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8415 73RD AVE W
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ADDRESS: 1,pq15 M (a (6p- Lk�&&f -
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TAX ACCOUNT/PARCEL NUMBER: -4-1 5
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS.: DETERMINATION: r] Conditional Waiver F1 Study Required E] 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 S: LID #- 21
SHORTPLAT
SIDE SEWER AS BUILT DATED: I] hl 00
SIDE SEWER PERMrF(S,).#: oiog-
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
LOT:
BLOCK:
LATEMP\DSrs\Fomis\Street File Checklist.doc
IJ7=1 9-9 (3
PERMIT NO:. 9242
City of Edmonds,
PERMIT EXPIRES
SIDE SEWER PERMIT
LYD #
Address of Construction: Y,15.
Property Tax Account Parcel No. 449� OM 030 1220�2. NOV e 6 2
Luuu
Attach copies of all access and utility.easements Verified and Approved b
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PUBLIC WORKS DD,
Owner and/or Contractor: MA-VNE-e
Contractor Lice.n se #: _<_4c� - n j;! C=C 4, ?0 44 — k"Q 0 Building Permit
<ingle Family invasion in to City *Right -of Way: 0 Yes, R-No
F! Multi -Family (No. of Units *RW C onstruction Permit
Commercial (No. of Units Cross other "Private Property: Yes
E] Public "Attach legal description and copy of recorded easement.
Owner/Contractor
Owner or contractor s%ignature and acknowledgement statement: Date
By signing for this permit I certify that I have read the City's public handout entit ' led
Side Sewer Specifications, and shall comply with all -City requirements outlined therein.
_N
WOOD
*2 CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EXCAVATI�D
.9 FOR INSPECTION CALL 425-771-0220 extension 329 2
24 HOUR NOTICE REOUTRED FOR ALL INSPECTION REOUESTS
. .... .....
........ FOR OFFICE USE,ONLY
Permit Fee R'e'P a i r F e'e` $ Issued By:
Trunk Charge Date Issued:
Assessment Fee $ Receipt No:
City Permit Surcharge Fee $5.00 Total Fees Paid $
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A$45 RE -INSPECTION FEE WILL BE CHARGED.,,
Job'Site Ready YES 'NO —Date: Initial:
Partial Inspection: Date: Initial:
Partial Inspection: Date: Initial:
FINAL INSPECTION APPROVED: Date: 11-1-990�_Llnitial.,OM As -built to Street File:
t, PERMIT MUST. BE POSTED ON-4,013 SITE6
�Vhite Copy: File Green Copy: Inspector BUffrCopy: Applicant
YL;temp;bldg;forms;ssperinitjlg4/00
The City of Edmonds
Side Sewer Drawing
NEW CONSTRUCTION 0
.45,CONTRACTOR ..... .
REPAIRS
� PT,
EASEMENTNO . .................. ............. ...........
LID NO . .................. ASMT. NO . . ..............
...... IERMIT NO.
OWNER, ........................................ ........... .. . I ....... ... .... BLOCK NO - ---------- --- ----- ..............
-------------------------------------
Im is
PA .. X� .........
LEGAL DESCRIPTION: LOT NO.
JOBADDRESS -, ...... ....... ......... .................. ................... .........
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0
01
...................................... I .................... I ............................... I .............. ....
NAMEOF ADDITION ........ ----------------------- --------------------------------------------------
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Approvcd: <g
DATE ...... �� .............. By ----- --------------------------------------
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