604 DAYTON ST.PDFIIIIIIIIIIIIII
10828
604 DAYTON ST
0
TAX ACCOUNT/PARCEL NUMBER:
7=m
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: Ej Conditional Waiver 0 Study Required E] Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR.: —
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
UIX
SEWER LID FEE LID #:
SHORT PLAT FILE: LOT: BLOCK:.
SIDE SEWER AS BUILT DATED:' �\A
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
LATEMP\DS'rs\Fomis\Street File Checklist.doc
The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS 0 EASEMENT No . ..........................................
�) 9 7 Q -
OWNER ..... /L/La4.-Z77Ui .... Ta � .............................................. CONTRACTOR ................. ................................................................................ PERIvUT No . ......................
ADDRESS ... 6.0.4 ..... ................................................ LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
0
10
NAME OF ADDITION
App,o
15-11,11
010
6L &-t�
0
DATE................................................ By .................................... .................................