10607 226TH ST SW.PDFiiiiiiiiiiii3527
10607 226TH ST SW
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER: J70 y a 5 00 3 O qq no
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS:— a od 1 - 60 53 DETERMINATION: ❑ Conditional Waiver Study Required Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER): o[OO`"j l JLioZ7J ���
PLANNING DATA CHECKLIST DATED: 5/0-&-
SCALED PLOT PLAN DATED: 1 I Ii
SEWER LID FEE $: LID #:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMrT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
LOT: BLOCK:
LATEMP\DSTs\FormsLStreet File ChecklisLdoc
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PAN`
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F
"]!lathing in this permit app=81 V s shall be
interpreted as allowing -or peracuttu�S
maintenance of any currently existing illegal,e
nonconforming or unpermitted building,
or site condition which dies Outside whet cope of e
permit application, regar
building, structure . Such building, structure or
son is shown on the
ite plan or drawing• of a separate
condition may be the subject
enforcement action.
1,014.1,01 4- 160 + Leo �z. •� flp .
ADD GUTTERSDOWNSPOIlTS
AND SPLASHBLOCKS
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N ` � JLke p,
Ct&l d MsOe 1,�TWO
>� 76 4w3'
I D(o0� aa(�� S{. GV1/
ONMER/CON7HACTORIS RESPONSIBLE
FOR EROSION CONTROL AND DRAINAGE
APPV�OVED 6�' PLANNING
STREET
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-74)-?-) COO
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FILE
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4--&-ry I
C er 117100.-L
Opp
Zone - S, _ orn
(�VOWLOJSNa* Setback _ Required Actual
0 N
v� m Sides (N.)
✓tee S; =(5) _ to ao
Other (� 10
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--
RE-SUB
BUILDING
CITOF EDMONDS T
Y
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i
BUILDING
CITY OF EDMONDS
REcE:jvE:®
APR 17 2007
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
S��e !�lasJ
c2007 —040,3
/ow 7 �e(si-sj
Ao0
W60-N
0
RECEIVED
APP% 1,7'2007
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
ST
REET FILE •
MAY 17 206r
BUILDING DEPARTMENT
CITY OF EDMONDS
PLANNING DATA 7=FILE:]
SINGLE FAMILY RESIDENTIAL
Name:
Date: S O
Site Address:
Check #: a0O _
``P,,lan
Project Description: C,oc,Ebk<-L A � ae•—
dCO%oc", or-N ncxthet't\ S1%C/
C,r-1 ud ► f\ 'b- C\eAC� 4pvxv�%\ �«��., ,� ���,�< <o orv., -mod �.
Reduced Site Plan Provided: E / NO)
Zoning:
Map Page: ko,Corner
Lot: (YES
Flag Lot: ES / NO)
Critical Areas Determination #:
❑ Study Required
10 Waiver
SEPA Determination: Exe mp
TR:�fxempt
❑ Needed (for over 500 cubic yards of grading) — 2S Cy `cao%n
❑ Fee ❑ Checklist ❑ APO List with notarized
Reouired Setbacks
Sty- W
Side: C
Side:
al '.(E O�
Actual Setbacks,:
Pt(&
Side:
❑ Detached Structures: No \e ghoa)cr ,
Rockeries: E l, q g�o � S1ncxnc, 0-
❑ Fences/Trellises: Noes gx
❑ Bay Windows/Projecting Modulation: Noc\.e- a�KocZ)c\ ,
❑ Stairs/Deck: S cc��
Buildin Hei ht
Datum Point:
Datum Elevation: + i
Maximum Height Allowed: /
Actual Height: 1 z
.Other.
Parking Required:
Parking Provided:
Lot Area: j3
Maximum Lot Coverage: 35% Proposed: 'Cl
0
Lot Coverage Calculations: AE_x�s}� -�`� To�a.� = ayg6 =1 g �/ Vq7
�(Glotoirl T
ADU Created: (YES / NO
Subdivision:
Legal Nonconforming Land Use Determination Issued: (YES NO
Comments
Plan Review By: Planning Data Form 04-11-06.doc
STATUS: ISSUED 6/12/2007
Expiration Date: 6/12/2008
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS.WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
h
Pro�ccfAddress 1=0fi07 226TH;ST ,S
Parcel No: 27032500309900
PROPERTYOWNER APPLICANT CONTRACTOR
MICHAEL NELSON MICHAEL NELSON OWNER ASGENERAL
10607 226TH ST. SW 10607 226TH ST SW
EDMONDS, W A 98020-6100 EDMONDS, WA 98020-6100
425-508-0292 425-508-0292
LICENSE 4 EXP:
• ' DESCRIPTION
603 SF CARACd ADDITION, 56 SF ENTRY ADDITION WITH 29 Sr COVERED PORCH AND 632 SF REC R00N4/LA UNDRYBATH
ADDITION. NEW CABINS-1-S AND APPLIANCES IN KITCHEN
VALUATION: $83,903
PERMIT TYPE: Residential
PERMIT GROUP: 2 - Addition
GRADING: N CYDS:75
TYPE OF CONST RUCT ION. VB
RETAINING WALL ROCKERY: N
OCCUPANT GROUP: R3
OCCUPANT LOAD:
FENCE: N ( 0 X 0 FT.1
CODE' 2003
OTHER: N -------OTHER DESC:
ZONE: RS-MP
NUMBER OF STORIES: 1
VESTED DATE
NUMBER OF DWELLING UNITS: 1
>XISTrl;G AREA
BASEMENT:0 1ST FLOOR: 0 2ND FLOOR:O
PROPOSED
BASEMENT: 0 IST FLOOR: 688 2ND FLOOR:0
3RD FLOOR: 0 GARAGE: 0 DECK:0 OTHER: 0
13RD FLOOR: 0 GARAGE: 603 DECK: 29 OTHER: 0
FRONT1
REQUIRED: See Below PROPOSED: REQUIRED: PROPOSED: REQUIRED PROPOSED:
HEIGHT ALLOWED:25 PROPOSED:16 5 REQUIRED: PROPOSED:
SETBACK NOTES: Subject property- is a flag lot; therefore, required setbacks are 10-foot side setbacks from all.properre lines. Proposed setbacks are as
follows: W =36', N=17', S=20', E=40'.
i AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK ALIT HORIZED
THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 1�/3 �17
HIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDINGOFFIC14JL OR RLSAIF�R gEPUTn' AND ALL FEES AVE PAID.
\
Signature Print Name Date Re as ey Oat
ATTENTION
ITIS UNLAWFUL TO USE OROCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECIlON HAS BE MADE AND APPROVAL OR .A CERTIFICATE OF
OCCUPANCY HAS BEEN GRANTED. UBC109; IBC I I0:% IRCI In.
a ARCRIVE 1-1 APPLICANT F-] ASSESSOR OTHER
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O 133, 1330 a 700 70d ,�, 'i 258 1257 1258 1256
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10828 541 �/ / 708 I20
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io m ro I 7,0 724 726 1360 809 —11 859
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601 yF 619 \/\ \,. / 14TH ST SW
btiq / \ &I 744 749 17r� 757 761 765 769 / ^
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22423=
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i 10615 ,0609 0'1' - /
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815 1434 1439
is Y 10727 l0 10607 630 "A
_-- 728 724 720 727 1a27 i�t , , �• 9925
1 O `\ 6ss 14TH WAY 813 1440 lads c
�Os \ 727
& d 10605 ` o c 10431 711 717 ... 735 1435 805 811 /449 :9:9:24
1448
228TH ST SW 724 728 ._ 1439 807 809 /1452 + 1457 \ 0
140 720 \ / jj
22605 22606 _a N 7,0 / \
9 ® 0 700 \ \ /^\`
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t ,e. 22623 22624 22625 \ \\�99; \.\ 7a9 �. 992n
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j� 22701 22628 22831 22830 22631 8 a 'ems , \� \74\ / `� '7a8 Q - - , 0916
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#P20a
CA File No:
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: " 6)
2. Property Tax Account Number: 2- % 0 3Z
3. Approximate Site Size (acres or square feet): / 3 L20C2
4. , Is this site currently developed? ?C yes; no.
If yes; how is. site developed?
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
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):
6. Site contains areas of year-round standing water: IV17 ; Approx. Depth:
7. Site contains areas of seasonal standing water: 1,V0 ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodwayfloodplain of a watercourse.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
G� Flows are seasonal? (What time of year? ).
10. Site is primarily: forested ; meadow ;shrubs mixed
urban landscaped (lawn, shrubs etc)
11. Obvious wetland is present on site:
For City Staff Use Only
1. Plan Check Number, if applicable? b1AA
2. Site is Zoned?
3. SCS mapped s
4. Critical Areas inventory or C.A. map indicates Critical Area on site? NO.
5. Site within designated earth subsidence landslide hazard area? �p „
DETERMINATION
STUDY REQUIRED efi�6 Z/ WAIVER
Reviewed bv: r �:�_ Date: q11 I-/ C} -7
#P20
oJkFEDP
�City. of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
oggqo Fax: 425.771.0221
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 the application 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).
Date Received: '-
City Receipt #: M 6440 M .
Critical Areas File #: 7 -
Critical Areas Checklist Fee: $135.00
Date Mailed to Applicant:
A property owner,. or his/her authorized 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 fording and locating the
specific piece of property described on this .forma In
addition, the applicant. shall include other pertinent
information .(e.g. site plan, topography map, etc.) or
studies in conjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, 'in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attomey's fees, _ arising from any action or infraction based in whole or part upon false, misleading, inaccurate . or
incomplete information furnished by the applicant, his/her/its agents or employees.
By, my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file this application on the behalf of the owner as listed below.
SIGNATURE of APPLICANT/AGENT
DATE
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to this application.
SIGNATURE Of OWNER DATE
PLEASE PRINT CLEARLY
Owner/Applica
//nt:
/"/�
�/el u f L / S/CXS A_2
Name
/060 77 G'2 .5-1—
Street Address
E"IMOW-74 s /"—A . y��Z
City State Zip
Applicant Representative:
Name
Street Address
City State Zip
Telephone: _SU Telephone:
Email address (optional): ,'��� Q {�a v/yr, Email Address (optional):
J
N� •
V�
December 17, 1976
MBIO TO:. Public Vlorks
Sewer Department
FROM: Leif R. Larson FT
City Engineer
SURJECT RE1v1AINING SI:I'O R CONNECTIONS RI FFPRED TO TT-T F.NGIPIFTRING DFPT.
We have examined the 19 remaining sewer connections referred to this
department, and have the following recommendations to'mal`e:
1) 213 Elm Street (Dimmick)
The existing residence is too loi-,r to reach the -sower in Elm Street,
and -it would be difficult to construct a sewer to Second Avenue. It is'
recommended that a waiver be granted, subject to proper functioning of the
septic system, pending the development of property.adjoi.ning Second
Avenue, wherein a combined sewer arrangement would allow this residence
to make connection.
2) , 931 Main Street (Nelson)
17iis property can connect to the sanitan, sewer, however, the soil.
conditions adjacent to the sevrer lateral at Plain Street indicate potential
problems with the sewer hookup. A i:raiver is recomrended subject to the
proper functioning of the septic system, and subject to connecting to
sewer if future development of.the property or plumbing additions occur.
3) 806 Ninth Avenue South (Yeager)
This property does not have gravity sewers available, and would best be
served through.an L.I.D. with gravity sewers to Figlith Avenue.
4) 716 Ninth Avenue South (r hzrdock)
This property. is. not served by sanitary sewer. It is recommended that
an.L.I.D. be formed with gravity sewers flowing to Eighth Avenue.
S) 929 Cary Road (Strickland)
Tlie.re exists a problem related to utility easements and the estate
settlement of business prior to Mr. Strickland's death. It is recommended
that a taaiver be.granted subject to completion of the utility easement,
proper functioning of the septic system, and no further development of the
property until sewer hookups are provided.
Hemo to: Olic *s Sewer. Department • Page
.12/17/76
.(continued)
6) 6502 170th Street S,6•v.. (Ayres)
This property is adjacent to the Lynnwood trunk sewer, hou�ever, no
lateral exists in Olympic Viet, Drive. The owners have had some difficulty
in arranging :For the lateral extension i.n the street right-of-way. It is
recommended. that the City reotuest them to contact throe contractors and
provide evidence of the contractor's estimate or refusal. to.accoiM)Ush the
work proposed. Should that evidence indicate the unavailability of a con-
tractor to do the work,, it is recommended that the City proceed with a
lateral connection, charging the resident for the actual. cost of work.
(See next connection.)
7). 6510 170th Street S.W. (t.�)thcgrove)
11ii.s residence adjoins the Avres residence, and could Jointly use a
sewer lateral. The recommendation for #6 appliesto this residence.
8) 18596 76th Avenue West (Cline Scuba Shop)
A lateral was not installed to this particular property tinder the
76th Avenue street project. Later, the City installed a lateral from the
north but inadvertently constructed fhe lateral on private property.
Attempts have been made to acquire an easement without results. This
.matter needs further study in acquiring an easement from either the owner
to the north or south to gain sewer service without removing, street or
walk _improvements. It is recommended that a waiver be granted until the.
City. can provide a sei•rer connection point.
9) 20216 76th Avenue West (Welcli)
This property- is not servedwith a. sewer lateral. in 76th Avenue.
This sewer connection will require an easement over adjoining property to
connect to sewers to the west.. Further study is required on this easement
made by the City. It is recommended that a waiver be granted subject to
the City arranging for a.sewer connection point. .
10) City Park (Dird. and Pine)
I1ie present restroom is more than 200 ft. from the sender and is belotij .
the sewer elevation. It is recommended that a waiver he granted subject. to
proper fUnctioning.of the septic system. .Also, any,chnng*es to the PD.6b-
ing which would expand the use (or should other regulations outside the
City apply), a pump should he installed and connection made to. the trunk
sewer running through the Park playf_ield.
11) 10521 226th Street S.W. (Jarvis)
This property is located in the vicinity of Olympic View 1•dater Dist.*
sewers. However, the property does not directly abut the sewer or have
access to the connection point. It is recommendedthat this property
participate in anL.I.D. with the surrounding neighbors for completion of
the hookup:
Hemo to. flic As Sewer 6epartment • • Page 3
12/17/7fi
(continued)
12) 1060S 226th Street S.W. (Johnston)
13) 10607 226th Street S.W.. (Kemp .
14) 10611 226th Street S.IV. (Sisom).
15) 10727 226th Street S.11. (Jatho)
Recommendation for Item 11 will apply to the above locations.
16) 718 Ninth Avenue South
This property is not served by sanitary sewer. It .is recommended
that an L.I.D. be formed with gravity sewers .flowing to Fighth Avenue.
17) 528 Eighth Avenue North (Scliroeder)
This property. does not abut a sanitary sewer. It is.recommended
that this property be included in an L.I.D. to serve. surrounding proper-
ties.
18) 20222 76th Avenue North (I.IcTbnald Log Cabin.)
This property is in the process of receiving a City approved subdi-
vision for duplexes, and plans for removal of the existing log house.
It is recommended that a waiver be granted on the existing house. Any
new construction will then .follow, the Subdivision and B.,ui.lding codes
requiring hook-up.
19) 7400 212th Street SJV: (Kenmore Pre -Mix)
With low usage rate andextent of lot size, it is recommended, that
a waiver be hranted.3f the property should be developed beyond its present
-usage, a sewer connection would be required.
14-wlsc -
Memo to: Director of Maintenance & Operation
Public Works
From: City Engineer
Subject: Sewer Connection Charges
Legal Description:
Date June 6, 1974
S 100 ft of the N 200 ft.of the E 130 ft. of the
SE 4, NW 4, SW 4, SW 4, of Sec. 25, T 27 N, R 3 E
RECEIVED
JUN 7 1974
Commonly known as: 10607 226th St. S.W. Owner: Mrs. Thelma Kemp
Z.F.F. Calculation:
Minimum( ) Z.F.F. x
( ) Lateral x
( ) unit x($ 25 )_
cc: Mrs. Kemp
$ 300.00
Connection Fee
$
Lateral Charge
$ 25.00
Trunk Charge
$ 10.00
Permit
$ 335.00
TOTAL
Form 6
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 forth 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 map(s), nor for any one representation
provided based upon said map(s).
Memo to: Director of Maintenance & Operation
Public Works
From: City Engineer
Subject: Sewer. Connection Charges
Legal Description:
Date June 6, 1974
S 100 ft of the N 200 ft of the E 130 ft. of the
SE N14 4, SW 4, SW 4, of Sec. 25, T 27 N, R 3 E
Commonly known as: 10607 226th St. S.W. Owner: Mrs. Thelma Kemp
Z.F.F. Calculation:
Minimum( ) Z.F.F. x ( )
( ) Lateral x
( ) Unit x ( $ 25 ) _
cc: Mrs. Kemp
$ 300.00
Connection Fee
$
Lateral Charge
$ 25.00
Trunk Charge
$ 10.00
Permit
$ 335.00
TOTAL
l
Form 6
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MAKE REMITTANCES PAYABLE TO:W.
SIEVERS
1974
SNOHOMISH COUNTY TREASURER
_...
EVERETT, WASHINGTON 9820e
REAL ESTATE TAX STATEMENT
p t z
SNOHOMISH COUNTY, STATE OF WASHINGTON
OF ALL STATE. COUNTY, .%AUNICIPAL,
^ •;
I
L E V Y SCHOOL, AND ROAD TAXES .
ASSE SSE D V A L UATION
CODE
i
RATE LAND BUILDINGS T A X
TO; AL GENERAL SPECIAL
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YOUR TAX DOLLARS WILL BE EISiRIBUTED TO THE FOLLOWING TAX DISTRICTS:
STATE CITY OR ROAD/LIB. COUNTY
.
SCHOOL DISTRICT PORT DISTRICT
OC
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FIRE DISTRICT
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LEGAL DESCRIPTION
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NOTICE.
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OR CHANGE OF ADDRESS BELOW
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GIRST HALF MUST BE PAID BY APRIL 30 _
OR TAX ECOt-4ES DELINQUENT.
SECOND .CALF DELINQUENT AFTER OCT. 31
TAX UP<C•_R S10.00 TO BE PAID IN FULL.
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NUMBER t �_ A�.CO:J!\T NVi� 1�E� a "'
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-UIL: FULL TAX
CHECK BOX TO I 4,
INDICATE FULL OR
HALF PAYMENT ; ,A HALF TAX Z
0'%A1T ED OR DELINQUENT TAX Ov e o
NOT INCLUDED IN ABOVE TAX >
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CITY of EDMONDS
200 Dayton Street • Edmonds, Washington 98020 • Telephone (206) 775-2525
Department of Public Works
CERTIFIED MAIL,
Ms. Thelma Kemp
10607 226th Street S.W.
Edmonds, Washington 98020
Re: Sewer Connection for Property -Located
at 10607 -226th Street S.W., Edmonds
Dear Ms. Kemp:
The matter of your sewer connection for the above refer-
enced property has been investigated by the Engineering and
Water/Sewer Divisions of the Public Works Department. Since
the property does not directly abut the City sanitary sewer
main, it is recommended that you petition for a Local Improve-
ment.District (L.I.D.) with the surrounding neighbors. There-
fore, a petition and sketch illustrating the area to be
sewered is enclosed.
For information related to the petition for this L:I.D.,
please contact Mr. Richard Allen, Assistant City Engineer,
at 775-2525, extension 220.
Sincerely,
LEIF R. LARSON, P.E.
Director of Public Works
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Enclosure
c-,
REGARDING: 10607 - 226th Street S.W. 70 3-D/&o o
(address)
R E C O R D O F C O N T A C T S
DATE NAME, PHONE NO., $ COMMENTS ACTION TAKEN INITIALS
ADDRESS of CALLER
5/l/74 Thelma Kemp Certified Letter No. 406384 sent Letter received. TE
requiring hook-up within 60 days.
6/5/74 Received connection fee memo from TE
Engr. in the amount of $335.
1974 May be over 200' Referred to Engr. TE
3
iDER: Be sure to follow -instr s on other S,
:PLEASE FURNISH SERVICES) INDICATED BY CHECKED OCK(S)•
(Additioital ehargea required for.these aerviees)
`E]Show address . Deliver ONLY
where delivered'. to addressee
RECEIPT
Received -the numbered article described'below
REGISTERED N0: a
'SIGNATURE OR NAME OF ADDRESSEE (Must always 6o futed;In)
CERTIFIED NO 1
J' L;
i 4' ' " '.� z 2 SI KrumOF;.ADDRESSEE'S GE �N
INSURED, NO. j
DATE DELIVEREDSHOW WHERE DELIVERED (OnIV if r8queated, and diialude ZIP Code)'
I• ;EIPT FOR CERTIFIEf 'AIL-300 -1 s..postage)
KEMP r THELMA 0`( Ai)I
00 10607 226TH SW LS 30
M EDMONDS, WASHINGTON 19
CD 98020
OPTIONAL SERVICES -FOR ADDITION— FEES �I
RETURN 1. Shows to whom and date delivered ............ 15¢
RECEIPT With delivery to addressee only ............ 6
SERVICES - 2. Shows to whom, date and where'delivered .. 350
�T :,,�.Wlth=deliverynto a df s ee only ............ 85¢
o DELIVER TOADDRESSEE:;;ONL`Y �? @;-a , .,,;t, 50d
® SPECIAL DEL IVERY (ext�a'feb r'egJired)r••• �1,-") .. I
►F7L74 PS Form 3800 NO INSURANCE COVERAGE -PROVIDED— (Soo other side)
Apr. 1971 NOT FOR INTERNATIONAL MAIL a GPO: 19799-797.4aa