19511 82ND PL W.PDFIIIIIIIIIIIIII
15358
19511 82ND PL W
ADDRESS:
TAX ACCOUNT/PARCEL NUM13ER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS: DETERMINATION: E] Conditional Waiver E] Study Required F] Waiver
DISCRETIONARY PERMIT #'
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID #:- 1,-3q
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\DSTs\Fomis\SUwt File Checklist.doc
APPLICATION
for
I no 161TY OT camonds 1-11 n SIDE SEWER PERMIT
a Mom 0-
EASEMENT No . ..........................................
NEW CONSTRUCTION REPAIRS 0
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o not cover any portion of, licensed
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—All, work Perfo-r-med �in 'Ity right -of- sewer.:b�fore, It-, has en Inspected.-i -.SidO Sewer C6ntra�iI6r
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0
ITY 0 -Ile
CITY of EDMONDS
131 OSS LICENSE APPLICATION
Civic Center - Edmonds, Washind%verlIF
City Phone �75-252bl R PT 9:11 1:
LICENSE NO.
ANNUAL FEES, PENALTY AFTER FEB. 15
0 HOME OCCUPATION
INSTRUCTIONS:
CLASS
YEAR
LIC EFFEC, DATE
�O.I�PEC.j
$10.00 (A)
ADDITIONAL $5.00
0
• All items must be completed
JREASG
V.-S'NIALL 13USINESS
or application will not be ac-
RECEIPT N
1; DAI h Ir!AIIJ
PRINT X
$15.00 (B)
ADDITIONAL $7.50
d�
cepted.
IN SPEC- BOX
FOR ISSUE OF
El Business with 10 or
• Sign and return application
FEE PAID
PENALTY PAID
CORRECTED
more employees
ADDITIONAL $25.00
0
with fee. Renewals received
LLt
LICENSE WITH
LC'ACTION.
$50.00 (C)
after February 15 must pay
j]r'NEW 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
(I_D�
I NAMEOF FIRM - I BUSINESS PHONE I NO. OF EMPLOYEES
MAILINGr ADDRESS NATURE OF BUSINESS*
v xg)A A�
b U,> 1 IN r- OZ.) A U U h t Z:� INDIV
LDUAL PARTNERSHIP CORPORATION
(P)
_�Slo
HOME ADDRES
A�
HOME PHONE DATE"OF 6 T OFeIRTH SOCIAL SECURITY NUMBER
-7q 4-z5-;L_
EMERGENCY NOTIFICATION- NAME & TELEPHONE 1, Ye) 7 - 7 7 e
(PLEASE LIST TWO) (2) NAME & TELEPHONE < - �'() 7 - 7 7_2 V 7X-
WASHINGTON STATE TAX NO.��'/- A P P L I C A N T'S S I G N AT U R E
DO NOT WRITE BELOW THIS LIN E`�'-,-
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 LAND USE CODE ZONING CODE
9'APPROVE 0 DISAPPROVE SIGNATU (f ';5Lu--z_�t *1 1 1 - -1 . (5 1 1 1
RE Fq
CONDITIONAL USE PERMIT
COMMENTS
E=
BZLDING DEPARTMENT
%6 APPROVE 0 DISAPPROVE
DATE
SIGNATURE
Building
Permit
E) Hotel/Motel
I)K Apt. Bldg.
2
t
(A)
ra
Occupancy
0 Office Bldg.
0 Restaurant
(0)
(R)
COMMENTS:
Group
0 'Hosp/Nurs Home
0 School
(H)
(S)
EI=IXCAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS)
FIRE DEPARTMENT
DATE �,17 1
U. F. 1. R.
0 APPROVE ZDIS.APPROVE
SIGNATURE 2',7,
COMMENTS: lup-ra-0 (1) fopr_E;s5 C;o FtcE
POLJCE DEPARTMENT DATE SIGNATURE
t"APPROVE 0 DISAPPROVE
.COMMENTS:
PUBXC WORKS DEPARTMENT
ZAPPROVII 0 DISAPPROVE DATE. _7F SIGNATURE J
COMMENTS:
NOTICE:
Nb-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 for.th on these
map(�_). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
'm a p (s)
t including, but not I'm*ted 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-1-o-yee-s o-r officlers -sh-a-111 be l"lab'Fe for the
information given on this map(s), nor for
ion provided based
any one representat'
upon said map(s).
STREETfILE EEM2ERi
PUBMC WCM — ENGINEERM
ACTION REPORT
CAM
N? 4105
SUSPENSE DATE:
Date: eo 1,:,2& Time: Al" ile #
i I f Attarhmpnt— r-1yac
REQUESTOR: NAME:
ADDRESS:
PHONE: 2 7-/ 0 0 0
REQUEST RECEIVED BY:
TELEPHONE
CONTACT IN OFFICE r --- I
OTHER:_ r---j
RECEIVED BY:
Pn[ITF Tn.
mamma
MEM
HIM
IMMIM
ACTION:
rw'z. I N F ISM TA -A 14
wAq=104jL- a X, T.,
-4111n
All Concerned Notified
Action Completed/File