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20908 WOODLAKE
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APPLICATION
for
The City of Edmonds SME SEWER PERMT EASEMENT No . ..........................................
NEW CONSTRUCTION n REPAIRS 0
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OWNER -------------------------------------------------------------------------------------------------------------- CONTRACTOR M F—)k(:A"-*4NT .............. PERMIT No. '454 P
IsADDRESS LEGAL DESCRIPTION: LOT No . ............. ..............................
.......................................................................................................... BLOCK No . ............................................
NAMEOF ADDITION . ....... t . .....................................................................
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Approved:
DATE t>�-..
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APPLICATION
for
The City of Edmonds SEDE SEWER PERNaT EASEMENT No . ..........................................
NEW CONSTRUCTION 0 REPAIRS 0
OWNER . ..... ..... ................. CONTRACTOR ....... PERMIT No.
...............
ADDRESS ... ...... LEGAL DESCRIPTION: LOT No . .......... .......................... BIA)CK No . ............................................
NAME OF ADDITION ....... iK 0 . ....... .............................
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STAFF ACTIO
BUSINESS LICENSE APPLICATION42/-06'( !REERSE APPL. NO.:
E
CITY OF EDMONDS SIDE DATE:
250 5TH AVENUE NORTH
,"tEDMONDS, WASH. 98020 CAPPLICATION FOR:
ELEPHONE (206) 775-2525
NEW [:] lIC LICENSE
BUS RENEW YEAR
INSTRUCTIONS
1. PRINT APPLICABLE LICENSE CLASS. FEE AND PENALTY PAID
IN ANNUAL FEE BOX AT RIGHT. PENALTY DUE ON RENEWALS
RECEIVED BY CITY CLERK AFTER FEBRUARY 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.
r ANNUAL FEES
TYPE BUS- CLASS FEE PENALTY
HOME A $10.00 S 5.00
SMALL B 15.00 7.5.0
*GENERAL C 50.00 25.00
'OVER 10 EMPLOYEES. OR EMPL WORK
OVER 120 MAN MONTHS PER YEAR.
AID
2. APPLICANT
NAME SOCIAL SECURITY NO.
DATE OF BIRTH BIRTH
HOME ADDRESS
3. BUSINESS IDENTIFICATION
BUSINESS NAME
NATURE OF BUSINESS BUSINESS PHONE
WASH. STATE TAX NR. EMPLOYEES I ORGAN. JOCCUPANCY
TYPE ORGANIZATION
IF BUSINESS IS-
TYPE
CAPACITY
HOTEL/MOTEL
L
NR OF ROOMS/UNITS
C CORPORATION
APT. BLDG
A
NR OR APTS
L LTD. PART
OFFICE BLDG.
0
NR OF OFFICES
P PARTNERSHIP
RESTAURANT
R
NR OF SEATS
S SOLE OWNER
HOSPJNURS. HOME
H
NR OF BEDS
SCHOOL
S
NR OF STUDENTS
4. BUSINESS ADDRESSES
BUSINESS ADDRESS
LICENSE MAILING ADDRESS
5. EMERGENCY NOTIFICATION
NAME AREA TELEPHONE
(1)
(2)
OFFICIAL USE ONLY
U.F.I.R. CODE PERMIT 0
C.U. PERMIT LAND US17G
111AL OE 0 Ly
LICENSE NUM El ACTION LA NEW BUS
LB RENEWAL
LC CHANGE
LD DELETE
JCL�Sj YEAR I LIC. EFFEC. DATE [REASG. LIC. NO I SPE
:CEIPT NO. DATE PAID Ak
PRINT ' X'
IN SPEC BOX
FOR ISSUE OF
FEE PAID PENALTY PAID C 0 R R E C T E D
I LICENSE WITH
0 i d I I - : I *LC' ACTION.
LICENSE APPLICATION AND CHANGES
PLEASE PRINT CLEARLY
2. APPLICANT
so IAL SECURITY NUMB
AST NAME, FIRST INITIAL
�p 101 C-1
DATE OF BIRTH PLACE OF BIRTH
V 0. 1 DAY I YEAR CITY
4- -Z I 111N,(�j 1<1 ("I KI Irililill ILI�j
m, I] En
HOME ADDRESS
BLDG. NUMBER I rSTREET APT. NO.
QI0I?IcI?%ll 11 -L I
CITY STATE �ZIP DE -
v A c-
I I I I I I I I t I I I I I I I 1 -1
/5. EMERGENCY NOTIFICATION (IN EVENT OF FIRE, BURGLARY, ETC.)
LAST NAME, FIRST INITIAL AREA CODE TELEPHONE
(1) -
CA n 2i 5�nl �Inrlll
LAST NAME, FIRST INITIAL AREA CODE TELEPHONE
(2)
1 1 1 1 1 1 1 1 11 1 1 1 1 1 1 1
5S OFFICIAL USE ONLY
U.F , I.R. NITS BUS. BLDG.PER
CODE j I/j jj,,/�,t A 5-J, .1316#OND. USIf PERMIT ZO
P I I I I M lq�
MIT Occu�fp.
CITY CLERK'S APPLICANT'S
SIGNATURE TU
LSIGNATURE
APPROVED [:] DISAPPROVED DATE BUS. TITLE
FORM CC-1 (10/76) F'lF-TJ 1PI'J To r.TTY (-,I,.FPI<
DATE
111AL OE 0 Ly
LICENSE NUM El ACTION LA NEW BUS
LB RENEWAL
LC CHANGE
LD DELETE
JCL�Sj YEAR I LIC. EFFEC. DATE [REASG. LIC. NO I SPE
:CEIPT NO. DATE PAID Ak
PRINT ' X'
IN SPEC BOX
FOR ISSUE OF
FEE PAID PENALTY PAID C 0 R R E C T E D
I LICENSE WITH
0 i d I I - : I *LC' ACTION.
LICENSE APPLICATION AND CHANGES
PLEASE PRINT CLEARLY
2. APPLICANT
so IAL SECURITY NUMB
AST NAME, FIRST INITIAL
�p 101 C-1
DATE OF BIRTH PLACE OF BIRTH
V 0. 1 DAY I YEAR CITY
4- -Z I 111N,(�j 1<1 ("I KI Irililill ILI�j
m, I] En
HOME ADDRESS
BLDG. NUMBER I rSTREET APT. NO.
QI0I?IcI?%ll 11 -L I
CITY STATE �ZIP DE -
v A c-
I I I I I I I I t I I I I I I I 1 -1
/5. EMERGENCY NOTIFICATION (IN EVENT OF FIRE, BURGLARY, ETC.)
LAST NAME, FIRST INITIAL AREA CODE TELEPHONE
(1) -
CA n 2i 5�nl �Inrlll
LAST NAME, FIRST INITIAL AREA CODE TELEPHONE
(2)
1 1 1 1 1 1 1 1 11 1 1 1 1 1 1 1
5S OFFICIAL USE ONLY
U.F , I.R. NITS BUS. BLDG.PER
CODE j I/j jj,,/�,t A 5-J, .1316#OND. USIf PERMIT ZO
P I I I I M lq�
MIT Occu�fp.
CITY CLERK'S APPLICANT'S
SIGNATURE TU
LSIGNATURE
APPROVED [:] DISAPPROVED DATE BUS. TITLE
FORM CC-1 (10/76) F'lF-TJ 1PI'J To r.TTY (-,I,.FPI<
DATE
:CEIPT NO. DATE PAID Ak
PRINT ' X'
IN SPEC BOX
FOR ISSUE OF
FEE PAID PENALTY PAID C 0 R R E C T E D
I LICENSE WITH
0 i d I I - : I *LC' ACTION.
LICENSE APPLICATION AND CHANGES
PLEASE PRINT CLEARLY
2. APPLICANT
so IAL SECURITY NUMB
AST NAME, FIRST INITIAL
�p 101 C-1
DATE OF BIRTH PLACE OF BIRTH
V 0. 1 DAY I YEAR CITY
4- -Z I 111N,(�j 1<1 ("I KI Irililill ILI�j
m, I] En
HOME ADDRESS
BLDG. NUMBER I rSTREET APT. NO.
QI0I?IcI?%ll 11 -L I
CITY STATE �ZIP DE -
v A c-
I I I I I I I I t I I I I I I I 1 -1
/5. EMERGENCY NOTIFICATION (IN EVENT OF FIRE, BURGLARY, ETC.)
LAST NAME, FIRST INITIAL AREA CODE TELEPHONE
(1) -
CA n 2i 5�nl �Inrlll
LAST NAME, FIRST INITIAL AREA CODE TELEPHONE
(2)
1 1 1 1 1 1 1 1 11 1 1 1 1 1 1 1
5S OFFICIAL USE ONLY
U.F , I.R. NITS BUS. BLDG.PER
CODE j I/j jj,,/�,t A 5-J, .1316#OND. USIf PERMIT ZO
P I I I I M lq�
MIT Occu�fp.
CITY CLERK'S APPLICANT'S
SIGNATURE TU
LSIGNATURE
APPROVED [:] DISAPPROVED DATE BUS. TITLE
FORM CC-1 (10/76) F'lF-TJ 1PI'J To r.TTY (-,I,.FPI<
DATE
2. APPLICANT
so IAL SECURITY NUMB
AST NAME, FIRST INITIAL
�p 101 C-1
DATE OF BIRTH PLACE OF BIRTH
V 0. 1 DAY I YEAR CITY
4- -Z I 111N,(�j 1<1 ("I KI Irililill ILI�j
m, I] En
HOME ADDRESS
BLDG. NUMBER I rSTREET APT. NO.
QI0I?IcI?%ll 11 -L I
CITY STATE �ZIP DE -
v A c-
I I I I I I I I t I I I I I I I 1 -1
/5. EMERGENCY NOTIFICATION (IN EVENT OF FIRE, BURGLARY, ETC.)
LAST NAME, FIRST INITIAL AREA CODE TELEPHONE
(1) -
CA n 2i 5�nl �Inrlll
LAST NAME, FIRST INITIAL AREA CODE TELEPHONE
(2)
1 1 1 1 1 1 1 1 11 1 1 1 1 1 1 1
5S OFFICIAL USE ONLY
U.F , I.R. NITS BUS. BLDG.PER
CODE j I/j jj,,/�,t A 5-J, .1316#OND. USIf PERMIT ZO
P I I I I M lq�
MIT Occu�fp.
CITY CLERK'S APPLICANT'S
SIGNATURE TU
LSIGNATURE
APPROVED [:] DISAPPROVED DATE BUS. TITLE
FORM CC-1 (10/76) F'lF-TJ 1PI'J To r.TTY (-,I,.FPI<
DATE
CITY CLERK'S APPLICANT'S
SIGNATURE TU
LSIGNATURE
APPROVED [:] DISAPPROVED DATE BUS. TITLE
FORM CC-1 (10/76) F'lF-TJ 1PI'J To r.TTY (-,I,.FPI<
DATE
DATE
CITY of EDMONDS --- PUBLIC WORKS DEPARTMENT
Routing of Buildi�g Permit Applications
Proposed Property Address of Application: .20908 - WooDlake Drive (Walcker)
DEPARTMENT
COMMENTS
DATE
V A T E R
C*�'/ '7-
S T R E E T
S E W E R
N 0 T E S
BUILDING
DEPARTMENT COMMENTS
r,
BUILDING DEPARTMENT
PERMIT APPU,CATION
AppHeant FBI
Inside Heavy Lines
UUN PERMIT
ZONE NUMBER
JOB
ADDRESS
z
NAMZ (0 VAJLE OF BUZESS)
PERMISSIBLE % ACTUAL %
LOT COVERAGE LOT COVERAGE
MAJIUM ADDRESS
PERMISSIBLE HEIGHT PROPOSED HEIGHT
TELEPHONE NUMBLIr—
ACTUAL LOT AREA TOTAL BLDG. ARJU
REQUIRE YARDS P R-0—P-0-8 BE 15—Y—A-10 S
'D
FRONf_ SI�_E REAR FRONf' SIDE REAR
NAME
A, DTR E 0-8
LEGAL LOT VARIANCE OR CONDITIONAL USE
[] YES NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
CITY
TELEPHONE 14UMBER
1_12
STILEE—Tr/W
EXISTING STREET R/W..... FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT 11T.
NAMZ
REMARKS
ADDRESS
CHECKED BY
CITY
TELEPHONE NUMBER
METER 81ZF,
SERVICE SIZE
CLEARANCE
CHECKED BY
STATE LICENE19 NUMBER
CITY LICENSE NUMBER
REMARKS
Legal Description of Property (Show Below or Attach Four Copies)
TYPE CONNECTION
VERIFIED BY
je--
PERC. TEST
PERMIT NUMBER
REMARKS
FIRE ZONE
I TYPE OF CONSTRUCTION
STREET IMPROVED
0 YES El NO
_9PECIAL INSPECTOR REQUIRED
[]YES 0 NO
OCCUPANCY GROUP
GAS
MNEW RrRESIDENTIAL LINE
NON-RESIDENTIAL
ADD ffo -_ ----I RETAINING
nDEMOLISH EJ WALL
ALTER EXCAVATE PENCE
n OR FILL ( A .......... Ft.)
REPAIR' PRE -MOVE swim
INSP. POOL
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31,04,
REMARKS
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WUR—WTOTNE DONE
Plan Chock No .....................
Valustlon
Fos
asolpt No.
21,ze , A0 -1
BUILDING
WOW51ED USjIV
PLUMBING
HEAT & GAS LINE
PLOT PLAN (Indicate Building setbacks, abutting streets)
tRETAINING
IN
PENCE
SIGN
WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
0
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00)
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