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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