23129 76TH AVE W.PDF111111111111
6398
23129 76TH AVE W
1.11Y 0 N
CITY of EDMONDS BUSIre-S LICENSEAPPLI AT �Nr Z
DATEIW4 LICENSE NO.
y Civic Center Edmonds. Washington 98020
City Clerk Phone 775-2525
T11)
I OCCLIfIA-1 ION $15.00
-rnFFTfl,�,L; (A, HOME
10. 0 11 M TYPE OF BUSINESS ANNUALFEE
iL TAF A T!!r, I
FEL AS% I t I C. L9_- 6
INSTRUCTIONS:
• All items must be completed
or application will not be ac-
cepted.
• Sign and return application
with fee. Renewals received
after February 15 must pay
penalty in add,iti_orL_to_tee.
,NEWt-USINESSES AFT8R
JULY 31, 1/2 FE
--MUE-0 F F I R M F, A/ 6 IQ 1< �AAS BUSINESS PHONE NO. OF EMPLOYEES
S C �c P 77 4—:`- A 776--3(,,P2— � � E Q E 1 ',.1 E D
MAILING ADDRESS -INATURE OF BUSINESS
'I C G 1982
eZ 31 9) cl — -7 6
C o A) -r R, A C re
EDMONDS FIRE DEPT.
8 IVA'n s" 1 11 1
RECEIPT NO. DA[E PAID
"I 6E BOA
FOR ISS 0 F
FEE PAID F 'NALTY PAID CORRFCTED
1100 TI,
LICENSE WITH
_11LO 1101 1 1 1 'LC' ACTION.
13 LIS I N ES �� W I r 1-1
1 TO 3 EMPLOYEES
(C). BUSI NESS WITH
4 TO 9 EMPLOYEES
El (ID) BUSINESS WITH 10
OR MORE EMPLOYEES
�20,00
$22.00
$75.00
A&TER FEB. 1'
22.50
0
S 3, 0
(PLEASE MAKE ANY NECESSARY CHANGES)
BUSINESS ADDRESS
y
OWNERS NAME
C t) Ile IV U 7- 7-
HOMEPHONE DATE OF BIRTH
0 NEW APPLICATION
(LA)
0 RENEWAL
(L B)
0 CHANGE
(LC)
0 DELETE
(LD)
INDIVIDUAL PARTNERSHIP CORPORATION
15�*�(S) = (P) = (C)
AV W
SOCIAL SECURITY NUMBER
7 7 6 - 3 � I P - / -3 j_i0i rrs 8L)oQcH,_ (j fq 1
EMERGENCY NOT IF1CATION (1) NAME & I ELEPHONE R /V U -r- 7- 'Y --.1
(PLEASE LIST TWO) (2) NAME & TELEPHONE 1 7- 41
i-IOME ADDRESS
Q6 ? - 76
PLACE OF BIRTH
WASHINGTON STATE TAX NO. (i�_14-6�Xee APPLICANT'S SIGNATURE
U
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 10 V44 — LAND USE CODE ZONING CODE
APPROVE 0 DISAPPROVE SIGNATURE 10 F
CONDITIONAL USE PERMIT
COMMENTS
Idio - I 91��j
BUILDING DEPARTMENT DATE
E!�A PROVE I-] DISAPPROVE SIGNATURE
COMMENTS:
2—
CAPACITY: (NO. UNITS, ApTs. OFFICES, SEATS, BEDS, STUDENTS)
Building
1:1
Hotel/Motel
(L)
Permit
0
Apt. Bldg.
(A)
I I 1 1-1-1
1:1
Office Bldg.
(0)
Occupancy
F1
Restaurant
(R)
Group
11
Hosp/Nurs Home
(H)
Er,=--
0
School
(S)
Fl E DEPARTMENT DATE- /0- U. F. 1. R.
3 ,_ P
�APROVE EIDISAPPROVE SIGNATURE
COMMENTS:
POLICE DEPARTMENT _F —.§"
PROVE 0 DISAPPROVE DATE / 10 I'G'NATURE 1 �04 -
COMMENTS:
KIC WORKS DEPARTMENT
APPROVE D DISAPPROVE
DATE SIGNATURE
COMMEN
APPLICATION CARD No . .......... ........ .... .. ........
ME for
The City of EdmondsslREET V w-w— SIDE SEWER P EASEMENT No . ........ ...... . . ...
OUTSIDE 0 INSIDE 77 REPAIRS 0
?gov I OC6
.... h7-
OWNER ..... .................................................. CONTRACTOR ........................ ................ PERMIT No.
I
HOUSE No. y ............. Ah STREET 2-Z
AVENUE LOT No . ............................................................ .
......................................... ................ BLOCK No . ...... * ...... — .......... * ... .........
NAME ADD .......
- .... . ......... �.w . ... .... 0 ............ .............................................
0
0
I—
L-1
/ cl -
Date Approyed:
BACKFILL WORK ORDER ISSUED ............................................ DEPOSIT, $ ......................................................
SEWER WORK ORDER ISSUED ................................................ DATE J
APPROVED
FEB 6 1%3
BY. or.,
............. ...........................................
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).