1036 EDMONDS ST.PDF1036 EDMONDS ST
ADDRESS: IO'210 Ed S S1I�.C�I
TAX ACCOUNT/PARCEL NUMBER: G04&�20410 10m
BUILDING PERMIT (NEW STRUCTURE): �`75
COVENANTS (RECORDED)
CRITICAL AREAS: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (OTHER):
PLANNING DATA CHECKLIST DA
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
OTHER:
LID #: LOT: I BLOCK: 41
LATEMP\DSTs\Forms\Street File Checklist.doe
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT EASEMENT No............
NEW CONSTRUCTION p REPAIRS
118-02050
OWNER...........Upy.d._H.._.Claric............................................................. CONTRACTOR....................................._............._............................................_. PERMIT No.......................
ADDRESS -------1036 EdmOndS..$t.......................................................... LEGAL DESCRIPTION: LOT No............................................... BLOCK No.............................................
s
•
Imi
0
NAMEOF ADDITION...........................•................•.............................................................._.............................
Dye Tested Oh Sewer 1972
Approved:
DATE................................................ By............................................_........_................
Side Sewer Drawing
The City of Edmonds EASEMENT NO- ................ -----------_-------------
218-02050 NEW CONSTRUCTION E] REPAIRS E] LID NO . ............... _ ASMT. NO - ------------------
OWNERJ�PP. W -CLARK .............................................................. CONTRACTOR ..................................................................................... PERMIT NO. ....................
JOB ADDRESS ---- 1036 EDMONDS ST
. .................................. ............................................ LEGAL DESCRIPTION: LOT NO . ......... ---------------------------- BLOCK NO. ...............................
..................................................................................................................................................................
•
NAMEOF ADDITION .......................................................................................................................
0
PWW-0001-1.1/75 (REV.11/78)
DYE TESTED ON SEWER
Approved:
DATE............................................ By ....................................................