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640 DAYTON ST
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TAX ACCOUNTIPARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION:,E] Conditional Waiver E] Study Required E] Waiver
DISCRETIONARY PERMIT #.'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS'DA'
EASEMENT(S) RECORDED FOR:
PERMITS
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DA'
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
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LATEMP\DSrs\Fomis\Street File Checklist.doc
APPLICATION
for
The City of Edmonds SIODE SEWER PER3HT
NEW CONSTRUCTION C] REPAIRS 0 EASEMENT No . ..........................................
OV*rNER .... ....... ........................................................... CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS ..... &AQ ...... Dar&zu..141'� . .............................................. LEGAL DESCRIPTION: LOT No . ............................................... 13IA>CK No . ............................................
NAME OF ADDITION
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DATE........... .................................... By ......................................................................