20822 76TH AVE W.PDF111111111111
6304
20822 76TH AVE W
APPLICATION
5
TF,q -City of Edmonds for EASEMENT NO - --------------------------------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION E REPAIRS E] LID NO - ------------------ - ASMT. NO - --------_--------
OWNER k�� - -------- ................ CONTRACTOR ---------------- PERMIT NO.
JOB ADDRESS .... LEGAL DESCRIPTION: LOT NO - ----------- I? ....................... . BLOCK NO - ------------------------------------
....................................................... i5kc�x_l ------- ---------- t .......... -------_------------ : -----------
NAME OF ADDITION -------------------------------------------------------------------------
Approved:
.............
DATE _e�:D By ...
'4
PPLICATION
'-A
ty,
'Re Cji of ;Ed mmiids,
t4*
Sf E_$1W,�R P M T"
NEW CONSTRUCTION REPAIRS
OW�NER .. .. ........ . ----- . ............ --------- je .. IIK 0
CONTRACTOR-
--- At-
ERMIT N
JOB - ADDRESS ------------------- NO - ----------------- ..... -,.,
---------------- ---------- 26. LEGAL DESCRIPTION: LOT NO . ...... 12 ---------------------- BLOCK
.... .. ----------- .......... z �4.
/*
NAME OF ADDITION
...............
........
r �wA
N
41
Approved:
DA . .............................. Ay� .......... - ------------------------------- .....
TE
4. P
CITY OF EDMONDS SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
PER
MIT
Call 775-2525 for side sewer insp6ctions BEFORE covering any portion of the construction.
Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday inspections.)
r2
ADDRESS LOCATION OF CONSTRUCTION ................
........... .. ....... ......
. . .....................................
PROPERTY LEGAL DESCRIPTION ........ =cna
T ....................................................................................
-------- -------------
....................... . ........................... ........... ........... ..................................................... .................. . ............... .................................. . ......................... .......................
........................ . . .....................................................
----------------------- .,I -
......................... OWNER 01.1%M/OR BUILDER .....
CONTRACTORS NAME & ADDRESS ------------- _,n .... . ............. . . ........ -t — ------------------------- - --- ------------------------------------------------- -----
4'.
--��lon is granted ... .......
P ....... 19MI1, for repair and/or connection of a side sewer to the city sanitary sewer
9: In necordance with City of Edmonds ordinances.
_2
ATTENTION IS CALI D 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.
1. 7
NOTE 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.
NOTE No. 3--Obtain full Information regarding 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.
A
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. &—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.
DISAPPROVED 0 Date ... . ...... By ---------------- Date ................... BY ................ Date ..... ......... . ................... By ..............
----------------
APPRAD
VED /0 Dat,._,/.� ..... By ------------ ...
-- - ------------------------------------------------------------------------------------
Remarks: ....... . ....... .......................... . ... .............................. ...................... . ...................................................................
............
............................ .. ........... . .................................. . .......................................................
-------------- V* ... ---------------------------------
BOT Pe Copi s MUS 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 of Cont cti rm Perfcrmin Construction)
n
was install n accord ce wi all gover J g ordinances of the City of Edmo
Dated this day of .......
/ -- - --------------- 1"V-7i ......................... .....
V -4 Check BEFORE you dig for: Water F], Gas E], Telephone E], Power C], Sewer E], Other E]
e i s MUS Be S. gn(
pi
Op
Co
.. .. .. ... r -i - r-m i�
on T Pe
I ct� 11 goVer g
C I
r
n accord ce a dsz
.............
MEMO TO:
FROM:
SUBJECT:
STKET FILE
DATE:F—j�E 13 - 19, -,� --3- 7
Harry Whitcutt
Building Official
Richard H. Allen
Assistant City Engineer
IA()NITAPT, 2c822-7(oTH 4%4Fv�J
After.review of the subject building permit appTication, we have the following
comments:
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DATE [4&
Reviewer's
Initials
1.
2.
3.
PERMIT ADDRESS
LEGAL DESCRIPTION
12
BUILDING PERMIT REVIEW ENGINEERING DEPARTMENT CHECK LIST
This ' lot included in.Suhdivision/Plat No.:
Site ln�j�eciion made
Uhat are around water and soil conditions?QL,-�>D-tX)a
4.
Site Drainage Checked?
5.
Storm Sewer Availability: Sht.--q- 0 f Dwq. Nol 455r7roJect- Q EVD-:2�
Roadsi de Ditch
6-.
Gradinq & Final Contours:
7.
Septic Tank System Design Approved:
8.
Sanitary Sewer Availability Nol a Project Wm
n
Side sewer availability: M1 -W
9.
Sanitary Sewer Connectio�nFees�7
10.
11ater Mains A Fire Hydrants (Indica izetla:7 IdW4
n) pjZig �A
Check Fire Dept.'s Comments —
11.
e espe
Side alks: 11,it ction shows co di ions of sidewalks as.follows)
K\ I Z
12.
I 1110)
Curbs: &` 'A ' -rivewa -ioys for safety, Incation.*
- 4J,9TJh)L_" Curb Cuts/P ys (Check dri vei-
grade and width): PiPt1A/A',-N
13.
Underground INring: Street Liahts:
14.
ht
Street Riq -of-way Bldg. setbacks: -ht. of ()fficial Street Map
15.
Existing Utility Easements?
16.
Access Easements:
17.
Site Pla f7 4CM
n checked for accuracy?
18.
Special Require ments listed in Memo to Bldg. r.(?Pt.-.-.
19.
Commercial &-Apt. Renuirements form completed?_
20.
-----------------
Drawings.stamped & notations made?.
21.
All I . tems filled in on Bldg. Permit Application?- 1,k)
mcs
22.
Bonds postedfor site work?.
23.
Right-of-way Invasion Permit renuired?
24.
Check Accuracy of Legal Description awe
.25,
..Check Against Assessor's Map for Legal Subdivision
26.
Does,it conform to City Approved Subdivisions? VIP". 5
COMMENTS:
MEMO TO: Harry 14hitcutt
Building Official
FROM:
SUBJECT:
Richard H. Allen
Assistant City Engineer
After review of the subject building permit application, we have the following
comments:
4--ok
MEMO� TO: Harry Whitcutt
Bui.-Iding Official
FROM: Richard H. Allen
Assistant City'Engineer
01 OT
SUBJECT: 2ce2 v-1 7:6� a
After review of the.subje-ct building permit application, we ha've the following
comments.
ZOW01 034MC—N ?P WCAMNI OF
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FILE DATJ:-- - 71 - I-S 1,177
51REE
Heno to: Director of -Public Works
From: Assistant City Engineer
Subj ect: Sewer Connection Marges
Legal Description:
Lot 12, llillo�.:dalc Gardens Division No. 1 except: 1-Jest 313 fect aml, except "'.Orth
12.5 feet in Southeast 1/4, Sout]).east 1/4, Section 19 - 27 4 Fnohomisll CoLuity
11,,,'ashington.
Coi-uionly Imam as: 4�0316 and 20322 76th Ave. 'Vno r: I James A. Anderson
Z.F.F., Calculation:
133.57 Z.F.F. \ 7.50
Lateral X
18 Unit X 25
cc: i
Don Architect
100.1.81 Connection Fee
Lateral Charge
450.00 Trun]: Charge
1.9.00 pennit
1401.81. TOTAL
C.6jpeL�Ytoj Ckk*M& co
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March 2v 1977
KID TO: JacI, Mtchell, Superintendent
Water -Sewer Depart=t
FRMI: Dick Allen
Assistant City Engineer
SUBJECT: MLLOW-UP SMR CMECTIONS AT 202,16 4 20222 7671 AMM" IM-ST
I met with �Ir. and Mrs. Welch arid �.Ir. SanChez at the 'Welch residence on
Friday, February 18, 1977. 1 advised them that ticir best route. for sewer
connection would be to obtain an ev-semnt from a neighbor to the west and
south'. 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
gave tlxm a saq-)Ic easement format and verbal informtion regarding the
methoch; of ca%)leting the sewer hook-up.
7hey will contact the neighbors in an attempt to accluire an easoment. They
will also contact a side-saw-er contractor for furtlier construction details.
I would recamend that you grant tliei:i an extension of 120 d&-,s from this
date in order to complete sewer connection arrangrawnts.
WAS
F4 LA: lee
0
S-rREET FILE
Hemo to: Director of Public Works
Fropi: Assistant City Engineer
Subject: Sewer Connection Cliarges
DATE March 8. 1977
Legal Description:
Lot 12., Willowdale Gardens Division No. 1 except: West 318 feet and except North
12.5 feet in Southeast 1/4, Southeast 1/4, Section 19 - 27 - 4 Snohomish County
Washington.
Comionly lmam as: 20816 and 20822 76th Ave. W-Mmer: James A. Anderson
14---77
Z.F.F. Calculation:
133.57 Z-F-F- X LSO Connection Fee
Lateral X -0- Lateral Marge
18 thit X $ 25 CITSO —.0 9; YOD Tnml,,- Marge
10.00 Permit
cc: Don Westlin, Architect
14 -77'
LL.-
3111,1-77
FILE
April 27, 1978
MEMO TO: Richard H. Allen
Assistant City Engineer
FROM Kenneth Kukuk
Water Leadman
SUBJECT: 20816 AND,20822 76TH AVENUE WEST, JAMES ANDERSON
COMPLEX (JACK KOSTELYK)
After inspection of the aforementioned complex it has been found
by the Water Division that the fire protection system still has
three discrepancies against it and until these are corrected
an occupancy permit should not be issued to the builder. These
discrepancies were made aware to the contractor approximately
six weeks ago and no action has taken place since then. These
discrepancies are as follows:
1. The outlet valve of the detector'check must have an
indicator to show the position of either being open
or closed. This can be of the OS&Y type or Mueller
NRS indicator valve..
2. Bacteriological samples mus,t be taken and approved
prior to acceptance of the fire line.
3. The hydrostatic pressure t est must be taken on the
fire system prior to acceptance.
It was acknowledged at one time on this project that there was a
pressure test taken and leaks around flanges near the fire hydrant
were found. At this time we have no knowledge that these -leaks
were ever repaired and this is the reasoning why.we must have a
test on the fire system prior to acceptance.
If you have any questions regarding this matter, please contact
me.
1111111111111111111E:54�---
KKK: j ab
CITY OF EDMONDS IRPNG DIVISION
PUBLI WORKS DEPARTMENTj ENGINEE
S-TJJEE--TAftQLEI0N FOR-RIGHT-OF-14AY CONSTRUCTION PER -MIT
THIS PERMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECTION PURPOSES
Applicant to Complete Parts A and B
A. Permit to be issued t o
For Work at:(address or vicinity 40 1 "46-
Type of Work to be done <) 9 311AF &ALL
(attach drawing when applicable)
Time Required -- Start:
Owner:
Name
Mailing Address
14
City State Zi
p
Contractor.
N e
Finish:
T�lephone Number
-.8tate License Number
o—
M -ilin Address
y State Zip Telephone Number
B, INDEMNITY: Applicant understands and by his 'signature to this"Application, agrees
to hold the City of Edmonds harmless from any injuries, damages, or claims of any
kind or description whatsoever, foreseen or unforeseen, that may be made against
the applicant or the City of Edmonds, or any of its de.,partmenfs, or employees,
including or not limited to the defense of any legal proceedings including.defense
costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and
materials for a period of one year following the final inspection and acceptance
of the restoration' by the Engineering Division.
Funds held from the Security Deposit (esti " mated restoration fee) will be held until
the final street patch is completed, at which time a debit or credit will be
processed for issuance to the applicant.
Work is subject to inspection ao—Kestoration in accordance with City Code. A
24-hour notice is required r i tion by Engineering. Call 775-2525, ext. 220.
I understand that this permi t mus e a ailable at the job site for i ection
purposes at all ti� I 11�,� X, /) 171-
Signature:/ Date:
b4n�k Por/'A!'9-ent
TO BE COMPLETED BY IS51JING/,,"ENCY:
Date Issued:__,L 7 Permit No.
Fee:
Security Bond:___
Time Authorized:
APPROVED BY
If)-//IV (RPxr1F;(1(1)
Date : 41�-�-
177
7 7
11f17 7 1 - r,,-.5-A C-11 ,
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0 1 STREET FIIE
CITY OF EDMF,31MDS HARVE H. HARRISON
MAYOR
CIVIC CENTER - EDMONDS, WASHINGTON 98020 - '(206) 775-2525
DEPARTM�NT OF PUBLIC WORKS
May 1, 1978
Mr. Jack Kostelyk
17926 73rd Avenue West
Edmonds, Washington 98020
Dear Mr. Kostelyk:
SUBJECT: JAMES-ANDERSON APARTMENT COMPLEX
2b.816 AND 20822 J�'67TH_ AVENUE WE,ST
After inspection of the subject property, the Engineering
Division and the Water/Sewer Division have found discrepancies
which must be corrected or completed prior -to final approval
and issuance of occupancy permit.
1. The outlet valve of the detector.,check must have an
indicator to show the position of either being open or closed.
This can be of the OS&Y type or Mueller NRS indicator valve.
2. Bacteriological samples must be taken and approved
prior to acceptance of the fire line.
3. The hydrostatic pressure test must be taken on the fire
system prior to acceptance.
4. Infall and,outfall storm sewer lines going into catch
basins must be grouted and flush to catch basin walls.
5. Roof down drain clean outs must be to grade, capped
and serviceable.
6. Water meter box to be exposed and serviceable.
7. Parking stalls to be marked compact car only, one to
be marked at fire hydrant, and one at the south side of building.
8. Landscape planting strip between curb and sidewalk.
QJ2�p AdZZZ
Hattendrof Dt. Asst C.E. IiDt. W.Leadman Dt. X/S S(Ipt- Dt.
'-,hdulin -Sec'. Df-.
C C_' 1� t10 6 wr
Mr. Jack Kostelyk
Page Two
May 1, 1978
If there are any questions regarding these corrections,
please contact Mr. Joe Hattendorf, of the Engineering Division,
775-2525, extension 220.
Yours very truly,
4
LEIF R. LARSON, P.E.
Director of Public Works
JWH: j ac
CITY OF EDMONDS
PUBLIC ORKS DEPARTMENTj ENGINEER# DIVISION
N EOR El GHT—OF-11.81 CQNSTRUCTION PERMIT
Lon a
THTS PERMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECTION PURPOSES
Applicant to Complete Par tSL A and-B
A. Permit to be issued to:
74
For Work at:(address or vicinit Y;2 a_
Type of Work to be done:
(attach drawing when applicable)
Time Req Start: 3 Finish: 3 - ;20- 7
Owner:
N I amr
Mailing Address 27? — 7370
City State Zip Telephone Number
Contra
11
City State Zip
MO-5r- /�-i J �'d /� 1:5
State License Number
:7 2-1
Telephone Number
B. INDEMNITY: Applicant understands and by his signature to this application, agrees
to hold the City of Edmonds harmless from any injuries, damages, or claims of any
kind or description whatsoever, foreseen or unforeseen, that may be made against
the applicant or the City of Edmonds, or any of its departments or employees,
including or not limited to the defense of any legal proceedings including defense
costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and
materials for a period of one year following the final inspection and acceptance
of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until
the final street patch is completed, at which time a debit or credit will be
processed for issuance to the applicant.
Work is subject to inspection and restoration in accordance with City Code. A
24-hour notice is required for inspection by Engineering. Pall 775-2525, ext. 220.
I understand that this permit must be a ilable at the job site for inspection
purposes at all times
Signature, Date: 3-2-0-71
r t
0 eror Xge�nt
TO BE COMPLETED BY IS��G AGENCY:
40e
Date Issued: Permit No.: 21- — 0 7 F e e
Security Bond:
Time Authorized:
APPROVED B
iU—/Ilv (Kevise-d)
Date:
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to: Joljyi
Director of Public I-Iorks
From: Leif F. Larson
City --rigineer
Subject: Sewer Connection Charges
Date: March 25, 1969
LegaL Descript.i.on: North 750 of the South 4749 of the East 210f of the
SE 1/4 of ME 1/4 of Sec. 19, T27Nq R4E, EXCEPT the
Eaet 30v for road.
Commonly Known as: 20216 - 76th Avenue W. Owner: Mrso Robert S. Welch
Z.F.F. Calculation:
82.5 Z.F-F. x $5.50
Unit x �325.00
LRL/Ic
453.75 Connection Fee
25.00 I'runk Charge
10.00 Permit
488.75 7 OTAL
City Engineer
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&I-Y OF EDMONDS
PUBLIC WORKS DEPARTMENT
RIGHT - OF - WAY CONSTRUCTION PER5TREET FILE
A. *Address or vicinity of Construction
'9t'h Ave. W
20822 �
0 Owner: General Telephone of , the �!.W.
Name Inc.
3831 204th St. S. W.
Mailing Address
L�nnwood, WA 93036
City, . State, Zip Code
Permit No. 8:-3 — 1,z�,
Issue Date IA-7 5,
9 Permit Issued To:
0 Ty e of Work to be Done:To place 2" PVC for
repfacement of bad telephone cable.
Work in Connection With:
El Sub or Plat 0 S I ngle Family
El Comml. / Ind. El Apt. Condo.
Pavement Cut: El Yes El No
9 � Contractor: r!eneral Telephone of the N. ItI. , &nc. C607 2100-28QI983.
Name
Same
Mailing Address
State License Number
City, State, Zip Code Telephone Number
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
B. APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
from any injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made
against the City of Edmonds, or any of its departments or employees, including or not limited to. the defense of any legal
proceedings including defense costs, court costs, and attorney fees by reason of granting, this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in a ccordance with City Code. Traffic. Control. to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering.
Call 775-2525, extension 220.
I understand that this permit must be available af the job site for iri�pection pur
,poses at all times.
'144-1 Date
Signature: 4�1&ZI/i. i/_
Owner or Agent AV
THIS PERMIT MUST BE POSTED AT THE JOB SITE FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued Bly,:.
Time Authorized: Vold after —days
Special Conditions:
Ammendments:
Permit Fee:
Security'Deposit:
Receipt No.:
Fund III Fee:
Street Cut Dimensions
X
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. December 1978
FIELD INSPECTION NOTES (Fund. 111 - Route coT)v to Street r)e-r)t.
r�mm�- +- � -
Diagram:
I
Contractor called for inspection Yes No
T Date:
,,x7ork Disa.pproved. By: Date.: Bv:
----------
Work Approved BV: Date:.
Inspector:
Ena. Div. December 1978
Rt
C
DATE: //Z 9'17 r
MEMO �TO:- Building'Division
y 'Dep ar ehi
Commun.it* Development
FROM: . Engineeri ng Division
Public Works Department
SUBJECT: FINAL INSPECTIONr
PROJECT: 6 -E7-Z!- 76 A T, L n--
APPROVED NOVAPPROVED
Engineering Divis ion
—T—
BY:
F ",6
Water, /ivision
BY:,
Sewer/VIS3-04
BY:'
9
ILE
OREET
C"It
IS17
DATE:
MEMO TO:' Building:Division
Community Development Department
FROM: Engineering Division
Public Works Department
SUBJECT: FINAL.INSPECTION
PROJECT: -0-42W.Z. -76-e-r-w
APPROVED NOT'APPROVED
Enginee7ln;Division
L
—7—
BY:
Water R�vi8ion
LBY:
ZX!7 Sewer Division
BY:
OF-
-E�Vr,- 444
/17.
P. � x'j"
0
April 27, 1978
MEMO TO: Richard H. Allen
As"sistant City Engineer
FROM: Kenneth Kukuk
Water Leadman
SUBJECT.: 20816 AND.20822 76TH AVENUE IVEST, JAMES ANDERSON
COMPLEX (JACK KOSTELYK)
After inspection of the aforementioned complex it -has been found
by the Water.Divisi6n that the fire protection system still has
three discrepancies against it and until these ar'e corrected
.an occupancy permit should not be issued to the builder. These
discrepancies were made aware to the contractor approximately
six weeks ago and no action has taken place since then-. These
dis epancies are as follows:
1. The outlet valve of the detector check must have an
1P indicator to show the position of either be I ing bpen'
or closed. This can be of the OS&Y type or Mueller
NRS indicator valve.
2.. Bacteriological samples must be taken and approved
prior to acceptance of the fire line.
3. The hydrostatic Pressure test must be taken on the
fire system prior to acceptance.
It was acknowledged at one time on this proj . ect that there was a
pressure test taken and leaks around flanges near the fire hydrant
were found. At this time we have no knowledge tha-t these leaks
were ever repaired and this is the reasoning why we must have a
test.bn the .'fire..'system prior to acceptance.
If you have any questions regarding this matter please contact
me.
KKK: j ac
stern
SfREET FILE.
COMMUNITY DEVELOPMENT DEPARTMENT
Building Division,
DATE: August 31, 1978
TO:
PUBLIC WORKS DEPT.t"'-�
PLANNING DIVISION
SUBJECT: #770182 & 770183 - James Anderson
20822-76th Avenue West
RECEIVED
SEP 1 1978
Public Works vepl.
Please review and advise any outstanding requirements on
above, in order�tha.t they may.be given final approval and
a Certificate of Occupancy issued.
Harry M. Whitcutt
Building Official
HMW/ae
SIWS LICENSE APPLICATION REVERSE STAFF ACTION
APPL. NO.:
CITY OF EDMONDS SIDE DATE: C�l
0
V2 0 5TH AVENUE NORT�_
MONDS, WASH. 9802
L APPLICATION FOR:
LEPHONE (206) 775-2525 W E
(LNEW LIC LICENSE
BUS, 1:1 RENEW YEAR
STREFET FIL
INSTRUCTIONS
1. PRINT APPLICABLE LICENSE CLASS, FE)E D PENALTY PAID
I
IWANNUAL FEE BOX AT RIGHT. PENALTY UE ON RENEWALS
I
RECEIVED BY CITY CLERK AFTER FEBRUiY 15.
2. NEW BUSINESS: COMPLETE ALL LICENSE APPLICATION BOXES.
LIC. RENEWAL: REVIEW LICENSE INFORMATION BELOW. PRINT
CORRECTIONS AND ADDITIONS AT RIGHT.
3. SIGN AND RETURN APPLICATION WITH FEE (AND PENALTY)
4. LICENSE WILL BE MAILED TO YOU.UNLESS YOU ARE NOTIFIED
- TO APPEAR FOR APPLICATION REVIEW.
LICENSE RENEWAL
REVIEW BELOW INFORMATION; PRINT CHANGES AT RIGHT
2. APPLICANT
NAME SOCIAL SECURITY NO.
DATE OF BIRTH PLACE OF BIRTH
HOME ADDRESS
�l . ANN-UAL FEES,
TYPE BUS. CLASS
FEE
PENALTY
HOME A
$10.00
S 5.00
SMALL B
15.00
7.50
*GENERAL C
50.00
25.00
3. BUSINESS IDENTIFICATION
BUSINESS NAME
NATURE OF BUSINESS BUSINESS PHONE
WASH. STATEJAX NR. EMPLOYEES OR AN. OCCUPANCY
T
'OVER 10 EMPLOYEES, OR EMPL WORK
OVER 120 MAN -MONTHS PER YEAR.
CLASS FEE PAID I PENALT Y PAI�
C
0
TYPE ORGANIZATION
IF BUSINESS IS:
HOTEL/MOTEL
TYPE
L
CAPACITY
NR OF ROOMS/UNITS
C CORPORATION
APT. BLDG.
A
NR OR APTS
D
L LTD. PART
OFFICE BLDG.
0
NR OF OFFICES
E
P PARTNERSHIP
RESTAURANT
R
NR OF SEATS
S
S SOLE OWNER
HOSP./NURS. HOME
H
NR OF BEDS
\-I-
SCHOOL
S
NR OF STUDENTS
4. BUSINESS ADDRESSES
BUSINESS ADDRESS
LICENSE MAILING ADDRESS
5. EMERGENCY NOTIFICATION
NAME AREA TELEPHONE
(2)
OFFICIAL USE ONLY
U.F.L.R. CODE BLDG. PERMIT
C.U. PERMIT —=USE ZONING
L IAL E L
LlCENSE NU,MBELR' ACTI�0 LA NEW BUS
LB RENEWAI.
LC CHANGE
LD DELEIE
CLASSI YE� LIC EFFEC. DATE REASG. LIC. No. I SPLI
RECEIPT NO. DATE PAID
PRINT X
19 F� (2 6 0,9, IN SPEC. BO�
FEE PAID FOR ISSUE 01
C 0 R R E C T E C
LICENSE WITH
'LC' ACTION.
LICENSE APPLICATION AND CHANGES
PLEASE PRINT CLEARLY
............................. ,
SOCIAL SECURITY-7-UTIM-B-DR-1
3. BUSINESS IDENTIFICATION
BUSINESS NAME (FULL)
ke __j . I T;0�1 1:�e wl /,�/xo jo I s I c,
L� —
NATURE OF BUSINESS (DRUG STORE, CPA, ETC) I BUSINESS PHONE___�
e, Irik-111,Nfik I I /I j I
WASH. STATE TAX NR ANTICIPATED TYPE OF CUPANC
G T TION) NR. EMPLOYEES ORGAN. CAPAE'l' Y
-.4 ENTER APPLICABLE TYPES AND CAPACITY
4. BU INE
SI SS
S . DDRESS
L- D G. NUMBER STREFT uj PT. NO
io) eV,4 -2—
T.
BLDG. NUMBER I I STREET J[A�.Nbj
Is P, A �, /),
I(5 �TAJ, / I ZIP CODE
I . I I I I . . I . 1 1112" v, )�-.c
5. EMERGENCY NOTIFICATION (IN EVENT OF FIRE, BURGLARY, ETC.)
LAST NAME; FIRST INITIAL AREA CODE . TELEPHONE
LAST NAME, FIRST INITIAL AREA CODE TELEPHONE
(2) etl , f
7 1 Yi 31[2: �/3 'I
A; -�ITO 16
53 OFFICIAL USE ONLY
APPLICANT'S
SIGNAiL
U.F I.R. J;p�'M- ITS BUS.
CODE
31 v /I c� 0
COND. USE PERMIT
- I I I I ni
LC�ITY CLERK" S
SIGNATURE
Pp OV
APPROVED DISAPPROVED DATE
FORM CC-1 (10/76)' r-� r7T I I F� T, I 7'r") �7 I
BUS. TITLE
'V (-T =QK
BLDG.PERMI CUP.G
_7j7_0,/&�� #wF
ZONING
. P 111,414 -
DATE 6 --.i — 7 c?(
DATE OF BIRTH PLACE OF BIRTH
0. 1 DAY I YEAR �CITY � 7T��
ST
r1l) �T(_ 3j_j
HOME ADDRESS
LICENSE APPLICATION AND CHANGES
PLEASE PRINT CLEARLY
............................. ,
SOCIAL SECURITY-7-UTIM-B-DR-1
3. BUSINESS IDENTIFICATION
BUSINESS NAME (FULL)
ke __j . I T;0�1 1:�e wl /,�/xo jo I s I c,
L� —
NATURE OF BUSINESS (DRUG STORE, CPA, ETC) I BUSINESS PHONE___�
e, Irik-111,Nfik I I /I j I
WASH. STATE TAX NR ANTICIPATED TYPE OF CUPANC
G T TION) NR. EMPLOYEES ORGAN. CAPAE'l' Y
-.4 ENTER APPLICABLE TYPES AND CAPACITY
4. BU INE
SI SS
S . DDRESS
L- D G. NUMBER STREFT uj PT. NO
io) eV,4 -2—
T.
BLDG. NUMBER I I STREET J[A�.Nbj
Is P, A �, /),
I(5 �TAJ, / I ZIP CODE
I . I I I I . . I . 1 1112" v, )�-.c
5. EMERGENCY NOTIFICATION (IN EVENT OF FIRE, BURGLARY, ETC.)
LAST NAME; FIRST INITIAL AREA CODE . TELEPHONE
LAST NAME, FIRST INITIAL AREA CODE TELEPHONE
(2) etl , f
7 1 Yi 31[2: �/3 'I
A; -�ITO 16
53 OFFICIAL USE ONLY
APPLICANT'S
SIGNAiL
U.F I.R. J;p�'M- ITS BUS.
CODE
31 v /I c� 0
COND. USE PERMIT
- I I I I ni
LC�ITY CLERK" S
SIGNATURE
Pp OV
APPROVED DISAPPROVED DATE
FORM CC-1 (10/76)' r-� r7T I I F� T, I 7'r") �7 I
BUS. TITLE
'V (-T =QK
BLDG.PERMI CUP.G
_7j7_0,/&�� #wF
ZONING
. P 111,414 -
DATE 6 --.i — 7 c?(
DATE OF BIRTH PLACE OF BIRTH
0. 1 DAY I YEAR �CITY � 7T��
ST
r1l) �T(_ 3j_j
HOME ADDRESS
SOCIAL SECURITY-7-UTIM-B-DR-1
3. BUSINESS IDENTIFICATION
BUSINESS NAME (FULL)
ke __j . I T;0�1 1:�e wl /,�/xo jo I s I c,
L� —
NATURE OF BUSINESS (DRUG STORE, CPA, ETC) I BUSINESS PHONE___�
e, Irik-111,Nfik I I /I j I
WASH. STATE TAX NR ANTICIPATED TYPE OF CUPANC
G T TION) NR. EMPLOYEES ORGAN. CAPAE'l' Y
-.4 ENTER APPLICABLE TYPES AND CAPACITY
4. BU INE
SI SS
S . DDRESS
L- D G. NUMBER STREFT uj PT. NO
io) eV,4 -2—
T.
BLDG. NUMBER I I STREET J[A�.Nbj
Is P, A �, /),
I(5 �TAJ, / I ZIP CODE
I . I I I I . . I . 1 1112" v, )�-.c
5. EMERGENCY NOTIFICATION (IN EVENT OF FIRE, BURGLARY, ETC.)
LAST NAME; FIRST INITIAL AREA CODE . TELEPHONE
LAST NAME, FIRST INITIAL AREA CODE TELEPHONE
(2) etl , f
7 1 Yi 31[2: �/3 'I
A; -�ITO 16
53 OFFICIAL USE ONLY
APPLICANT'S
SIGNAiL
U.F I.R. J;p�'M- ITS BUS.
CODE
31 v /I c� 0
COND. USE PERMIT
- I I I I ni
LC�ITY CLERK" S
SIGNATURE
Pp OV
APPROVED DISAPPROVED DATE
FORM CC-1 (10/76)' r-� r7T I I F� T, I 7'r") �7 I
BUS. TITLE
'V (-T =QK
BLDG.PERMI CUP.G
_7j7_0,/&�� #wF
ZONING
. P 111,414 -
DATE 6 --.i — 7 c?(
DATE OF BIRTH PLACE OF BIRTH
0. 1 DAY I YEAR �CITY � 7T��
ST
r1l) �T(_ 3j_j
HOME ADDRESS
APPLICANT'S
SIGNAiL
U.F I.R. J;p�'M- ITS BUS.
CODE
31 v /I c� 0
COND. USE PERMIT
- I I I I ni
LC�ITY CLERK" S
SIGNATURE
Pp OV
APPROVED DISAPPROVED DATE
FORM CC-1 (10/76)' r-� r7T I I F� T, I 7'r") �7 I
BUS. TITLE
'V (-T =QK
BLDG.PERMI CUP.G
_7j7_0,/&�� #wF
ZONING
. P 111,414 -
DATE 6 --.i — 7 c?(
DATE OF BIRTH PLACE OF BIRTH
0. 1 DAY I YEAR �CITY � 7T��
ST
r1l) �T(_ 3j_j
HOME ADDRESS
DATE OF BIRTH PLACE OF BIRTH
0. 1 DAY I YEAR �CITY � 7T��
ST
r1l) �T(_ 3j_j
HOME ADDRESS
I-REET FILE
DATE: Z=B-
MEMO TO: Building Division
Community Development Department
FROM:. Engineering Division
Public Works Department
SUBJECT: FINAL INSPECTION
PROJECT:
APPROVED NOT APPROVED
W-W
Engineering Division
BY:
Water Division
BY:
Sewer Division
BY:
STREET
CITY 0 F EUMON09 HARVE HI HARRISON,
MAYOR
CIVIC CENTER EDMONDS, WASHINGTON 98020 - (206) 775-2525
COMMUNITY DEVELOPMENT DEPARTMENT
May 3, 1978
Mr. James Anderson
8808-184th Street S, W.
Edmonds, WA 98020
BUILDING PERMITS #770182 & #770183-
2*0816 & 20822 - 76TH AVENUE WEST
D1978 with the
The above permits expired March-__24
following noted deficiencies:
1) Permits have not been given final approval
by the Community Development Department,
Fire Department, or Public Works;
2) Premises have been occupied without a Certifi-
cate of Occupancy Permit being issued;
3) No Business License has been approved by
this Department;
4) No application has been made for renewal of
Permit.
Unless action is taken, before May 10, 1978, to come into
compliance with the City's Codes, the matter will be re-
ferred to the City Attorney to file charges.,
71j, 4�t_llt L 10,
HARRY M. WHITCUTT
Building Official
RKW/ le
CC: Fire
,-'Public Works
City. Clerk
k
DATE� OAK COMPLETED 'By OREMAN.
LC_6
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(=�$F C, r-:,- U c-. u e_ u
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ElJV IRIONMEN'IT'A"L,ANALYSIS
ME
EXEM T UNDER DISTRICT SEPA
U
PRO EDURES,SECTION
PARA IT E M_
.DATE.C:�) Y _14-1 u
INTERPRETATION A E F E A UP-Tb`:^
BY
0. H, G tOND _K V
D r -T H:
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TYP
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PERMIT
TYPE
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COMPANY
TYPE
FOREIGN CONTmA,C,TS,,
COMPANY
EASEMENT
GRANTOR
DATE GRANTED
EASEMENT
GRANTOtl,--'
[�A-T-r-GRANTED
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A
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DATE AEC.
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PUP* t-A CC:>L�Q AREA
LOCATION-
LI
DATE
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SCALe'l
REVIS,�ON
REASON FOR, WORK
ENGINE rz R
AS B 1111 T
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DRAFTSMAN
U.G., FILE' NOL.
:VT A P',T-,,
APPROVALS
E�VRONMENTAL ANALYSIS
I N I
EXEM UNbER DISTRICT SEPA
R EDURES, SECTION V44,
RA IT
DATE-! Y 1 U
I N T E R P R ETAT 10 N, R E F E
D
O.H. O.G. COND:�,-'4 KV
ADD-lj�>CKT �TL fi
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DATE GRANTED
PERMIT,
TYP
DAJS��,(�A-ZN T E 0
FOREIGN, CONTA�T$-�
C6 M P A N Y
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COMPANY
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GRANTOR
DATE GRANTED
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GRANTO
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WAITI�R-
S R
W.A.R. FORM
DATE AEC.
FUSING COORDINATED
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INVFNTOAY
MAP POSTED
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TRANSF. CARD