19514 82ND PL W.PDF15359
19514 82ND PL W
ADDRESS: / J,-�57/ 4 _ L-2:�a� P&
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: E] Conditional Waiver . E] 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 #:
FOR:
(V
WATER METER TAP CARD DATED:
OTHER:
LATEMP\DST's\Fomis\Street File Checklist.doc
APPLICATION
The City of Edlmonds STREET FILE for
EASEMENT-N Iz
NEW CONSTRUanON REPAIRS [3 0 .. .... ...... ..............
.... ......
... .. .... ...
....................... . . . ...
........... _PERMT-No.- -.74
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........ z ..... Sta ..
ADDRESS ..
ON: LOT No . .......
. . ...................... . ... ......
. ........ '0= No . ............................. ....
.................
IV
NAME OF ADDITION .........
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Sol"
3044c�
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Approved:_,` 000,
MUILMIN
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DATE ... 2 ;y7:: >,:; ee�_ �__ - - - 7e ...... .....
APPLICATION
for.
The City of Ed.monds SME SEWER P=MT
EASE3JENT No . .......................................
NEW CONSTRUCTION REPAIRS 0
NTRACTOR.
OWNER .. �rs P
........... 6-- a'rlee �- ................................... co .... ...... ...............................
ADDRESS 4/nIl ............. V .................................... LEGAL DESCRIPTION: LOT No . ..... / ........................ .......... BLOCK No . .............................................
.............................
NAME OF ADDITION ... ..... 0/
f%
Approved:
DATE... ; ............................................ By ........................................................................
0
0
14,
V77
'Cl
-07 F DIM, 0�� ND, -,S1DE'*:SEWER,-'*?ERM1T
ICITY.
W ktI4: M%R prpl��RTNT_NT.
S F
x.
2:
a I 'T.
inspection , s BEFOfilk. covering�.anyportlon. of h -5*n!truFtlonzN�
C 11.:7.76- 07;*'fdr side serwitir . J. -
t e
'24 hours' `�Aun.,
lnsp�ectldn, WIll be. provided 'withi 6,1 ,after -r��uest*.!. �Nosit`., or::�oiida�,inipe�tfons!)7�`
X
'51 214'A,.,'.j & PlAcd�:V6st i.
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1MTY�1UiG'A,V,D* ESCRIPTION.L� I.: .
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........................ 7
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7 ............................ . ............. .....................................
............ . .............. '98*1
I : . , "� "', ''. : i . , . I., � -!;, '.. , - . . . , --.H .6,t:
. .. . � �. ��� ., I. NORD CONST. :5 W arHipp, seatt'i
........ ....... ..!L-OVV`NER- AND/OR, BUMDER .................. ; ......... ...........
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47KXCTOWSWAME
6 n�
Russ:.,'.J 'h sort:-.- .6009 M 'ado
-OADDRES& ............. ............ A ....................... e
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ssion s,,tgran ................. . .................... d
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73
0 a'�sz e-'sewer,jo
icon
W -;4-1',____* ----- " , '*�. , I .
.,tl,'syst4�anvffi(ac:ci)i-dainc�3'.' 4ih--'City,'of:,kdM0 6rdinane",,"'
Z 4.
7:.
0 �L
X� -T4E I;,
0 i—,i,ne,,owners,-of,th�.ljibpert�� may obtixim*.a�-Peimlt�tb,.;C'onst���t,:�ewer-,irisid6 pfoiiei-t�Mnei�' A ifeehied' 'S'Ide� , §iiFeir C�jjj�'acj�j',' empio,
sidesewer in. stre;et area;: Do not, A�st,bli,
cover.any portion' -of sewer before it h&s_been`insp�ectedr1
wor . peri.�rmed. in:�city' rilkht-of-wayoireq�ires,*an. In�vasto'n.'bf.:RJkht-ofrWay'P�rhilt-obtiLiniLble. from theCit)�*-Erfgine?er�"'s oftt8e.
k" 'L
'�t:-�NO'kE,iqo�'3L20b�bJn�'f'ulI inforniation-regardirigOrain�n6e '11. 1� :630 and
Regulations, governlhg lse%4rs .%,K�n'you. get permit.
NOTE 4No. t
side -sewer musi�have-ai.�Ieasi,30 inchii_cov6rag�,�t pr6plirty.-Ilne. and,j 2 -Inc esAnside.'propert
V Iline;.;minimum grade of.'2 ;.No'-Ab
inds'.16 g
",shar�-ii...than will, be'.permltte'�,,
TE.,No.
0 es'torid:;l to .�rlgfiial '6ondltlon�- Contractors shiiji -I net nproP6
SL:!Trenbh�.: I. street musi be.,water. settled -and.'silirface,* usiree�t%r' . I. ".
".4ork which' .4 , . ".. , be��re r. afgAlure,
May develop within one',Yiar,of-completion :, -�, .,;, ''' 1, � - .;, . " : , 9po lb]6,:fo AtiiF.�to.
4. 4"
6zIt -is"' unlawful --'to� alter or d6
cir to d.b.,-ailify, work -,'on %
!NOTE). No., -ot Iie'
Y.. er work thir� 113,.P�lor e) ri�ii; -;� L"t�e'�maln,seW6r,..or.�i���-�,,ppur-ie"n,ancesi,exc'ept,'t6..,,iri',il..",
�.sert the -pip6JnW
the-wye-
F
B*
bfS"kA6VED.i, ........ ...... Y.� ... ...
.... 777"'
W, APPROVEI
.... ............. ..... ....
........... ......
............
fINAL, INSPECTION' -PEND ING�,-.kEC8-I?fdf .,EASEMENT-':,
........ . .......................... .... . ................. .............................. ... .......
......... . ..... ...
...... . ...... . ....... ............
........... ......................
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Ab
rrpit.. Vie 'N ST e,;!Signed By',, OwnC-r'. OL*-Firin --Pe�forrniiikt�C(iiiki-�'cti6ii��-PAIO*A�",�r6i�k-eq�6st*�.Por.-,.1n�pi�6
tjdn�
14 T.
v
4
C .......... .. .........
............ 16fl
�Ow, e
y 4
ontractin Fi erfcfming Construction,) V,, perm
o 'eirning"ordiniances 6?,*;ihd,idify, o :Edjribnd§.;
S�,
ed�in rdance,Lftiit;_.;11;:g:2
ed this....
Dat
7 It.
Che6k--BEFORE-. jou. diglor:� Wate P'l )ho'ne* '':;-AoiVe Ot�'ei��
r,, e ej r C],: Se* %vVE]
T�,
CITY of EDMONDS BONESS
LICENSE APPLICATION LICENSE NO.
Civic Center - Edmonds, Washington 98020
ANNUAL FEES
PENALTY AFTER FEB. 15
City Clerk Phone 775-2525
4R�94OME OCCUPATION
CLASS
YEARS
Sqjftj.
0
C.
$10.00 (A)
ADDITIONAL $5.00 0
I Nb I Kus, riONS:
18
I 7�
RM
11
XSMALL BUSINESS
All items must be completed
RECEIPT
NO.
DATE PAID
.
A—
$15.00 (B)
ADDITIONAL $7.50 0
or application will not be ac-
'71
PRI NT X
cepted.
A �I
Io I]
IN SPEC. BOx
FOR ISSUE OF
El Business with 10 or
Sign and return application
FEE PAID
PENALTY PAID
C 0 R R E C T E D
LICENSE WITH
more employees
ADDITIONAL $25.00 0
with fee. Renewals received
L 15-4,Dnl
L _j I
'LC' ACTION.
$50.00 (C)
after February 15 must pay
NEW APPLICATION (LA)
penalty in addition to fee.
El RENEWAL
(LB)
NEW BUSINESSES AFTER
0 CHANGE
(I-C)
JULY 31. 112 FEE. (PLEASE MAKE ANY NECESSARY CHANGES) 0 DELETE
(LD)
E OF FIRM
I BUSINESS PHONE
-7 V L/ 7
MAILING ADDRESS NVURE Ol� BUSI(qESS
�7 J- 7.;2 tv
7f- e -Nl
NO. OF EMPLOYEES
S -A-d—DR E INDIVIDUAL PARTNERSHIP CORPORATION
7-;2 (P) P
EM (S)
HOME ADDRESS
HOME PHONE DATE Of BIRTH P ACE OF.BIRT SOCIAL SECURITY NUMBER
:Z/,7- Zs��q 2 1r 0-' /17,21, - - L-1�1 _q - / 1// - --2 ;?,� /
EMERGENCY NOTIFICATION: ' (1) NAME & TELEPHONt ',4 /,02-
(PLEASE LIST TWO) (2) N A M E & T E L E P H 0 N F 45-2t�U 6' 7' z
WASHINGTON STATE TAX NO APPLICANT'S SIGNATURE
DO NOT WRITE BELOW THIS LINE
STAFF REVIEW: FILL IN LAND USE CODE, LIFIR NUMBERS, ZONING, ETC. CHECK APPROVAL OR
DISAPPROVAL, DATE, AND SIGN. IF DISAPPROVAL, PLEASE COMPLETE "COMMENT"
SECTION. ROUTE TONEXT DEPARTMENT ON LIST.
PLANNING DEPARTMENT
2"APPROVE 0 DISAPPROVE
COMMENTS
DATE a% 22
S I G N AT U R E Y1
ILDING DEPARTMENT DATE 2 -13 -7 7--
APPROVE 0 DISAPPROVE SIGNATURE - I& - ...
F%A-W
COMMENTS:
��APACITY: (NO. UNITS, AP'TS., OFFICES, SEATS, BEDS, STUDENTS)
FIRE DEPARTMENT DATE
EJ APPROVE $ DISAPPROVE SIGNATURE C---z
COMMENTS:
LAND USE CODE ZONING CODE
I I . I I 1(")-1 01 1 -1
CONDITIONAL USE PERMIT
Building El Hotel/Motel
Permit Apt. Bldg.
(L)
(A)
- / Office.Bldg.
(0)
Occupancy 0 Restaurant
(R)
Iroup 0 Hosp/Nurs Home
(H)
fff,l 51 0 School
(S)
10Ms
009FIRIMEW
P96CE DEPARTMENT
DATE 20/ SIGNATURE Z�
If APPROVE 0 DISAPPROVE
COMMENTS:
PUBLIC WORKS DEPARTMENT
IYAPPROVE ED DISAPPROVE DATE -3zl SIGNATURE At24:z4-'
COMMENTS:
ni r-AcIr! mr-rIPM111 -re-%