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CITY OF EDMONDS
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Address of Construction:
Property Legal Description (Include all easements):
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SIDE SEWER - PERMIT
PERMIT3872
Owner and/or Contractor:
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State License No. Building Permit No.
❑ Single Family Invasion into City Right -of -Way No ❑Yes
Multi -Family (No. of Units ) RW Construction Permit No.
❑ Commercial Cross other Private Property: [ N,o ❑ Yes. ,
❑ Public Attach legal description and copy of recorded easement
r
I certif�fhat I have read and shall comply with all city requirements
as indicated on the back of the Permit Card.
Date
* CALL DIAL -A 1DIG (1-800-424-5555)BtFORE ANY EXCAVATION
OFFIC : USE .ONLY
*.FOR INSPECTI bN-Cia LW-�, PUBLIC W RKS DEPT.
Permit Fee: ' Issued By
Trunk Charge/A5. 06) Date Issued: 7 .A
Assessment Fee: Receipt No.: % a OZ /
.Lid No.:
Partiallnspection: Date Initial
Comments
Reason Rejected: Date -Initial -
Final Inspection Approved: DateInitial
** PERMIT MUST BE POSTED ON JOB SITE **
White Copy: file Green Copy: Inspector Bull Copy: Applicant
Revised 3190
The City of Edmonds Side Sewer Drawing i - z
EASEMENT NO . ............................................ .
4
NEW CONSTRUCTION ❑ REPAIRS ❑ LID NO ................... ASMT. NO . ..................
OWNER.................................. ----------------------------- ------------------------------- CONTRACTOR .................................................................................... PERMIT NO. 7U-3-cz.
JOB ADDRESS 11.0 ........ 3rcl ......... ).O!q
...a . .......... .......
PWW-0001-11/75 (REV.11/78)
LEGAL DESCRIPTION: LOT
NO . .........................d............. BLOCK NO. .................................. ..
�-5p.e—CJPt......1 P ...0V11e.t7.....-;- PCC/ . ..... --
NAMEOF ADDITION .......................................................................................................................
Approved:
DATE ....................
3 04 )It?
By-4 ...............................