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21718 88TH AVE W
V
V
APPLICATION
for
The City of Edmonds SEDE SEWER PERNEIT
OUTSIDE E] INSIDE E] REPAIRS F]
C/
OWNER..................... er.-Y-410A...D.-S ................................
HOUSE No ........... 16... ------- 5.5?: ... ) ---------
... ..... ... ------ ------- ---
BACKFILL WORK ORDER ISSUED ...-
SEWER WORK ORDER ISSUED ..........
Date
CARD No . ......
EASEMENT No - ------
.................... CONTRACTOR .................................................................................................... PERMIT No
STREET
.................... AVENUE LOT No . ...................................................................... BLOCK No . ...............................................
NAMEADD . .....................................................................................................................................................
DEPOSIT, $ .......
Approved:
..................
DATE................................................ By ...........................
0
CITY
PLICA-��Ie"5
CITY of EDMONDS BUJ§ESS LICENSE AP
-6
j DAS. ILICENSE NO.
Civic Center Edmonds, Washington,9
City Clerk Phone 775-2525
TYPE OF BUSINESS ANNUALIFEE AFTER FEB. 15
rm jF!!!-,—p-E-C, �4
SIYVIJI IjIrqjMrWqj IREPWIC.10.1 , (A) HOME OCCUPATION $15.00 $ 22.50
11S,*RUCT IONS: /i 1031 7 -, 7 W 1 7 071 Ej (B) BUSINESSWITH $20.00 $ 30.00
41, itern I ted
S rnUSt be cornpic RECEIPT NO. DATE PAID
A-I TO 3 EMPLOYEES
6r application will not be ac-
71., 01M "9 161 �
PRINT 'X' (c) BUSINESSWITH $22.00 $ 33.00
IN SPEC. BOX 4 TO 9 EMPLOYEES
cepted.
FEE PAID PENALTY PAID
Sicn and retUIn application Z I
'I to
FOR ISSUE OF
CORRECTED (D) BUSINESS WITH 10 $75.00 $112.50
LICENSE WITH OR MORE EMPLOY EES
1��
with fee. Renewals received - 1 101
after February 15 must pay
LC' ACTION.
g, NEWAPPLICATION (LA)
'El
penalty in addition to fee.
RENEWAL (LB)
NEW BUSINESSES AFTER
0 CHANGE (I-C)
JULY 31, 112 FEE. (PLEASE MAKE ANY NECESSARY
CHANGES) 0 DELETE R E- CITY E D
NAME OF FIRM
BUSINESS PHONE
NO. OF EMPLOYEES
413_5
0 MAY 12 1083
MAILING ADDRESS
-6 T
NATURE OF BUSINESS
15bNfQfi D <V A W"11PT.,
-Z,. 1 -7 S
G
BUSINESS ADDRESS
-F
INDIVIDUAL /PARTNERSHIP CORPORATION
--I (P)
(S) (C)
OWNERS NAME
/Z-A
HOME ADDRESS
A
HOMEPHONE
TE OF PIRTH
CE OF BIRTH
SOCIAL SECURITY NUMBER
-7 -7 y — L7� 1�) '9 C>
WERGENCY NOTIFICATION (1) NAME&TELEPHONE J),r: r-2,
-7 -2 0
(PLEASE LIST TWO) (2) NAME & TELEPHONE ),e� t--,VA
5/
WASHINGTON STATE TAX NO. oQ0 ;)(<3APPLICANT'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
&APPROVE 0 DISAPPROVE
LAND USE CODE ZONING CODE
SIGNATURE
CONDITIONAL USE PERMIT
COMMENTS
rTZI KT-::q
UILDING DEPARTMENT DATE '1� - i '- -463
�-XPPROVE 0 DISAPPROVE SIGNATURE ,A
MENTS:
CAPACITY: (NO. UNITS, APTS. OFFICES, SEATS, BEDS, STUDENTS)
Building
0
Hotel/Motel
(L)
Permit
FTI I I I
0
EJ
Apt. Bldg.
Office Bldg.
(A)
(0)
Occupancy
0
Restaurant
(R)
Group
0
Hosp/Nurs Home
(H)
0
School
(S)
jIVE DEPARTMENT DATE U. F. 1. R.
APPROVE 0 DISAPPROVE SIGNATURE 61 ( I I
DMMENTS:
DEPARTMENT
r-APPROVE 0 DISAPPROVE DATE SIGNATURE
I OMMENTS:
KIC WORKS DEPARTMENT
APPROVE 0 DISAPPROVE DATE SIGNATURE A5f
PLEASE RETURN TO CITY Cl--FRK
PUBLICUORKS DEPARIT Fj u UIVE
BUILDING PER�!IT
LC (addressT (date)
Fl"4� 's- A 1r2j9 "
Street Right -of -Way Existing
REQD N
Z
Access Easements Existing_
o to NA
H
p4
Utility Easement Existing___DD_�j
--Y�EQD
EE REQOL
Lot Per Subdivision
Plat Assessor
Site Plan Checked for Accuracy
Z
Underground Wiring Reqd.
H
C
Check Accuracy of Legal Description
.Z
Review by.
Date
Existing Water Main Size'
Wa Main Required
a Main Required
Service quired
z
t D s t
rHydrant Size Exist
P�
Hydrant Reqd Per Fire Code
Size
Detector Check Meter Reqd.
Me
Cross Connection Inspec
Fire Department ts
t ts_
Wat LnIte- Charge Reqd.
�e
v
ew by.
Date
T De
tic -Tank Design Approved
t n A pp r
Date
T P
S ar" e rnm
t si! R
Sept Tank Permit Reqd.
ep t eq d Ov
Permit No.
t No.
an1tc
S a 7we
ry wer Availabjlity—
Sanit r Availability
Z70i
Proj-
Drawimng No.
File No.
j
-Side Sewer Availa *11ty _
Sanitary Sewer Connect, Fee
S C
Reqd.,
�3:.
Review by
Op en Ditch Existing _
qd.
--Size
Culvert Reqd.
c4
Catch Basin Reqd.
dicate on Site Plan
dicate o
Shoulder draina � tain collection on swalFe open off
Op 0
Manhole re
'Indicate on S
Soil tions and Ground Water Field Checked
Re by
Date
RevisKd: lV10-1977
Page 2
Revised: lv 10-1977