1121 2ND AVE S.PDF111111111111
4836
1121 2ND AVE S
The City of Edmonds
AA /I
APPt"ATION
for CARD No ...........
SIDE SEWER PERMIT
EASEMENT No . ....................... .................
OUTSIDE (3 INSIDE 0 REPAIRS [I
f 'A
OWNER _.9,;be
A --law . . . ..................................................... CONTRACTOR ..... .. . .. ... .. . .... ... ... PERMIT No.
(7 -7 ....
Ah STREET a0g',560'e,014S-1 O'Ut, W
1 2 &,d (
HOUSENo.04KA94f .. I ...... ........ .............................................................. AvENUE LOT'No................................... ................................ BLOCK No. ..3 ....... .......... ..................
NAMEADD &,0044�-1 . ....... ..... .. .. ....... .............. ........................
60
0
Date
BACKFILL WORK ORDER ISSUED ...........................
SEWER WORK ORDER ISSUED ..................................
................. BY.... .............
-CA&
11::PT. WE.'!, LIST
2N 4tS5':
LI+ILDING PEPNIT
II Street Pdpht-of-Way Exisfing_ 4L.10 RIND RINDL
Access Easements Existinly Mnl)
Utilitv Eascinent Existincy Pi'.O!)
C)
Lot Per
plat Assessor 1tat]
;r �► Site PI'm for Accuracy
P3
1) a. t C
stincy Pater '.'.dn
L
ffy(lrant Pen
"reo "Ir C
F.. ii Pctector (1�ccl, "cil-or Pomii-red
'1)t1C T"111": Tk::;J",,'!
Peou-i-ml
"0.ii Side Sm-er Avai)abild-
Er
S,131i t,11�1 ')'Q �:01','WCti011 I PCOId.17C(I
I C_ It i -10
J)itcI j:X4St: ],,
Culvert Pool
Catch Basin !�(,(Iuiro(l
dc.;,7 C
Nan"101c I-Cquired
(-, , "C
,Soil , Cit.iolS ' GFOL11id Field (106,Cd
" 'c� rc
Revia', by
Reouirc(I
Si.z
Indicate oil rite 111mi
111dacallo oin-. �ic P3,U)
Date
Str-. 11,1viw; 1"cou
irod
Curb wiI (-,ittc Ccidrcd
Sidcall; 'colirod
Cur') Out for Drivu-m-, Rcolil yed
Pik lit - Construction PC i Rccluirccl,
",Onc* ction "C
Boncl Pc-'Mircd for is hmprovcpients
I Ir y X, ic
Strcct N Sj _gfi Pcriiircd
-c rc icy Si-nim!' Rcmd. red
11-rc Perindt Sitc Inspection macic on 8 11-7
—7
Sci.:cr
u Mitcr
St-rcct
Engincerinp
li
Speciao l�.cquirc,,,cias listcd in mcm.o to Bui hl. i Il-
Rate
Pemit Apr
,14 1 (1 j
> JA VDatc IA)
C S tx 'I")Cd and" ""Otatic"Is �U(lc
By Date
App7-cvc(l by Puldic Rcpfftvlcllt