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1241 VISTA WAY
ADDRESS: 124� (3TR (,Utl�(
TAX ACCOUNT/PARCEL #: pp,5 p'-� p DQa o ((n 00
BUILDING PERMIT (NEW STRUCTURE) #: .
COVENANTS (RECORDED) FOR:
CRITICAL AREAS #: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
CRITICAL AREAS #: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORD FOR:
PERMITS (OTHER — list permit #'s):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED: t� 6
SEWER LID FEE $:
LID #:
SHORT PLAT FILE:
LOT:
BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE/ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
L:\TEMP\DST's\Forms\Dana's Street File Checklist 5-14-08.doc
"Nothing in this permit approval process shall be
interpreted as allowing or permitting the
maintenance of any currently eaishq illegal,
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nonoo ormnng or unpermitted building, structure
or site condition which is outaide the scope of the
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AP `-
Required..
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Actual
ppeermit application, regardless of whether such
bnilding, structure or condition is shown on the
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site plan or drawing. Such building, structure or��
condition may be the subject of a separate
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APPLICATION
for
The City of Edmonds
SIDE SEWER PERMIT EASEMENT No ...........................................
NEW CONSTRUCTION ❑ REPAIRS ❑
120-00700
OWNER............ EdwaH... G....B.rack......................................................... CONTRACTOR.------------------.............----------.....:------------....------------...................... PERMIT No. ......................
ADDRESS ........1.24----V1-s-ta--W&y-----------------------------------------------••------------ LEGAL DESCRIPTION: LOT No.---------------------------------------------- BLOCK No. ............................................
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NAME OF ADDITION ..................................................
Dye Tested On Sewer 1972
Approved:
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DATE..........................•..................... By..........----------------......------..............------............