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ADDRESS: I I c,� .,C.. AeAu ci
TAX ACCOUNT/PARCEL NUMBER: 005cAZcc)C� 1`--�OO
BUILDING PERMIT (NEW STRUCTURE): 101 Uoct 3% C k0asx, mthtm - 1" -Icc�
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:
DISCRETIONARY PERMIT #
DRAINAGE PLAN DA
PARKING AGREEMENTS DATED:
EASEMENTS) RECORDED FOR:
DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
PERMITS (OTHER): I q LADD4 33CCARAORA .1
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID #:
SHORT PLAT FILE: LOT: I —+ BLOCK: 2
SIDE SEWER AS BUILT DATED:(D ' ID - C010
SIDE SEWER PERMIT(S) #: 14 ( Z
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
LATENINDSTsTonns\Street File Checklist.doc
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q ADD DEmr,L lm I' PENCE I DP.IIOI.ITION
m xUM7>8.et Or d I PERMIT PEE
ALTER REeIDENTLtL I Dw1:LLL\a PLAx CHECK :�•+ ' I ••, .lt?�5•y'p Tye
❑UNITE I FEE -
REPAIR NON.REB=JENTIAL I `.� ( Va
PROPOHBD U9E. I / I AMOUNT DUE ' _8� -'ram' • t .. �.�y��f{ L^:t:.� '4' ., j
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u, \DDInBo : t t>uI m ATTpxTlox Nt PUCATION: APE'RO!JAL 4 tr� )
\eltnowled6e tent I tore read - D \ �"�tb 7,'`
form\Uon R:+en u correct: u,.'tnAt I em the owner.. or the dnlr \arbor iiCatlOn 18 net a permitTFHq
tsM \Rent of tIIe owner. I \Rree to comDl7 with mot" "ntnerner. no\petwn A::THORIZEST signed bythei:!rector of Building
Thl
i�,` lr.ukE.�
I\ByR rondtraeBon; wad m domR the wont \,LU•orlxed
WORK NtYtBD t1on, or his dei,utY; and fees are paid; and
"Uill t emDlored In Ttot\tlen , f the lanor G.Ee of the 8twte of Wedhlr.Rton O.tf.Y TIIff receipt is acltnowledged in'space provided
rawtlnR to Wortfmco CemDene><.tlon J:.ar\na. _
:! 1 Vr• IN
(EtC<Pt Demolll ons whlcl, QiNi } r
NOTE: rmit 1 i:10 oil Year k eted nl �r
IIPECTION Dtay.C'rOR'S S1GNA
91GNA IUWA: F:t OR AO T) ATE SIGNED , ,/ s ,f S _
DEPARTMENT
n .., , i ' t
r e CITY OF
ATE, / .� � •`Yt':tj. �'')-r: ,:f�4'h'"yr'X: ..+t `
EDKO"S ✓ s -� lrfti:'. .
p N o
do Cbeck Fee '
! TE: Applieont Subject to PR M1I07
done on prlvnte DroDM7 ONLY. DILB L••�!•.
TTIf Permit MTeT\ wura to D< Idefr\II�. drt,ew"s. .. "••
ou the public doruuln (carp. Dern,ledm, ', . -�
Ant Nnetmet:m etc.) .''• `. •,
+r - nnupnlesr will r ;od fepar\t< E^ : •_,,
4
.........
• ''I
IMPORTANT! Press Firmly While Writing Application! .
� ,( �C)
' APPltcant Plil •_ NUMBER LVi � I
Building Re notion Per I� Ins}de IleavS Lines B E AD RE '
OWNER'S NAME •J ._./�' �% J.n `y C li) t`.. r t_r� �� 1 . ' ,l
-
ADDRESS
t EDMONDS PRp;.MOV.E
PCT
ERMIT NO.
& EL NO. HLDO. PERMTT NO. •)
FIRE 1 FOR WORK / Z :;
ZONE AT NEW RITE
MovlNc CONr OR MOVE CONTRACTOR'S INSURANCECOVERAGE
STREET ADi88 N_ OF SURETY
)j - PROCIDINO P.L. d: y
l P.D. COVER�.G F. •�Ii
,�' �' �. % �' "'I �.S'• rf STREET ADDRESS
CITX A ZONE,1 I TLL N� T /�
�--C� (�V111 Ii/�C 1J• �`'(1//.� CITY.
CONTRACTCR'9 Cr1T BUBINEBfl
STATE �- LICENSE NO. �L/Ip
LICENSE NO. VALID 1N8./'t-�'� 7. CHEGKEB BY:I LATE
CW
SITE DESCRIPTION '
ADDREtl9 OF PRESENT. BUILDI G BITE UiLDING DESCRIPTION :
N
sent ludaw' to r ttneh .r
• S — (show
a pl ) DF.BCRIBE BASIC CONSTRUCTION k PRJEJS/E{7NT USE OF 6, LDING' '
R.� /aC 1- e/ /f/!-dam �J !_/f_�/— ,.•Y ;.
OVERALL LENGTH OF'.BUILDING:
P1
C L LOADED I WIDTH AS LOADED BL
HEIGHT AS IA. AREA -
D -S OF EW BUILDING BITS _ .F.I,• _ BQ. FT,
rEnoa below or tine f mpfes) DATE
{.
1.exal nrrt ion of Nnw BIEti• 91t POLICE DEPT. APPAO:AL OF MOVING ROL7TE
-�
By:
Time to Commence Moving:
...... ............ _
. MOVING KOt11-E 1".me to FYnlen �5nWn8: ..
FDLE DE TM NT CLEAIUNCE OF ROUTING DA E
By: D TE
-ENGI RI �. CE
C WC
j
_ RECEIPT NO. /. i...
. RED BY: RELOCA IO. .. ( ''
CLY-A PERMIT ,[1 t).�..G) `?.l
Power Company ❑ _ _.. FEY. i (:
1
Telephone C.'.' ::::`:
ompany O THIS PERMIT 'PHIS PERMIT DOES NOG. BECOME
' NAME OI•' UWNEI: OF 1LEs11'E ATTENTION • _
x%I
R HOM A' Is;tlR AUTHORIZES VALID UNTIL SIGNED -BY• THE;,_.,;,.'
BUILDING OFFICIAL OR HIS- DEPU- -_
ONLY THE Ty, THE. FEES ARE PAID, AND RE-. ,1. ' .
r at• RELOCATION CEIPT IS ACKNOWLEDGED IN' THE
I hereby cknowledge that I have ma this placation; thOF
the information given Is correct; and that I am the owner, aBUILDTIN SPACE PROVIDED
duly licensed moving contractor, or the authorized agent of one city and state laws regulating NOTED
-
of these. I -Tree to comply with - /,• l%-!'{:;f.�
building relocation; and in doing this work, no person will be
1
-' "" ""-'• sitar's Bltmatutt _
employed In vlolat:^n of the Labor COLD, Mate of Washington By .� •>'.�
relating to Workmp 1's Compensation in ce.BUILJJJ
ING
Signature of Owner. % ' �i ,� INSPEDCTTON
.COntractor, OI .-. DEPARTMENT y/,(...... •• /... ,.
/..... Date .......... ...
Authorized Agent .- /%l .. J .
Signers . �/ (�'J honeys' CITY D -
. /
Address _4w may.. .• -.... `.. ....-No.."f.( /,J-•'7� .... EDMONDS DISTRIBUTION OF. COPIES .
� ?. t........................_. PR 6.110-1 WHITE — File (Bldg. Dept:)
-',i....•../.-. YE,,WW — Move Inspector
City .. .. .. i :
GREEN — "-sacasor i•,, :
�—...c•�t'..j....._............................................ GOLDENROD_S,?olice Dept.
Q� ; '1
o Dato ........ ate••------ PINS —' Mov'.. Contractor ; 1.:.1
.............
7"
...... 0__ --Distract
0
City Of Edmonds ---Water Department
TAP CARD
DateARR.1,9 .. 26.6-PA19
......... No Meter No Tap
MWED. FROM W
Size............. Z)1Ze .......... 0-; 9.
Mfgrs. No .... ............................ " Style.... .......................... . ......
For.................. ... . .... ...
.................. .................................................. ... .... Z; .. . ....... .... . . ....... ........... . .
..................................... 4 ........ e
. .............. .... . ..... . ....... . ...............
LotNo ........................................... Blk. No.._................................._..............
Add...... ............................................ , ......... m ...... .................................. . .... . ..... . . ............
Si6rvice ''Location ................................................................
. .................... . ... . ..
.................................................................................... . ....... . ....... . ....... .......
MeterLocation ... .......... ............................ ............................
. ....... . ........... .
MakeTap ............................................................. . .
...... . ........ . ................... ..... .
Pressure ............................... lbs. Test .................................... %
SendBills to .......................... .......................... . ................ ...........................
.................................................. . Date of Work .. ............... ................ . ................ . ....... . ......
- 4
I . .... .................4
................................ . .... . ... .................
........... . ............................................................. ...................................... Foreman
Guar. Voucher No ......... .................................. $ .................. . ......... I ........ .......
Remarks: .......... . .................................................................................. ............. ........
.............. : .................................... ............................................................... . . . ..........
.......................................... . ........................................... . ................ . ...... ..... . .......... . ..
....................................................................................... . ....... . ................ . ....................
....................................................................................... . ......................... . .............
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.. . .........................
. ...... . ...............
OUTGOING
Index ......... Reg ....... Route ik
........ StenciL ..... Card. —
INCOMING
Index ........
Reg .......
Route Bk ......... Stencil ..... Card .......
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i APPLICATION
f for
The City of Edmonds SIDE SEWER PERMIT
OUTSIDE ❑ INSIDE ❑ REPAIRS ❑
/07- OMb
OWNER........ .-................... `.0 C ..
HOUSE No... ! l _ 3 ` .--••-------.C......••----. '-'...._-------•---
•
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•
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R
CARDNo . ......................................
EASEMENT No. ......................................
L...&/�-�-p---.....----•--•---•--------------•----------•--•-•-------- PERMIT No. ..-. /..7-l.Z:.... CONTRACTOR ..................... / .
STREET �J
------------------ AVENUE LOT No. .........1..!-_ ...............-.�... --.......................... BLOCK No. ...............................................
NAME ADD. ...........% .......... .15 /
APPROVEE
r-
7-
Date Approved:
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ ..............................................
SEWERWORK ORDER ISSUED .......................................... DATE .-..............................-----.......... BY .... ..................... ...........