19408 82ND PL W.PDF111111111111
7623
19408 82ND PL W
-0 0-
ADDRESS: Tvwo pl,
TAX ACCOUNT/PARCEL NUM33ER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: E] Conditional Waiver Fj Study Required Ej Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE
LID#:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:7k,1/1 SIDE SEWER PERMIT(S) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER MEETER TAP CARD DATED:
OTHER:
LATEMP\DSrs\Fomis\Su=t File Checklist.doc
#4 APPLICATION
FILE: for
The City of Edmor�_&b SEDE SEWER PERMT EASEMENT No.
NEW CONSTRUCTION REPAIRS.
T=61!
OWNER ....................................... ---------------------------------------- CONTRACTOR ............................................ ......... w .......... PERMIT No:
........................ ..................
...................................................... K Vo- ...............................
LEGAL DESCRIPTION: LOT _7
No._-Ir
ADDRESS--Avemml �_- .................. ...............
NAMEOF ADDITION .............................................. ....................................................................
.......................
a.
Shwavown a
_�,WATFA-SEWM
bEPART
T"
4 4
p K
can 1176-11071 or 8140, sewer
InspecUpns BEFORE ring any, jo;
(Inspection win �be loa *1 construcuon.)
P,—Idkd within 24 hours after req cove
uest. No a".. r.- Or 1101114&Y hulpetions.
fAMATIOZf Ojr ()Oisniuctol
.............
............................................
........ . .. ............... . .......... .
. . .............................
...............
.. ......................
........................... . .... .......
. .......... . ........ ......... . ..........
....................
. .......................
.......... . .... ............. ...... ....................
.... . ....................
................................... . ................... . .......
.... . .................. . ..................................................
.. ........ . ...
_-, ........ ..... ...... 0%Q14M AND ']aUl
/OR
LDEia .......... . .... j 1:
. ..... . ............... .................. . .......... . .
00"BOTOR-fil- NAIM & ADDRIESS ... 5 joio- ........
.....................
................. i ...... .............. . .............. . .. . M I
perad"On to, granted .......... .................. ........
.... 1� 7 J a
.193"tM Wa000rdauMe 19 ......... for repair and oonamUon of & side
wftb City of ja�� Qr6� /or sewer to the
city gawtary sewer
Ile —
ON CALLED TO THE pOLLOWING:
1-7be.0 Mrs the
O_ PrOPertY Way obtain Permit to
side B=jr lAtreet area. Do not cove construct sewer, inside PrOpOrty line. A licensed Bre So -or Ctntmctor Must be
j rght.of_w.r any Portion of sewer before it has been inspected.
N1, 2--All work, Performed in clit 1W rewiris an Znvasion Of: Right Ployed to construct
an,
J�OTV No. 3_�Obtaln fuh Lut—AU011 gegarding 0 t obts'21"16 from 010 City Engineer's of
_of _W&Y, Fermi
rdinazice 11.16-030 and Regulations g ties.
N9TJ1 NO- 4-TOP Of aide sewer must have at I OVOrning side mowers when you get permit.
Abarpeir thau.,% WW be permitte east 30. ln.ch6,4 -coverage at property it-
.NO72 No.- &_Vrrvache, in d. and 12 inches Inalft.pr"an? line; minimum, "S Of Sit. No bends in grade:
street must Pe water settled Ind surface of street restored
:.work v!Wqb -&YAS-14 within one Year of c=pletjon. to original conditt
NdTX No, 6-41". ot onatractfs "I
unlawt be resPOUlbo for failure due to Improp,; 7
e%to alter or do any other w W&elz Provided for in ths Permit or to
ftrt the Pipe,, to the wye. ork
d ItWk ol the main "wer,or it& appurtenances except t
0
DISAPPROIVED
Date._..
. ....... . ...... ...... By ................ . Dat& ...........
................ D&t& ....... ..
te, ... . ................ By.w.
....... ............ ... ... . ......
................. ................... .
......................... ...................... ......
..... .. . .. . ................. ;11 ....................
. . . ........................ ....................
................. ......
............
.................. . .. .......... ....................
33e'Signed by 0Wnei Of Finn Performin ..........
To Reote�
r
Wt, ]PO bw
JP�Ctton
.. .... hereby certif
Y that Ithi d er IrstaHatiOn poliatfUcted �4Ad t1lis
Acebt
all:90V
Oerwit-
e. s of'the City of:kdin
A!,
94L
Dated this ......
�.dar. ej .. 4v
Cbeek B�RZ ... .. . ............... . ..
*m_ fur; 1ya I . __;
ter
Tele0one 0, Owei:
Sew& [3, Other
WT 0
100 ;z -
CITY of EDMONDS
' BU S
aw
1_5
LICENSE APPLICATION DAIIIW� 7i LICENSE No.
Civic Center - Edmonds, Was n on
hi gt
ANNVFEES
City Clerk Phone 775-2525
PENALTY AFTER FEB. 15
QTPF:r:T
F11
F tg� HOME OCCUPATION
INSTRUCTIONS:
CLASS
I YfWA 10 LrVEPFE6WMVt
RVAS6.4MV."
E
$10.00 (A)
ADDITIONAL $5.00 0
• All items must be completed
13
0 SMALL BUSINESS
or application will not be ac-
RECEIPT NO.
DATE PAID
PRINT X A_
$15.00 (B)
ADDITIONAL $7.50 0
cepted.
L
IN SPEC. BOX
F R ISSUE OF
0 Business with 10 or
• Sign and * return application
FEE PAID
PENALTY PAID
'ID
CORRECTED
more employees
ADDITIONAL $25.00 0
with fee. Renewals received
__j
I I 114'LC'
LICENSE WITH
ACTION.
$50.00 (C)
after February 15 must pay
'�4 NEW APPLICATION (LA)
penalty in addition to fee.
/El RENEWAL
(LB)
NEW BUSINESSES AFTER
0 CHANGE
(LC)
JULY 31, 1/2 FEE. .
(PLEASE MAKE ANY NECESSARY CHANGES) 0 DELETE
(LD)
NAME OF FIRM BUSINESS PHONE NO.. F EMPLOYEES
MAILING ADDRESS NATURE OF BUSINESS
p;
C-
:�BUSI`NESS ADDRESS
0�11_10 F - / 1-2 1/ / C, -- 'd z P/. 4,1/
HOME PHON� JPATJ OF B11
EMERGENCY NOTIFICATION:
(PLEASE LIST TWO)
WASHINGTON STATE TAX NO. /V
STAFF REVIEW:
INDIVIDUAL PARTNERSHIP
= (S) rz,::z� (P)
HOME ADDRESS
7H PLACE OF BIRTH
(1) NAME&TELEPHONE
(2) NAME&TELEPHONE C,
APPLICANT'S SIGNATURE
DO -NOT WRITE BELOW THIS LINE
CORPORATION
= P
SOCIAL SECURITY NUMBER
7
FILL*IN LAND USE CODE, UFIR NUMBERS, ZONING, ETC. CHECK APPROVAL OR
DISAPPROVAL, DATE,'AND SIGN. IF DISAPPROVAL,. PLEASE COMPLETE "COMMENT"
SECTION. ROUTE TO NEXT DEPARTMENT'ON LIST.
PLANNING DEPARTMENT DATE LAND USE CODE ZONING CODE
2"APPROVE 11 DISAPPROVE f
SIGNATURE
CONDITIONAL USE PERMIT
COMMENTS
BUYDING DEPARTMENT DATE 3 -/ 2--- ?1
VAPPROVE 0 DISAPPROVE
Building
0
Hotel/Motel
(L)
SIGNATURE 42 601��
-V
ermit
1
Apt. Bldg.
(A)
I U
7 1
ffice Bldg.
(0)
COMMENTS:
Occupancy
0
Restaurant
(R)
QrouD
0
Hosp/Nurs Home
(H)
CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS)
17—
0
School
(S)
FTE DEPARTMENT DATE
$APPROVE 0 DISAPPROVE SIGNATURE
COMMENTS:
PqkfCE DEPARTMENT
rAPPROVE 0 DISAPPROVE DATE
COMMENTS:
EMMA I
W-1
S I G N AT U R —E—ANW11
i=l
PUPL4C WORKS DEPARTMENT
eAPPROVE .0 DISAPPROVE DATE SIGNATURE
COMMENTS:
PI.MAQr: Dr:TIIDKI Tn r"ITV f-I E:r--)I/
NOTICE:
No warranty.l.of -a-ccuracy.
The information'shown 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 ' wa rra nt the
accuracy of anything set for.th on these
rnap(�_). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
tHe -map(s), including, but not limited to,
th'e location of any sewer stub shown. Such
sewer stubs may or may- not exist and. may
or may not exist at the location sh own.
Neither the City of Edmonds nor its
h-a-1.1 be 1-`1a-b--11e for the
empto-yee-s o-r officers -s i
information given on this map(s), nor for
ion provided based
any one representat'
upon said map(s).