19503 82ND PL W.PDF1111111111 lill
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19503 82ND PL W
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ADDRESS: lEi�5 - ZZ2zyD P/, k)
TAX ACCOUNT/PARCEL NUM13ER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: E] Condifional Waiver E] Study Required E] 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 #: 13q
SHORT PLAT FILE: LOT: BLOCK:
-70
SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) #: '41
I C/
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED:
OTHER:
LATEMP\DSrs\Fomis\Street File Checklist.doc
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C `0F`EDM0-NDV--'-z;1�'S1DE;S
ITY
WATER -SEWER
TE Y
RMIT,' L
X
(call 718-1107 for side sews tnspecttons� BEFO
Ri� �' �. any ilortion of t6
Inspection wjI1 be provided wit oons ructign.)
I�n 24 hours after recitiest, NO'Sat,". Zun., or hoito'
day Inspections,
f
ADDRESS LO19AVION OF bONSTRUCTION .... J.9.5011 ... & ... 1.95.0.3 ... . ... 82*nd-...P.1aqe west
. .. .. ........ .. ........... .. ................... . r ............ .... . ... ................................. .....................
PROPERTY LEGAL DESCRIPTION....".. Lot. 13, - Ma6fewbod
.............................................. . ............................. ........................
...........................
"4 ........ ........ . . .. ....... ....... ...... ...... ...... .......... ......
. ..... .........
OWN
-Hwe s
I . ................... . .... ........ OR BUILDER .............. *.4 ........................
Nord"
...........
..................... .................
eWer-'&_Pj.Um ingi 16o
Ru-ss'',,,J'o'6�'so' 09� N MOadowdal
NA]ft',& ADDRESS
............ ........ ........ . .....
......... ............
"'Wash '. '96620,
s M ....... jiliirej
Y's IVY lseli�p,
66s.*. "y:,�"jta' , - r`
to;�,We
is �xL, L.,
''The -;Owl
lobta14's; no ruct-s
1� ll�is; of ihe kooeAr, rnl'a'k.
10 ed Vioconst c
-olde� sd*ei,tn,sti6et aiea. '�Db iiot,c �poi�ion,.of -,sewei,bsf6r6 A' has. bserl'in pl'ust be �bmi;l Yed tlq�, �onst 1
spicted'
iLAII �wo�k
jconk
ru
t-of-*a3r requtfe�d iajpl - ..tl
i: N pv"joni -of RI*ght'-of-wWF`
O!rE 'I - , !ok7q�bb ahmble',from- the C ty Prigloews I office.
btWn full �iortrnottofi!�re
lkardIfig Ordinance 1'1;16;036: &6d'�keg'�lations'.gov6rning�side�iowerswli on.you, , get permt
t
NOTE -No. �4—Top,bf.sidii 's*e*'Wer�',Mtis�,�h"�riit,,Ieaii*30 incheixoVeiv�je ai,�io�e�tj
lfi�e:- and'12 ip6heO iiiitdiB,,'prop�rty.'.ilhe,',.iiliiiiliii,� gr
r. than -% w�111 %e, peppitt?d! rd grade of, 2 No, bonds In .,�ra�ds
NOTE Nix ;5---:T.rench4 In, street m�it-bs water �setiled "d 's&fice of atree�ivlr_tistorid 1
w6rk"whicii rnay'�develop o,6rIgjnsa,�condItjojj. imp
within one year 6fcorhpletion contractom shall be lrejij�onsible fo
.r fallure due 6 - iff�pro�e',
ul o alter or do n, th
0
NOTE t oiher'.w6r� -ihan.is'o
'th- " per�nl 1pt 0
e pipeAnto the wye. t,:'or to do gny',�iork,pry the, mal
A,sewer or its:&ppurieriances ex pt to.in
ce.
DISA.PPIXOVED.
...... ..... By .................. DA,w ...........
. . .......... ....
B*
................ ........ .........
ate
'APPROVED
.......... ....... ....................................... ...................
P
Wmarks: ........ 7 ... .. . ...................... . .. .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . .
. . . . . . . . . . .
. . ... ........ ..... .. ....... . . I . ........... .. . . . . ... . . . ............ ........................ ........ ......... ..... ............ .. .. ... ..
. . . . . . .. . . . .. . . . . . . . . ... . . . . . . . . . . . . .
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ry
'pa ,
C
heck'BEFOj
.:.P'e S!gn6d By':Q�yner �ff, i�irm'i�eifo*rzning:.iDpn��urti
PRIOR To Rbqu'
est ForIns
7
.... .......... ......... hefdby- ,'certifv that the.side sewer Installati6
g,Construcbon5 1-1 '. .., _."::. ) I � L . I . I ..n tonstructed -under, thls�'�611'hllt,,,��'�
rn pidinances of t `iy �df 'E
M Ci dirionds,.':
Daited this
........ . .... .... clay of�.._7e
............ .............
VU you CLIg, ;or: W;4�-.Ir, i[]� c"28 '01 Telephoine -'PowlBr r
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'f�47:r 7% LICENSE NO.
B A ON
CITY o� EDMONDS "AL
CIVic Center Edmonds, Washington 98020 kT ANNUAL FEES
City Clerk Phone 715-2525 PENALTY AFTER FEB. 15
HOME -OCCUPATION
LIC. EFFEC: DATE JREASG. LIC. NO -C $10.00* (A) ADDITIONAL $
INSTRUCTIONS: CLASSIYEAR .§PE 5.00 -1f.
All items must be coirn,pleted SMALL BUSINESS
or application will not be ac. RECEIPT NO. .. DATE PAID IN X $15..00 (B) ADDITIONAL $7.50 0
IN SPEC.
cepted. Vo Box 0 Business with 10 or
_ .1 /1 FOR ISSUE OF
Sign and return - application PENALTY PAID CORRECTED more employees ADDITIONAL $25.00 0
1 LICENSE WITH
with fee. Renewals receiv'ed zv-40 I I _L__L_L_ 'LCACTION. $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 OF400ff Cttq�-%� BUSINESS PHONE NO; OF EMPLOYEES
I a - 41 v d CA 0-� A01111PIL, ..
MAILING ADDRES NATURE OF BUSINESS
C>70806 dop).
mlillk Lto. q4n61
aawGwE 1ADDREf
tq_�o 14 0_;� f5R 041 IQ I W
44PIVIDUAL
PARTNERSHIP CORPORATION
do?)e� - -
cx:3 (S)
(P) P
QVVNERS NAME
/1 %.+
HOME ADDRESS
1%, ., .16,C
P NE'
CYWE 1h
DATE ?FBI TH
!0 J P1
PLACE Or BIRT�
rift A A
11 W7
SOCIAI SECURIWNUM ER
EMERGENCY NOTIFICATICIN: (1� NAME & TELEPHONE
(PLEASE LIST TWO) (2) NAME & TELEPHONE !I3Q_:1j4h1:7
WASHINGTON STATE TAX NO. 10 APPLICANT'S SIGNATURE
D -NOT WRITE BELOW THIS' -LINE//
0
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.
7779
PLANNING DEPARTMENT DATELI-10 797. LAND USE CODE ZONING CODE
APPROVE 0 DISAPPROVE
SIGNATURE?
CONDITIONAL USE PERMIT
COMMENTS
BY(LDING DEPARTMENT DATE
10 APPROVE 0 DISAPPROVE Building 0 Hotel/Motel W
SIGNATURE Permit Apt. Bldg. (A)
Office Bldg. (0)
Occupancy 0 Restaurant (R)
COMMENTS: Grou 0 Hosp/Nurs Home (H)
CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS) 0 School (S)
FIPE DEPARTMENT DATE 4/ -U.F.I.R.
APPROVE 0 DISAPPROVE SIGNATURE
COMMENTS:
Pq,WCE DEPARTMENT DATE :f . - SIGNATURE
Cf APPROVE 0 DISAPPROVE
COMMENTS:
PUP�IC WORKS DEPARTMENT
[��IAPPROVE 0 DISAPPROVE DATE
SIGNATURE
COMMENTS-..
r, i , . - - - --. i � .
NOTICE:
N'o ... warranty.l.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 * wa rra nt the
accuracy of anything set forth on these
map(�_). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
-map(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
. h. a- I. I b e l.`I a- b..'Fe f o r -,I h e
emp]-o-yee-s o-r officer-") S i
information gi,ven on this map(s.), nor for
ion provided based
any one representat'
upon . said map(s).