21408 HIGHWAY 99IIIIIIIIIIIIII
14028
21408 HWY 99
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CITY OF EDMONDS
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890 19 o
Address of Construction: -�?,
Property Legal Description (Include all easements):
Owner and/ r cintrac� .
State License No.
❑ Single Family
❑ Multi -Family (No. of Units )
Commercial
❑ Public
SIDE SEWER PERMIT
PERMIT s `? C°]
Building Permit No
Invasion into City Right -of -Way: ❑ No ❑ Yes
RW Construction Permit No.
Cross other Private Property: ❑ No ❑ Yes
Attach legal description and copy of recorded easement
I certify that I have read and shatftomply with all city requirements
as indicated on the back of the Permit Card.
le � 9
Date
* CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION *
I OFFICE USE ONLY
* FOR INSPECTION CALL 771-, PUBLIC WORKS DEPT.
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Permit Fop lJ/Q �- Iccttpri R ' C6& 7 nVlf
Trunk Charge: Date Issued:
Assessment Fee: Receipt No.:
Lid No.:
Partial Inspection: srn It Cio' ,- Cogo--- Date ff-_�tJ- Initial C• C
CommentsS� Y- 7cS r
Reason Rejected: Date Initial
Final Inspection Approved: Date i- —On Initial
** PERMIT MUST BE POSTED ON JOB SITE **
White Copy: File Green Copy: Inspector Bull Copy: Applicant
Revised 3/90
The City of Edmonds
Side Sewer Drawing
EASEMENT NO. ............................................ L
NEW CONSTRUCTION JX REPAIRS ❑ LID NO . .................. . ASMT. NO. ..................
OWNER............ ........ .J7/`-/may--...?-- -f .............................. CONTRACTOR.............•----.....----.._...._....---•--.._.........---.........-•--•-•---..... PERMIT NO.
JOB ADDRESS .........T%.�" -}`q T ............................... LEGAL DESCRIPTION: LOT NO. ...................................... BLOCK NO. U %
ee
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NAMEOF ADDITION.........................................................................................•-----•._..__.._.._......__...
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Approved: QAr•T G ( I/- 130- yy —eaJ CAI i 7-1ST
PWW-0001 -1117(REV.11/78)
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DATE .. !-R :a ° BY� Goa? ------------------------------