19407 82ND PL W.PDF11111111111111
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19407 82ND PL W
ADDRESS: MgLI),7- S221-11b
TAX ACCOUNTAPARCEL, NUM13ER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: E] Conditional Waiver. E] Study Required E] Waiver
DISCRETIONARY PERMIT
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:7/Z, Z/1 5
I / .
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DA
LID#:
LOT: . BLOCK:
SIDE SEWER PERMIT(S) #: 141ax�r
LATEMP\DSTs\Forms\Street File Checklist.doc
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CITY of EDMONDS M. [CrAJ10N
Civic Center - Edmonds, Washingt
FILE
City Clerk Phone 775-2525
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LICENSE No.
El, HOME OCCUPATION
CLASSIYEAR LIC, FFEC. DATE IREASG.LIC.NO.ISPEC] $10.00 (A)
INSTRUCTIONS: 4
All items must be completed . q SMALL BUSINESS
or application will not be ac- -RECEIPT NO. DATE PAID PRINT A- x $15.00 '(B)
Lb / / 01 IN SPEC. 13OX
cepted. ell !2 1-21 4 11 FOR ISSUE OF El
- Sign and return application PEE PAID NALTY PAIDI CORRECTED
. d I LICENSE WITH
with fee. Renewals received __j z 4',d I I I 'LC'ACTION.
after February 15 must pay
penalty in addition to fee.
NEW BUSINESSES AFTER
Business with 10 or
PENALTY AFTER FEB. 15
ADDITIONAL $5.00 0.
ADDITIONAL $7.50 0
more employees ADDITIONAL $25.00 0
$50.00 (C)
rV NEW APPLICATION (LA)
6RENEWAL (LB)
D CHANGE (LC)
JULY 31, 1/2 FEE. (PLEASE MAKE ANY NECESSARY. CHANGES) 0 DELETE I (LD)
NAME OF BUSINESS -PHONE NO. OF EMPLOYEES
ra c I a, QJ4 -4-
MAILING AD15RESS NATURE OF BUSINESS
0 ii4_ CA 0 0) -eA
c7.>?680( a
ma 14h,
P
1_.
Ald Pl-(A) -
16 V_F Ue t1ly 1
DATE OF BIRTH , _-N
P
IVQIVIDUAL PARTNERSHIP CORPORATION
;n (S) (P) P
OME ADDVESS
7L _ -
6 is �� atA�
L S�QCJJ R I TY
.ff-- I
EMERGENCY NOTIFICATION:# (1) NAME & TELEPHONE :4� u a v, in
(PLEASE LIST TWO) (2),NAME & TELEPHONE JA4hVE pe4tvse_W- :jjC�-,:Zijj4-j
WASHINGTON STATE TAX NO.— 6 APPLI CANT'S SIGNATURE
DO NOT WRITE BELOW THIS LINE
STAFF REVIEW: FILL IN LAND USE CODE, LIFIR NUMBERS, ZONING, ETC. CHECK APPROVAL OR
DISAPPROVAL, DATE, AND SIGNJF DISAPPROVAL, PLEASE COMPLETE "COMMENT"
SECTION. ROUTE TO NEXT DEPARTMENT ON LIST.
PLANNING DEPARTMENT
0 APPROVE 0 DISAPPROVE DATE't-l' LAND USE CODE ZONING CODE'
Ira M I I
SIGNATURE
CONDITIONAL USE PERMIT,
COMMENTS E=
BUILDING DEPARTMENT
0 APPROVE 0 DISAPPROVE DATE Building 0 Hotel/Motel W
Permit
SIGNATURE )C Apt. Bldg. (A)
'D Office Bldg. (0)
COMMENTS: Occupancy 0 Restaurant (R)
Qroup 0 Hosp/Nurs Home (H)
CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS) 0 School (S)
FIRE DEPARTMENT DATE U. F. 1. R.
APPROVE El DISAPPROVE SIGNATURE 010D]
COMMENTS:
POYCE DEPARTMENT
0 DISAPPROVE
VAPPROVE DATE SIGNATURE
COMMENTS:
�PUBL - WORKS DEPARTMENT
� �PPROVE 0 DISAPPROVE DATE SIGNATURE
COMMENTS:
PI FAqF r1[zTI!P1`0 -,'-n f-ITY (-I r-Mr
APPLICATION
LE for
The City of Edmonds, SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS EASEMENT No . ........... ..............................
4,441,
OWNER- . ......... .... .... CONTRACTOR ..... F-L. ... j ... 5.? ... s ......... ------------------------------------------------------- ............ PERMIT No..: -
.......................................... ............................ 16 . S
...........
Awn C:!:) g:> — EE�2NC>
—00 —1— ---� --> EL40CK No . ......... ..................................
ADDRESS 1� . . ...................... —
....... .............................. ... ............... ---------- --- - 'LEGAL - DESCRIPTION '. --LOT- No. .............
NAME OF ADDITION-.::
.. . ................... .............. ...... ............ ....................................................
T
F='L-
ml
do
66,
2*MP %
5-
7r- Lfltaele- 7"71r-
LOT 1c)
Approved
DATE ... ....... ... ....... 715i, ....... By ...
. .............. ..
1P
Elt- E
WATEWSEWER, DEPAJ%TMENTP`z,-"
7—
ILIE
-�BErORE, co�`erIng,;.,any� por,ior�,, iof Ahe conqru�tlon.,N�%.
11 �7-,* 1.107) for -`side'
kinspectiozi -,*III' be prov ded wIthIfi1,,44;- hours%after 'r6§dest.1, i�6)iSit um,� 7or tholld' 'in ppctionsd ,
ay, S
q
_bF `Place, ...,West�.
...............................................
M I
AbDRESS,-LOCATIO' RIUI CTIONI.`... ... : .........
........................... . .............................. ......... .........
-0 J� -
-Maoiewood-.
L � I .
..PROPERTY LEGAll DESCRIPTION:..�.:.: ................ .......... .. ......................................
7 ..... ............. .................... ...............
.......... .............................
. . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . .................... .................. ........... 01 XWWE R A LN D 0 R.B U I E, D E K ... 001.e. S..
.. ......... I ....................................................... ................ ..............
CO— A�RACTOW& NAME& AJ)DREQQ Rus's J oh n S'b n, Sewer & P! onbtnq -16009 North- Mead 6wd a I e,- -Road,'-
...........
........................................... �.P ................... ...........
. .......... ...................................... : ....................................
.1915
. .. .......
PerinissionIs granted .......... !� ... q0y ..................... ... .... lor.repair. aKd/6r',ibonneejjoij of a Side'. sew' the Fewer
6ft
04tem'hf accordance�-witk City f Edltnondg,'opoin ces,�
o
LED�ITO,'THE FOLLOWING:
q TION ISXAi,
N I I . . - . I 1 .1
Noi 1---�The� owners_of4the.'_propeky� may obtain.s. permit-t6, c6niti.uct.seN�er,-In�ide.;�ropei7ty,,I�.nel., A,�jtcensed Side:Sewer, Contractor,, must, be,;employ',ed,io; c6n'struct
side sewer In, street �ares,.-, - Do; not, cover any'portion, 6f`s�weij)siore-.IC' has bee'61tispected.
NOTE No. 2—AIII,,work performed' -in,.'city, right-of-V�ay requlrei;� anl�Imiaibrlvof,, -RI ght'of-W.&Y.Termit, 66tafnable� from 1fie_CIt`yEnginleer*' fflebl.
NOTE No. 3�dbtain fum Informationi,regarding �Ordi�n*'&�rLeer',1-1�,�6�O'�6'��nd::,Regulations; v
.,go ernin
NOTE� No., 4—Top;,qf.,,fsIde -sewer* must bay6.atjJe"t 30iJ�chcs:iqoverage,,,&t, r6pert' j in' anal" 1 i;'Inbliis .ki nilalil' property IIhe;_-,?mInImum, giade;�ot:2 % Vo��befiils- in�-gradel
y
-sharperlithaii�l/��..will,'be:�ermitted.
and, surface of:�strli�tl�restoredt-to, orIgIh6X,coi1dffl6n,. icontr' rs,'sl�aff:bei responsi� e fl�i, faii6re d�us;,.to� improper'
NOTE No�'5—Trenc eson, street �must. be; water settled' to
work which may,develop within� 'One -5iear,of,cornpIetfofi-.,-
NOTE, No. 6� It lw,unlawful,��tojilter, or do, any. other. work,',thari 4s_provididl for 'in -the perrhlt�, or,;to do,,.any�,,hork- o . n,.the- main' sewer or.its, ap , puriena"nces, 'except to, in-
sert'the',pipe 4nto, the, wye..
CUT
DISAPPROVED, D-it" ........... ....—By ............ .... Date Date ................................... IAY ................
a . ............... y
APP . ROVED Z7
0, ..... . .... ..................................
, , : - ............................ .........................
7
D
lWiyiarks::
.................. ......... _'." ........ ................ .............
............ ...... ......
................. .............. I ................ . ................ ..
. ....................................... ....................................... ........
......................... a ........................
�(j, C
0 M T-;Ve Sig-ried�,,Oy,�IP,,wife�,of,Firrii.'�Per-f,;rming,,!C6nstru'c I tion,,.,PRIOR,,Tib-i,,Request','F�or.tI.nsp6dtioii�',—''�-
... ........ ........................ ..... Ud
atiOnt�co'zis rue e !,.und6r'Ahis?�beiihif
ing, Firm P
-he�City,,ioPlEdm6n:ds,;
i"ki't X vern OfA
V Cheek'BEFORK you,
jDate
d* this..:..n_ ....... dA ........
Y�' of, ...........
g for,:-Waier E]-,,, Gas --Q, ..TelbPh' '�Se'wer,E];,. Oth6rEje V11 V,
NOTICE:
Nb--warranty of accuracy,
The -information on the attached
map(s) was compiled for use by the City of
Edmonds its Employees and Consultants.
The city of Edm.onds does not ' warrant the
accuracy of anything set forth on these
map(§-). Any person or entity -requesting a
copy should conduct an independent
I mation shown on
inquiry regarding the 'nfor
-m a p (s)
t including, but not limited to,
th-e loc'ation of any sewer stub shown. Such
sewer stubs may or may, not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
ernp-to-yee-s o-r offi,ce*r_'s' sha-H be 111a-b-'Fe for the
information given* on this map(s), nor for
ation provided based
any one represent
upon . said map(s).