19509 82ND PL W.PDF11111111 lill
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19509 82ND PL W
ADDRESS: At
TAX ACCOUNT/PARCEL NUM13ER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DA
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
DETERMINATION: [] Conditional Waiver [] Study Required 0 Waiver
SHORT PLAT FILE: LOT:
LID #:-1-3q
BLOCK:
-,) --f rN
SIDE SEWER AS BUILT DATED:& SIDE SEWER PERMIT(S) #: !!Z15.711-r-11
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
LATEMP\DST's\Fonns\Street File Checklist.doc
NOTICE:
Nb--warranty.1of 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.qnds does not ' warrant the
accuracy of anything set for.th on these
map(§-). 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
ernp-to-yee-s or offiCe-rs -S'hal] be 1--ia.b.-Ife for iffie
information given on this map(s), nor for
ion provided based
any one representat'
upon I said map(s).
"Zi
TL r:& s CA A
APPLICAtION
for
y SIDE SEWER PERMIT 1. - . .. . tarZcE!)S,��'-7 a.
mu� EASEMENT No . ..........................................
NEW CONSTRUCTION REPAIRS E]
OWNER............ ................... . . ................................................... CONTRACTOR ......
.......... j N ........
--PERMIT-No::-.--i: .................
ADDRESS JF�
.. . ....................... .... . ................ ............... ..................... !k.... .-LEGA-L --DESCRIPTION—LOT-NO.- -------------------- :.: ...... ........... �BI,40HCK No . ............................................
NAMEOF ADDITION ......................................................................
q-6/ F21— .
4
im—Deep
I
-vl=l
Lr
V T I
20'
Approved:
By .... .... ..........
DATE . . ..... .. ..........
TY___`D MU 0,NN
Of
S
� r �, t., . '.
'Xi
T XT �,
E
3ZZ'
i 1E IRMI "T
4.
(Call 146410.71.
11�er�i'jnsl];eCflons,;
or, -,s,lde1,:se
FORE�
Inspection .1441,I)s Pr6yJdedW ]BE . I COverfing'�,
lthln"2Choursi aft 08-11Y, portion, �tlie, 66nst
er, requ�st. ructlop:
insp ctlo'
e
ADDRIES
nox,OY C, 1V
S 1980 & 1.95
TRU QT._joN,_-: ....... :.; ...... . .11 ;� .826d Tj
...............
PROPERT DESC, Rip
Lot '15 .........
ap Tewood q.:
. ............. ....... �.; ..........
. ..... .. .....
........... .......... ........ ........... ........... ... ...... ...
............ ........ .......
................
7 ................. ............
.. ............. ............ .................
............. ............
....................................
............ ............. 0WINER, ..... ...............
AND BUI, N
CON iMER.:* gi!�q�'.Rq!�
es
'C' T. ........ ............
......................
T44 0 !"A�1EA "D SS ... .....
RE nsOn:; lumbing-,,& so
.......... rw ............. ............ weri .16009,;,'N..
...............................
granted ...... Mia..V .... 3.0.* ..... .... MA-Adowda I Edowds
.... .. .... . ..... 7 ...
....... ..............
19
or.repa�r
systeim"In, accordim .............. ....... . -73
ce'W1`th,`C1tk of, W
Edrilonds o d
r inane of
"CALLEVVdI THE",1,k6tLow'
&,S1de;,,seW:er:f04h ,
47, IdN; is tY
N, 1NG':
oN�n�rs,
-of ith'
e Propert
y may obtain -a Permit tbiconstruci eewer
er"In street
NOTE, N Do rfot cover a nside
2L—AIII. woik p'e,f. nY Portion -prop6rty"Ifne. nsed'�Slde
Sewer Contiaq�or,��16st
r�OTEI No. Ofs6wer before It has "beem, Inspected
rmed. ln,,di ty right- Of-W&Y.,requ I
'I—Obtdin full 'informa!iorj!' res, all! jnvaslo��,of,, IU'ght Ibel(emPloyed.'to�iconitruci
Must hl�ve'a
. .4 . regarding Ordinance, 111.16�036',
—Top;�6�� sf�e� sew �of
NOTE NO: s er -,and,,Regulaelons ailnable.frO�J'the C
harper_tjjan�l% t least 30� Inche is,� Ity Enkineer's office,.
NOTE No.; 5-- iwll,be� Xovernlng��slde)
Tren-ches In, stree I I Permitted,. DYePage At:property ;lIn 'and, 12,ijn!6Ij6, u�_gei pe
�; _,_� .: , I. � le -Inside, ' - -;1 - rrnit�
work t must,be�Patbr. settled,and- surj _�Proper7ty line; -MinjmUrdl,,ra�
Which, may �develo��.w &ceI,OV'street. r 11 . : , - " e,-of 2�%,.,, No, lbends, lhi "grade,
0 Lon'.
';i�!'�unlaw'fjU t6 It- �oredl Ao�.orlginEI1,c' ndit""f
N . OTE� No;, 61—it- Ithin. Pne year of COMP16tion.:' es
'the,P[PeAnt6 a er or., do any-,6the��,:Wo . -k ,,Contract6 sil
-sdrt, lithe wy6,,; r Ahan�Is; provjdj� j I . ... .. � I. � .-. . , .. 1, �s . -�P�be 'resPonsIbI6i4'0r:faJI�r61:d
0 �!n th6ip� .. r . . � �, 1. 11 ., I'll � . ; , " .: U
_:rffilt;, or to- do W o" �Llto,,.1rnprop
�ny.. rkl.on the rnajn,,A gr
iens,
PIS wexcepr,�tb,
:E]:- -'Dat
..................
t
AIPPROVhly . ...... ....
::--A ..... D
B
�D
...........
Remarks
.................... ....................
. ..........
................ I - .1 1 1 17
........... :.
.......... ...... .............. ............. .
........................... . ..........
Pe. ............................ ..................
ticop ......... *...';.-.:.:5.
'Be Sign ed' 1�y. O.Wn . . .................
eniq pjr_M'.,p6jf6rjjji ........................................
qns�tru c
a
-ion
e 8 t,Y,, 6'
hispectibn.�.
.... ... ....
Y certify 1that4hd.iSide-sew'6j,�"-'
1�ner q,; on ct . .. .. ....... ............. .. hereb
nist c n
n, acc T nstructjon)� on,
rda e�
a 0 pn. . tallat! construcie th
b
brdinanc VEdrhon&V: - under -P
is�, e
7 .......... ...........
W
e ep one-:
h
er' �Sewer.
"'ry 0
CITY of EDMONDS BJWS LICENSE APPLICATION
Civic Center - Edmonds, Washin
City *Clerk Phone 775-25S M ANNUAL FEES
, ) FFT PH =
LICENSE NO.
PENALTY AFTER FEB. 15
0 HOME OCCUPATION
INSTRUCTIONS:
CLASSIYEARI
LIC. EFFEC. DATE
LIC. NO]SPEC.1
$10.00 (A)
ADDITIONAL $5.00 0
• All items must be completed
JREASG.
i
Kr --SMALL BUSINESS
or application will not be ac-
RECEIPT NO.
DAIt: FAIIJ
A
PRINT'X'
$15.00 (B)
ADDITIONAL $7.50
cepted.
IN SPEC. BOX
ISSUE OF
0 Business with 10 or,
• Sign and return application
FEE PAID
PE NALTY PAID
CORRECTED
more employees
ADDITIONAL $25�00 0
with fee. Renewals received
L
LICENSE WITH
'LC'ACTION.
$50.00 (C)
after February 15 must pay
W APPLICATION (LA)
penalty in addition to fee.
0 RENEWAL
(LB)
NEW BUSINESSES AFTER
0 CHANGE
(LC)
JULY 31, 1/2 FEE.
(PLEASE MAKE ANY NECESSARY CHANGES) 0 DELETE
(LDi
NAME OF FIRM
BUSINESS PHONE
MAILING(ADDRESS NATURE OF BUSINESS*
-e A4 AV2
NO. OF EMPLOYEES
-:---tJtJZ)INtZ)Z�o AUUHtbb
ff //_
�, -)
INDIVPUA L
PARTNERSHIP CORPORATION
Z'.2
Ezf(S)
= (P) P
NA
HOME ADDRES
H'OME PHONE
77 -
DATE/OF B TH
_ 17
M2 �z
OFjBIRTH
-
-4,
11
J]
SOCIAL SECURITY NUMBER
EMERGENCY NOTIFICATION/ (f)
�
NAME & TELEPHONE
Jt_
Y07 77Z
(PLEASE
LIST TWO) (2)
NAME & TELEPHONE
%a - 7 7a -i� 7,-P
14ZI
WASHINGTON STATE TAX N
APPLICANT'S SIGNATURE
�, t",
-DO NOT WRITE BELOW THIS LINE
STAFF REVIEW: FILL IN LAND USE CODE, U.FIR NUMBERS, ZONING, ETC. CHECK APPROVAL OR
DISAPPROVAL, DATE, AND SIGN. IF DISAPPROVAL, PLEASE.COMPLETE "COMMENT"
SECTION. ROUTE TO NEXT DEPARTMENT ON LIST.
PLANNING DEPARTMENT DATE3 LAND USE CODE ZONING CODE
26APPROVE El DISAPPROVE SIGNATURE-Y) C->
CONDITIONAL USE PERMIT
COMMENTS
B;ALDING DEPARTMENT
116,6 APPROVE ET DISAPPROVE
DATE
SIGNATURE AftA 0!jQ o C,
Buildigg
Permit
ED Hotel/Motel
�KApt. Bldg.
M
14 V.r
(A)
Occupancy
1:1 Office Bldg.
0 Restaurant
(0)
(R)
COMMENTS:
Grou
El Hosp/Nurs Home
0 School
(H)
(S)
==IXCAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS)
�v
FIRE DEPARTMENT
DATE &/7 1
U
Cj APPROVE 5e-DISAPPROVE
SIGNATURE 727,
LOJ471 I? I
C 0 M M E N T S: lu P_ I- D (1) 4 0 Ple, c--S s C;b F1 e o5. r/,(_�,,.S H,-
POLJCE DEPARTMENT DATE SIGNATURE
lb--)�PPROVE 0 DISAPPROVE
COMMENTS:
L�C WORKS DEPARTMENT
A PROVE 0 DISAPPROVE DATE-3 16-7 SIGNATURE
COMMENTS:
PLEASE RETURN 1-0 rITY r.1 FIRK