115 EDMONDS ST.PDF11111111111111
13903
115 EDMONDS ST
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER: ���Z3OOIOI �-GY�
BUILDING PERMIT (NEW STRUCTURE): Z915
COVENANTS (RECORDED) FOR:
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 DATED:
SCALED PLOT PLAN DA'
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATE[
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
OTHER:
LID #:
LOT: BLOCK:
L\TEMP\DS'Ps\Forms\Street File Checklist.doc
APPLICATION
The Cityof Edmonds for
SIDE SEWER PERMIT
NEW CONSTRUCTION ❑ REPAIRS ❑ EASEMENT No ...........................................
112-05500
OWNER---------.Audrey--.14•...iil rS------------------••-•------•-•----•----------•-------------- CONTRACTOR .......... .............................----......------....----•---••--...................... PERMIT No.......................
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ADDRESS 1.1. ....TllOndS $t.......... LEGAL DESCRIPTION: LOT No. BLOCK No. ...
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NAMEOF ADDITION................•---...--------•-----------••----.........----•-•----....----............................................................
Dye Tested On Sewer 1972
Approved:
DATE................................................ By------.........-----............................---.................--