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18826 88TH AVE W
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CITY of EDMONDS BUSIN NSE APPLICATION DATE LICENSE NO.
,A
4
Civic Center * Edmonds Washinnton 98020 &IFCT
City Clerk Phone 775-2525 rlLt
ANNUAL FEES
o�
PENALTY AFTER FEB. 15
—
HOME OCCUPATION
INSOCTIONS:
CLASSIYEA
LIC.
EFFEC. DATE JREASG.
LIC. NO.
Sotc,
I I
$10.00 (A)
ADDITIONAL $5.00 0
0 , ems must be completed
0 SMALL BUSINESS
or application will not be ac-
RECEIPT NO.
DATE PAID
PRINT'XI A-
$15.00 (B)
ADDITIONAL $7.50 0
cepted.
IN SPEC. BOX
FOR ISSUE OF
El Business with 10 or
o Sign and return application
FEE PAID
PENALTY PAID
CORRECTED
more employees
ADDITIONAL $25.00 0
with fee. Renewals received
L
LICENSE WITH
'LC'ACTION.
$50.00 (C)
after February 15 must pay
5d: NEW APPLICATION (LA)
penalty in addition to fee.
0 RENEWAL
(LB)
NEW BUSINESSES AFTER
0 CHANGE
(LC)
JULY 31, 112 FEE.
(PLEASE MAKE ANY NECESSARY CHANGES) 0 DELETE
(LD)
NAME OF FIRM BUSINESS PHONE NO. OF EMPLOYEES
A� A 4
MAILING ADDRESS NATURE OF BUSINESS
(0" "A rc�,
BUSINESS ADDRESS 65 '--4 5�_ INDIVIDUAL PARTNE RSHIP CORPORATION
I R P,-) TL = (S) (P) P
OWNERS NAME HOME ADDRESS
tm
HOME PHONE DATE OF BIRTH PLACE OF BIRTH SOCIAL SECURITY NUMBER
>
EMERGENCY NOTIFICATION: (1) NAME & TELEPHONE
(PLEASE LIST TWO) (2) NAME & TELEPHON.E :t� o; -7,-? 6-
AWASHINGTON STATE TAX NO. APPLICANT'S SIGNATURE AA114P
DO NOTWRITE BELOW THIS, LINE --
STAFF REVIEW:- FILL IN LAND USE CODE, LIFIR NUMBERS, ZONING, ETC. CHECK APPROVAL OR
DISAPPROVAL, DATE, AND SIGN. IF DISAPPROVAL, PLEASE COMPLETE "COMMENT"
SECTION. ROUTE TO NEXT DEPARTMENT ON LIST.
PLANNING DEPARTMENT DATE LAND USE CODE ZONING CODE
APPROVE 0 DISAPPROVE SIGNATURE
CONDITIONAL -!!SE PERMIT
COMMENTS
BUILDING DEPARTMENT
mIZ-3 180
DATE
13--;!�PPROVE El DISAPPROVE SIGNATURE
Building
Permit
El
0
Hotel/Motel
Apt. Bldg.
(L)
(A)
0
Office Bldg.
(0)
COMMENTS:
Occupancy
Group
0
El
Restaurant
Hosp/Nurs Home
(R)
(H).
CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS)
0
School .
I (S)
FIRE DEPARTMENT DATE 41 U.F.I.R.
APPROVE 0 DISAPPROVE SIGNATURE
COMMENTS:
PUBLIC WORKS DEPARTMENT
0 APPROVE 0 DISAPPROVE DATE SIGNATURE
COMMENTS: 3 Oq - 0 4 -3 50
I'll r- A *-- r%"**rf11Nk1 - - �1 Z
;9
APPLICATION
for "FAIAMW oLmr
The City of EdmarPTRM FVJE Ell
SIDE SEVVER
NEW CONSTRUCTION 7MTREPAIRS 0 EASEMENT No . .......
OWNER ............ W".F-.4 .................. ------------------- ............. CONTRACTOR ------ C.6,vs'l . ........ PERMIT
ADDRESS ---- - ----- ... AK6 ------- P� --- 45-41MAWS LEGAL DESCRIPTION: L0TNo....aq..:? ..................... ........... BLOCK No . ............................................
NAME OF ADDITION ....... .. 7-1 ..........................................................
"D W
0 6A Y9
RBCEIVW
JUL 12 14`71,
Approved:
# A 0
DATE .... ------- By*�
.*.# ---
/01' " !�x
NOTICE:
-N'o...W,. a'r-ranty ttached
The -information *shown on the a
Map(s) was compiled for use by the City Of
Edrnondsl its Employees and Consultants.
Th.e City of Edm.onds does not. warrant the
�th on these
accuracy of anything set fo
map(�-). An I y person or entity -requesting a
copy should conduct an independent
orm-ation shown on
Inquiry regarding the inf
-map(s),, Includin6l but not limited to,
wer stub shown. Such
the location of any se
sewer stubs may or may, not exist. and may
hown.
or may not exist at the location s . . .
Neither the C;tyc)f Edmo-nds nor its
emp'-o*yee*s o'r office-rs -shal] be 11a.b.-IF-e for t-he
information given on this map(5), nor for
any one representation provided based
upon said map(s).
CITY OF EDMONDS SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT
Call 7.76-1107 for side sewer inspections BEFORE covering any portion of the construction.)
Inspection will be provided within 24 hours after request. NO Sat., Sun., or holiday inspections.
ADDRESS LOCATION OF CONSTRUCTION ..................... ...... :26 ........... ..............................................................................................................................
PROPERTY LEGAL DESCRIPTION ............. oz 'n, :;2
. ........................................................................ ................................................................................
................................................... O1VNER,,kND/OR BUILDER .....
................ ...............................................................................
---%NTRACTORIS NAME&
=-,, - 'r''
. ............................................................ ------------ ...................... a_.- ............................. ! ........ ...........
�_,i.�sionls granted.. --------- 1 19-71., for repair and/or connection of a side sewer to the city sanitary sewer
systeffn in accordance dmo_nd,`s,_or'dinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. 1—The owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must be employed to construct
side sewer in street area. Do not cover any portion of sewer before it has been inspected.
No. 2—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office.
1, CE No. 3—Obtain full information regaxding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 4—Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2%. No bends in grade
sharper than % will be permitted.
NOTE No. 5--Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to improper
work which may develop within one year of completion.
NOTE No. 6--It is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the main sewer or its appurtenances except to in-
sert the pipe Into the wye.
DISAPPROVEDDate --- - ----------------------------------- By ................ Date .................................... By ................ Date .................................... By ................
APPROVEDDate ... ................. e,� ------ ,--w ---------- . ......................................................
It4mnarks: ................................................................................ I
...................................
................................................................... ........ ......... . .............................................................................................................................................................
BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
hereby certify that the side sewer installation constructed under this permit
;r
K' G" i _n'struci
---- irac ;W , i i� n�
41ft;7"o on ing r �r �c
was installed in accordance with all i0verning ordinances of the City of Edmonds.
I
Datedthis ............................ day of ................................................................. 19 .........
Check BEFORE you dig for: Water E], Gas [], Telephone E], Power E], Sewer E], Other E] V V
PERMIT
Call 7.76-1107 for side sewer inspections BEFORE covering any portion of the construction.)
Inspection will be provided within 24 hours after request. NO Sat., Sun., or holiday inspections.
ADDRESS LOCATION OF CONSTRUCTION ..................... ...... :26 ........... ..............................................................................................................................
PROPERTY LEGAL DESCRIPTION ............. oz 'n, :;2
. ........................................................................ ................................................................................
................................................... O1VNER,,kND/OR BUILDER .....
................ ...............................................................................
---%NTRACTORIS NAME&
=-,, - 'r''
. ............................................................ ------------ ...................... a_.- ............................. ! ........ ...........
�_,i.�sionls granted.. --------- 1 19-71., for repair and/or connection of a side sewer to the city sanitary sewer
systeffn in accordance dmo_nd,`s,_or'dinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. 1—The owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must be employed to construct
side sewer in street area. Do not cover any portion of sewer before it has been inspected.
No. 2—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office.
1, CE No. 3—Obtain full information regaxding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 4—Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2%. No bends in grade
sharper than % will be permitted.
NOTE No. 5--Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to improper
work which may develop within one year of completion.
NOTE No. 6--It is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the main sewer or its appurtenances except to in-
sert the pipe Into the wye.
DISAPPROVEDDate --- - ----------------------------------- By ................ Date .................................... By ................ Date .................................... By ................
APPROVEDDate ... ................. e,� ------ ,--w ---------- . ......................................................
It4mnarks: ................................................................................ I
...................................
................................................................... ........ ......... . .............................................................................................................................................................
BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
hereby certify that the side sewer installation constructed under this permit
;r
K' G" i _n'struci
---- irac ;W , i i� n�
41ft;7"o on ing r �r �c
was installed in accordance with all i0verning ordinances of the City of Edmonds.
I
Datedthis ............................ day of ................................................................. 19 .........
Check BEFORE you dig for: Water E], Gas [], Telephone E], Power E], Sewer E], Other E] V V