19501 82ND PL W.PDF111111111111
7628
19501 82ND PL W
# 0
ADDRESS:
TAX ACCOUNT/PARCEL NUM13ER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: — DETERMINATION: [] Conditional Waiver El Study Required 0 Waiver
DISCRETIONARY PERMIT
DRAINAGE PLAN DA
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID #:
SHORT PLAT FILE: LOT: BLOCK:
,Z/--z
7,:2
SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
OTHER:
LATEMP\DSrs\Fonns\Street File Checklist.doc
APPLICATION
% for
'the City of Edmonai SIODE SEWER PERMT
NEW CONSTRUCTION REPAIRS 0 ........................
C25:
.................................................. .......... ................................. C -RACTOR
ONT . ... .. Wo; .....................
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ADDRE ........... _V4
.............................................. -LEGAL-DESCRI-PTION.: -LOT, No . ..... i: ........
...................
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...................................................
NAME OF ADDITION .................................................. 6cc� . * . -
.....................................
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Approved:
DATE ......
M,
:10 MV.50 MRIPS*,-'��,,SIMEI
C I Tr Yr 00. F
T.ME A
WATEIPSEWER DEPAR NT-,e
P—AE. RNI�ITV'
e
lCall, 716,110T*.for. side sewer.;'Insp.ectionst BEFORE ;cov rIng'Jany,.,!portion� of the! construp�16m
NInapec�ibnwlll,be p Ided within, 2C;hours-,after
n5y
0
ADDRES .% _ An West—
501 439 195.03 �_82M �Plat6*�'
SONFOF CONSTRU CTION..,....f�,.: ........................................... 1 ......... .................................................. . .. ......... ........ .............
7
lot 1.3 zmdolewood.11
PAOPERTY:LEGAM, DESCRIPTION ........ ............................................
................................................................
..................................................................
.............
............................
........... .......................................................................................
................ ............................... ...................................................
AbrA. "H
omes.
EIV ANWOR, BUILDER .... ............................................................................................................
.......... ....................... ..........
,JC '$pnSewer'&,P1,Ut�M:ng 16.009. mead vidal e' Rd'-.,:: Edmo
Rus -.Jbh� 0
...........
V f7 IVA, T�OR.Si,'�qX&,k.&,,AMDRESS;.-. ...................... .......................
................ .......... ........................... ...... ......... .
.. ............ .........
30 A 9802(
- ....... ....... 19 ...... of, a side isewer to,,the�,iitv-.,iaiiitiii�y'.,,sewe . r,
i . . .......
s tem _d "i'Edmonds0ol�,d* A
ys'
'M VION iS,,CALLFD, TO. THE FOLLOWING':,
NO,.- rTo. I —The owners of the property may -obt-EEin,&.'perinif'�t�,.cbngtruef, sewer Inslde�,pr'o'perty, line�A licensed Side Sewer Contractorvmust*lbs� ernp-lo "stiuci.
-yed4o'con
side sewer iw street area. Do not cover.any portlon�,of.sew6r before It 'has� been'lnspected�'
-NOTE No. 2�Alll work,.performe.d in, city, rigfit-of_way.,requir�es 'an.'inv"lon,�6f'.Righ�-,6f-Way�-Per;mtt obtain-ablej from the City,-,Englneer�s',6ff'1ce1.:1-
NQTIT�No. 3—Obtsdn� full I Information. regaxdIng Ordinance 1-1.16; 030 and. Regulat!ons� gpve�nin.k%,�ide,'sewers;,wheri,,you.k�t permit.,
NOTE' No, 4-�-Tqp,,of side. sewer must have atleast�30:jncjfes
coverage ,at property line, and 12�.'I*nci�es,.insid*el'�roperty iine;'%mifilnllum'.�grade of `2'%-.-No, bends, in grade
sharper than W will be'permittdd-.
NOTE, No... 5�Trenche& In, street, must be.water settled -and, surface of .�treetjestoied �to,"orig'iriai,-ponditio"n� ldontracto*is sha.M. be-:responsiblb,� for failu 4 re; due Adr Improper
w6-rk whlchlay� develop; within one�year 6V�completlon�
ri
NOTBI N(Y.A�It As.,unlawful to alter or �do, any. other:.work,Ahaw is �provlded.'for I he permit, '.�or to, do. any,.
work orr, the main sewer'orAts, a:ppurtaiancevekc6�t� to, in -
serf the� pipe.int6 'the wye�
R MA
Date ... ..............
DISAPPi'LlOVED, Pate.. ................. 0� ........ ...... .1
..........
ate.
1. . . . ............ ...... ........ ............ ..................................
APPROVED,,,
D
,Zaiiiarks: .................................................
............... . .. . . .......... ........................ ........ ...................................... ...................
.................
p
................... e ........ ...........
.... . ................... ....................... ...... ......... ...... .............. I ................................................... ....... 7 ...................... -7 ...... 7':
O.-T �,�Pe '4-'Co
- ----- IF
we (1110 r�j - - " �_ra, I n g I r
Vd�jn c� dan., wit.
s 1n,,a h'al
'Check, BEFORE,
e, g-p Firff -Peif or ing - - on�structio
,-B §1 -,-B� .6.�vm�� PR1ORkT6*Reques+t,,.F' 1'�
M 6r-.:, nsPectibn,.:--,
:71
by
�66rtify-,ihdt.,thei.�ide�-sewer.qlistallation, -const'ruc�ted,�under,-,thisipe�mit,,,..*
rf,- mg C Liciio
r�2nnin-gW,1�6rdirTanc'bs f
......... ...... 9"'17
ate&�tftist� .... .......... ..............
udig--�q��'.Wai�f�6�,% .,Ga�,,E];, Teie�honeE],�. -,,Power 'S'ewer Othe�,,l
Elf a
;2
BOESS,LIC S LICENSE NO.
T
V CITY of EDMONDS EN �AD N
CiVic Center - Edmonds Washinnton 98020 L
iwCity Clerk Phone 775-2525
ANNUAL FEES
PENALTY AFTER FEB. 15
INSTRUCTIONS:
CLAS . SI YEAR
. SG. LIC NO.JSPEC.
LIC. EFFEC: DATE
ME OCCUPATION
$10.00 (A)
ADDITIONAL $5.00
• All items must be com,pleted
131074
RECEIPT
NO.
DATE PAID
IREA
X
SMALL BUSINESS
or application will not be ac-
AL-
PRINT 'X'
$15.00 (B)
ADDITIONAL $7.50 0
cepted.
IA-,11101�1114
IN SPEC. BOX
FOR ISSUE OF
0
Business with 10 or
• Sign and return application
KEE PAID
PtNALTY PAID
CORRECTED
more employees
ADDITIONAL $25.00 0
with fee. Renewals received
L
LICENSE WITH
'LC' ACTION.
$50.Op (C)
after February 15 must pay
NEW APPLICATION (LA)
penalty in addition to fee.
RENEWAL
(LB)
NEW BUSINESSES AFTER
0 CHANGE
(LC)
JULY 31, 1/2 FEE.
(PLEASE MAKE
ANY NECESSARY CHANGES)
0 DELETE
(LD)
NAME OF&IIIIIIIIIII1111111W 4tZfW . %, tA__ I BUSINESS PHONE
t �A —
MAILING ADDRES
Led. qt2q 6
NO; OF EMPLOYEES
-fM-A-zE- /
NATURE OF BUSINESS
. I dop)et (R-NW . )
a"GINE 1ADDREf
pq-�o 1 -4 o 8R Afa P I LAJ
kNPIVIDUAL
PARTNERSHIP CORPORATION
doe)o ��Xd
6110 llld�S, Ufa
V
I A (S)
(P) P
_qVNERS NAME
;gm m - + m\
HOME ADDRESS
248& ��
a (1,
ave. wa. 16.2
t-IOME P�ONE
Cz
.
DATE �F 131rTH
PLACEff
BIRT�
SOCIA� SECURIT�
1
. NU R
14- 0 In.
R I a 47
ri.,
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Az-) ILI/
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EMERGENCY
NOTIFICATTCN: (11
NAME & TELEPHONE
F. -
�Q iw- 2 d
(PLEASE
LIST TWO) (2)
NAME & TELEPHONE
11 gn — I I I I
WASHINGTON STATE TAX NO.
APPLICANT'S SIGNATURE
DO NOT WRITE BELOW THISIINE//
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 DATE 6) 7 9 ��j L . AND USE CODE ZONING CODE
V APPROVE EJ DISAPPROVE —T--]
SIGNATURE
CONDITIONAL USE PERMIT
COMMENTS
B�KLDING DEPARTMENT DATE ��, —/6 - - B . uilding
V1 APPROVE 0 DISAPPROVE .44- 2 f rmit 0 Hotel/Motel
SIGNATURE Pe Apt. Bldg. (A)
1�(Ij 1011106 �- Office Bldg. (0)
COMMENTS: Occupancy 0 Restaurant (R)
Gro 0 Hosp/Nurs Home (H)
CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS) E) School (S)
JFIPE DEPARTMENT DATE U.F.I.R.
APPROVE 0 DISAPPROVE SIGNATURE
COMMENTS:
PO)ACE DEPARTMENT 1 11 1
Ef APPROVE 0 DISAPPROVE DATE SIGNATURE
COMMENTS:
PU iC WORKS DEPARTMENT .
�MPPROVE 0 DISAPPROVE DATE SIGNATURE
COMMENT&
C-)! rT1 I n t
NOTICE:
No 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
rnap(�-). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
t-Fe -m a p (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 shown.
Neither the City of Edmonds nor its
emp-to-yee-s or officer-'-) -sh-a 1.1 be Iia b.-Ii-e for the
information given on this map(s), nor for
ion provided based
any one representat'
upon . said map(s).