1234 CORONADO PL S.PDF1234 CORONADO
PL S
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER
BUILDING PERMIT (NEW STRUCTURE): 1 -'_ 1 "' 1.r;
COVENANTS(RECORDED)FOR:
CRITICAL AREAS:
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DA'
PARKING AGREEMENTS DA'
EASEMENT(S) RECORDED
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DA
DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: c BLOCK:
SIDE SEWER AS BUILT DATED: �ilk,%C��' Z
SIDE SEWER PERMIT(S)
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
L:\TEMP\DSTs\Forms\Street File Checklist.doc
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT EASEMENT No ...........................................
NEW CONSTRUCTION O REPAIRS O
401-01500
OWNER...................................................................... CONTRACTOR...-•--••--•----•--.--•---------....--------.........------......---.............---•--........... PERMIT No. ......................
ADDRESS ...... 1234 Coronado P1 ace ..--..... BLOCK No .............................................
.................... .......... LEGAL DESCRIPTION: LOT No. .
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•
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NAMEOF ADDITION................................•-.............--•---..........--•--.....................................................................
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Dye Tested On Sewer 1972
Approved:
DATE................................................ By.....---............---.................----..........................