1223 CORONADO PL S.PDFIIIIIIIIIIIIII
10669
1223 CORONADO
PL S
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ADDRESS:
TAX ACCOUNT/PARCEL NUMBER:M0022 QQMQ4 0
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
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 DA
SCALED PLOT PLAN DA
SEWER LID FEE $: LID
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATEDJ (y- W SY I �A -I v
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
LOT: Z4 BLOCK:
LATEMP\DST's\Forms\Street File Checklist.doc
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT EASEMENT No ...........................................
NEW CONSTRUCTION REPAIRS O
401-00900
OWNER........... O.en.1amin..Qs.t_ cm .......................................................... CONTRACTOR.............................................._................................................... PERMIT No.......................
ADDRESS ....... V... Q)"O► 440 .. Mize ................................................
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0-
0
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LEGAL DESCRIPTION: LOT No ............................................... BLOCK No.............................................
NAME OF ADDITION ..........
Dye Tested On Sewer 1972
Approved:
DATE................................................ By................................_.......__......._..._................
coom-
hereby made for', permit to construct the foll,wing work� in accordance with the a
BIIX'-..7 . ..... . ... Ad
Tel. No
Build
Tei. No
Remar
ws regu tin this
cable Codes and Statcla la 9.
is ;L correct statement, and I agree to comply with all appli
or
Oct to the above conditions, and to
PERMIT for the above work is hereby approved, sub"
proved ptans and specifications, and Building Department rotations thereon.
INSPECTION RECORD�
cover Plumbing, Sewer or ct
This pennit does tu).
COMPLAINTS MO BE WRITTEN:
NO VERBAL COMPLA- WILL BE ACCEPTED.
THIS FORM MUST BE COMPLETE.
CoutiTE
��ul• I�/ 1:u1MMY���`�i
CITY OE' EDMONDS
Name: 40 �%J✓i �'�0 /�
Address: 8�.�j %dpLR p 4IRy �Z)
.DATE .9 3,9 - 91.
Phone: r77 & -! 8 C/Z
STREET FILE
ADDRESS OF PROP= TO BE E VESTIGATED: FA2 _ CO�vii�,r�t17.a—f?��c �% _ %✓7rno.aJL�S'
Name of Owner: RoBEP— l/El mer✓ "
Address: /Z3'Cdk'r1n/Ant� ��. Phone:
DESCRIPTION OF COMPLAINT: IFC�r vv URI-L- S / it/ )eJ r "f
� C�it o ►/r D 12 Cb rr1 CJ ��L �' 7-0 -3i�5 1W 0 ✓LEy -- zz'µ a zy*z I Z-v o 2 'i-C Z
i egy K7,�6(/ j'i v c 1iy;,D1>0 A/l
OWn PS"�-� /R4 91e ep 06,W 1) 4T- 122 3 C-bjCd Vi PO P� .
DO NOT WRITE BELOW THIS LINE - FOR CITY USE ONLY
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CODE SECTION VIOLATION:
HEET FILE
TYPE OF ACTION EXPE= :
TIME REQUIRED TO INVESTIGATE / ACT ON COMPLAINT:
RESULT OF INVESTIGATION:
d ; A
DATE: �p '3 / 9'/ TIME REQUIRED:
c �
/ c
INVESTIGATED BY