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21305 80TH AVE W
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ADDRESS:
TAX ACCOUNT/PARCEL #:
BUILDING PERMIT (NEW STRUCTURE) #:
COVENANTS (RECORDED) FOR:
CRITICAL AREAS #: DETERMINATION: 0 Conditional Waiver El Study Required El Waiver
CRITICAL AREAS #: DETERMINATION: Conditional Waiver Study Required E] Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORD FOR:
PERMITS (OTHER — list permit #'s):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID #:
SHORT PLAT FILE:
LOT:
TB_LOCK_-
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED'
STREET USEIENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
L:\TEMP\DST's\Forms\Jana's Street File Checklist 5-14-08.doc
APPLICATION
I CIO for
The City of Edmonds SEDE SEWER PERNW
EASEMENT No . ..........................................
NEW CONSTRUCTION C] REPAIRS
32-5- Q!qlsno
OWNER....... -On-54A .. .... ................................. CONTRACTOR ................................................ ................................................. PERMIT No . ......................
ADDRESS ... 2.13-0.5 ....... l0th.-.Ava,,,.\Al,, ...................................... LEGAL DESCRIPTION: LOT No . .............................................. BIA)CK No . ............................................
W
NAMEOF ADDITION .........................................................................................................................................
-JurNa') IC04
D\ja, -Tqs+acl or% 5avi(Lr
Approved:
0
DATE................................................ By ......................................................................