach copies of all access and utility easements Verified and Approvedb
Owner an&or Contractor: 4!g r
Contractor License #: N ti-rS &J'W" Building Permit*
53c:�
]A Single Family Invasion into City *Right -of Way: 1:1 Y,es ,FTNo
Multi -Family (No. of Units. *RW Construction Permit
Commercial (No.. of Units.' Cross other "Private Property: Yes
E] Public **Attach le n an. copy of recorded easement.
M'
Owner/Con acTor
1--j
Owner or contractoEaL,,r- �ure Q�A�owledge mient statement: Date
S
By signing �+r`sq)emir certify that I have read the City' ' public handout entitled
Side Sewer-Kpecifications, and shall comply with all City requirements outlined therein.
2 CALL DIAL -A -DIG (1-8004ZU-'�555). BEFORE ANY. EXCAVATION W.
W FOR INSPECTION CALL 425-771-0220 extension T�3061r&,
HOUR NOTICE REQUIRED FOR ALL INSPECTION REQUESTS,
..................
... . .. . .....
FOR OFFICE USE ONLY
. . . ........
.... ...... ....... .
Permit Fee $ —Repair Fee Issued'By* lid,
L T nk Charge $ Date Issued- Q )b[LD 1,
(V104 Sp.
sses-
im Unent-Fe",/ Receipt No:_
City Permit Surcharge Fee goo 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 Date: Initial:
Partial Inspection: Date: Initial:.
Partial Inspection: Date: Initial:'
FINAL INSPECTION APPROVED: Date: nitial: As -built to Street File:
t- PERMIT MUST BE POSTED"ON JOB SITE't,
White Copy: File Green Copy: Ihsped.tor Buff,Copy: Applicant
L;temp;bldgforms;sspennitjlg4/00
APPLICATION
for
The City of Edmonds SUI)E SEWER PERMIT
NEW CONSTRUCTION E] REPAIRS E] EASEMENT No . ..........................................
113-01400
OWNER---------- Raul ... JC,...-Leac4 ----------------------------------------------------------------- CONTRACTOR ................ ----------------------------------------------------------------------------- PERMIT No . ......................
ADDRESS ...... .............................. - ................ - .......... LEGAL DESCRIPTION: LOT No . ................... -------------------------- BLOCK No . ...... - ............................ — -
NAMEOF ADDITION .........................................................................................................................................
Dye Tested Oh Sewer 1972
Approved:
DATE................................................ By ..................... ................................................