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23620 79TH AVE W
11111111111111 15256 23620 79TH AVE W NOTICE: No warranty of accuracy. The .information shown on the attached map(s) was compiled for use by the City of Edmonds, its Employees and Consultants. The City of Edmonds does not warrant the accuracy of anything set for on these map(s). Any person or entity requesting a copy should conduct an independent inquiry regarding the information shown on the map(s), including, but not limited to, the location of any sewer stub shown. Such sewer stubs may or may not exist and may or may not exist at the location shown. Neither the City of Edmonds nor its employees or officers shall be liable for the information given on this map(s), nor for any one representation provided based upon said map(s). LJ APPLICATION The City of Edmonds for SIDE SEWER PERMIT EASEMENT NO . .......................................... NEW CONSTRUCTION REPAIRS 0 LID NO. .-A0.e> .... ASMT. NO. ................. OWNER ------ %.t"F .. ........... PERMIT NO. ------------------------------------- CONTRACTOR ...... ............................................................ W05 JOB ADDRESS - -------------- LEGAL DESCRIPTION: LOT NO. ...................................... BLOCK NO. ............. ...................... NAME OF ADDITION ...... ENz;P�-- ------------- 1 �L ------------------------------------------- approved: )ATE ........lS.......... By,4� .............. . . . . . . . . . . . . . . T. -M .1!P Ek h M CITY' -':0FONDS' `jED.M,1, w�,-Stb.El WATEWSEW*RbEPARTMENZ 0. P. A-.O� 7 7 J hCaM.,7,15-2525for ;side *'nsp'ections BEFORE covering .any 'portio,n,* of the const ruction .inspection. will tie -provided4 wlthin'24 hours after, requst.,: No,Sat:Sun :or hollday insActlo6s) ................ ESLOCATION IOFCONSTRUCTION. G PROPERTYjEGA%,,,DESCRIP.TT(jN .......... .......................... . ................. ........ ............. ...................................... ........................................ ............................. .................... ......... : .......................... .............. ...... ....... -'03M TERAND/OR- BUILDER ............ (wNTRACTOR'S NAME DRESS—.. .................... ......... ......... ......... • ................... . ............. pair Pei . . . ............. 19 -Tor, re AndVorconneetloa.oUk, side, sewer �- tothe citysanitary !sewer with .Clty of"Edmonds-ordinances. A 'ENT1ON,..IS::CA1LLED1`TO THE FOLLOWINGII :' NPTE:,No!. -IThe--ownersoi:_Ahe, propert' y may. obtain a permit %fos -construct s6wer' Anside property line.. -A, license& Side Se�ver -Contractor must.1,4 eml)16Y4�Ao; cons6ruct:. side, sewir,'Jfi� treet.area. Do; not -cover any,%Porti6n of -,sewer rbefor'e It Inspiceti& e :t .:NOTE , , in;;city'right-6f-w&y je:q'6liesan,� invasioW*Oi -IiJghi.'of;VVay�F�erryiit:obtEI . n abl c-� I from, the City Endincer!s:' office NOTEsl� ..'Obtain'. full''F�formaiion, rej;ardln� O�af' R' o. ;3—. and' nance'MM030'. egulations governing. 'Ide { ,NOTEcNo- 4-L-sThoa�rpofr'i;.,I deI sewer` inust- llave a least,36; Inche's:'c6vcrage,. at':.pro'-perty�Ineand.12Inches.,JnsId4- ' property line;.filnimum:,gradeofl/.obends..,ingrade be',permItted: .. NOTE!,No-, rface of street restoredgfreet�.must ibi�:,wateiz settled'. and .surface work �whi&-.4na�.'develbp. within one yeir�of completion.: to. orikinE�l;clond.l.ti,on�.',Con.t.iadtors.,shalI be responsible for Jallure� du�"to I Mproper, "nI4 to,alter',or.do,any �othir work thari I �iis . �,provided for.' ln�-,the,per . rn�t, o��to-� NOTE) �No,'o;6r-1t.!Jjj,u wfu`Il� �,,Eer-t�.the��ipefiritc�,,thetwy6... o;any "work: on the main sewer or Its. *�appurtenances,+e'xcept_to (DISAPPROMEW'.' Da te ............. Y:Date e.... e DateBY".. APPROVED .............. ........................ BY ..CjV1 Remarks'... ............................... *..� ...... ................. . ....................... ................. ...... ............................ .......... ............. .................... ...... ........................................ ....................... 7 ...... ... ....................... .......... .................... .............. ............... ........ ;BUTH Petmiti'�'06pfes;-MUST, Be.. Signed:. By Y bwner, of, Firm, Perfoi*mi'n nstr�ftion. PRI**' Request 7or-J.nspec ionz.. J Performing'Construction. OR,To . ........ ..... ...... ............................. ................. ....... . hereby ce tif-�:that M6�siide'�'Sewei *installation: con tructed-under-this;Perm'it, .WIng . Firm- -:Perfcrm ]fig -�Constructiofi.), f c Contracting I ��-xinstall'edt-in�ydcc6kdb.Lnce;lwith�Ol..g:by'6rhing'�'ordihiiices-of;-the�.City-',of Edmonds:,, Dated[ ,this ..;.. 77P( . . .. ........ ................. .............. Sewer �E];� erl J1 JrCheck BEFORE 'i'dig" f -'se oth 0 Telephone E3;, - oiveri;jEb; j e e City of Edmonds AFPUCATION for SIDE SEWER PERMIT EASEMENT NO. -------------------------------------------- NEW CONSTRUCTION REPAIRS -®� LID NO. ? ----- ASMT. NO. ------- ._______ OWNER' JOB AD///D]]]RESS 4J ,-)q--------------------2,9--=-- c------------------------- !^" ✓' 4.' CONTRACTOR _-- °_,� _ r:_ ti.> -- .... . PERMIT NO. LEGAL DESCRIPTION: LOT NO- ------------ - — ---------- .... .- BLOCK NO.._---------------------------------- ------------------------------------------ __________________________________________________________________________ ________________ ___ NAME OF ADDITION----------------------- �--- Approved: DATE ------------ a JAN 9 19,76 Public marks Dept. BY------------------------------------------------------------ STREETFILS ... CITY OF EDMONDS USE PERMIT ZONE NUMBER CONSTRUCTION PERMIT APPLICATION jos JIT E/APTa ADDRESS r OWNER NAME/NAME OF BUSINESS _ } i— LEGAL DESCRIPTION CHECKJ SUBDIVISION NO. LID N0. ` w CIO I MAILING ADDRESS PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP, TESCP Approved CICITY 7� r•-.0 1 .; r t �� ZIP TELEPHONE NUMBER RW Permit Required ////'�''��.'r EXISTING REOUIRED DEDICATION Street Use Permit Req'd ❑ "`r "" � \ U PROPOSED - Inspection Require Sidewalk Required O 0 2 NAME REMARKS J l U w ���/� IW0f / 0471 i / fi�lr� w ADDRESS , ' 1/l�uj U Q CITY ZIP TELEPHONE NUMBER /lq'/11*/ �n NAME _ ENGINEERING MEMO A REVIE Y� L ADDRESS M METER SIZE LOING SUPPLY O. OF FIXTURES � U ccCITY w ZIP TELEPHONE NUMBER Z O U RKS a 3 STATE LICENSE NUMBER EXPIRATION DATE SEPA REVIEW ADB NO. A E POSED COMPLETE EXEMPT A.93 •-3'L I Legal Description of Property - include all easements SHORELINE M Z O F- EXP a IAN OR CU PLA W BY pppggq EE ��G / _j SETBACKS — FEET �IGH LO OV,f<R i Z w N FRONT SID REARf', { � a Property Tax Account J EMAR / a Parcel No.I Ai I PLUMBING .r, NEW RE IAL r�. lxl , yy ADDITION MMERCIA MECHANICAL ►; y APT. BL El O REMODEL SIGN CHEC TYPE OF CO UCTION ""�r CODE HEIGHT aGR FENCE REPAIR CYOS. (_ FT)' DEMOLISH ODSTOVE SWIM PO SERT HOT TUB/ INSPECTOR RED AREA OCCUPANCY GROUP OCCUPANT LOAD ❑ YES Z t 1 GARAGE RETAINING WAEl L REN A REWS - CARPORT ROCKERY Z P GRESS INSPECTIONS PER UBC 305 Z o (TYPE OF USE. BUSINESS OR ACTIVITY) EXPL a EC .3 Ltrvr fIf'T" GAN ,�1 ,p �jQi i/4L 2 C/ VIA 600e_ co NUMBER OF STORIES NUMBER OF Lu p DWELLING. m O c� UNITS ', � , . 1C� DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN FINAL INSPECTiqft4uikj 14 �� C T ' cam- TION FEE PLAN CHECK F �� BUILDING Q� CJ n� HEAT SOURCE: l.J' GLAZING Plan Check No. ::5 C, HANI L 501r This Permit covers work to be done on private propert G DI LL Any construction on the public domain (curbs, si Ik TATE SURCHARGE r � driveways, marquees, etc.) will require separate SID Permit Application: 180 Days Permit Limit: 1 Year - Provided Work is Start ithin 0 Da sT°R IN E FEE c j ENG.. SP TI "Applicant, on behalf of his Or er ouse, eirs, ssigns and y successors in interest, agrees t in nify, efe and hold j harmless the City of Edmond W hing n, its officials, employees, and agents from any d a lai for damages of = whatever nature, arising directly or d rom the issuance of this permit. Issuance of this per hall not be deemed to PLANCCK DEPOSIT ° modify, waive or reduce any requirement of any city ordinance i nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE ( '' provision." I hereby acknowledge that I have read this application; that the ATTENTION APPLICATION APPROVAL Information given is correct; and that I am the owner, or the duly authorized agent of the owner. I agree to comply with city and THIS PERMIT state laws regulating construction; and in doing the work authoriz• AUTHORIZES This application is not a permit until ed thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his/her Code of the State of Washington relating to Workmen's Compensa• WORK NOTED Deputy; and fees are paid, and receipt is ti n Insur nCe. INSPECTION acknowledged in space provided. SIGNATURE (OWNER OR AGENT) DATE SIGNED DEPARTMENT OFFICIALS SIGNATURE DATE CITY OF EDMONDS CALL FOR RELEAS D 13V DATE ATTENTION INSPECTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 771-0220 UNTIL A. FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — Inspector A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC ,Q CHAPTER 3. //� � PINK — Owner GOLD — Assessor CA FILE NO. 2 Z Critical Areas Checklist ------- ------------------------------------------------------ Site Information (soils/topography/hydrology/vegetation) 1. Site Address/Location: Q 3 bl_�� 2. Property Tax Account Number:` 3. Approximate Site Size (acres or square feet): T^t� S� 4. Is this site currently developed? _X yes; no. r\ If yes; how is site developed? l a, 5. Describe the general site topography. Check all that apply. Flat: less than 5-feet elevation change over entire site. 7 \ S35_Si_ Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a horizontal distance of 66-feet). •, Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise of 10-feet over a horizontal distance of 33 to 66-feet). Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a horizontal distance of less than 33-feet). Other (please describe): Site contains areas of year-round standing water: n ; Approx. Depth: Site contains areas of seasonal standing water: n o ; Approx. Depth: What season(s) of the year? 8. Site is in the floodway n 0 floodplain of a water course. 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year- round? Sri U Flows are seasonal? (What time of year? ), 10. Site is primarily: forested : meadow :shrubs : mixed urban landscaped (lawn,shrubs etc) X 11. Obvious wetland is present on site: V) D ::. 51ie isanedZ '.; gC upped s©1{ty�ses '. ;. Wetla�d;ivenio or C„�nap q?�}cats welatid pre3ec►t on see s "� Critical'tlieas ]t�ventgr3�-ETr C A Fliep inrcates Crlticaj �4rea on site < . 5. Sie within deslgriated earth subs�depeslade hazafd area? �� r Site destgtiatocl ©h the n ironmealally SensKV-6 Areas } �DISTERtkilflVA"T)€•Oi'.�1�;:: .. .<, :r <, ,V .S > 0 Y. `} �•�• N.' 9t i. ♦ r late. J „ r L '�S. ^a ekk.dK RN 10/03/97 City of Edmonds TTW CRITICAL AREAS CHECKLIST The Critical Areas Checklist contained on this form is to be filled out by any person preparing a Development Permit Application for the City of Edmonds prior to his/her submittal of a development permit to the City. The purpose of the Checklist is to enable City staff to determine whether any potential Critical Areas are, or may be, present on the subject property. The information needed to complete the Checklist should be easily available from observations of the site or data available at City Hall (Critical Areas inventories, maps, or soil surveys). An applicant, or his/her representative, must fill out the checklist, sign and date it, and submit it to the City. The City will review the checklist, make a precursory site visit, and make a determination of the subsequent steps necessary to complete a development permit application. Please submit a vicinity map along with the signed copy of this form to assist City staff in finding and locating the specific piece of property described on this form. In addition, the applicant shall include other pertinent information (e.g., site plan, topography map, etc.) or studies in conjunction with this Checklist to assist staff in completing their preliminary assessment of the site I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the best of my knowledge (fill out the appropriate column below). Owner/Applicant: Name Street Address City State Zip Flo C)(�— 0�1c v Telephone Signature Applicant Representative: Name Street Address City State Zip Telephone Sigrid — 1v Le Date Date c:receptionyanakaci.doc I �� 1�7 3 (over) rr?c.1S9v CITY OF EDMONDS 121 5TH AVENUE NORTH - EDMONDS, WA 98020 • (425) 771-0220 • FAX (425) 771.0221 DEVELOPMENT SERVICES DEPARTMENT Planning • Building • Engineering February 24, 2000 Mc Jim Burnett 23620 79th Avenue Northwest Edmonds, WA 98026 Subject: Determination regarding Critical Areas Checklist #2000-22 Dear Applicant: GARY HAAKENSON MAYOR Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City is located on the reverse side of the form (bottom of page). It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records. ......... IMPORTANT INFORMATION TO BE NOTED. PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIST OR CRITICAL AREAS STUDY, The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a project -specific determination. y You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED. Permit applications include the following: Enc: Determination cc: Kathleen Burnett 6201 9th Avenue NW Seattle, WA 98107 * Architectural Design Board C: ReceptionU ana\C R LT R. doc Building Permits Conditional Use Permits Subdivisions Variances Applications to the ADB* Land Use Applications Any other development permit applications. Thank you. Planning Secretary Incorporated August 11, 1890 Sister City - Hekinan, Japan �' P1�F►- MUD �' GXA�E_c." f3Es7Tca.� EKIS 5i:tFps►€ �. ec� ,I t , UAW PEP. WT J. ..�E-�ctlet, �Ps zi' AttEcc Fiitea� \ t ^^4410a,cs t #� •. � � � ' rst�rr5 uxc �! ra.+U , 7 ac�secavq �� '� s rxa �_._ -it �tw ;��� 'vs"xc --`•�.y - r _�\ •itatrmt.'unjoax�y ► . �;---�--- r :: ' i � -- _ - Hr' ,;� AF.r L Udactiyc�R•. . ;. � Jr4�� � � � � !j c�� Sn:ktctsw...Y-S- tala5k� ryr� , tX�.J;L•t'r•.�..w. �N- cs.�u,--ca`tsi +er.•.'t sc � .. u-.aara� �9�.-}�!�.,�� `` _ t H4, , � ^ ._�n � \ YGt:u rst.•tt :.&tt -�k�y � -,. ! i ~ 1 .� :& 1 vxCtat' w4d.t�wu •;.£L :_W4 t t). wrv� c•_Ytx ` ssS�Gltr•iillibQ1 wo1 __._ __ - _ - • LL =�e� � —..•.. '�'�j Jf1'�P tMRi:P 6 -. �i . � _ 1 -. � � ti-�.`w.� � ..: �, Q�fyj� s U On* .: �- -..mac •• �' x.t�1i•'Tt, °Fl .,� i .' ,r' � . `. -Mst.w.3e761:'ftN •, 1S K hU..,- it7 - . - �y ' u� �tlE • for V_Et tt � _t'PP�_tacl_ .` 'ft Zlz TSU*fr.`.=lj —_ - i ou tx • - W..CL � l.Y'n"(It(; 1 iJW vets tti--• V p ^ Q y �. . - - -? - ;• � ��C`,S•"!J'+A- ----.x ..,,r t/ Ti,¢ 1 c: itg:a! scaatj r i Ct�'F} F37 r�t li y ux ACCEP BLE TIGHTLINE-MATERIAL `� N-12 ADS SCh'40.PVC- R 35 (ASTM D3034) t • -.. . ;1 � ��/ c�W-:A�iL7f'� L.:_ : . ,1- � 'il •L� r r�� -!T'^t i..�- `�i � , R � OV D AS NOTED — ---- - - - - -- } .` - - - �mot... .�u.s.0 C...r:_iiE .io w b:t� �: tl�iU .i 1at. _.. _ .: L�T'•3- ifrJ_ Pt�Sf,,c. .c:.�: -, � - Ac:.a - � r_:r.:. DATE�." J FILE ff SITE PLAN �- - CITY OF EDMONDS BULLDI G PLANS (3): ELEVATIONS APPLICATION STREET' LANDSCAPE PLAN �-- MENTAL DATA Receipt # to the SIGN EXHIBITS (3) ARCHITECTURAL DESIGN BOARD PLAN MODIFICATIONS TO FILE NUMBER: OVNER/REPRESENTATIVE HEARING DATE PHONE ADDRESS r'>?. %)n %[' 3 ,i>f-/�'r/I> ZIP CODE CONTACT PERSON l_:-�. LLB �1 il' / l�1F `•. �'C;:!/,/ PHONE '7'7c1- 3G-:5'1. ADDRESS ZIP CODE ARCHITECT/DESIGNER__ �= �. F / /_ !7 !/ PHONE PROPERTY ADDRESS r_y ! r: :� `;)7 /� /� V 1_ �</ �')/'1 U rl L) _S ZONING C LEGAL DESCRIPTION I'/:7- 7 (L-7 r= t'l.c'o,�,),_,.). Li (: t C N _ ,:. r-- N �!f c at c z.!- C c;• ; r-_; :.,: c, �1 . PLANS SUBMITTED FOR APPROVAL: 1. Building Plans — Preliminary Final Site.Plan ,.. Landscape Plan Elevations t' 2.- Sign Elevations Site Plan_ Landscape Plan 3. Modification of previous approval EXISTING USE OF PROPERTY _, / rr ('.r r_/- /-j).�./r./ -/ V-0/-11_- DESCRIPTION OF PROPOSAL APPROXIMATE DATE WORK WILL BEGIN ON PROJECT ESTIMATED TIME FOR COMPLETION OF WORK I (we) hereby certify to the best of my (our) knowledge, that the statements and information contained herein.are, in all respects, true.and correct. (Signature of Appl•ican�-)" 12/78 _...__.-S'-st-t�-ta2-tsa�.-.-�.t_4ait.�---..,0::�.3>.-�:-::..-.:�:wc::aa_5..:__:� .: _ � -• -T-�pj1:�-1'�L.1S •(y---:: r{.-Qt-Z 1.."!r.-4�-YIG=7-: _�:..-.-.ii::.p=p-.�..-�� �'� .. - �_.. _' _-._��__� _..-_..__�. �....-.�'�__�-�_ ._ _� ....ram'^-_r.� .�. _..,.�. •' �.r __-..._1:...�.'�.:_ ...�.�. _. ._.��. ... �--...�.. �Q�__..�.._.�_.... �..��_-r,-.--...�.8.-�....�.� .. _. .^ ' jt44A • � �• �::� ,..{ -.r tit - +-, --+.- . .� � �'� , �.. -f, � . � � � .w.w•w4� 'r r: 1: ., �...�n.V,rp4�y --.TrY'•�w.-�•e-'-,r. � - � � �i . � � 4� # �r' �T�' � i, r fed. �-{•♦ .• I - .. ', - 7 .ti \y ![ NL lit-- - -- _ _ - i-Tr, `,lr ��' �. :; � `I�I�..-.•1-'[•,�i^«.• ...r! �r� *-',y�ij' `��r�.;�� ~f'`.• y� ♦� ;r �� 4__._� ' :.tom. ryj ••��. ,... _�. S. ..i•�.Xr ' - �?�i(j! tfiii is � `� ` � ?'.�:,I 'Yi 3; ,, ✓�+t�i: �%' � . ��t'i ,t '' .5�:.. ""• lr: t����°�`"�� *' , ., 1' yI,c, : �Z���`� �° _ 1 ,' Iy',C� ,l�cl� ! I jllll�: f '•t t?;�! I. s:�.a•.::. fir. �s:�d:��.. '� a.�+'1Gi:�i:�?t+P.il r��' •... �1 }�� � �..-:r7s =�`.j _, _ . -�� " C12 - 7� APPROVED .. "s." ��. 1. _• -� NVI . - s' a .. . v. __ ,► vi , s .r r ._ irv�ti''aabasa j -.- ..... And-s6-77 - APPROVED ow I STREET DECLARATION OF RESTRICTIVE COVENANT WHEREAS err ny/1 CorCl V )mm are the owners of the following described real estate in the City of Edmonds, to wit: 1=4 L0+ 5 n r IAC'-r W1 ow br,,Jcz E) 1 V. �4� gccO�di nG Prccorc4e� i n Vo)). °n 12,J ►'eco��s 1r) S?vh0m1s)) Cou,e? WHEREAS, the above named owners are desirous of imposing a restrictive covenant upon said premises in compliance with Section 19.00.040 of the Edmonds Community Development Code. WITNESSETH: that for and in consideration of the premises, the above named owners do hereby declare and grant to the City of Edmonds as Grantee the following restrictive covenant, to -wit: That at the time of the execution of this Covenant the Grantors have agreed or the Ordinance of the City of Edmonds provide that no building for multiple family housing may be erected on subject property containing more than units. Said Covenant shall be binding upon all present and future owners of said real estate and their heirs, successors and assigns. STATE OF WASHINGTON) ss. COUNTY OF SNOHOMISM DATED this —Z % day of t , 19 Grantor G antor C7, On this day personally appeared before me C A a61, ..) m . Cyg, !_ and AKS 1 J4,). / AS to me known to be the individualsrddeesccn'bbed in and who executed within the foregoing instrument, and acknowledged that they signed the same as their free and voluntary act and deed, for the uses and purposes therein mentioned. GIVEN under my hand and cial seal this &� 'E , 19 . �, , _ Notary Public in and for the giate of -;L%•% Washington, residing at CATHLEM K. 1 ',e^ ). 2. \\i 8 9 0. 1 9 y CITY OF EDMONDS AURA M. HALL 250 - 5TH AVE. N. • EDMONDS, WA 98020 • (206) 771-0220 FAX (206) 771-0221 MAYOR COMMUNITY SERVICES DEPARTMENT Public Works • Planning . Parks and Recreation . Engineering g January 25, 1994 Carol Cummings 23620 79th Ave W Edmonds, WA 98026 RE: Plan Check #93-001 According to building division records the subject permit application has expired. Your plans will be held for 10 days in order that you-: may'come in and pick them up. If they are not picked up by February 4, 1994 they will be recycled. If you intend to do the project, it'will be necessary to fill out a new application form and pay new plan review fees. f you have any questions, call the Building Department at 771-3202. Thank you, Sharon F. Nolan Permit Coordinator cc: Building Official C/YW //V �ic.�u�a �0/!4�✓S �/IlI Nola Cho PIC/�C� • Incorporated August 11, 1890 • Sister Cities International — Hekinan, Japan APPLICATION CARD No . ...................................... The Cityof Edmonds for SIDE SEWER PERMIT EASEMENT No . ...................................... OUTSIDE ❑ INSIDE ❑ REPAIRS ❑ OWNER •--� -------- E:=.. _ .........) ti.:. CONTRACTOR .6"'. ja.L.............................................................. PERMIT No. ? HOUSE No....... %v_(>. - ........ �� -•--...�'yx.t-...... ......... STREET AVENUE LOT No . .....:...... ----. BLOCK No. NAME ADD. iI Date BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ ------------------------------ SEWER WORK ORDER ISSUED .......................................... 2 -36o Approved: DATE................................................ BY .........