650 BELL ST.PDF11111111111111
10263
650 BELL ST
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER: GO 4 DLyZ05 e o 1 -16-0
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS L,/ — 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 $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
LOT:
LID #:
BLOCK:
LATEMP\DS'l7s\Fomis\Street File Checklist.doc
APPLICATION
for
The City of Edmonds SIDE SEWER PERNaT EASEMENT No . ..........................................
NEW CONSTRUCTION 0 REPAIRS r-1
114-03200
OWNER........... TbQ;r.fi.n .... Nlel.s en ................................................... CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS ....... �5.Q ... Rgt-ll .... at ...........................
V
0
6,
........................... LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
NAMEOF ADDITION .........................................................................................................................................
Dye Tested On Sewer 1972
Approved:
DAIS................................................ By ................