21617 80TH AVE W.PDF111111111111
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21617 80TH AVE W
CITY 0
-of EDMONDS B, ESS MRA,-,Q I f%-A LICENSE NO.
CITY [L(t D
0
0
Civic Center Edmonds, Washington ttpf
City Clerk Phone 775-2525 ANNUAL FEES PENALTY AFTER FEB. 15
LYJ HOME OCCUPATION
4STRUCTIONS:
All items must be completed
or application will not be ac-
cepted.
Sign and return application
with fee. Renewals received
$10.00 (A) ADDITIONAL $5.00 0
0 SMALL BUSINESS
$15.00 (B) ADDITIONAL $7.50 0
0 Business with 10 or
more employees ADDITIONAL $25.00 0
$50.00 (C)
atter r-ebruary lb must pay EX NEW APPLICATION (LA)
penalty in addition to fee. El RENEWAL (LB)
NEW BUSINESSES AFTER 0 CHANGE (LC)
JULY 31, 112 FEE. (PLEASE MAKE ANY NECESSARY CHANGES) 0 DELETE (LD)
NAME OF FIRM BUSINESS PHONE NO. OF EMPLOYEES
B & C Maintenance and —Supply (2o6) 776-326o lione
MAII�ING AIDDRESS NATURE OF BUSINESS
21617 80th Ave. liest Building and. ground-, maintenance service-
jy 208 Business address for office purposes only
Edmonds, Wn. 98020
eqipment stored elsewhere. OR Li -e-
BUSINESS ADDRESS INDIVIDUAL PARTNERSHIP CORPORATION
Same as above = (S) (P) (C)
OWNERS NAME HOME ADDRESS
R.tan L. Siegmeth Same as above
H�I�g PHO DATE (y f RTq PLACE OF BIRTH SOCIAL SEffITY NUMBER
779-'326o Mar 980 Yakima, Wn. 537-5 -1141
EMERGENCY NOTIFICATION: (1) NAME &TELEPHONE -Rick Slegine'th - "I
(PLEASE LIST TWO) (2) NAME & TELEPHONE Paul McMullin J20 771-4103
A
WASHINGTON STATE TAX NO.-c600 353 839 APPLICANT'S SIGNATURE
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,'
SECTION. ROUTE TO NEXT DEPARTMENT ON LIST.
PLANNING DEPARTMENT DATE LAND USE CODE ZONING CODE
M APPROVE El DISAPPROVE SIGNATURE
V I i- I � L I I I
CONDITIONAL USE PERMIT
COMMENTS
BUILDING DEPARTMENT
Us,-�PPROVE 0 DISAPPROVE DATE 3.. _,90. Building 0 Hotel/Motel
SIGNATURE Permit 0 Apt. Bldg. (A)
F11 I I 1 0 Office Bldg. (0)
COMMENTS: Occupancy 0 Restaurant (R)
Group 0 Hosp/Nurs Home (H)
CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS) E-1 0 School (S)
FIRE DEPARTMENT DATE -q-1-po U. F. 1. R.
1��APPROVE El DISAPPROVE SIGNATURE
COMMENTS:
PO DEPARTMENT
ROVE 0 DISAPPROVE
DATE' SIGNATURE
�j APP
COMMENTS:
PUBLIC WORKS DEPARTMENT
0 APPROVE 0 DISAPPROVE DATE SIGNATURE
COMMENTS:
PLEASE RETURN TO CITY CLERK
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 Edmonds 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
..-----fh-e -map(s), including, but not limited to,
the 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
emp-l-o-yee-s o-r offiCer-s) Sh-alil be I.iab-.Ile for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
APPLICATION
for
The City of Edmon' FILE SME SEWER PERMIT EASEMENT No . ..........................................
AEL I NEW CONSTRUCTION REPAIRS
'2
OWNER....... ........................................................... CONTRACTOR .......... . ...................................................................... PERMIT Nlo,�
z LEGAL DESCRIPTION: LOT No.
ADDRESS BLOCK No..... ... ............... ....................
I ...... /,? .. ........................... ................. ........ ...........
& 0'0 7W A11C, NAME OF ADDITION .......................... W-4..P.A, ,
......... kz..e.9
C/ -Q�
0-
A
,.Co
A-PpRo:,V,
APk I is
7. 67.
el
Approved:
-�� 7..
DATE...... .. ��* .... ** ....... * . ....... By ....... .............
11
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TF� 3F
.,V OF11)MONDS
CITY
call' JF;Roip6ct.', 64107 wbew
T
DEPARTMEN (No. 2036
ea, di
ti6ns Satuiday, Sunday Or fi�lidsyi
ERMIT
SIDE SEWER P
1021 21st Avenue South
----------------
ADDRESS_ ........................................................ .........
owner
William D. Barr OR ........... ... * ....................................
6WNkA.................................................................................. ........... CONTRACT .............................
Pril 17 6? ......... 7 ...... days to REPAIR'or CONNECT- a side sewer
i is. granted .... ............. 19 ........ I for ........
_p,�_.Vernj�§s on. ..........................
- :'j%' ti-i-q1ty S�Wer.s. in, ce.rd.nce with aPillication on ffle and governing ordinances.
NT . ION IS CALLED TO THE FOLLOWING:
ij�__ATTE property line. A licensed Side 'Sewer Contractor must
h of the property may obtain a permit to construct sewer inside of sewer before it has been Inspected.
.�NQTE-No.--L—T e owners area. Do not cover any portion
be employed to construct side sewer in street side sewers when you get permit.
9L T6_ E. 'No. 2�Obtaln" full information regarding Ordinance ll,.16.030 and Regulations governing nj
NOTE N6. 3—Top of s . Ide sewer must have at least 30 Inches coverage at property line and 12 Inches inside property line; mi mum grade of 2
in grade sharper than % will be'permitted.
No -bends Contractors shall be responsible for
No. 4—TrenChes in street must be water settled and surface of street restored to original condition.
failure due to improper work which may develop within one year of completion. or its appur-
.%��NOTE 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 main sewer
tenances except to Insert the pipe into the wye.