1000 EDMONDS ST.PDFIIIIIIIIIIIIII
10928
1000 EDMONDS ST
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):_lg62,O1OD
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DA
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED: q '24 -&2
SIDE SEWER PERMIT(S) #: 0209
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
FOR:
WATER METER TAP CARD DATED:
OTHER:
LID
LOT: 192, BLOCK:
LATEMPMSTs\Forms\Street File Checklist.doc
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9CATIO , VIUILDING -PERMIT C. Appl. No.ZY --.(a
DM,ONDS Suilding Department Permit- limit, .one.:yea*. .
flON:;: is Hereby;made for a ,permit to construct the following work, in accordance with-.tht:aceom- ;
as. rai d .specifications. Two •sets :, are submitted herewith for approval. {
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a�<repair.�t7�- 1 g ...•.•. .I
. Use zone•-.. Fire. zo e..•.--• i
Const. type �f
.huh: ,.. Lod) . •.......... Ad�ldfn•��..� �
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'`_.:..:..-:. .` ..... Area.::Z.S ...L.� Septic tank..-•Q2ti!...:
Bl g` set-baeka front.... � r%....-. r. siide .-._-...7....•...-••--.•.. 1.
side--:...:.-..% rear % : `-.....:..
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Jwner'�ilJ.%»-►• '�/�
-Tel. -Ne:-�.Z
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iulder S%.o
Address-._........ •....
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Tel. No..C::..- {
Plansby...:.........••--••...••...••--------•--•-••--•--•.........---...
Addresz••••-•.........•............•••••.....
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Tel. No...:-•--= =.f
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;,.:Remarks
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----------------•---•---..........----•--'-•--•••••----..............•.
�-�The •above is" a. correct statement, and I,agree to comply with all applicable --Codes. and
.... •. .......• •....-.
State '.laws regulating this
' Signed Owner/Agent..:-. - �..-• ��. .--.. Address----- ---------------- :. Date J ...1
P.EIRMIT'-.'.forthe above work is hereby approved, subject to the above conditions;'and to compliance with:the•ap•;_
_proved plaiis.'aiid specifications, and Building Department notations. thereon.
... � ' Valuation'::.. ` ermit fee.......-..�t) ............ Recd.' by ............. ......
ildin Department j .-........ Date.- .Z...............• .
VC
--
this Permit does not cover Plumbing, Setver or Electrical installations.
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The City of Edmonds
41* APPLICATION
for
SIDE SEWER PERNTr
OUTSIDE 0 INSIDE 13 REPAIRS 0
OWNER ............ L,%) :.-V . .............Ph ............ I ................
HOUSE No . .....
.0
BACKFILL WORK ORDER ISSUED .............
SEWER WORK ORDER ISSUED - ...............
- fte-
CONTRACTOR --- .......
STREET
AVENUE LOT No . ........ / ......
NAMEADD ..................................................
Date
.............................. DEPOSIT, $.. ..... ...............
.............................
Approved:
DATE.,-.7 ..
CARD No. . ...... ...............
EASEMENT No. .......... .................... - ..........
............................. PERMIT No. N. U
I
BLOCKNo . ...................................... ............
...................I................:.:.......... .............. ........
S
/!
CITY OF EDMOND S
PUBLIC WCPM - ENGINEERING
ACTION REPORT FILE
SAP
N° 2798
SUSPENSE DATE:
Date 7 �� Timerr File #
n �.,.. r.m,....... r--1 V -
REQUESTOR: NAME:
ADDRESS: lbon �j • SV m5�/
/ PHONE: :71 — �7�
REQUEST RECEIRAMI C 11, C
TELEPHONE•
CONTACT IN OFFICE
OTHER: 0
RECEIVED
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ACTION:
I
All Concerned Notified O
Action Completed/File
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AUG:" ENTO' J
.................... ......District
City of Edmonds ---Water Department
TAP CARD
Size....`
.... ..... No .........................................
Meter
ze.................
..Tap
........ Size ...................................... . .
i
......
Mfgrs. No ............................................... Style.......................::. ........................... A .. . .....
For.............. .0.0.............E ;
........................ ......... a ---------------------------- I ---------- — -------
Lot No. 0 .................... ............ lk-
Add ...... I .........
-- -------- ---
Service Location ..........................................
. ................................................
.................................................................................................... I ..................... . ............ .
MeterLocation ................................................................................................
...................... I ................................................................................................... . ..............
MakeTap ................................................................................................................
. .......................................................................................................................... . ............
Pressure .............................. lbs. Test .................................... %
SendBills to .........................................................................................................
............................................ ..... ............................................................ .
Date of Work . .... .... .........
................................................................................................................ Foreman
Guar. Voucher No ........................................... �Remarks:
.............................................................................................. : ........
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............................. ............................
........................................................... MEET.Pi..... .. ....... . ..............
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OUTGOING Index ......... Reg ....... Route Bk ......... Stencil ...... Card .....
-INCOMING Index .......... Reg ....... Route Bk ......... Stencil ....... Card. .......