21034 74TH AVE W.PDF111111111111
5879
21034 74TH AVE W
I
ZN
Q-X
City of Edmonds City of Edmonds
121 5th Ave N City of Lynnwood N
City of Mountlake Terrace
Edmonds, WA City of Woodway
98020
This JOCUMent is foi genera� infom-,at;oo p,-iipose� oniy and is provided on an as is'
and F1 b Ti I VaIjC"(V' Of PLINiC sources and no
a
Wal r in, I e I this docurnent agree
o%
to;n (ZT kgf TItE
i officiats, officers, 0� A
0 1 �rj V claim. (Icniand or action, aris-Ina, R
InpZx
out of any use 0
City of Edmonds
121 5th Ave N
Edmonds, WA
City of Edmonds
City of Lynnwood
City of Mountlake Terrace
City of Woodway
Thi�., Joc-untent is fot ,,eneral intumnaG�n p�J;pcses '-)nly and IS pt-Ovided on an 'as is
and 'as availlable' basis. The date. t!scd ccino� hom a vanetvuf pubtic soutces and no
k d t�',I'V -'n"a ' 11 IL , 4� C6616ii Li 10 1., a I t I
�%;�I Y 0 a r, 11) 15, E h CIOCUment autee
a
sjv(-1 �J;#Citj dT-Wrl%&Las� its officials, off I c ers.
Ir S , _ . .
Ist Wy cTT�-T), demand or action. ansina,
PISSI t ment .
Oy
s S t S
Z-1", ion ol d ",I
12/10/2013
- rf-, 3 F
S ti, � JLE
'TREr
94
City of Edmonds City of Edmonds
121 5th Ave N City of Lynnwood N
City of Mountlake Terrace
Edmonds, WA City of Woodway
98020
T m 11: 1, fLI )n pu!pc,es on�y
i -n ra' nlat� and is provided on an 'as is'
-1 Val iPt
cc'' —1241
a 1, (1 --A-�)e� [10M -)T pubtic somces and no
a
r
f
q ny ki a U-Uracy. User,., ot this document aoree
f
irl.de inify and v S. ItN/ 0 Edmonds, i,s officiats, officers, 7L
STRtbt3T
-1 e. rorl and zl-�
ernp�oy,es and/o g of J"s ainst any clairn, demand or a,!,:on, arising
ocunient
out of any use or pos4sess n of this a,
BUSINESS LICENSE APW#WW6 DATE LICENSE NO.
CITY of EDMONDS
Edmonds, Washington 980�
.1�'— Civic Center
A A
City Clerk Phone'775-2525 PENALTY AFTER FEB. 15
81 b -U FLE-dt 24 19a] 1-101�4E OCCUPATION
CLAS� YEAR LIC. EFFE1, DATE JREASG. UE—N-0—[S`PEC] $11),Qo (A) ADDITIONAL-$5Z-O 0
INSTRUCTION�:
Offi)blic jvjf,� SMALL BOSIN,'ESS
All items must be completed
RECEIPT NO. DATE PAID
or application will not be ac- PRINT-X- $15.00 ADDITIONAL $7.50 0
IN SPEC. BOX El Busines .-wI-61`0 or
cepted.' LR- s
LIV //
CR � �11 FOR ISSUE OF
Sign and return application FEE PAID PENAI PAII5 CORRECTED mo.re--4�nployees Abttg��25.00 0
I LICENSE WITH
with fee. Renewals received It IL —Al I I I I 'LC'ACTION. $50.00 (C)
after February 15 must pay (;XNEW APPLICATION (LA)
penalty in addition to fee. 11 RENEWAL (LB)
NEW BUSINESSES AFTER D CHANGE (LC)
JULY 31, 1/2 FEE. (PLEASE MAKE ANY NECESSARY CHANGES) 0 DELETE (LD)
NAME OF FIRM BUSINESS PHONE NO. OF EMPLOYEES
S, c-'affle Pe (�A-rs 12'N �- 2 — —0
MAILING ADDRESS j I NATURE OF BUSINESS
0 S C, x o C,
0
BUSINESS ADDRESS INDIVIDUAL PARTNERSHIP CORPORATION
2103�1 05 go C) (S) (P) (C)
OWNERS NAMI� HOME ADDRESS
[') r ok d C�
HOME PH [DATE OFJBIRT PL�CE OF PIRTH SOCIAL SECURITY NUMBER
Z7" (� — — --
�N I / -2-,� <� -7 1 . 1;4 K, -.�
EMERGENCY NOTIFICATIOW (1) NAME & TELEPHONE 'y e�- 0 6;
(PLEASE LIST TWO). (2) NAME & TELEPHONE U1(*id.,,, OL-- 1'7)1
WASHINGTON STATE TAX NO.- A/1 ly �PPLICANT'S SIGNATURE
V.,
DO NOT WRITE BELOW THIS LINE
STAFF REVIEW: FILL IN LAND USE CODE, LIFIR NUMBERS, ZONING, ETC. CHECK APPROVAL OR
DISAPPROVAL, DATE, AND SIGN. IF DISAPPROVAL, PLEASE COMPLETE "COMMENT"
1#11 SECTIONj#ROUTE TO NEXT DEPARTMENT ON LIST.
PLANNING DEPARTMENT DATE LAND USE CODE ZONING CODE
9 APPROVE 0 DISAPPROVE
SIGNATURE. 14- im 2� I
CONDITIONAL USE PERMIT
COMMENTS E=
I BUII MING DEPARTMENT 5
DATE Q.
�AP
Building
El
ROVE 0 DISAPPROVE
SIGNATURE
Permit
Hotel/Motel
C2�Apt. Bldg.
(L)
(A)
EEI I I 1 0 Office Bldg.
(0)
COMMENTS:
Occupancy
Group
0 Restaurant
El Hosp/Nurs Home,
(R)
(H)
CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS)
El School
(S)
FIR E DEPARTMECTL I V CD DATE 7-1.-)--
U. F. 1. R.
XPPROVE 0 DISAPPROVE /�
SIGNATURE A/
COMMENTS:
PO�L�E DILIPAWYNtir-mirm �Ur-r,b* DATE-2- 2-1 --kl SIGNATURE '1�-4
C?�APPROVE 0 DISAPPROVE'
COMMENTS:
PUBLIC WORKS DEPARTMENT
0. APPROVE 0 DISAPPROVE DATE .212Y SIGNATURE
COMMENTS:
I PLEASE RETURN TO CITY CLERK
APPLICATION
The City of Edmonds for,
EASEMENT NO. _ -----------------------------------------
SIDE SEWER PERMIT -
NEW CONSTRUCTION F� REPAIRS M LID NO . .................. ASMT. NO. ...............
OWNER------------------------------------------------------------------------- - --------------------- CONTRACTOR ............................................................... .................... PERMIT NO - --------------------
JOB ADDRESS 21034 ---- -- 74th-Avenue --- W-e-alt ---------------------------- LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------
................................. ------------------ ------------------------------------------------------------------------------------------------------
NAMEOF ADDITION .......................................................................................................................
rk�l
fc��-' of:
Sir- ". .1 ,
but noi
shc'.7n'-suc') sav;w awm MIV
rjr r
1h
NO* E&Md.� nc . )i its
Y nip map nor for u, r -
6ye Testid, Not on Sewer 9/5/74
Approved:
DATE............................................ By .............................................. -------------