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20216 76TH AVE W.PDF111111111111 6283 20216 76TH AVE W 1 0 ADD RESS: 12_�l �o ,TAXACCOUNT/PARCELM BUILDING PERMIT (NEW STRUCTURE) COVENANTS (RECORDED) FOR: CRITICAL AREAS #: Cle -/�DETERMINATION: E] Conditional Waiver Study Requir—ed _kWaiver. CRITICAL AREAS #: DETERMINATION: Conditional Waiver El Study'Required El Waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORD FOR: PERMITS (OTHER —list permit #'s): 61 (gel PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: -f7(-Z-qlol SEWER LID FEE $: LID #: SHORT PLAT FILE: LOT: BLOCK: SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) GEOTECH REPORT DATED: STREET USE/ENCROACHMENT PERMIT FOR: WATER METER TAP CARD DATED: OTHER: L:\TEMP\DST's\Forms\Jana's Street File Checklist 5-14-08.doc CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS ./v v MAILING ADDRESS 2- 7� 7 CITY ZIP TELEPHONE vz-5-- Z,,� --oee, NAME ADDRESS CITY ZIP I TELEPHONE NAME ADDRESS r ,P 0 , CITY ZIP TELEPHONE STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY T-4 (511 j _2 �l (0 PROPERTY TAX ACCOUNT PARCEL NO. 4j Iq NEW ESIDENTIAL 0 PLUMBING / MECH ADDITION COMMERCIAL COMPLIANCE OR CHANGE OF USE C3 REMODEL APARTMENT SIGN n REPAIR 0 GRADING CYDS FENCE X FT) E] DEMOLISH TANK OTHER �RAGE NING WALL CARPO RETAI FIT 0 ROCKERY RENEWAL (TYPE OF USE, BYSINESS OR ACTIVITY) EXPLAIN ") (9,0�f NUMBER NUMBER OF CRITj1CAWL OF DWELLING AREA STORIES UNITS NUM DESCRIBE WORK TO BE DONE y _7 21 '(0k F PERMIT EXPIRES USE P I ERMIT ZONE NUMBER JOB ADDRESS 7& SUITE/APT# PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Permit Required 81 Street Use Permit Req'd C) EXISTING - PROPOSED Inspection Required 0 Sidewalk Required 0 REQUIRED DEDICATION- FT Underground Wirtng required METER SIZE LINE SIZE I NO. OF FIXTURES I PRV REQUIRED YES 0 NO 0 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE mairee- .olzez A M/W 2Q�a2_0 jr ENGINEERING WED/DAT9 4��e . -21Z FIRE REVIEWED BY DATE W z z UI 5 U. wl VARIANCE OR CU SHORELINE OR AOB# INSPECTION REO'D I PBOND OSTED 0 YES 0 NO SEPA REVIEW SIWAAt9 HEIGHT COMPLETE I EXEMPT ALLOWED PROPOSED AL� D, PROPOSED EXP x LOT COVERAGE REQUIRED SETBACKS (�E� PROPOSED SETBACKS (FT.) ALLOWED OPOSED R FRONT SIDE REA FRONT UR IE REAR . PIC z 19 70. 2-01 sl_ z _r4l z PARIIING LOT AREA PLAII Y/,) DATE QL REO'D I PRCVIDED f/ GRCEV 4 . 3 . EMARKS41 r_-Cx-:,c- j6,,-3o,54oj1Ak17 'CHECKED BY TYPE OF SQ& ION OCCUPANT V OU P SPECIAL INSPECTOR REQUIRED E] YES AREA 6dduPA., LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D VALUATION FEE PLAN CHECK FEE HEAT rURCE GjrG % LOT SLOPE % BUILDING. PLAN C14ECK NS: VESTED DATE PLUMBING MECHANICAL THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC 2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE GRADING/Fl SEPARATE PERMISSION. STATE SURCHARGE 41"2 W PERMIT APPLICATION: 180 DAYS - PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES v SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS ENG. INSPECTION FEE W i IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND. HOLD HARMLESS THE CITY OF LANDSCAPING 2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND cc INSPECTION FEE ( ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT R7.EIPT L.j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE 74?// '0 NOR LIMIT IN ANY WAY THE CfTY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION." R C IP�,�� TOTAL AMOUNT DUE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION N APPROVAL GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPf THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by,the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid. and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. 9 OF IALS SIGNAT RE DATE #C SIGNAT (OWNER 0 E DATE SIGNED 11 (425) I -/e, _e . 7714 )220 lie RELEASED BY ATTENTION EXT 1333 ftv L IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 164 awl Afx! I i A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- : CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ORIGINAL - FILE YE�� - INSPICTOR'f FAX PINK - OWNER - GOLD -'ASSESSOR 5/98 NORTHWEST GARAGES 334-9262 ,2-5— a /10 APPROVED AS NOTED BY ENGINEERING — Date: --3Lz k�%T Pftvr,. OIL" A 0('-T/,v9cc- C4 . If e, c .zq � 'p,-Opose,j 0 7/ Al,�l '0 7-,Akd�c, A' ig= pf- roe s,,c A ll-ocrse—, 16 'A 12' L e- C. e, k,, 4 ' �ec- 7- ;,4 SCALE 1" Af?-5 4ee-,<s 0 = STOCK PILE TO BE COVERED WITHIN 24 HRS XXXX SILT FENCE IF REQUIRED Mahmood Koopal ------ > SLOPES 20216-76th Ave W. Edmonds O=DISTRUBANCE AREA #!04�5 16 x 24 GARAGE RECEIVED ADD GU iTERS/DOWNSPOUTS AND SPLASHBLOCKS STREET FILE JUL 10 DEVELOPMENT SERVICES CTR. CITY OF EDMONDS *A FILE IVO._!�1]6 5 Critical Areas Checklist -------------------------------------------------------------- Site Information (soils/topography/hydrology/vegetation) I Site Address/Location: -7/47A /Iy`� _LA2 j 2. Property Tax Account Number: - I' 3. Approximate Site Size (acres or square feet): a 4. Is this site currently developed? —Z'yes; _ no. If yes; how is site developed? 5. Describe the general site topography. Check all that apply. L,�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 I 0-feet over a horizontal distance of 3 3 to 66-feet). Steep: grades of greater than 3 0% present on site (a vertical rise of I 0-feet over a horizontal distance of less than 33-feet). Other (please describe): 6. Site contains areas of year-round standing water: c7� ; Approx. Depth: 7. Site contains areas of seasonal standing water: Approx. Depth: What season(s) of the year? 8. Site is in the floodway 11V ��) floodplain of a water course. 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year- round? — 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: /1_111Z�l - ------------------------------------------------------ For City Staff Use Only ----- --------------------------------------------- ---- L' Site 1sZone-d.?..._r__M "-3 . .. .... ....... . -,,,$,CS mapped soil ty s)? V pe( Wetland.inventory or C*.A.'map ind . icates wetland present on site? KO 4.. Critical Areas invent ory or C.A. map indicates Critical Area on site? :!.5 -:8aeo designated' earth.w�sidence landslide. hazard area? within d k 6. Site designated on the*E.nvirbnmentally Sensitive Areas Map? 1ATElkMINATION fta—chkAoc; Rev 10/03/97 0 11 Edmonds 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 (4 ZO � 73 0 -2-o7 Telephone Signature Date Applicant Representative: Name Street Address City State Telephone Signature Date Zip (over) c:recepfion\jana\cac1.doc FM FILE NO. Critical Areas Checklist - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - -- - -- -- - - - - - - - - - - - - - - - - - -- Site Information (soils/topography/hydrology/vegetation) I Site Address/Location: "J,/� 2. Property Tax Account Number: . 1' —00 -76' / 7 3. Approximate Site Size (acres or square feet): _ _ - * )16- 4. Is this site currently developed? _L��_Yes; no. If yes; how is site developed? 5. Describe the general site topography. Check all that apply. V-11"'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 I 0-feet over a horizontal distance of 3 3 to 66-feet). Steep: grades of greater than 3 0% present on site (a vertical rise of I 0-feet over a horizontal distance of less than 33-feet). Other (please describe): 6. Site contains areas of year-round standing water: (7> ; Approx. Depth: 7. Site contains areas of seasonal standing water: Approx. Depth: What season(s) of the year? 8. Site is in the floodway IV ��) floodplain— of a water course. 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year- round? Flows are seasonal? — (What time of year? — ), 10. Site is primarily: forested I— ; meadow -- - shrubs —;mixed urban landscaped (lawn,shrubs etc) 11. Obvious wetland is present on site: ------------------------------------------------------- For'City Staff Use Only— ---- ---------------------- ------ Sjw,.is,Zone0 CM -�3 .. .... ... ... ....... . .... p scs mapped soil type(s etland inventory or C.A. map indicates wetland present on site?—' Cri6ca'l Areas in* v'ent'or'y' or C.A. map indicates Critical Area on site� :8ii6 'Within designated eakh -subsidence landslide hazard . area? :6.- Site designated on the Environmentally'Sensitive Areas Map? DETEAMINATION _,�Jcnl?_6 ^ca_chk.doc; Rev 10/03/97 1�1 0 Edmonds 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, sig n* 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 -ZOZL City State Zip (4 -,� -0 � 73 -- 0 -2-o7 Telephone Signature Date Applicant Representative:' Name Street Address city State Telephone Signature - Date Zip (over) c:recepdon\jana\cac1.doc 0 0 c. May 15, 1998, Mahmood R. Koopai 2021676 th Ave. West Edmonds, WA 98026 CITY OF EDMONDS 121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221 BARBARA FAHEY MAYOR COMMUNITY SERVICES DEPARTMENT Public Works e Planning/ Building e Parks and Recreation 9 Engineering e Wastewater Treatment Plant Subject:. . Determination regarding Critical Areas Checklist # 98-135 Dear Applicant: 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 CHECKLIS OR CRITICAL AREAS STUDY, The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a project -specific determination. You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL 4N PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED. Permit applications include the -following: Building Permits Conditional Use Permits Subdivisions Variances Applications to the ADB* Land Use Applications Any other development permit applications. Enc: Critical Areas Determination * Architectural Design Board C:ReceptIonUana\CRLTR.doc Thank you. Sharla Graham Acting Planning Secretary 0 Incorporated August 11, 1890 0 Sister Cities International — Hekinan, Japan ,,CITY of EDMOODS S 1,6E SEWER PERMIT t il 'For Inspect PERMIT NO. 07769 Address of Construction: 4>��AlklOQ Property Legal Description (Include all easements): 4L Owner and/or Builder: Contractor & License No: F4-V /0 V1 0 RZ 2 &1 COX) 0� sa(S Single Family Residence EDMON - DS Multi -Family (No. of Units TREATMENT PL ANT Commercial (No. of fixture Units Invasion into City Right -of -Way: No Yes (If Yes, Right -of -Way Construction Permit required. Call One -Call -Center (1-800-424-5555) before any excavation.) Cross 1� other Private Property: No Yes (If Yes, easement required, attach legal description and county easement number.) JF-70�0 20 30 PLEASE READ THE ITEMS LISTED ON THE BACK I certify that I have read and shall comply Date with the items listed on the back. Permit Fee: I ilssued BY: Trunk Charge: 00 IDate Issued: 151-11-6p 77 Assessment Fee: "�00- 00 Receipt No.: F ZOB Partial Inspection: Comments Date Initial Final Inspection Approved: Date Initial 00 Rejected: C) Reason Date PERMIT MUST BE POSTED ON JOB SITE W cr_l Wh.ite Copy File Green Copy Inspector Buff Copy - Applicant r--O� . 0 NO EXCISE fAX REQUIRED SIDE SEWER EASEMEI�T, THE UNDERSI(;IjED .'RANTOR, Melvin D, Coplin, owner -�-,f the following described parcel: SEP 3 1987 KIRKE VIRS, 8 isb cowq lignum is Y, P. (� --- . ;0 The North 75 feet of the South 399*feet of the East 210 feet .n - hf the Southeast quarter of the Northeast quarter of Section 19, Township 27 North, Range 4 East, W.M.; C3 EXCEPT the East 30 feet for road. =C:, an se CD< Situate in the County of Snohomish, State ofWashina� (M HEREBY GRANT AND CONVEY to the grantee, thafresent an f t 4=;:.e cwnerss their heirs and assigns of the following dese b�d,-E: parcel: The North 75 feet of the South 474 feet of the East 210 of the Southeast quarter of Northeast quarter of Section - Township 27 North, Range 4'East,W.M.; EXCEPT the FAst 30 feet for road, Situate in the County of Snohomish, State of Washington. U EASE14ENT for the instal.lationt operation and maintence of a side sewer line over, under and across�the:following strip of land to wit: A strip of land 10.0 feet in width, lying 5.0 feet on each side of a centerline describ.ed as follows: Beginning at.a poiht on the North line of *the South 297.0 feet of Southeast quarter nf the Nortneast quarter of said Section .19, a Distance of 204.4 feet. Be*aring N89"20155"W from the East line thereof; Thence N30"05127"E, 163-05 feet to the terminus of the Centerline herein described. The maintence ot said side sewer line easement granted and conveyed herein shall be the the resnonsibil;ity of and the cOstsi'th6t6of borne by the grantee, their he;irs and assigns. Date this—'?Y'\� day of 7z STATE OF WASHINGTO Co *_j C/) r'n a .,I,! 1!2i M] ::0 M 0 70 0 County of SNOHOM I SH on this 2ND day of SEPTEMBER A� D* 19 87 before me, the undersigned, allotary Public in and for theState of WASHINGTON duly commissioned and sworn personally appeared CORRINE WELCH to me known to be . the individuaL--.; described in and who executed the foregoing instrument, and acknowledged to me that —he— signed and sealed the said instrument as----BER—free and voluntary act and deed for the uses and purposes therein mentioned. I WITNESS my hand and official seal (Acknowledgment by �87090-2031102 off % P���.*nd year i this esw ...................... .. ............................................... o T A,��, N ry u lic n and for the State of Washington, y �OA idingat ..�jjg, WA S . .. . 1 ppoi t p . .................................................. B L\C' ;yh 'r y appointment expires on 2/25/91 ....................................... INSURANCE COMPANY OF CALIFORMA213, sL38 Of WAS\\ 1 Vo VUEO 18 1 .jk� The City of Edmonds Side Sewer Drawing EASEMENT NO - --------------------------- — ------- 0 NEW CONSTRUCTION REPAIRS F� LID NO - ------------------ ASMT. NO - ------------ OWNER ----------------------------------------- CONTRACTOR ----------------------------------------------------------------- PERMIT NO. JOB ADDRESS ... q -7tR &\.) c -\g-. ___ -- -- -- --- --- ---- ----------------------------------- LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------ NAMEOF ADDITION ----------------------------------------------------------------- ---------- EDRONDS ----------- ------------ I TREAIWEENT PLANT I I 77 0 rk3 PWW-0001 -11/75 (REV. 11/78) Approved: DATE 1..�)-.-17 ............ By 51�--7 ... ... ... ... D 7- 117 --- ---- ---------- ------------------------------ GARY HAAKENSON CITY OF EDMONDS ftmwmw� MAYOR 121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 FAX (425) 771-0221 DEVELOPMENT SERVICES DEPARTMENT Website: wwwdedmondsma.uss I HEET FILE 1.1? C. 1 S (4 "1 Planning - Building - Engineering April 10'1', 2008 Mahmood Koopal 20218 76"' Ave W Edmonds, WA 98026 MEMO TO: Edmonds School District Verizon Northwest SNOCOM Police and Fire Dispatch SNOPAC Snohomish County E911 U.S. Post Office Snohomish Countv Assessor's Office Snohomish County Information Services Snohomish County P.U.D. Puget Sound Energy Edmonds Fire Department Edmonds Police Department Edmonds Utility Billing Edmonds Public Works Edmonds Building/Street File Edmonds Address Files Lynnwood Disposal Comcast Cable Waste Management Northwest Please be advised that a new address has been added to the City of Edmonds Official map book. The address of 20216 76"' Ave W has been short -platted under S-06-040. The existing structure/address to remain as 20216 76"' Ave W, a new address has been added of 20218 76t" Ave W. Please see attached rnap page 256. 1D Tax ID Number: 27041900119300, new parcel number for new lot created, addressed as 2021876 1h Ave W If you have any questions regarding this letter, please contact a City of Edmonds Pen -nit Coordinator at 425-771-0220. Please contact our office if you wish to be removed from future address change notifications. Sincerely, T 1he A4 Senior Permit Coordinator Edmonds Building Department I_\Temp\DST'sVA aster Letters\New Address4/10/2009 Incorporated August 11, 1890 Sister City - Hekinan, Japan 2010 a 84TH All 8328 G G a-. 8 832,5 2U320 8ws 2 CD 3 8303 0310 cc 19823 '9807 1 8310 w o (D. lz 83 r* 8301 8310 1-5 8303 04 83073 8301 83RD AVE.W, 2022 H �ff 19908 20301 FS 8224 1 T 20115 8220 Ak 82ND: PL W PL -1.310 \"90" 209 ea, '-'Os 8215 20036 -82ND AVE W- 20306 20220 20130 0037 28 0222 Li a 2 1 - 9 8116 8113 0 N) 2022 81ST.PL W 8100 20320 8105 202 2 'Po. 81 ST. AVE W [2.113 20001 I 2012j 8018 fE W. 71 20225 20301 2.111 PL "I 0 16 1 20410 -0 8D02 8001 20229 201141 [20112 '1 real, [I'll, 11-0, 8005 2 8006 20227 2011 F. -.,o, 8D02 /E '20411 .1 7929 do BOTH AVE W BOTH AVE.\ 2011, 19919 19729 1� 92 119525 7924 2e �77.. 7926 7918 79 7923 7: 7918 7919 2177924 7925 7922 7923 7916 7921 7929 9,�, 7916 7926 79il 79,5 vEW 7906 - S3 7915 7912 7915 �79 12 7916�( 1.17 T 7909 7 40 - 22 -.11, "', - 7905 20407 - ** ---- --- - -, -;-011 7906 79 e 7901 7821 7829 7826 7914 7913 7831 7900 - - vv 7902 7824 7823 7833 7819 --- - 7828 7901 7.0117909 7830 o 7828 7820 7822 7825 7324 -- 7816 7816 7920 7827 7832. 7824 -- 7833 7815 7820 7818 Villa Do Rey 7812 7809 7808 7818 7817 7820 T IL 7809 -- --- -- 7819 7818 -- - -- 19806 78100 7812 781-1 7816 Copperfield 7812 8 7811 7811 7808 AZq 7821 7823 7825 19805 Alpine ay Care 7805 7804 7803 7806 7802 78.1 7803 7805 7803 �j - --- 7805 71108 lew 7811 THPLW ------ 7728 --- 7802 T 7730 7 -1 7729 1 7730 7731 1 7726 7730 7740 77111 7812 7727 724 T '17 724 - 7717 7724T-- 17 �-A -77/9 7720 7719 7717 _7714 / 19808 Olympic Wesi 771ei - - 7715 - - 111D trio ---- aj 7713 -- N -- MH PL W. --- 7714 7710 7709 7709 7710 7709 --7712.- \19807 7711 7716 N 7711 7709 - 7704 wesl 1 7708 77TH AVE W 7703 7702 k Or, p;c 7701 12 7624 7630 7628 7 7625 71 623 19 7 7612 7620 X 7631 1615 76 7640 7619 0 OD U3 76 --d 7620 (1) 71 11) 76 7617 7616 7616 7813 7620 7600 I is 7618 7:14 7 1 1 1 1 1 1 1 19914 0 71 7016 76 - T T "'low Wil" fs�i 0 in IFIII 1111111 1" Z1, 76fH VE W T dz T 2 0 117 C. 1 S (0 0 0 CITY OF EDMONDS 121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221 Website: wwwdedmondsma.us DEVELOPMENT SERVICES DEPARTMENT Planning - Building - En ?� gineering August 22, 2006 MEMO TO: Edmonds School District Verizon Northwest SNOCOM Police and Fire Dispatch SNOPAC Snohomish County E911 U.S. Post Office Snohomish County Assessor's Office Snohomish County Information Services Snohomish County P.U.D. Puget Sound Energy Edmonds Fire Department Edmonds Police Department Edmonds Utility Billing Edmonds Public Works Edmonds Building/Street File Edmonds Address Files Lynnwood Disposal Comcast Cable Waste Management Northwest GARY HAAKENSON MAYOR Please be advised that the attached address has been added to the Edmonds address system: 20218 761h Ave W (Lot 2) Previously one parcel addressed 20216 76th Ave W. Lot 1 will remain 20216 761h Ave W with existing home. Occupancy: R3 Tax ID Number : (for short plat): 27041900110500 Subdivision: S-06-40 Lots#: 1& 2 If you have any questions regarding this letter, please contact me at 425-771-0220 or Zulauf@ci.edmonds.wa.us. Please contact me if you wish to be removed from this list. I JoA " Permit C1 Edmonds Department L\Temp\DST's\M aster Letters\New Address8/22/2006 Incorporated August 11, 1890 ';ister Citv - HPkinan—lanan STREET FILE CITY OF EDMONDS 250 5th AVE. N. * EDMONDS, WASHINGTON 98020 e (206) 771-3202 COMMUNITY SERVICES FILE NO. 01.1.12. October 6, 1986 MEMO FOR RECORD LARRY S. NAUGHTEN MAYOR PETER E. HAHN DIRECTOR On August 28, 1986 1 met with Mel and Nancy Coplin of 20222 76th Av. W., Edmonds, WA (774-0247) to discuss the possibility of the City putting in their sewer and carrying the contract. On September 24th I also had another discussion with the Coplin's. I also talked to Mrs. Welch and she indicated she could hel' the Coplin's with their problem and, -according to Mel p Cop4in, on October 2nd Mrs. Welch did offer to help. On October 2nd Mel Coplin came to 200 Dayton St. to meet with me to discuss his problem. I indicated that the City did not want to finance his sewer as added cost would cause the project to cost more than what he could have it done for. I informed him of his LID assessment of $513.10 which includes the permit fee of $55.00. Mrs. Welch's figure would be $355.00 plus $55.00 for a permit.' Mr. Coplin indicated that he would go and see Mrs. Welch and work something out with her. If he needed additional assistance I informed him to call or come down and see me. � Mr - M BRM/cmr PUBLIC WORKS 0 PLANNING 0 PARKS AND RECREATION 0 ENGINEERING 0 0 STREET FILE M E M 0 R A N D U M RECEIVEQ August 14, 1986 AUG 15 1986) TO: Bobby Mills PUBLIC WORKS FROM: Rhonda Marco/�� SUBJECT: Coplin Request for Financial Assistance in Sewer Connection Peter and I briefly discussed the request and he asked that you make contact with these people to find out what other financing arrangements they have attempted to make; i.e., loan company, etc. Also, it is odd that the bank or mortgage company at the time of the sale did not require the former owner to make the sewer connection. This is normal practice these days. Peter does not want us to play "social worker" but make contact with them and see what they have done to help themselves. You may recall the situation involving Mrs. Berzhalns on Edmonds Way in which we hired Russ Johnson to make the connection, the City Attorney drew up��-- an Agreement, a Promissory Note, Mortgage Note, and later a Guaranty Agreement, Installment Note, etc. A sewer lien was filed by her bank. This process required Council approval. Her debt to the City amounted to $1,695.68 with interest at 10% in 1984. Since we do not have a citizens' hardship committee as we did in years past, I feel that the Coplins will need to show proof of not being able to get financing elsewhere. Assure them that this will be kept in confidentiality. However, once it goes to Council, it is not. Attached are the street address files for this address and the neighbor which apparently involves the need for the easement addressed in the letter. I see that this is in a pocket area not accessible to sewer in 76th. We had recommended that this be done by LID back in 1977. They need to access the sewer from the west and connect into the main from 203rd. We need to have a sewer connection charge figured for the property. The next door neighbor at 20216 - 76th Ave. W. was figured back in 1969 to be $453.75 plus trunk charge and permit. This property would probably be about the same. Engineering will need to provide this information. It would seem that the Coplins may have been in contact with Engineering at some time, since they refer to the being unable to afford the estimated amount of the hook up. This is another one of those situations we need to establish a written procedure to handle this kind of situation. Scott will need to be involved. SIF(F FILE November 1, 1977 MEMO TO: Leif R. Larson Director of Public Works FROM: Dick Allen Assistant City Engineer SUBJECT: SEWER CONNECTIONS AT 20216 AND 20222 76TH AVENUE WEST These are the connections on 76th Avenue that can not reach the 76th Avenue sewer due to the telephone conduit blocking the way. The only solution that we see at the present time would be to have a sewer brought in from the west to the back yards of the properties. This arrangement would best be done through a program of cleaning up these pockets of unsewered areas through a Local Improvement District. We also need the additional time to get to this program and recommend that the work be done through a consulting engineer. Also, easements will probably have to be obtained. I would further recommend that we plan to initiate some sewer projects next year. RHA: Iv k-er" 1-,V eir-s 363. ' S or- . FlOr z4e- f dc OF VAIMI MWO'j d) H.QUA'00 PLAX ' Tsz&" ve" WW* 140 A6?JLftK are stgoce iswfo Moto or- 001f ?Cep"Wiry Ira tyahl FU%"-V) 9 MEMO TO: FROM November 1, 1977 Leif R. Larson Director of Public Works Dick Allen Assistant City Engineer L 'I SUBJECT: SEWER CONNECTIONS AT20216 AND 20222 76TH-AVENUE WEST These are the connections on 76th Avenue thatcan not reach the 76th Avenue sewer due to the ' telephone conduit blocking the way. The only solution that we'see at the present time would be to have a.s*ewer brought in from the west to the back yards of the properties. This arrangement would best be done through.a program of cleaning up these pockets of unsewered areas through a Local Improvement District. We also need the additional time to get to this program and recommend that the work be done through a consulting engineer. Also, easements will probably have to be obtained. I would further recommend that we plan to initiate some sewer projects next year. RHA: lv �4. I\' I 7/S //-/- 7'Z. Assyt C.E. date 4. -'.Sup6r... date SIGNED z] R07JTING MIRP11 Initial Date 3/P�/77 2-. 4. �Messacje: 7,_ -5X-/2 dale 24 From: Date: [E-7-72 -,,C"ITY OF EDMONDS PUBLIC WORKS DEPA,RTMENT TO: Richard Allen Asst. City Engr- LU F.- D 0 :5 2 Lu P.- < SUSPENSE DATE: / 01q DIRECTOR Investigate and Report Take Appropriate Action Prepare letter/memo for my signature For Information Previously Ref'd Status of Action? Return to: ADMINISTRATIVE SECRETARY ASST. CITY ENGINEER x BUILDING & GROUNDS SUPT. EQUIPMENT RENTAL SUPT. STREET DIVISION SUPT. TREATMENT PLANT SUPT. WATER/SEWER SUPT. COMMENTS: Please advise of the current status regarding the e twO.addresses. ca Thank you. FROM: Larry e, Sewer LeadMan DATE: 9-27-77 (3/77) _F so March 2, 1977 �ENO TO: Jack Mitchell, Superintendent Water -Sewer Department FROM: Dick Allen Assistant City Engineer SUBJECT: FOLIal-UP SEWER CaVECTIONS AT 20216 & 20222 76TH AVENUE I -VEST I met with Mr. and Mrs. Welch and Mr. Sanchez at the Welch residence on Friday, February 18, 1977. 1 advised them that tJieir best route for sewer connection would be to obtain an easement from a neighbor to the west and South,, and to connect to the sanitary sewer main an 203rd Street S.W. I also advised them that their would be a sewer connection charge. I also gave them a sample easement format and verbal information regarding the methods of completing the sewer hook-up. They will contact the neighbors in an attempt to acquire an easement. They will also contact a side -sewer contractor for further construction details. I would recomend that you grant them an extension of 120 days from t1lis date in order to complete sewer connection arrangements. RHA: lee "FIXIA-AW f 0 S-TilEE-T FILE May 13, 1977 MEMO TO: Leif R. Larson, P.E. Director of Public Works FROM: Richard H. Allen Assistant City Engineer SUBJECT: SEWER CONNECTIONS WELCH/SANCHEZ - 20216 and 20222-76TH AVENUE WEST In reference to my memo of March 2, and Larry Ogle's of May 6, 1977 we are not getting anywhere toward completing the hookup of the subject houses. Going over the background, the sewer hookup was obstructed by the telephone duct. Unfortunately the City did not notice this until the street was improved and attempts were made to put in sewer laterals. 1 believe the property owners have a good point in their argument that the City is not providing equal services in the vicinity. Others along the street have been abli� to connect without difficulty. The two subject properties have to obtain an easement and connect to the LID 139 sewers to the west. It.appears that we are at a stale- mate. I would recommend that the City pursue some method of assisting them in obtaining a sewer connection to their property line. I would like to discuss the methods of handling this at your earliest convenience. RHA: g 1 I M-A pia/ MEMO FOR RECORD May 6, 1977 SUBJECT� ROBERT WELCH SEWER CONNECTION - 20216 76TH AVE. W. ' On May 2, 1977, 1 contacted Mr. and Mrs. Robert Welch regarding the status in obtaining the necessary easements to make their side -sewer connection. Mrs. Welch explained to me that she had chronologically compiled conversations with City officials regarding the connection issue and has never received a satisfactory answer. She mentioned that she was assessed for improvements on 76th Avenue West but never received the full service she paid for. She also explained that when the improvements were being made, the proposed sewer line was never installed to her property line. On the day in particular, and I quote Mrs. Welch, "When my line was being initially started, I noticed two or three City of Edmonds officials looking at my line shaking their heads and then they left. My line never was installed." She found out later that due to the telephone con- duit adjacent to the sewer main, it was impossible to achieve grade to pick up the Welch property. At this point, Mrs. Welch feels that she is going to wait on the City. She also said that she and her husband are getting on in years and that the financial cost is three times what it was when they wanted to make the original connection. She stated she is in an inconvenience if she ever desired to sell her property since the house is not connected to the sewer. I explained to her I would relay her thoughts to the proper people to see what action could be taken. She feels the City. of Edmonds made the error and that the City should correct it. it LDO: j t Attachment March 2, 1977 MFID TO: Jack " iitcJicll, -Superintendent Water-Smer Deparm, crit F RG, 1: Dick Allen Assistant City En-incer 1 L3 SUBJECT: F-OLIG,,'-IJP SETIER COINECTIMS AT 20216 20222 76111 AMNIJI" 1%TqT I m.t with Mr. and I-Irs. Vielch arid Mr. Sandiez at the Wolch residence on Friday, Februan, 18, 1977. 1 advised them that tJicir best routc for sewer connection vzoul� be to obtain an casement frm a neighhor to the wc.st and S011thp arid to connect to the sanitary sewer main on 203rd Street S.W. T also advised theri, tJiat their would be a seiqcr copnection charge. I also f7ave theri a sample casement foiTiat and verbal information rep C, arding Vic methoch; of complctinr the sewer hoolIZ.-up. They will contact the neighbors in an attcr.mt to acquire an casercr-it. 71-icy will also contact a side-sev�cr contractor for further constniction details. I would recouriend that you grant tJiem an extension of 120 days from this date in order to complete smer connection arrangements. RI LA: lee CITY OF EDMONDS p U B Ff RJE E,, r JS.- ILDLEPARTMENT TO: SUSPENSE DATE: LU M 0 DIRECTOR Investigate and Report ADMINISTRATIVE SECRETARY Take Appropriate Action ASST. CITY ENGINEER Prepare BUILDING & GROUNDS SUPT. letter/memo for my signature - E QUIPMENT RENTAL SUPT. For Information STREET DIVISION SUPT. Previously Ref'd TREATMENT PLANT SUPT. Status of Action? Return to: WATER/SEWER SUPT. COMMENTS: V FROM: DATE: I 0� FILE MEMO FOR RECORD May 6, 1977 SUBJECT: ROBERT WELCH SEWER CONNECTION - 20216 76TH AVE. W. On May 2, 1977, 1 contacted Mr. and Mrs. Robert Welch regarding the status in obtaining the necessary easements to make their side -sewer connection. Mrs. Welch explained to me that she had chronologically compiled conversations with City officials regarding the connection issue and has never received a satisfactory answer. She mentioned that she was assessed for improvements on 76th Avenue West but never received the full service she paid for. She also explained that when the improvements were being made, the proposed sewer line was never installed to her property line. On the day in particular, and I quote Mrs. Welch, "When my line was being initially started, I noticed two or three Citybf Edmonds officials looking at my line shaking their heads and then they left. My line never was installed." She found out later that due to -the telephone con- duit adjacent to the sewer main, it was impossible to achieve grade to pick up the Welch property. At this point, Mrs. Welch feels that she is going to wait on the City. She also said that she and her husband are getting on in years and that the financial cost is three times what it was when they wanted to make the original connection. She stated she is in an inconvenience if she ever desired to sell her property since the house is not connected to the sewer. I explained to her I would relay her thoughts to the proper people to see whataction could be taken. She feels the City of Edmonds made the error and that the City should correct it. LDO: j t Attachment _"r I -n-- _'Int -- PAM 0% March 2, 1977 13 KID TO: Jack Mitchell, Superintendent Water-Scwer Department FROM: Dick Allen Assistant City Fm-i.neer SUBJECT: MUL01-UP SEWER COINECTIONS AT 210216 & 20222 76111 AVr-,MT,- 1,,T,,;T I met with Mr. and Hrs. V-,,'ClcJi and Mr. Sanchez at the Welch residence on Friday, Februan, 18, 1977. 1 advised them t�at ticir hest route for sewer connection uould be to obtain an easement from a neighbor to tie vrest and solit1l, and to connect to the sanitary sewer main on 203rd Street S.W. T also advised them that their would be a sewer connection charge. I also r7ave them a swnple easeixnt format and verbal information regarding the mctJlo&,; of completing the sewer hook-irp. 7hey will contact the neighbors in an attempt to acquire an casement. TI-icy will also contact a side -sewer contractor for further construction details. I would recamend that you grant them, an extension of 120 days from this date in order to complete sewer connection arranpmients. @ IA: lee 00 STREET FILE ,00 . , December 17, 1976 NDiO TO: Public Works - Sower Department FROM: Leif R. Larson City Engineer SUBJECT REMAINING SENER-CONIN1E, MONS P1-'FFPRED TO T1-TF ENGIMM-PTNG DEPT. We have examined the 19 remaining,sewer connections referred to.this department, and have the following recommendations to mal�-e: 1) 213 Elm Street . (Dilmick) The existing, residence is too low to reach the sewer 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. Y septic system., pending the development of propert" adjoining Second Avenue*, wherein a.combined sewerarrangement would allbv,, this resiidence to make coTmection. 2) 931 1-lain Street (Nelson) -This property can co.nnect to the sanitary sewer,however, t he soil conditions adjacent to the scvrer lateral at, Main Strect.indicate potential problems with the sewer hoolaip. A v.Taiver is re.coff;ionded suhject to the proper functioning of the septic system, zold subject to -connecting to sewer if future development of the propert�'or plumbing ad,ditions- occur. 3) 806 Ninth Avenue South (Yeager) This property does hot have. gravity sewers available and. would hest be served through an L.I.D. with gravity sewers to Eiplith. Avenue. 4) 716 Ninth Avenue South (thirdock). Th.is property is not served by, sanitan, sewor. Tt is recommended that an L.I.D. be formed with gravity sewers flowing to Eighth Avenue. 5) 929 Cary Road (Strickland.) There exists a problem related.to utility casements and the'estate settlement. of.bus'iness prior to Mr. Stric.l-,land's death. Tt'is recommended that a waiver be g-tanted subject to conpletion of the utility casement, proper functioning of the septic system, and no further development of the property until sewer hookups are provided. Mem.o to: PAC Works Sewer Department Page 2 12/17/76 (Continued) 6) 170tla Street S.W. (Ay:res) .71iis property is adjacent to the Lynnwood tninl< sewer hourever,.no lateral exists in 01)Wi.c View Drive, the owner-, 1have had'some difficulty in. arranging for the lateral extension, in the strOct right -of -w 'ay. It is recommended that:theTity request them'to contact three contractors�and provide evidence of the contractor's estimate or refusal to accomplis.�'. the work proposed. Should tJiat evidence indicate the unavailability of a ton - tractor to do the work, -it is recomcnded that the City proceed witb a lateral connection charging tlte�resident for the actual -cost of work. (See next connection.) .7), 6510 170th Street $.111. (1.�)thegrove) T'his residence adjoins the Avres residence, an(I could jointly use a sewer lateral. , The recommendation for #6 �pplies to. this residence. 8) 18S96 76th Avenue West, (Cline Scuba Shop) A lateral WaS.Tiot installed to this particular propert), tinder the 76th Avenue street project. Later, the City installed a lateral from the north but inadvertently constructed the lateral on private property. Atteq)ts have been made to acquire an easement without results. * This matter needs further study in acquiring an easement from efther 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 sewer connection point. 9) 20216 76th Avenue West (11,161ch) This property is not served with a sewer lateral. in 7.6th Avemic. 71-iis sewer connection will require Mi.eAsement o . ver adjoining property to connect, to'sewers to the west.. Further study is required on this. easement made by -the -City. Itis.recommended that a waiver be.granted subject to 3 the City arrangin.g for a sewer- connection point. 10) City -Park . ('Mird and Pine): The present restroom is more. than 200 ft. from the sewer an(! is helow. the sewer elevation. It is recommended that a waiver he grante(i. subject to proper functioning Of the septic system. Also,­�any chnnges to the pltunb- ing which would expand the. use (or'should other -regulations outs.i de t] I e City apply) a pump should be installed and connection made 'to the trunk sewer rwin.ing through -.the Park playfield. 1.1) � 10521 226th Street S.W. . (Jarvis) This priopert�,- is located in . the vicinity of Olympic View 11ater. Dist. sewers. 11owever, the property does not directly ahut the, sewer or have access to the connection point. I't is rocoiincnded,that this property participate in an L.E.D. with the surrounding neighbors for completion of the hookup. P-lemo to: -PuPic Works Sewer Departmc�nt Page 3 12/17/76, (continued) 12) 10605 226th Street S.11. (Johns ton) 13) 10607 226th Street S,. IV. (K2a) .14) 10611 226th. Street S.W. (Sisom) 15) 10727 226th Street S. V.1. (Jatho) Recommendation forltem. 11 will'apply to the. above locations.. 16). 718 Ninth Avemle South Mis property is not served by sanitary sewer. It is recommended that an I—I.D. he formed with. gravity' sewers flowing. to Eiglith Avenue. 17) 528 Eiglith Avenue North. (Schroeder) ary sewer. It is recommended This property does not abuta san i t, that this property be included.in an-L.I.P. to serve surrounding proper- ties. 18) 20222 76t]i Avenue North OlcDonald Log Cabin) This property is in the process of receiving a City approved subdi7 Nision for duplexes - and plans for removal of the existing log house. It is recommended that a waiver be granted on the existing Tious e. Any new construction will then follow the Subdivision and Building codes requiring liookajp. 19) 7400 212th Street S.W. (1,.cnmore Pre -Mix) With low usage rate and extent of lot size, it is recommended that a waiver be -r,:uited.1f the property should be developed belrond its pres ent usage, a scwer connection would he required. Id-Wisc FILE Date: March 25, 1969 to: John E. Moran Director of Public Works From: Leif R. Larson City Engineer Subject: Sewer Connection Charges Legal Description: North 751 of the South 4741 of the East 210, of the SE 1/4 of NE 1/4 of Sec. 19, T27N$ R4Eq EXCEPT the East 300for road. Commonly Known as: 20216 76th, Avenue W' Z.F.F. Calculation: Owner: Mrs, Robert S. Welch 82. 5 ) Z. F. F. ' x ( $5.50 $ 453.75 Connection Fee ) Unit x ( $25.00 $ 25e00 Trunk Charge $ 10.00 Permit $ 488.75 TOTAL LRL/le City Engineer 75 F .417 117, 4 �71 3ai-e— F7 REGARDING: ?ec;2)4— (address) R E C 0 R D 0 F C 0 N T A C T S DATE NAME, PHONE NO., & ADDRESS of CALLER 1�)Zj -7 -76 z, '717 , _ajL__� -�?O c2 -7 COMMENTS _A9 OAJI �b ja-11na-'0 / . kiYa:/, ACTION TAKEN Initials Date: karch 25, 1969 7.,IeMo to: John 11. Moran Director of Public Works From: Leif R. Larson City Engineer Subject: Sewer Connection Charges I Legal Description: North 751 of the South 4741 of the East 210, of the SE 1/4 of NE 1/4 of Sec. 19, T27N9 R4E. EXCEPT the East 301 for road. Commonly Known as: 20216 - 76th Avenue W. Owner: Mrs, Robert S. Welch Z.F.F. Calculation: LRL/lc 82.5 Z.F.F. x $5.50 $ 453.75 Connection Fee Unit x $25.00 $ 25.00 Trunk Charge $ 10.00 Permit $ 488.75 TOTAL City Engineer V REGARDING: 20216 - 76th Avenue West 01PI-16 0 (address) R E C 0 R D 0 F C 0 N T A C T S DATE NAME, PHONE NO., & COMmwrS ADDRESS of CALLER 1/1/74 Robert Welch Certified Letter No. 4061.93 sent requiring hook-upwithin 60 days. 5/l/74 Wishes to connect but needs lateral location. LU W. 01-0-0 to ACTION TAKEN INITIALS Letter received. TE No lateral found to property. TE Referred to Engr. -RECEIPT FOR CERTIFIED MAIL-3C ST. 4.16-08900 CER! WELCH, ROBERT S. I 1 U 20216 76TH AVE. W 40 SI 0 �Whldo, c\j EDMONDS, WASHINGTON 2, f, You 98020 the a( OPTIONAL SERVICES FOR ADDITIONAL, FEES 3," If -You RETURN I. Shows,,tho whom and Cate delivered .......... a ratu R E W delivery to addressee only CEIPT 2, Shows to whom, pate and where delivered gUITIMI SERVICES With doliver-y to addresseeonly 4. It YOU DELIVER TO ADDRESSEE ONLY ........... ADDRE SPECIWL -DELIVERY (extra fee required) - Servic P Form NO INSURANCE COVERAGE PROVIDEi S 3800 Apr. �. 5�, Save I 1971 NOT FOR INTERNATIONAL MAIL A": AENDER-,:Be,'sure,fo:..foil'o'w,,I'nst.r6'c'f'idris OLEASE R I XTiED!`BY,. N SH .�'E`i4V10E,(Sj.'­INDIC �­CHECKED -,BLOCK ( d(I A ition b6ha :6"d e iverld,�a--v4-� ress? 'Sh' "addi b 'I .e . dih Ve r,'e* d V [11: W h �oe Wre A td4ddres­see;. -:RECEIPT eielk&ihe:,hu�i escribid,,tbilbw F USrt REGISTERED11M ".,SIGNATURE, RNVE� -,ADEIRESSE always P n ­PERTI.�IED, 'NO6 -3 .-IF-,AA SEE',S;'AGENT 406,2`93,,': 9. INSURED NO.' 'SHOW, �WH DELIYERED­ (Qfi1y,if,,-, DATE, DELIVERIDI ER1,' tM J7zbW.d1 '.0 _7 -A r C D M'C-,- -Ll�� H 1 00-2 ILI, -cl G -O-s, -M .10 I;_ CIS ev Aj L .L2 Q-0 —jI) f !I. Z I Oft (5srD 10 21 94 lz 05? 1. z O'P, Z I't I-� 17.L. a --�- �61-2 S&Lz z -7 "LAI "Lz gm= ,0 �4- 77777- -777� In 4 tk, Ali' liy 25. : -777 7, 77 77 o" 777% ;k!-, f 40T i, , Vwj-�- , vli U1 , NO N 5 4. 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