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1101 EDMONDS ST.PDFiiiiiiiiiiiiii 10941 1101 EDMONDS ST ADDRESS: I ( U I . E:A"()Nd5 7iL TAX ACCOUNT/PARCEL NUMBER: QD5C�j I OODDD600 BUILDING PERMIT (NEW STRUCTURE): Iq6 o3 g COVENANTS (RECORDED) 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: — SIDE SEWER PERMIT(S) GEOTECH REPORT DA' STREET USE / ENCROACHMENT PERMIT #: FOR: WATER METER TAP CARD DA' OTHER: LID • BLOCK: - L:\TEMP\DSTs\Forms\Street File Checklist.doc a A PLICATI#4 & WORK PERMIT, .y.QQ Application No. ....1....'.ti ' CITY ' OF EDMONDS Building Department Permit Limit, One. Year O N, is hereby, made for a permit to construct the following work, in accordance with the accompanying. plans ms:.'.' 1 �v/,Addn.-.— Xf.0 GroundL ......................................... . ............ Area. ...... o. Stories ..,.: yd� ( _..._..._.......................... ...... _...... Const Type.... --...... ............. Height ................. Address _.1 �.._..........--•---..._ ... ......._. Usa Zone............1/ Fire Zone .................... �L.�u p� 3 . +;,�:::._'.Block_..._..----•----... Add'n '1 ... ..._.................._.................. Sewerage..,_............................... ........ ............ �,v ' Width_.4._1................ Min. Bldg. Setbacks, Front and Rear. .�.......:�........... Side&......... Z_... . y0 Address.._. _ _._ .._. 1..._... Phone......... 4�...:3� U —------- ............................ _. Address --- --- ._....... _.......... _...... _......... ................... Phone ....................... _....... i The above is a correct and I7Qgree to comply Address...... .w_.......... ..... ........... ............. ....... _........... Phone ....................... _....... Address.................... ._........... Phone ....................... _....... Address Address. ......... _..................... _.............. Phone....... ....... Phone ............. Codes and State Laws regulating the work. Signed: Owner/Agent.. ..... .......... I... .................... s--- ... �.................. ..................----............. Date........ PERMIT for the above wo is hereby approved, subject to the above conditions, and to compliance with the approved playas and specifications and Building Department notations thereon. VALUATION PERNW FEES $ ............................_....... Bldg. .... $... APPROVED: Date........ .............6.. ....................... BUILDING DEPARTMENT By....i9D... ., Herbert . . .,: ...Bld ...... ....... .•--............... ... Plbg.$... 1.....1.............................. Heat. .. .$...... 3............................ Elect. ...$........................................ Others... $........................................ TOTAL FEE j�� .....1.•s NOTES: No work requiring Building Department or City Engineer's hispection shall be covered before inspection and approval. Twenty-four (24) hour notice requested. Contact the City Engineer prior to construction of all site utilities, such as APPLICATION CARD No . .................... ... .... . . ... for The City of Edmonds SIDE SEWER PERMIT EASEMENT No . ........ ............. ....... ........ .. OUTSIDE 0 INSIDE 0 REPAIRS 0 0 9 BACKFILL -SEWER W Date Approved: K ORDER ISSUED ............................................ DEPOSIT, $ ...................................................... ORDER ISSUED ................................................ .......................... DATE ................... BY ... t�/X`Y.'e .... I .......... i