1150 C AVE S.PDF11111111111111
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1150CAVE S
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER: 0045�0 S 3oc) O I 1p 0o
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID #:
SHORT PLAT FILE: / LOT: J(D BLOCK: 2--
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
FOR:
WATER METER TAP CARD DATED: 'Z- f H21 a Z
OTHER:
LATEMP\DSTs\Forms\Street File Checklist.doc
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AppL;
APPUcATiv . & BUILDING' PERM
Permit limit,` one. year.
CR'Y OF
EDMONDS Building .Departmset '
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�pP(iCAi10N is hereby made fora permit to consecud the following work in accordance anth the aceom• kti t
panying plain and apedf;2tioiv.'Two sets are submitted herewith for aPPL
Off -St
n alter .. Parking
ys
S/ �I. P /1.0...... :....................
Work(a repau i.. L� ............ „
Const. typ ...... •r :f..L•••:• Fire zone
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e......................... Lse zone....
Occupancy . .........If o SCl� �/G � i .
Add
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CBlk.:....... Gh� h
Lot Address.. i...............
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O..nj:'......pk
...Area.J.....
Lofrontage......::............................
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Z �.. ... r: aide .. ...... 1. side. ............:... .........—front........... ... ...... :.. F�
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tip.... .................... -
No biz•
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Tel: No...............
Address..................
Bader �•
Address. ....................
.. Tel. No .:..
Plans by ............._.... -
:.
' Remarks ......:....................•--............... ,.
.....
.............
...................... • ' .
laws' hn this
_.
The above u a.correct statement, and I agree to comply with all applicable Codes and' State regula g
.
work- 9
/ • Date.:
'.
Signed Owner/Agent..-.{//n/...
pERMf' for the above work is hereby. aPP
raved, subject m the above conditions and to compliance with-the.ap «r i){
pmved`plan� and speeifintions 'and Building Depa—ent-notatioiis thereon.,-
Permit fee ......3 ...
F.
Valuation ...-.... ��r'-......
Da .,
Building Department,' By.
• Vic;
I
_?his 'permit does not cover plumbing, sewer, o,•,uselectrical installations, nor does it penmit'any work.•fo be
NOTE l}twdys mt be planned to meet the of ficidl`grades'of streets„ - i
done, in the Right of Way areas. Drivci�ays an i ws
and alleys, and plans for future sidewalk development.
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�07-- / 6 SSA i//STD Utz
11
APPL. IMION
for
The City of Ednmm& SIDE SEWER PERMIT
nTT'r-q'FnV. n INSIDE n REPAIRS r7l
Date
BACKFIM WORK ORDER ISSUED ............................................ DEPOSIT, $.. ...............
SEWER WORK ORDER ISSUED .... .................................... ......
CARD No . ........... .
EASEMENT No. .......................... ........... .. .
Approved:
.........................
.......... . ........... 8yi ......... .................. ............. I ..............
ty of Edmonds ---Water Department
TAP CARD
DatePAlp-FEB_ .1�
No............... .. No........---..... ..............._......
Siz..................... Tap Size ............. _.....................
.
Lot No .........
-.......
- ....
-
Add----------------------------
Service Location
:Meter Location ........... --............ _................ _....... _....... _....... ....... ...... _...
.........................
MakeTap --------------------------------------------------
. .............
'Pressure .............................. lbs: Test ....... -............................ %
Send Bills to.......................... ......................... ................. ....... ..._....
_:.:..........
Dateof Work ................................................ --------------------_....._...-.................
.........................................._................................................................. Foreman
Guar. Voucher No .................. ---....................... $........... _.... _................ _.....
Remarks: ......... _.................................... .................... ...........................
_.._...._
.................. ................................ ................. A ................ _...... ......... -...... __....._.........
Index
........Reg......Route Bk...... —Stenal.....Card........
Index .........Reg......Route
Bk....
_... Stenal..... Card .......
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