22406 72ND PL W.PDFlill iiiiiiii
5722
22406 72ND PL W
BUSIS tin- SE
CITY of EDMONDS L
0
Civic Center - Edmonds, Washington 9802
City Clerk Phone 775-2525
INSTRUCTIONS: CLASS I Y�EAR LIC. EFFEC. OAT
• All items must be completed
or application will not be ac- RECEIIPT NO. DATE PAID
cepted.
I P
• Sign and return application FEE: PAID PENALTY PAID
I
Renewals received
with. fee. I, I
after February 15 must pay
penalty in addition to fee.
NEW BUSINESSES AFTER
ffljVON
I
PENALTY AFTER FEB. 15
K HOME OCCUPATION
$10.00 (A) ADDITIONAL $5.00 0
0 SMALL BUSINESS
$15.00 (B) ADDITIONAL $7.50 11
El Business with 10 or
more employees ADDITIONAL $25.00 0
$50.00 (C)
0 NEW APPLICATION
0 RENEWAL
t CHANGE
JULY 31, 1/2 FEE. (PLEASE MAKE ANY NECESSARY CHANGES) El DELETE
NAME OF FIRM
-1H SA��-4\t-6
MAILING ADDRESS '
?xa P�, tj.
I V". IrSOAD
PRINT 'X'
IN SPEC. BOX
FOR ISSUE OF
CORRECTED
LICENSE WITH
'LC'ACTION.
DATE* LICENSE NO.
BUSINESS PHONE N
-7 2 Y - D6 I —
NATURE OF BUSINESS
(LA)
(LB)
(LC)
11 M,
EMPLOYEES
I
BUSINESS ADDRESS INDIVIDUAL PAR—T'N' ERSH I P CORPORATION
.2.zYLi6 7 ;L`1 J. jj = (S) (P) Q= P
OWNERS NAME HOME ADDRESS
6) 1 11 Co "'o Ir OU0-6 I P1 - lj.� A"'J." J-1. ?S-ej-d
HOME PHONE DATE bF. PIRT PLA . IR 2. -
C�E 'IF SOCIA SECURITY NUMBER
y- q)40 7
EMERGEN( FI ) NAME& TELEPHONE la, — Iq
(PLEASE LIST TWO) (2) NAME & TELEPHONE gco-e- r-- 3�y ffli.3
WASHINGTON STATE TAX NO. C 600 A01 77 APPLICANT'S SIGNATURE (J. V1 C 4an
DO NOT WRITE BELOW THIS LINE
STAFF REVIEW: FILL IN LAND USE CODE, UFIR 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
APPROVE 0 DISAPPROVE
SIGNATURE
irmtT
COMMENTS
UUNDI I IONAL USE PERMIT
BUILDING DEPARTMENT DATE \CJ�31i
Building
0 APPROVE 11 DISAPPROVE
SIGNATURE 9C'.C-Vre5-
0
Permit 0
Hotel/Motel
0 1 1 1 1 0
Apt. Bldg.
Office Bldg.
(A)
(0)
COMMENTS:
Occupancy 0
Restaurant
(R)
I I CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS)
Group 0
0
Hosp/Nurs Home
School
(H)
IS)
FIRE DEPARTMENT DATE 1P 4? U. F. 1. R.
APPROVE El DISAPPROVE SIGNATURE' -7v
[7[9 1/) 10 zi
COMMENTS:
Powt'E DEPARTMENT
/� 'r�F
L9 A ROVE DATE ZZ
0 DISAPPROVE ro �SIG�NATURE
COMMENTS:
PUBLIC WORKS DEPARTMENT
0 APPROVE 0 DISAPPROVE DATE SIGNATURE
COMMENTS:
PI F=A-c,'P: -IQ9T1 MKI Tn -nITV f--1 r-101Z
CI*F EAM, DS ENGINEERING DEPOIENT 0ACTION REPORT
k, -`EET FLE
Date 3/26/73 File
Subje-Et installaTion of new driveway- Attachments Yes
HNo
ROUTING:
Name
Initial
Date
Name
Initia
Da te
I Rhonda
2 Bill
3
7
4
INITIATOR:
N &me Wm. Cooper Phone 774-0605
Address _2240&��-72d pl. w.
ACTION:
1. Received request for permission to install 11' driveway _(gravel). I advised
him he would not need a R/W-Tn—vasio—n Permit but that we would want to take
a look at the street before giving hirR permission. I also told him we would
-ff—
want--to--know w en started on the work. The d(ain question is: can he put in
a gravel driveway entranceAthere are no curbs, gutters, etc.)
All concerned notified
Action Completed I
APPLICATION CARD No . ......................................
for
The City of Edmonds STME-cy FILE SME SEWER PERNaT
OUTSIDE F-] INSIDE E] REPAIRS F] EASEMENT No . .......................................
s�Q/) _25-6 �_/D /6V
OWNER.... --------- �%..t .....
.. .............................
.. CONTRACTOR ---------------------------------------------------------------------------------------------------- PERMIT No.
HOUSE No . ...... (,� - _T
--------------------- _ ...... .....
\N,
................................... .....................
STREET 1� -e
AVENUE LOT No - ---------_
:BLOCK No.
NAME ADD . .......................................
O�&
t-
PPROVED
ika 2 5 1963
Date Approved:
BACKFILL WORK ORDER ISSUED ........ .......................... DEPOSIT, $ ................. .................. _ ------- ?I
61
SEWER WORKORDER ISSUED ------ ........................ .......... DATE 13 y .........................