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TAX ACCOU NT/PARC EL #: �0 6)0 2- 06 6Cr3
BUILDING PERMIT (NEW STRUCTURE) #:
COVENANTS (RECORDED) FOR:
CRITICAL AREAS #: DETERMINATION: El Conditional Waiver E] Study Required 0 Waiver
CRITICAL AREAS #: DETERMINATION: Conditional Waiver El Study Required 0 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 #: I -OF
SHORT PLAT FILE:
LOT:
BLOCK:
SIDE SEWER AS BUILT DATED: t5/ &
SIDE SEWER PERMIT(S)#: 4 1 --5
GEOTECH REPORT DATED:
STREET USE/ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
LATEMP\DST`s\Forms\Jana's Street File Checklist 5-14-08.doc
APPLICATION CARD No . ..................... ... ... ..........
for
SIDE SEWER PERMIT
EASEMENT No . ......... ............ . ......... .........
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The City of Edmonds S
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OWNER ........ Z4��Xol ...... ...................................... CONTRACTOR .. 6-S .... PERMIT No.
STREET
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HOUSE No. ........................ AVENUE LOT No . ......... 65 ..................................... BLOCK No . ....... ... ..............................
NAME ADD ....... IN
. .. ........
..........................
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Date
BACKFILL WORK ORDER ISSUED . ...........................................
SEVER WORK ORDER ISSUED ................................................
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Approved:
DEPOSIT, $ ................. ....................................
DATE ...........
;z (Z' — G '7
APPR�QVED
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\F�EP -"l 1963
BY............................................... I ........................ I
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