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21822 76TH AVE W.PDF1111111 1 1111111 21822 76TH AVE W Water tervice Drawing The City of Edmonds EASEMENTNO . ............................................ NEW CONsTRUCTION 59 REPAIRS Cl LID NO . .................. . ASMT. NO . .................. .......................... PERMIT NO . .................... CONTRACTOR ................................ ............................. OWNER ...... ... BLOCK NO . ................................... `2 -1-1 -7 LEGAL DESCRIPTION: LOT., NO . ...................................... JOBADDRESS ............ ................................ ..................... ....... �DSZZ NAMEOF ADDITION ..: ..................................................................................................................... I Wolrt-% 1 1% cofper 1" Re. W/"W-9x Approved: DATE ............ B, PwW-000i-ill75 (REV.11178) 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 forth on these map(s). Any person or entity requesting a copy should conduct an independent inquiry regarding the information shown on the 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 employees or officers shall be liable for the information given on this map(s), nor for any one representation provided based upon said map(s). L11-19ff Xr Pre -application meetin February 12, 1999 — 9:00 a.m. Applicant: Carletti Architects Site Address: ' 21822 and 21830-76h Avenue Wesf Medical Building Attending: Representing Ci1y Staff Gordy Hyde, Rob Chave, John Westfall, Conni Curtis. Representing Applican : Peter Carletti, Carletti Architects; Kathryn Emory, TCI Engineers Rob asked Applicant to explain his project. Applican : There are two existing residences on the site (21822 and 21830-76t" Avenue West). What we're proposing to do is remove the two residences and construct a new medical clinic (approximately 4,683 ST) for a group of urologists. Currently the property is zoned RM2.4. We have filed for a Conditional Use Permit on the property and for SEPA. A DNS has been issued, and our hearing is scheduled for March 4 at 9:30 a.m. I've had conversations with Karissa and Brian of the Planning Division and with Jeannine Graf of the Building Division. We are going to file for ADB today. The Applicant went over the plans, noting setbacks, square footage of building, indicated 23 parking stalls — one barrier free. Applicant provided landscape plan showing trees to be removed and location and type of trees to be added. He also provided an im,gation plan. This will be submitted with ADB. In addition will be submitting the application for a free-standing monument sign. Sign will use ground lighting and the base will be landscaped. Will be a one-story building with metal weathered copper roofing, brick wainscot, approximately 3'4" high, wraps entire perimeter of building with a pre -cast concrete steel cap. Dark bronze aluminum store -front windows, "stucco" -type natural white finish. No rooftop mounted mechanical units — all mechanical units will be in second -floor attic space. Two pole lights, couple of ground lights at the side, and some ball packs around the building. Building Division was unable to attend meeting, but Applicant had spoken with Jeannine prior to today. They discussed height calcs, and datum points are indicated on the plans. The Applicant then addressed drainage. Most of site drains onto 760' Avenue West; parking lot will Just drain into catch basins as shown; 48" diameter underground storage, orifice release into the existing storm drainage system in the street. Need a lateral sewer connection and will replace the driveway. Applicant asked if City is aware of any downstream drainage issues. Engineering (Gord rmwater design. Water quality y): We have reviewed primarily traffic and sto amendments are required for the outside parking lot areas. Our ordinance provides for bioswales, but there are alternatives that are also approved — a wet pipe can be used, filtered systems .... for specifics on this issue, contact Don Fiene, our Hydraulics Engineer. Provide all information required on checklist for ADB application (site cross -sections, driveway slopes, etc.) With the number of stalls you are creating, you are right on the cusp of requiring what we call a high -traffic load driveway, and it looks like you are designing a standard residential driveway. A high -traffic load driveway is merely a drop curb situation where you'd have a wheel chair ramp on each side — I have typically required a high traffic load driveway anytime you're providing more than 20 parking stalls. Because you're right on the cusp and are this far along in the design, we may not require it — I will let you know. Driveway dimension is 24' minimum — it looks like you have all your dimensions on these plans as to traffic stalls, etc. We do have a need for a traffic report for SEPA. The Traffic Engineer has asked for the following information: trip generation, traffic distribution, level of service analysis of the following intersections: 76'hAvenue West/220th Street SW 76thAvenue West/Highway 99 VhAvenue West/216 h Street SW 220th Street SW/84th Avenue West 76'hAvenue West/212th Street SW 220th Street SW/Highway 99 Page I Pre -Application Meeting February 12, 1999 Carletti Architects/Medical Building Applicant indicated the traffic report had been completed and submitted with SEPA and that they have been provided with projected amount of impact fee. Per Applicant, Jeannine had called him two days ago indicating that she would not be in attendance today, so he sent her a memo confirming their conversation. She didn't have any issues, and he had no more questions regarding building issues. John asked if Jeannine agreed with the B-Occupancy. Applicant: The Applicant stated he could meet UBC 304.1 #8 and allowable area per table 513. We talked about the fact that we're okay in allowable area. For 5-N, when you're less than 20 feet, bearing walls have to be one -hour, so we have the two indicated on our plans. We talked about the fact that parapets wouldn't be required since we're greater than 10 feet, you can have unprotected openings; therefore no parapets required. We talked about the overhangs and the fact that in the code overhead projections all the way up to 30", so since you could have unprotected openings, those don't need protecting. Note: This is subject to UBC 503.2. 1, the 30 " overhang is an ECDC code, not UBC Fire/Building-fJohn) John indicated a fire alarm requirement for corridors and office uses required by building code in lieu of one -hour corridor construction — is that a trade-off there? Applicant indicated no — we don't need it because in the new UBC, all the rooms only require one exit, so every exit exits out into this hallway — under the new UBC, a hallway is considered an intervening room. Lobbies aren't considered as intervening rooms, so since the doors are all going through intervening room, you have no rated corridors. Per Applicant, Jeannine agreed with the conceptual design, but means of egress will be checked during permit review. John asked then if no second exit required. Applicant pointed out two exits. Per Applicant, Jeannine indicated that the distance appeared to be adequate, but the architect should check the half -diagonal rule for spacing of exits. John asked if Jeannine had discussed med. gas with him. Applicant said yes, she needs to know quantity of gasses that are there. John asked if Applicant had certified installer — to provide Building Division with that information. Applicant indicated a requirement from Medicare regarding one -hour separation walls in various other rooms. Per John, one hydrant will be required spaced at 300'. Applicant indicated they will place the hydrant on the side of the street where the water main is. Fire extinguishers are indicated throughout. Per Applicant, there will be an emergency generator backup because of a Medicare requirement. Applicant indicated that in talking with Jeannine, the issue was brought up regarding the two separate properties and property lines — do we need to do a lot line adjustment, a lot aggregation? Rob said that a lot line adjustment will be required. Applicant asked what happens about these trees? Do we have an ordinance for removing these trees or do we evaluate that with the landscaping plan? Per Rob, it's evaluated with the landscaping plan for ADB. CAMy D�=mts\Engscc\DEVELOP\Prc-AppMtgs\PrcApp2.12.99. Ldoc Page 2 r�' log j w lie -C 911 I'l lgil I I- I b 1:111-i I ol 9 91 1 i 15 1 1", 1, w, I if b 0111 - ij 21 jjml-�lll ATTACHMEN� �tp C. 1 S03 July 16, 1999 0 0 CITY OF EDMONDS 121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221 DEVELOPMENT SERVICES DEPARTMENT Planning - Building - Engineering Nikolai Bossoff DCI Engineers 2821 Northup Way, Suite 200 Bellevue, WA 98004 BARBARA FAHEY MAYOR SUBJECT: Proposed Building Permit for Edmonds Clinic at 21822-76" Avenue West (ADB-99-28)(P 99-133) Dear Mr. Bossoff-. The Engineering Division reviewed your civil site design. The review team notes the following revisions/corrections. Please contact the review team member(s) directly for questions regarding their comments. Storm Drainage — Don Fiene. LW—raufics Engineer at (425) 771-0220. Ext. 323 0 The stormwater calculations regarding use of dead storage are good for sediments, but do little for oils. Parking should be treated by a bioswale. The "Gullywasher" will require frequent maintenance. A bioswale is preferred. Explain why a bioswale is not used here. Using a bioswale could negate the extra size for a wet pipe. 0 Provide a legend on the Erosion Control Plan. If you have any other questions, do not hesitate to contact me at (425) 775-7744. Sincerely, �h-a (4X0-- GORDON C. HYDE Development Services Engineer GCH/cmc c: Development Services Technicians Peter Carletti GAENGR\G0RDYW028a.D0C Incorporated August 11, 1890 Sister City - Hekinan, Japan �1'11 C. 1 S01 June 4, 1999 Nikolai Bossoff DCI Engineers CITY OF EDMONDS 121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221 DEVELOPMENT SERVICES DEPARTMENT Planning - Building - Engineering 2821 Northup Way, Suite 200 Bellevue, WA 98004 BARBARA FAHEY MAYOR SUBJECT: Proposed Building Permit for Edmonds Clinic at 21822-76'h Avenue West (ADB-99-28)(PC 99-W3 Dear Mr. Bossoff- The Engineering Division reviewed your civil site design. The review team notes the following revisions/corrections. Please contact the review team members directly for questions regarding their comments. Storm Drainage — Don F-iene. Hydraulics fnzi�neer at 02�) 771-0220. Ext. 323 * Provide additional information noted in Stormwater Drainage Report. Provide legend, notes on sequence of construction, erosion control notes and soil stabilization notes. 0 Revise notes as indicated. Utilities — Jim Waite. WaterlSewer Supervisor at (425) 771-023 • Revise water design and notes as indicated on plans. • Install sewer cleanout at property line. Please note that some of the proposed details can only be used on private property. For public right-of-way, please use the attached details. When the revisions are complete, please return the attached redlined plans and drainage report together with three sets of revised plans and two drainage reports for additional review. It will be necessary to provide a construction cost estimate for City staff to determine the Engineering Division fees and to establish bond amounts. If you have any other questions, do not hesitate to contact me at (425) 775-7744. Sincerely, 0 0 RDON C. HYDE Development Services Engineer GCH/cmc c: Lara Knaak, Permit Coordinator Peter Carletti RAENGR\G0RDY\9028.D0C Incorporoted August 11, 1890 Sister City - Hekinan, Japan 0 ST R BARBARA FAHEY CITY OF EDMONDS MAYOR PUBLIC WORKS DEPARTMENT - 7110 — 210TH ST. S.W. - EDMONDS, WA 98026 (425) 771-0235 - FAX (425) 744-6057 - E-MAIL: kIein@ci.edmonds_wa.us WEB SITE: www.d.edmondsma.us May 19, 1999 STREFT Ben Thal 8423 Main Street Edmonds, WA 98026 Subject: Water Leak Credit at 21822 — 76' Ave. W. (#452750) Dear Mr. Thal: I have reviewed your account and will allow a credit for the billing period between April 5, 1999 through May 5, 1999 in accordance with our City policy. The policy states that the customer will be billed at the retail rate based upon the average water consumption for the same period during the previous year. In addition, the excess water lost from the leak will be billed to customer at the City's wholesale rate with a 15% surcharge added for administrative cost. Only one leak credit will be granted in any three-year period. Should you have any additional questions after you receive your new billing, please contact Denise Burke, Utility Billing Clerk, at 771-0241. Sincerely, Jim Waite Water/Sewer Supervisor JW/lk cc: Denise Burke Utility Billing Clerk wordata\water\credit99\#452750 0 Incorporated August 11, 1890 0 Sister Cities International — Hekinan, Japan may 10, 1999 Mr. 3im Waite Public Works 7110 210" SW Edmonds, WA 98026 Re: Account 4-52750 Leakage estimate 2182276 th Ave. W. Edmonds Dear Mr. Waite, RECIMEDD NIAV � � 299 PUBLIOC The above is a rental house with one occupant, that moved out. While the house was vacant, vandals entered and trashed the house including the destruction of the toilet with a shovel. (Police investigation) The water ran for up to 10 days before being discover. I think the usual water usage was about 5-6 100 cubic feet / pay period. The usage was 51 100 cubic feet during the vacancy. A leakage estimate is appreciated. Ben Thal 8423 Main St. Edmonds, WA 98026 UA PILP, IYU. —1 tj - f� D U Critical Areas Checklist - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Site Information (soils/topography/hydrology/vegetation) I . Site Address/Location: Z I t 2112 4 2,19 3o 1( '144 ,�ve, W 2. Property Tax Account Number: (4(pla ooi ooq- )4 4(plo Approximate Site Size (acres or square feet): 11,0120 :,,Pt 4. Is this site currently developed? yes; no. If yes; how is site developed? re*ldlwa 5. Describe the general site topography. Check all that apply. Flat: less than 5-feet elevation change over entire site. Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a horizontal distance of 66-feet). Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise of 10-feet over a horizontal distance of 33 to 66-feet). Steep: grades of greater than 30% present on site (a vertical rise of I 0-feet over a horizontal distance of less than 33-feet). Other (please describe): 6. Site contains areas of year-round standing water: Wk _; Approx. Depth: 7. Site contains areas of seasonal standing water: NA- Approx. Depth: What season(s) of the year? 8. Site is in the floodway floodplain of a water course. 9. Site contains a c ek or an area where water flows across the grounds surface? Flows are year- round? IV )� Flows are seasonal? (What time of year? 10. Site is primarily: forested ; meadow ;shrubs mixed urban landscaped (lawn,shrubs etc) X .01 11. Obvious wetland is present on site: DETERMINATION CONDITIONAL WAIVER ^ca_chk,doc: Rev 10/03/97 City of Edmonds CRITICAL AREAS CHECKLIST The Critical Areas Checklist contained on this form is to be filled out by any person preparing a Development Permit Application for the City of Edmonds prior to his/her submittal of a development permit to the City. The purpose of the Checklist is to enable City staff to determine whether any potential Critical Areas are, 'or may be, present on the subject property. The information needed to complete the Checklist should be easily available from observations of the site or data available at City Hall (Critical Areas inventories, maps, or soil surveys). N 1101d 2 3 19% An applicant, or his/her representative, must fill out the checklist, sign and date it, and submit it to the City. The City will review the checklist, make a precursory site visit, and make a determination of the subsequent steps necessary to complete a development permit application. Please submit a vicinity map along with the signed copy of this form to assist City staff in finding and locating the specific piece of property described on this form. In addition, the applicant shall include other pertinent information (e.g., site plan, topography map, etc.) or studies in conjunction with this Checklist to assist staff in completing their preliminary assessment of the site I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the best of my knowledge (fill out the appropriate column below). Owner/Applicant: mall h:�Ve-4 Name Pr f *1 Nddki � I( e)o . pL Street Address W*45 / hA 02-6 city State Zip +1,5 - Telephone Signature /11 Date Applicant Representative: 6d Va. C Name 2,24,* Rlwysi�lt Street Address 6V4 v4opll � *47 M11-3 - city State Zip 3�60 - -*,4 -a 3 �+ Telen Sigvtur�� 11 LM 119 Date creception\jaWcad. doc (over) 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 forth on these map(s). Any person or entity requesting a copy should conduct an independent inquiry regarding the information shown on the 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 employees or officers shall be liable for the information given on this map(s), nor for any one representation provided based upon said map(s). CITY OF EDMONDS - SIDE SEWER PERMIT WATER -SEWER DEPARTMENT PERMIT Call 775-2525 for side sewer inspections BEFORE covering any portion of the construction.) (Inspection will be provided within 24 hours after requst. No Sat., Sun., or holiday inspections. ---------------------------- ------------------ ADDRESS LOCATION OF CONSTRUCTION -------------------------------------------------------------------------------------------------------------- - -------- PROPERTYLEGAL DESCRIPTION ----------------------------------------------------------------------------------------- ** ------------------------------------- .... ............................................. . ...... ............... . ........................................................................ . .............. . ...................................................................................... OWNERAND/OR BUILDER ---------------------------------------- ----------------------------------- - ------------------------------------------------------- CONTRACTOWSNAME & ADDRESS --------------------------------------------------------------------------------------- - ------------------------------ - --- ------------------------------------------------------- Permission is granted ----------- - ---------------------------------------------- 19 ......... for repair and/or connection of a side sewer to the city sanitary sewer w ­n in accordance with City of Edmonds ordinances. D TO THE FOLLOWING: nstruct ATTENTION IS CAM NOTE No. 1—The owners of the property may obtain a permit to construct sewer Inside property line. A licensed Side Sewer Contractor must be employed to co side sewer in street area. Do not cover any portion of sewer before it has been inspected. NOTE No. 2—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office. NOTE No. 3—Obtain full Information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit. NOTE No. 4—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 'A will be permitted. NOTE No. 5--Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to improper work which may develop within one year of completion. ork on the main sewer or its appurtenances except to in - NOTE No. 6�It Is unlawful to alter or do any other work than is provided for in the permit, or to do any w sert the pipe into the wye. DISAPPROVED � Date --- By ................ Date ----------------------- B ................ Date -_------------ ------------------- BY ---------------- Py Date ... ........................ By_ -------------------- * ----------------------------- APPROVED Remarks: ........................................................................................................... . ........................................................................................................... .............. ....... .. .............. ­ ......................................................................... . ........................................................................................... Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection BO�H Pernji( Co 9� ................ . .... hereby certify that the side sewer installation constructed under this permit wner of Cont tin ming Construe * n) was instal in accorda e with 11 governing ordin ces of the City of Edmonds. day o - - ---- ------------------------ ---------------- 119 7. Dated this .... 1.2-13 ----------- r Ej, Sewer Other Check BEFORE you di or: Water Gas E], Telephone Powe 9 APPLICATION The City of Edmonds for EASEMENT NO - --------------------------------- SIDE SEWER PERMIT NEW CONSTRUCTION REPAIRS E] LID NO . ..... ............ . ASMT. NO - ------------------ OWNER ------- -.5 .................................... CONTRACTOR -- ---------------------- - ------------------------ ...................... PERMIT NO. =PS-4.4 a JOB ADDRESS --- -- — ---- ............................. LEGAL DESCRIPTION: LOT NO - ---------------------------- . ........ BLOCK NO - -------------- ---------------------- ........................................................... ...................................... ................................................................ NAME OF ADDITION ....... ......................................................... ... ....... t r� Memo to: Director of Maintenance & Operation Public Works From: City Engineer Subject: Sewer Connection Charges 0 I Date July 28, 1975 1 A4RJ1I Legal Description: Hadley's Acres�, Rlk 2, S 75 ft of N 225 ft of Lot 1 Commonly known as: 21822 76th Ave. N. Z.F.F. Calculation: 75.910 Z.F.F. x $5.50 Lateral x Unit x S 25 6R cc: Owner: David Mest 16515 Linden Ave. N., Seattle 98133 1�3 $ 421-33 Connection Fee NV S 100.00 Lateral Charqe S 25.00 Trunk Charge S 10.00 Permit 556.33 TOTAL Assistant City Engineer 0 I -, rr�. 6 REGARDING: 21822 - 76th Avenue West (address) R E C 0 R D 0 F C 0 N T A C T S DATE NAME, PHONE NO., & COMMENTS ADDRESS of CALLER 7/17/75 Kenneth Drake Certified Letter No. 406699 sent (renter) requiring hook-up within 60 days. 9/22/75 David West Mr. West came into office and paid (owner) connection fee of $556.33 and obtained permit #5316. vie) P s1qa1WT*Ts1F*T*TM5W3 K49W4 N ACTION TAKEN Letter received. INITIALS JT Inquired about installing common JR line with neighbors (Rodgers). Asked if they did put in common line if both would be charged a lateral charge. Referred to Engr. JT -nCEIPT FOR CERTIFIED MAIL-30� (plus postage) SENT TO s. Kenneth Drake Mr. or Mr POSTMARK P"TMA ' K OR DATE 0 DAT E N STREET AND NO. 21822 76th Avenue..West n P.O., STATE AND ZIP CODE 'S W S t Edmonds, Washington 9802, CD A EES OPTIONAL 5EIRIVICES FOR ADDITIUVIAL F OPT '0 �L �E v, I ------ RETURN d w rem and date delivered ... ....... 1 shows to wl ow o o" y r , 'see� With delivery to addressee only ............ r y to� 150'� 50. �..3 0-, RECEIPT 2. Shows to whom, date and where delivered 85e' SERVICES With delivery to addressee only ............ DELIVER TU —ADDRE§-S—EEONLY .. ........... ........ ........... .. .......... ... SPECIAL D LIVERY (extro foe roqui rod) ... .............. .. ..... .... . PS Form 3800 NO INSURANCE COVERAGE PROVIDED— (See other side) Apr. 1971 NOT FOR INTERNATIONAL MAIL GPO� 10700-397-450 ........ ..... ... tft 0 'SENDER: Complete items 1 and 2. ..REIURN TO"' spa on Add your address in the ce rever- 1. Thq-following service is requested, (check one) Show to whom and date delivered ... 7 ----- 1—' '15 'Z hom, date, & address of delivery.. 35(o 0 Show to w 5 and DELI VBR ONLY TO ADDRESSEE 14 show to whom and date delivered ------------ 6�0 DELIVER ONLY TO ADDRESSEE and - show to whom, date,- and address o.f delivery ... ... 850 .................................... 2. ARTICLE ADDRESSED TO: M q "Mr.' or Mrs. Kennetfi Drake C X 21822 76th Avenue West z M Edmonds, Washington 98020 0 ARTICLE DESCRIPTION: M REGISTERED NO. CERTIFIED NO. INSURED NO. ;o 406699- - m 2 or agent) (n (Always obtain signature of addresses or agen M I have received the article described above. M SIGNATURE a 4. PCs DATE OF DELIVERY A M /4 �Iex N z 5. ADDRESS (Complete only If re deste - d) 0 J. Fn 6. UNABLE TO DELIVER BECAUSE: r GPO: 309'11��_My HLE 0 Da te Julv 28, 1975 Menio to: Director of Maintenance & Operation Public Works From: City Engineer Subject: Sewer Connection Charges Legal Description: Hadley's Acres*, Blk 2, S 75 ft of N 225 ft of Lot 1 Commonly known as: - 21822 76th Ave. .1-1. Z.F.F. Calculation: 75.910 Z.F.F. x $5.50 Lateral x Unit x 5 25 cc: Oviner: David I -lest 16515 Linden Ave. N., Seattle 98133 S 421.33 Connection Fee S 100.00 Lateral Charqe S 25-00 Trunk Charge S 10-00 Permit ,$ 556.33 TOTAL Assistant City Enqineer I e, COAIAI- CA'a- 4 cveor P/< 2 -5 7SIC7- 0,74 IV 'Z 25 -f��t 1-0 t �Ot -rr Lot d elolth 'z 1 �2 7. 4-,� 00')(7SX,0/4?q?) .33,74-8 3 P-, F 10 75 7,5 3 _3 *3 3) S 7, 77 r Z, q- F 4- Lal-erql 100,00 7o ro/ owlim I>h%)10 wMr 14 gwl!50 Lid MW AJ swr6c 749 / 3 0 lc� teo zr6 01 16 6, pt U M� el -i z MAKE REMITTANCES PAYABLE TO- 1975 FSNOHOMISH COUNTY TREASURER [__EVERETT, WASAINGTON 98206 REAL ESTATE TAX STATEMENT SNOHOMISH COUNTY. STATE OF WASHINGTON OF ALLSTATE. C '-'UNICIPAL. SCHOOL. AN 'AXE S. L E V Y ISSED VALUATION T A X ODE RATE LAND BUILDINGS TOTA.-L C, SPECIAL i VVILL DC W[3jKIt5UItU J�.. ltlL rLJLLUVVli\lt, IAA Ul�)IHI(-Ib: STATE COUNTY C "Y OR RO -'D/ Ll . B. SCHOOL DISTRICT 1, �TRICT OTHER IS CT FIRE DISTRICT HOSPITAL ','!,,'ER SEWER FOR"EST FIRE D111L DRAIN NO. 0 —, — -7 � 7334., LEGAL DESCRIPTION CL 0 ISE" C 0. HADLLEYS O.C;-.,.ES BLK 0112 D--2 K E ST. S 7 5 F T OF N 2- 2 5 FT W L "i To 1 z T TL C' L4 A /0� LLJ 0: . LIS,\ Ap C/ v s --j �%lkn PLEASE PRINT CHANGE OF �,.XPAYER NOTICE: OR CHANGE OF ADDRESS BELOW NAME CO 16 5el 5, STATE —C :�E_ FIRST HALF MUST BE PAID BY APRIL 30 OR ENTIRE TAX PLUS INTEREST MUST BE PAID. SECOND HALF DELINQUENT AFTER OCT. 31ST. TAX UNDER $10.00 TO BE PAID IN FLJLL. E PROCESS NUMBER ACCOUNT NUMBER 1975 FULITAX CHECK BOX TO INDICATE FULL OR H;,LF TAX HALF PAYI",ENT L n M I T R 0 1 1 m MAX YEAR YEAR INTEREST l)R FULL F CHECK M. 0. CASH 4 1 03 I IT At I. eD 11--4 4-74.5 D_ 100 D - -7 ,nC,7 'Al 0 c) (�� c -A. 1", + Ile + CD,D. FIT I 1 �; J h M., f 17-4- D - -7