19411 82ND PL W.PDF11111111111111
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19411 82ND PL W
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ADDRESS: ZZ�Ll-- YVV/) & �u
TAX ACCOUNT/PARCEL NUM33ER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:
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 $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DA
OTHER:
DETERMINATION: E] Conditional Waiver E] Study Required E] Waiver
LID #: Z3—q
LOT: BLOCK:
SIDE SEWER PERMIT(S) #: 44&L
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SIZIIE DESCRIPTION
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LICENSE NO.
PENALTY AFTER FEB. 15 ..
fty 0
0S LICENSE APPLICATION
CITY of EDMONDS BI
=F Civic Center Edmonds, Washing 1 ANNUAL FEES
City Clerk Phone 775-2525
0 HOME OCCUPATION
INSTRUCTIONS:
CLASSIYW
11111-11t.
BRXEDNIATI!
$10.00 (A)
ADDITIONAL $5.00 0
• All items must be completed
SM ALL BUSINESS
or application will not be ac-
RECEIPT N 0,
DATE PAID
PRINTX
$15.00 (B)
ADDITIONAL $7.50 0
cepted.
C71 /I- 1h
1
IN SPEC. BOX
FOR ISSUE OF
EJ Business with 10 or
• Sign and return application
FEE PAID
F5ENALTf,PAID
CORRECTEd
more employees
ADDITIONAL $25.00 0
with fee. Renewals received
L I Z�')' 14, If I
L I
LICENSE WITH
'LC'ACTION.
$50.00 (C)
after February 15 must pay
M NEW APPLICATION (LA)
penalty in addition to fee.
6RENEWAL
(LB)
NEW BUSINESSES AFTER
D CHANGE
(LC)
JULY 31, 1/2 FEE.
(PLEASE MAKE
ANY NECESSARY CHANGES) 0 DELETE
(LD)
NAME OF FIRM
MAILING ADDRESS
zs; .411 W12 Pz
7194
BUSINESS ADDRESS C,,� �z
OWNERS NAME
I BUSINESS PHONE NO. OF EMPLOYEES
Z,) - .1 -
NATURE OF BUSINESS
-e
j INDIVIDUAL PARTNERSHIP CORPORATION
E�'(S) (P) (C)
HOME ADDRESS �/// - 7,;2 ,y . /16)
4iw - Ie 615 , ZV41
MT�- L4C)e" 0,
HOME PH(5_NE DATE OF BIRTH PLACE OF BIRTH SOCIAl SECI'RIT'� NUMBER
7 7 5 - er*2(2 0-32 5510
EMERGENCY NOTIFICATION: (1) NAME & TELEPHONE 12W�- "LAMAX _�H,577 - &5B f2mn
(PLEASE LIST TWO) (2) NAME & TELEPHONE416fiL46V/_K�A�- 77,6 -.7-2;�5-yg
WASHINGTON STATE TAX NO. ZV/& APPLICANT'S SIGNATURE
DO NOT WRITE BELOW THIS LINE
STAFF REVIEW: 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
C?`APPROVE EJ DISAPPROVE DATE '-1 3 C41 LAND USE CODE ZONING CODE
SIGNATURE-n f �4_LkZ_t9,u I I T-1 1/z In I I
CONDITIONAL USE PERMIT
COMMENTS
B�WDING DEPARTMENT DATE
(�T APPROVE 0 DISAPPROVE SIGNATURE
�- f01 47
-;,-7 7
COMMENTS: I Zz 6�tz�4_
===2-cAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS)
Building
El
Hotel/Motel
(L)
Permit
[�(Apt. Bldg.
(A)
0
Office Bldg.
(0)
occupancy
0
Restaurant
(R)
Group
El
Hosp/Nurs Home
(H)
0
School
(S)
FIRE DEPARTMENT, DATE 79 U. F. 1. R.
PP�R4E 4�-DISAPPR VE SIGNATURE
N:1
GUMNVENTS:
POUCt DEPARTMENT DATE N 6a_
tAAPPROVE 1-1 DISAPPROVE t SIG ATURE
COMMENTS:
PUB�L� WORKS DEPARTMENT
L>I�PPROVE LJ DISAPPROVE DATE SIGNATURE
COMMENTS:
PLEASE RETURN 'TO CITY CLERK
NOTICE:
N'o ... warranty of accuracy.
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 - warrant the
accuracy of anything set forth on these
map(�_). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the informa tion shown on
tF�e -m a p (s) , 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
ernpto-yee-s or officer--) S'hal.l be I'lab.-Ile for the
information given on this map(s), nor for
ion pr 'ded based
any one representat' ovi
upon said map(s).
7 �Y. - . -.- — - __ - -, — --,— : _. _ - - _ --- -
4,
CITY OF EDMONDS 4 SIDESEWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT 4416
Call 776-1107 for side sewer Inspections BEFORE coveringL*i any portion of the construction.)
In;pection will be provided within 24 hours after reques . t. NO Sat., Sun., or holiday Inspections.
-)DRESS LOCATION OF CONSTRUCTION ........ 19411 A 19409.!: 82nd..PJ_a.c.e...W.e_sA ................... . ........................................................
.....................................................
..................... ................ ................................................................................................. .......
A-OPERTY LEGAL DESCRIPTION ....... ------ MaPlewood
......................................... ........ . ...................... ............. ...................................... ..................................... ......................................................... .......................
......... OWNER)"DIOR BUILDER ........ Nord ... Homes
......... .... . ............ . .................................. . .......................................................
Russ Johnson Sewer Plum6inq ..... 16009 North Meadowdale Road
CONTRACTOR'S NAME ADDRESS ............. ...................... ............................................ . ........................................................................................
Permission Is granted ................. 4 . ..................... 19_334 for reptair &�Wlt connection of a side sewer to the city sanitary sewer
system In Accordance with City of Edmonds ordinances.
—TENTION IS CALLED TO THE FOLLOWING:
onstruct
rE No. I —The owners of the property may obtain a permit to construct sewer Inside proper�y line. A licensed Side Sewer Contractor must be employed to c
- side sewer In street area. Do not cover any portion of sewer before it �haa been inspected.
NOTE No. 2—All work performed in city right-of-way requires an Invpzion of alght-of-Way-]�*r-,�Jt obtainable from the City Engineer's office.
NOTE No, 3—Obl.In full Information regardlng Ordinance 11.16,030 and Regulation,, gvrnt.g side were when you get permit.
t have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2%. No bends in grade
NOTE No. 4—Top of side sewer mus
sharper than �A will be permitted.
NOTE No. &--Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to improper
work which may develop within one year of completion.
NOTE) No. 6—It Is unla ful to alter or do any other work than is provided for in the permit, or to do any work on the malin sewer or its appurtenances except to in-
sert the pwipe into the wye. I
By .............. Date ................................... By .. .............
SAPPROVED Date ... ......... ........... By ....... ........ Date .............
. . .........................................................................................
APPROVED Da 7=7 ---------------- By...
1000
Remarks: ....... . .................................................................................................... ..................................... . ...................................................................
. ....................... ......... ............. ;0`111V ------- ------- * .......................... .......................................... ----------- * ----------------- ........ _ ---------- ---------------------------------
BOT �Pe it Cop' s M ST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
.... ... . tify UIS t the side sewer installation constructed under this permit
ue
1; � .1 hereby cer
..... . ............. ...................... .
ner- of -Co.-- ing Firm PerfGrmin tructigIlL
11 gov
-ts inst ed in accor n w-Wh all gov of the City.,of FAmords.
'day
'11' -7
........... .......... of ....... t
Dated this.. --------------------- ......
Check BEFORE you dig for: Water E), Gas Ell Telephone 0, Power El, . Sewer E], . Other 0