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BUSINIt LICENSE APPLICATION
-EDMONDS
sum VE
T NUE NORTH
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fijkWASH. 98020
TELEPHONE (206) 775-2525
INSTRUCTIONS
I . 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.
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 I
TYPE BUS. CLASS FEE PENALTY
tiOME A___$IQ.PO $ 5.00
G_MALL_ B 15.0-U—
_.-j 7.50
*.GENER'A1_--C____'50:bO 25.00
2. APPLICANT
NAME SOCIAL SECURITY NO.
DATE OF BIRTH PLACE OF BIRTH
HOME ADDRESS
3. BUSINESS IDENTIFICATION
BUSINESS NAME
NATURE OF BUSINESS BUSINESS -PHONE
WASH. STATE TAX NR. EMPLOYEES. I ORGAN. �OCCUPANCY
*OVER 10 EMPLOYEES, OR EMPL WORK
OVER 120 MAN -MONTHS PER YEAR.
CLASS I FEE PAID I PENALTY
TYPE ORGANIZATION
IF BUSINESS IS:
HOTEL/MOTEL
TYPE
L
CAPACITY
NR OF ROOMS/UNITS
0 C CORPORATION
APT.BLDG.
A
NR OR APTS
L LTD. PART
OFFICE BLDG.
0
NR OF OFFICES
E P PARTNERSHIP
RESTAURANT
R
NR OF SEATS
S SOLE OWNER
HOSP./NURS. HOME
H
NR OF BEDS
SCHOOL
S
NR OF STUDENTS
4. BUSINESS ADDRESSES
BUSINESS ADDRESS
LICENSE MAILING ADDRESS
5. EMERGENCY NOTIFICATION
NAME AREA TELEPH NE
(2)
OFFICIAL USE ONLY
U.P.I.R. CODE BLDG. PERMIT
OCCUP
._T
C.U. PERMIT I LAND USE I ZONING
Clly CLERK'S
I
54NAIURE
APP OISAPPROVFD DATF
STAFF ACTIO
REVERSE APPL. NO.� lya7 g :1
SIDE DATE:,/e-' 11'7 / 1,01'
APPLICATION FOR:
NEW LIC. LICENSE
BUS. 1:1 RENEW YEAR_:j
9FFICIAL �E O�L
_E ' A':
B 7L CFO LA NEW BUS.
LICENSE NU? R N
LB RENEWAL'
LC.. CHANGE
LD - DELETE
CLASSI YEAR DATE I REASG. LIC. NO. I SPEC
'41 C. EFFEC.
RECEIPT NO. DATE PAID A.
PRINT X'
16/. IV] I) L7 IAV IN SP'EC. BOX
F R ISSUE OF
FEE.PA I ID PENALTY,PAID CORRECTED
LICENSE WITH
'LC' ACTION.
LICENSE APPLICATION AND CHANGES_
PLEASE PRINT CLEARLY
DATE OF BIRTH
MO. I DAY I YEAR
I I b Z-11 15 C)
HOME ADDRESS
TIAL SOCIAL.SECURITY NU
MIER
PLACE OF BIRTH
K-1 T Y F�TA7TE
P,F_f4,,T,T, L, INA I
3. BUSINESS IDENTIFICATION
USINESS NAME (FULL)
I&
NATURE OF BUSINESS (DRUG STORE, CPA, ETC) BUSINESS PHONE
WASH. STATE TAX NR.
ANTICIPATED
TYPE OF
OCCUPANCY
(REGISTRATION)
NR. EMPLOYEES
ORGAN.
TYPE CAPACI
,P�d
IN] 114
tfDl
-A]
*-=.ENTER APPLICABLE TYPES AND CAPACITY
----
1-
4. BUSINESS ADDRESS
rlBI_DG. NUMBER I I STREET-- APT Nn
EILDG. NUMBER H STREET APT. NO.
I , / A— -1 1 1 1 1 . . k i r- 11
CITY STATE ZIP
LT_ -F_
�,EA . i-, I
'5. EMERGENCY NOTIFICATION (IN EVENT OF FIRE, BURGLARY, ETC.)
LAST NAME, FIRST INITIAL.- AREA CODE TELEPHONE
/ - <
A, (�UI'Dpl I St I' I I I 1 2106
LAST NAME, FIRST INITIAL AREA CODE TELEPHONE
(2) !��AAU_ r__1 --%q I
SQ
5S OFFICIAL USE ONLY
U.F.I.R PRIM. UNITS BUS. BLDG. PERMIT OCCU P -
D E -9
z I bl� 10,2 P
;�/� J;? 101-viij 1 1
COND. USE PERMIT LAND USE ZONING
V"I
L,ICANT'S
,NATURE
110SI. TITLE DATF- IORB/7?)
APPLICATION
The City of Scimond for
SME Simim PMMT
SSOTREET NEW CONSTRUCTION 2— REPAIRS 0
OWNER...... . . ........ lv�� , " --111111 ------- I ... --------
4 a zb
ADDRESS ..... ...... ............. ... ... ....... ..........
llb-
I
EASEMENT No.
CONTRACTOR ......... ;
------- �V# �-- ..... ................................... PERMIT No- Q-3--
LEGAL DESCRIPTION: LOT No. ..3
........................................... BLOCK No . ............................................
, 0 , t
NAME: OF ADDITION ----- . . ..... . . .... -----------------------------------------------------------
Approved:
VED
K-E
DATE ----- By ....
j
NOTICE:
No warranty of accuracy.
The -information'shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of �Edm.qncls does not warrant the
accuracy of anything set for.th on these
map(�-). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
tf�e -map(s), including, but not limited to,
th e location of any sewer stub shown. Such
sewer stubs may or may* not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
.b-1--e for the
emp]-o-yee-s o-r officers sh-al-I be 1--ia ,
information given on this map(s), nor for
any one representation provided based
upon said map(s).
4zd' , ko'
— - - - ------------ -------- -W-1117-1-1 - - XUV' 0,
-4
CITY OF EDMONDS Call PROSPect 6-1107 when - work
CIVIC CENTER — WATER -SEWER DEPARTMENT Is ready for inspection. (No inspec-
tions Saturday, Sunday or holidays.) N2 3104
SIDE SEWER PERMIT
338 - 20th Place South ------------------------------------------------------------------
ADDRESS........................ ................................................................................................ . ..........
OWNER� ------------- Roger --- Kleven ------------------------------------------------ coNTRAcToR-Northwest.-Sew-er ... Cons.t....-C-orp ......
Permission is grntd..AuguAj�_.�� -------------------- 19.6 8, for ........................ days to REPAIR or CONNECT a side sewer
with City Sewers in accordance with application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. i—The owners of the property may obtuJn 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.
NOTE No. 2—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 3—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. to original condition. Contractors shall be responsible for
NOTE No. 4—Trenches in street must be water settled and surface of street restored
failure due to improper work which may develop within one year of completion. main sewer or its appur-
OTE No. 5--It is unlawful to alter or do any other work than Is provided for in the permit, or to do any work on the
tenances except to Insert the pipe into the wye.