19507 82ND PL W.PDF11111111111111
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19507 82ND PL W
ADDRESS: dLil) Z - X2J1
TAX ACCOUNT/PARCEL NUM13ER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: E] Conditional Waiver Study Required 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: SIDE SEWER PERMIT(S) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED:
OTHER
LATEMP\DSrs\Forms\Street File Checklist.doc
APPLICATION.
OT FILE for
The City.of Edmonds STf IEE
SIDE SEVVIM PFMAM
ENT o . ........ ZS=
NEW CONSTRUCTION REPAIRS 0 EASEM W ....................................
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Approved:
DATE...
CITY "OF EDMONDS
WAT.kWSE j&R- DEPAAT4j� PERMIT
W.
4,37
all :7 1107 for sfde-_.fiev�er fnspe�6fjons, lai�F'O R'Fq
;ns,pecti,on Will, be 'Provided w . Ith ccr.vering','a.�. of
in 24 kjLj,, after req�dst.. e constriicilo
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"'P. CqNST'A 19505:,,.&: 195
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SS LICENSE APPLICATION LICENSE NO.
CITY of EDMONDS
Civic Center Edmonds, Washingtln..W20 ANNUAL FEES PENALTY AFTER FE6.15
City Clerk Phone 775-2525
STREETFILEL] HOME OCCUPATION.
CLASs [YEAR I L C. EFrEC. DATE JREAS13 LIC.. NO.jSPEC. $1000 (A) ADDITIONAL $5.00 11!
INSTRUCTIONS: I I., . . . I
• All items must be completed ./—,11,-7. 1. 1 - I I I I 1 1.1 SMALL BUSINESS
or application will not be.a&- RECEIPT NO. DATE PA !NT'X' $15.00 (B) ADDITIO
IN SPEC. BOX
cepted. 14/1 FOR ISSUE OF C3 Business with 10 or
FEE'PAID PENALTY PAID' CORRECTED. more employees ADDITIONAL $25.00 0
• Sign and return application r I LICENSE WITH
with fee. Renewals received I zi 1, 41 1 1 1 'LC' ACTION. $50.00 (C)
after February 15 must pay >91 NEW APPLICATION (LA)
penalty in.addition to fee. 0 RENEWAL (LB)
NEW BUSINESSES AFTER CHANGE (LC)
JULY 31,'1/2 FEE. (PLEASE MAKE ANY NECESSARY CHANGES) 0 DELETE (�D)
NAME OF FIRM BUSINfSS PHONE NO -OF EMPLOYEES
MAILING ADDRESS NATURE OF BUSINESS
INDIVIDUAL PARTNERSHIP CORPORATION
B U�S I �N DRESS
f
_5--o s - o 7 P (P) (C)
OWNERS NAME HOME ADDRESS
.113 L,-t 0,
DATE OF BIRTH LACE OF BIRTV,," AL SECURITY NUMBER
7 je�k- 2,7— X_!5� x j tl-3
EMERGENCY NOTIFICATION: - - (1) NAMEA TELEPHONE C
(PLEASE LIST TWO) (2) NAME & TELEPHONE
WASHINGTON STATE TAX NO.- APPLICANT'S SIGNATURE
DO NOT WRITE BELOW THIS LINE
STAFF REVIEW: FILL IN LAND USE CODE, LIFIR NUMB . ERS,'.ZONING, ETC. CHECK APPROVAL OR
DISAPPROVAL, DATE, AND SIGN.. IF.DISAPPROVAL, PLEASE COMPLETE "COMMENT"
SECTION. ROUTE TO NEXT DEPARTMENT ON LIST. -
PLANNING DEPARTMENT DATE3—/V- 9'7
LAND USE CODE ZONING CGDE
NaPPROVE 0 DISAPPROVE `�) r * -
SIGNATURE
CONDITIONAL USE PERMIT
COMMENTS
PXLLDING DEPARTMENT DATE
T3 APPROVE 1:3 DISAPPROVE SIGNATURE 1,64
24
COMMENTS:
I I I ' CAPACITY: MO. UNITS. APTS.. OFFICES. SEATS- BEDS. STUDENTS)
Building 0 Hotel/Motel
Perm it fA, Apt. Bldg.
(L)
(A)
M611 10 F3_ Office Bldg.
(0)
Occupancy 0 Restaurant
Group 0 Hosp/Nurs Home
(R)
(H)
17C-1 113 0 School
IS)
I-Iht UtVAH I MtN I DATE 2- L4� 1:1 W-J.H.
0 APPROVE .4. DISAPPROVE- SIGNATURE C, -z
UT
COMMENTS:&PA 10- A-D r> &�S /06 T)4/m A 0? 6: _c x r ;L)
LICE DEPARTMENT
DATE Sir.NATHRF
APPROVE 0 DISAPPROVE
COMMENTS:
0::4 9=A
POLIC WORKS DEPARTMENT
j6APPROVE 0 DISAPPROVE DATE. 3 SIGNATURE
rn%1 r—Ae%r— M��IIMSI �0% o�%l �MIA
NOTICE:
N'o wa rra nty...of -a-ccu racy..
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.qnds does not ' warrant 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
�._t_Fe -map(s), including, but not limited to,
th-e lociation 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
ern p]-o-yee-s o-r off ice-rs -sh-a-1.1 be [i a-b.-Ife for the
information given on this map(s), nor for
esentation provided based
any one repr
upon . said map(s).