1149 C AVE S.PDF1149CAVE S
TAX ACCOUNT/PARCEL NUMBER:,f ,D
BUILDING PERMIT (NEW STRUCTURE): �' l 1 W 6 9 D bFP6
COVENANTS (RECORDED)
CRITICAL AREAS: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
DISCRETIONARY PERMIT
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER): [,qj /���p 01ULQ ( iut6m,b) M203J(� I I�� (IJ�I 2,005D2-iDI CUAP. A )
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID #:
SHORT PLAT FILE: LOT: �7 BLOCK:
SIDE SEWER AS BUILT DATED: Z( Z� I
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED: f2 -71 t n:
LATEMP\DSrs\Forms\Street File Checklist.doc
1 i
&TED�MAP NO.:
660590 '
rt BUILDIN.G DEPARTMENT APpllcant Ftii
Inside IIeavy Lines JOB ADDRE8s
PERMIT" APPLICATION.
NAME (OR NAME OF BUBDLESS) REAR YARD BETHACx
BIDE YARD SLTTDACK STREET Sr TBACCa, (yea
t x ,
a. ��.
°h►C (' — ' ° BITS (s
"�AiLINO ADDRE80 LOT AREA VAC 4?
t7 UBE 20.^IE I Z - IR'�L•,' :{) • ,
�: p I ELEPHONE NUMB nIJ1LDL':O w.-iEw I VARIANCE NUMBER( •W7 } h ,i1� }
It
NAME
PLOT PLAN APPROVED _ {.( I,•s, ; s• . -- k R ;,•5"" G+�
�D BB /
�!_-T.7P BT R/:V P.I. PEPTCISC7CY 7'IDa P'ttOPER14 I C �+-
VE-XIBTDLC STREET R/w
tl TELEP.SONE 'LUMBER _ _-.•...3.
CITYPLAN ST. R
W
REMARKS Z
N trt' 1 1 d3 4ty
/ NAME
ACHECKED i1
}` +
Cqq ADD - '~`c J =! •N' e°ti'h�rtr�
i N
METER SIZE I SERVICE B1ZE I CLEARANCE .I CIiEC1PSD HY, r _�, T I.A. )i`tjJa /• }Y y' �•• N U
TELL
F C T� Y �/ t may. - / h � 4.•t)y..y�'p��1 r � ��.
ID•B ' G�• a a . jj11
[ TE LICENSE N CITY CENBE NUM
STA,'_ f rl`tt) a L [' { 0,
BER
. TYPE CONNECTI ") yERINREU BY d - I^ �'w•te7;n I .` ,,,'fix'
lASd DaxrlYtlon o1 PruperlY <Bbow low or Attach Your Tea) �/ rrC. t P, L% ) }(J,j a fit•.t r
I l% PE-R// I PERMIT NUMB P1 1f-t"c. f Y �5� >�" I'4- }
t O REMARKS
• i" �� �-�{-4ry;ryit t�iI ("•¢' ) I'Y1-)Ir �i 1
X `Ca - y - ,
tI STREET ,r
i FIRE ZONE
� TYPH; OF CONeTRUCTION IMPAOVBD}^� (1 d,#.Q Y )) •( Hi
I , �' I �:' � ffD :� 1 -) Al �1�\�ryt�p N .. �'t.. •
SPECIAL INBP.E CUIRED I OCCUPAOROUP :'� ';Zw ./ '� )ttnf �. y++•
n YES
PLAN CHECKED BY Y'>•r'1"}�S •cam ,..•'.
GAS
LEBIDEEl
NTLIL ❑ LINE '-•.�+ 1i �"11�-r'..'� J�'•4 yly,i*�t I1J�:'?
NON-RESIDENTIAL BICN
❑RETAINTNG 1 Ah.,y tG'k4�sr rl L`
ADD ❑{
DEMOLISH ❑ Fw'E2.CE '•(� ? �•+y(a ��""'
❑❑ EICCAVATE ❑ _ _ ( SS ..i�(1• ,t�'r`�•
ALTER OR FILL
❑PRFi:IOVE I 1 POOL h f o •,�
RIAIR ❑ INBP. l� 1 y-h rt�^l'• •s:' �
NUMBER OF STORIES I NUMBER OFW.
) latrY �7 ti
UNITS 1Nc / .I •I ; ^� t •Y=!krt r'S t't'7
..5
NANO BI'•��Ott'E n � _ _ ) ji , +��I�I� V ��b N
Vnluat on I Fee
";AVE
I.,y r. Plan Cheek •L,
,f' ,'Y4a, .,C, • yfy ' y •i
2
O 08ED E BUILDING �•� �•4LG r� -..}'# '' ' S� 1 r�
LAN (iadlCete BuUAlna eetbocka. nbuttln6 atreete) PLIIatBINa _ / . (/ `� — T''3f ;r$A` 1k }
d p{� I HEAT &CAA LINE•:'li3cLic.,q R.t$
� FENCE.���t't5
`r 1J I RE?AIN±Na WAI.I. —I—_ ." •� ZYYf'•fi
�
9WI]IMIKG POOL
yyy, •; {
t t DEMOLITION _ �"E]I,_ •t'1
^ik PRE -MOVE INSPECTION 1 t {
EXCAVATION OR FILL{�"+�� t
TOTAL AMOUNT DUE I l� k•„^_zy ,e.Y�y r-
I hereDY w•-ynovtedee tact I t 10 read tole aDphrntlo�•ne _ � _- n1TEl�Tio� APPLICATION APPROVAL �t-
tortaatlon given L wrrect: and thet I em the owner, o .ai
iced ngeat of tao owner. I aSree to comply �� city and state lava nga- ii W t ,.,N
lntmg ttonetrnctloa; ertc Ia dol'g the work n.thorl-d tberlby no Deno' ,l h� application permit tID111 • -' •j ?r't'l a =• i
AUT•HORI=6 signed try the BuildingOfficial or his D(.
will be employed 1n vlolatfo' of the Labor Cede of the state of 97aahfngton TEDB PERMIT llcation is not 8 Pe .�"'. ^-.
to workmen's Compeaaailon Insaraaee. p-' •.)'`..',•t,•"-'.�.'`!Yf
relatmS ONLY THE -.t'it
tvoRR NOTED uty: and fees are paid, and receipt Le ac- 1 ..1 :��
NOTE: Permit Limit one Year (Except DF)IOLITIONS wh1<h kllowledged in space provided- br.. rl ,VtX1
sMll De tomDlMad 1n mnev days: MOVED -IN BUILDINGS shall be aim- t,�. fix? ? '
DIetM In ale months.) INSPECTION IRE(:•1'OR'S SIGNATURE.. ••.{R,;,L.ut;}t,;n,IC3r.1 . Iy'.,e';•.
DATE SIGNED DEPARTUE.`aT 11`: ('u* ��=�1 ', � +'-`••
9t0 'ATURE (ONNER OR AGENT) / g
jt
` . CITY OF
r S v h
DATE ' / - ?'•'r t It
ED310VDS .' y
`101•g; Applicant Subject to Plan Check Fee PR e•IIa:
work to be dedens on prtte property ONLY. FILE
13ta Pemu• n tnsidewalks. drla-ewaya• j :'y ': ' `) :l
Any tonetruetlutx s.unt Ott the Dupublicd•-:fain (curbs, 1 Mon. ,•, •• •'.••: •,�
rrmrqe<e.i will recmrt seDa+ate Mrn• s. /' 1 .` ' .'_ '-L-
' ,.4,'• i1• ; rl� it
_ -. ..�._-.^. .+a.•.. sess•adres�I'S�I-f% _
APPLICATION CARD No . .......................................
for
The City of Edmonds SIDE SEWER PERMIT
OUTSIDE E] INSIDE E] REPAIRS ❑
----=A-SEMENT No . ......................................
07- 0 9 DOO
- 23
OWNER ...... 4: . ........ el� ------------------------ CONTRACTOR ..Y// ...... 41-0 .... PERMIT No.( .. 2 ---- :7�
HOUSE No.'/ s/. STREET No. . .......... XJ;� ................................................. BLOCK No. ...............................................
............................................................................ ................ AVENUE LOT ...........
/NAME ADD . ............. ........ Kt;�� .................. : .......................................... . ....................... ..
.................
At
BACKFILL WORK ORDER ISSUED ..............
SEWER WORK ORDER ISSUED .....................
..... DEPOSIT, $ .............................................
DATE
0. 7
.7... /.J.62 y By ....... ...................
APPLICATION CARD No. ......................................
for
The City of Edmonds SIDE SEWER PERMIT
A..4k,7SEMENT No . ......................................
OUTSIDE E] INSIDE E] REPAIRS E]
OWNER ------- C� ------- //� ------✓2v�-.4
------------------------ CONTRACTOR ... 'IV ... PERMIT No.
--- --------
HOUSE No. x/. STREET -No.
...................................................................................... -- AVENUE LOT ................................................................... BLOCK No. ...............................................
BACKFILL WORK ORDER ISSUED
SEWER WORK ORDER ISSUED -----
........................ DATE ................................................
1,
F76 p? imljz7
By...................................................................
City...of Edmonds ---Water Department
TAP CARD
DatMAR 2.»_..1967»PAID
»»
Meter No..I...1f........ �,a No...... �7......................
p
Size.. 3 ..li . ----....... Size ........ ....... ...............
....»»
Mfgrs. No ................................... - ------ Stvle -------------- :.... -....... _..............
For /V 4-r.....
..�d�.................... ........._.......
................................ 1.... �.... Go n.t-� z/. :..:_» . �.».......
LotNo ....................................... B1k. No ..................... .-.......................
`e -1-1
[Service Location
.. » .».......... ...
MeterLocation ........... --....... »...................... ......... _....... .
... - , .............».
Make Tap ............................ =..................
.............................
Pressure ...... ....... ...:................... --------lbs. Test.._......---------...------......:..%-
i Send Bills to ...................... ----_....................................... .... ».............
..:.»...»Fl:
E....---- .......•------ ....--- ........---- .........� _ -
Date of Work ....»------
-----------•..............................._..........._.......»-----•-----......----------................ Foreman
Guar. Voucher. No ................ ...
R omarlra•
r
-OUTGOING
Index ......... Reg ....... Route Bk----- --- Stencil ...... Card.... —
INCOMING
Index ........
Reg .......
Route Bk....
..... StenciL.....
Card..,» ..
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