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20816 76TH AVE W
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STREETFILC C I T Y 0 F F D M 0 N D S
PUBLIC WORKS DEPARTMENr -
Routing of Building Permit, Plat, or Subdivision Applications
Proposed Property Address: ' 20816 - 76th Ave. W.
DEPARTMENT
CONHENTS
NITI
& DATE
W A T E R
-71
S E W E R
S T R E E T
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B U I L D I N G
0 R
P L A N N I N G
ADDITIONAL INFORMATION:
/,2 -:5-- 7
9
7
I A /-1 .2 /,Yf
k- I
Bldg. B ;_v 0
USE PERMIT
-BUILDING DEPARTMENT ?,Iipplicant Fill ZONE NUMBtR RECM1'7_,""
PERMIT APPLICATION s de Heavy Lines JOB 01
ADDRESS 4
A, 4
NAME (OR NAME OF BUSINE.SS)
VARIANCE OR COND. USE NO. NO. HEIGHT
James A. Anderson
Ir — . Pubflr�. t-FVIJ- 7 1
W MAILING ADDRESS 7 1
z PROPOSED YARDS LOT COVERAGE
0 CITY NE NUMBER, FRONT SIDE REAR
SIGN AREA
VIRONMENTAL REVIEW
ALLOWED PROPOSED.
0 COMPLETE 0 EXEMPT z
NAME
I- Donald R. Westlin
U
REMARKS
W ADDRESS
u P.O.-Box 1332
PLANNING DEPT. APPROVAL DATE
It CITY
TELEPHONE NUMBER
Lynnwood, Wa.
178-0171
LEGAL LOT
YES NO
ILOT AREA. -7-
7SUBDIVISION N 0.
NAME
STREET R/W
EXISTING STREET R/W' FT. DEFICIENCY."THIS P R . OPERTY
COMP. PLAN ST. R/W FT. FT.
..Jack Kostel�k
0 ADDRESS
U
<
Z CITY
I'_
TELEPHONE NUMBER
REMARKS
z
0
U _S��5E&fENSE NUMBER
CITY LICENSE NUMBER
CHECKED BY
KO-ST-EJ-290KS
Legal Description of Property. (Show Below or Attach Four Copies)
Lot 12, Willowdale Gardens Div. #1
STREET AND/OR UTILITY WORK
R E Q'D. 0 YES 1:1 NO
I
R/W PERMIT REQUIRED. W
DYES 11 NO
- z
UNDERGROUND W
WIRING REQ'D. 0 YES ONO:
z
2 Except W..318 ft & except N 12.5 ft
TYPE CONNECTION -;(ES
N
SANITARY SEWER 0
V!ERIFIED BY
U in SE 1/4, Sec. 19--27-4
0
SEPTIC SYSTEM
;fES
APPVD BY CITY ENG.
NO
ERMIT NUMBER
ILI
0
REMARKS
W
METER SIZE
SERVICE SIZE
CLEARANCE
CHECKED BY
ILI
REMAR
-&NE rve'4
WRE;Z
NEW . RESIDENTIAL GAS
El El LINE
E:
ADD NON-RESIDENTIAL 11 SIGN
E� I
0 DEMOLISH RETAINING
. EIWALL'
ALTER EXCAVATE FENCE
D OR FILL E1 X
F1 0
.19,
C ONSTRUCTION
/M
ICODE
/97-3.
SPECIAL INSPECTOR.
REQUIRED.
Y.ES NO
K
AREA.
OCCUPANCY
GROUP
I
OCCUPANT
LOAD
I.:
(L
PL dKED BY THIS SITE IS LOCATED IN THE CITY W
-REPAIR PRE -MOVE swim
INSP. POOL
OF EDMONDS. LOCAL SALES I TAX
SHOULD BE CODED 31.04. 0
REMARK . S z
j
NUMBER OF ))�RIES___
I NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Apartmpnt Aididin 9
z
0
L
U
In
W
a
M
0
'JOICATE BUILDING SETBACKS,
ABUTTING STREETS)
VALUATION
PLAN CHECK
NO.
BUILDING
PL UMBING
HEATAGAS LINE
eo
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
FEE
126 oo
Vr