23450 78TH AVE W.PDFiiiiiiiiiiiiii
15212
23450 78TH AVE W
ADDRESS: --s
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS:--eQ5 -1a DETERMINATION: El Conditionat Waiver E] Study RequireAwaiver
DISCRETIONARY PERMIT
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE
SHORT PLAT
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DA
LOT:
LID #:
BLOCK:
LATEMP\DSrs\Fomis\Street File Checklist.doc
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Critical Areas Checklist
65,_&�
CA File No:
Site Information (soils/ topography/ hydrology/vegetation)
1.. Site Address/Location: c4_1�6D AVL W. Ear'of)J.4, L.34 9�Dab
2. Property TaxAccount Number: .0 C,� L- C�, C,' 0, 01 It Q C
3. Approximate Site Size (acres or square feet): % JA -P, Q
4. - Is this site currently developed? X yes; — no.
If yes; how is site developed? 5'1 n r2, �=j h T)_ rn e-' Dn e- c- r,-
�' I i ,
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 10-feet over a horizontal
distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: N 0 Approx. Depth:,
7. Site contains areas -of seasonal standing water: N 0 ;Approx. Depth:
What season(s) of the year? N 0 N E-,
8. Site is in the floodway N 6 floodplain N 0 of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
—Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow shrubs -mixed:
urban landscaped (lawn, shrubs etc)
11. Obvious wetland is present on site:
For City Staff Use Only
1. Plan Check Number, if applicable?
2. Site is Zoned? P`a- 'A
3. SCS mapped soil type(s)? iN ct_��cxck �, 'I o-,,A oXn=,.,p 0
4. Critical Areas inventory or C.A. map indicates Critical Area on site?. Ro
5. Site wid-tin designated earth -subsidence landslide hazard area? �40+ OC4 b,
A
DETERMINATION
STUDY REQUIRED
Reviewed
-7c, WAIVER
ate: .5-1 -1 -CG
'17C. 1%9�
e #P20
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
The Critical Areas Checklist contained on this form is to
be filled out by any person preparing a Development
Permit Applicationfor the City of Edmonds prior to
his/her submittal of the application 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).
Date Received- 1:1 1 �4-7) 4 V&
City Receipt#: " Z-�o'Z,51
Critical Areas File #:
Critical Areas Checklist Fee: $135.00
Date Mailed to Applicant:
A property owner, or his/her authorized 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 assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City.of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information furnished by the applicant, his/her/its, agents or employees.
By my signature, I certify that the information and exhibits;herewith submitted are true and correct to the best of my
k
knowledge and that I am authorized to file this application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANVAGENT
I 11W I �
Property Owner's Authorization ! '
By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the
Owner/Appficant:
r ,
L-,r 1, C- %L poxan o cA, Gn (A:�4ai
Name
')3145-C) -?,Ra AVE LZ.
Street Address
EArf)c)n3:s
city State Zip
Telephone:
Applicant Representative: .
R E C E I
Name 200'
APR 2 3 3
Street Address PERMIT COUNTEF,
city State zip
Telephone:
Email address (optional): - Email Address (optional):
.Mi
CITY OF EDMONDS
121 5th AVENUE NORTH - EDMONDS, WA 99020 - (425) 771-0220 - fax (425) 771-0221
www.edmondswa.gov
DEVELOPMENT SERVICES DEPARTMENT
May 4, 2015
MEMO TO:
Edmonds School District
Verizon Northwest
SNOCOM Police and Fire Dispatch
SNOPAC
Snohomish County E911
U.S. Post Office
Snohomish County Assessor's Office
Snohomish County Information Services
Snohomish County P.U.D.
Puget Sound Energy
Fire District 1
Edmonds Police Department
Edmonds Utility Billing
Edmonds Public Works
Edmonds Building/Street File
Edmonds Address Files
Lynnwood Disposal
Comcast Cable
Waste Management Northwest
Allied Waste
DAVE EARLING
MAYOR
Per the request of the Snohomish County E911 Office, in preparation of the GIS driven
NWS (New World Systems) CAD (Computer Aided Dispatch) which is to go into effect
June 2015, 1 have attached a spread sheet of corrected addresses for the City of
Edmonds. These addresses were corrected due to an audit check by Snohomish County
for even and odd addresses to be on the correct side of the street. The spread sheet
contains parcel, owner, old address and new corrected address.
Owners have been notified through a separate mailing.
If you have any questions regarding this letter, please contact a City of Edmonds Permit
Coordinator at 425-771-0220. Please contact our office if you wish to be removed from
future address change notifications.
Sincerely,
Linda Thomquist
Senior Pennit Coordinator
City of Edmonds
Cc: file
Incorporated August 11, 1890
Sister City - Hekinan, Japan
Thornquist, Linda
From:
Sent:
To:
Subject:
nfi��
FiLd
Memo.pdf
Thank you,
OffiRk
F8
City of Edmonds
2015 Address C
Thornquist, Linda -
Monday, May 04, 2015 3:06 PM
Allied Waste; Angela Edwards; Bard, Mike; Cunningham, Diane; Curt Kiessig; David
Baxter, Dowd Kim (kdowd@snopac9ll.us.com); Frontier, Jacqueline Amble;'Joanne
Coughlin'; Johns, Kristin; Kenyon, Denise; Kuhnhausen, Kris; Lawler, Patrick; Linda Dolan;
Matthew Crisler, McMurphy, Linda; PSE; Rohde, David; Sharon Euster, Silva; Steve
Wheeler, Tammy McGowan; Terry Peterson; Thornquist, Linda; Tim Harris; Todd
Merriman; Vicki Thoroughman; Westfall, John; Witt -Williams Vicki (vicki-whitt-
williams@cable.comcast.com); Zulauf, JoAnne
Important! City of Edmonds Address Changes
Linda Thornquist
Senior Permit Coordinator
City of Edmonds 425-771-022o ext. 1336
Our hours arefrom 8am to 4--30 Monday, Tuesday, Thursday and Friday. On Wednesdays
our permit counter closes at noon.
DATE: Aprif 23, 2015
TO: GUSTAFSON ERIC WILLIAM
23450 78TH AVE W
EDMONDS, WA 98026
RE: House address changes for Enhanced 911
Current address: 23450 78TH AVE W Parcel: 00465600001200
Snohomish County will be implementing a county -wide advanced technology system in June that will vastly
improve police, fire, and emergency medical emergency responses through the 9-1-1 system. In preparation
for this event, Snohomish County Enhanced 9-1-1 Office is validating all addresses located in the
Geographic Information System (GIS) for emergency responses throughout the entire county. A recent audit
by the county has identified a considerable number of buildings in the City of Edmonds whose addresses are
not consistent with the approved protocol for addressing buildings, which could result in delayed emergency
responses to those locations. The current address above has been identified as one of these. In an effort to
cooperate with Snohomish County, as well as Fire District 1 and the Edmonds Police Department to improve
fire and public safety for all types of emergency response, the City of Edmonds will be changing the above
address to:
23 519 78TH AVE W
The main purpose for this particular change is to properly align odd and even address numbers on opposite
sides of the street, and ensure they are in proper numerical sequence.
We understand that this change may cause you some inconvenience, and even some financial expense, and
we apologize for that. However, please understand that the change will provide additional assurance that
police, fire, and public works services are quickly able to find your address during your emergency. For your
convenien ce, we have enclosed * a USPS addressing kit, which will help you make the appropriate
notifications to your utilities, creditors, insurance companies, magazine subscriptions, etc.
In order to be prepared for the upcoming upgrade to the E911 system, we anticipate that this address change
will need to take effect by June 8, 2015, the date when Snohomish County E911 will implement the new
technology. If you have any questions please contact Linda Thomquist, Senior Permit Coordinator for the
City of Edmonds at (425)771-0220 or by email at linda.thomquist@edmondswa.gov.
Best Regards,
Leif Bjorback, Building Official
City of Edmonds
C: Fire District I of Snohomish County
Edmonds Police Department
Edmonds Finance Dept/ Utility Billing
US Postal Service
90MONDS WATER DEPARTMKN'r
59-427
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23450 78t AI
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'_MATER DAa OTHER
RZADMS CODE USED AMOUNT' D CREDITS BALANCE
CHARGES AT],
BALANCA FORWARDED,'�"
563 rcB iso 46 13.40
FEB lacl
.40
rro liRss 4.80
ITB I R AR
16.65
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12.80
APR 13 WA 43
APR 18CI .35
APR 18 SS 4.80
9.60-
APR 18AR 1825 -PAY 13 69'. 26.63 — 1A
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653 JUN 18 47 13.60 WA
CT
JUN 18
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18 4.80 SS
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698 ON 25'69' 45 13.20 WA
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25169 18.81 AR
AUG 25169 37.21 IL
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HOURS BY APPOINTMENT GTREET FILE AREA CODE 206 MAIN 2-d614
DONALD HUGH HEDGES
ATTORNEY AT LAW
1109 HOGE BUILDING
SEATTLE, WASHINGTON 98104
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is 0 ITRE6 * 60
HOURS BY APPOINTMENT 7 FILE
DONALD HUGH HEDGES
ATTORNEY AT LAW
1109 HOGE BUILDING
SEATTLE, WASHINGTON 98104
November 25, 1969
Mr. Ron Whalley
Director of Public Works
City of Edmonds
Edmonds, Washington 98020
Dear Sir:
AREA CODE 206 MAIN 2-6614
You are hereby requested by me as owner of the property at
23450 - 78th West, Edmonds, legally described as:
Lot 12, Harvey's Addition, as per plat
recorded in Volume 14 of Plats on page 24,
records of Snohomish County.
to remove your li6n for unpaid water services furnished to the
above property.
You might recall our telephone discussion regarding this matter
and the fact that I have had to take back this property which I
was selling to George and Juanita Roberts on real estate contract.
I acknowledge now that I had an incorrect understanding that the
city might have a lien which would affect my title. Mr. John
Wallace of the city attorney's firm advised me of the pertinent
statutes. Upon analyzing these laws (R.C.W. 35.21.290 & 300)
I have concluded that your lien is valid only for the four -month
period immediately preceding the water turn-off date.
An employee of your staff advised me that the bills owing as of
June 18 amount to $18.81, as of August 25 $37.21 and as of
October 1 $46.22. Inasmuch as the $18.81 is owing for a period
prior to your lien claim, I have deducted that amount from the
total of $46.2Z and tender herewith my check for $27.41.
Would you kindly reconnect the water to this property at your
earliest convenience. The account will remain in my name until
such time that I rent or sell the property.
Thank you for your assistance in this matter.
Very truly yours,
1"2 1.
Donald Hugh Hed s
DHH:cg
cc: John Wallace
7-
4'A
HOURIII my APPOINTMENT
AMC^ 0009 AkO6 MAI", 2-90 A
DONALD HUGH HEDGES
ATTORNEV AT LAW
ItOO HOOK OU16CHNG
GRATTL.K. WASHINGTON 04104
November 25, 1969
Al
Y
44
V
'Mr
Ron Whalley
:'-;D$"ctor of Pablic Works �4
'4
a -Edmonds
tdvi6nAs, Washington .98020''"
..:Dear Sirz
0
of
are hereby requested by as as mner the. pe
?8th West, *bwnds, legally do
paribed as:..
"A
Lot 12, Harvey a A4dition as per plat
re
'24
oorded.in VoI� 1kof.Flats Inge
re
Cords of aidboidish Couoty#
rekove 'your It lor unp&14" *'ter,,,tservicss; f4m shs& to' %6
ir 4
mt+
one i au4elm -i�agiiding
Wel*
on migh�;i reoal
w
-to-taIkel-Imak this p.r^
j�%d the fact that I hays had ch
Q.,
an rsij,.9
A
A4
ing to Peoige 'and, Juinit;a Rdb6i-tIii r" 'A
*Ax. sell
J.
gA, v
ekn*o'Aedge� now tb4it I had an,inoorrect unders:4ndlAg, that.' *0
A- 1.
e 4:
11tj might havi lion which w9uld affect my t;itle.
0-of
��,*fu6s of the city attornev1,i'f1zwAt aftised u the .1*rVLnen�.,
t
CY.1,15.21,
otiittutec Upon analyzing thess laws (Rt .290 &,300).
h,
on
d cluded.,that your lion: a valid only,'. f9i, thipl, r,0
41
'j*riod immediately ;Irseeding, �thi water turn '4&
",'Omployes of your staff &OU
od me tha t - th
"6,
-$18,.81, as of,Auguat 25 $37*21 and a
80 _ i ,
`;=d 18 amount to of. 1
y
h 'M
Q'r t for-4 poriod
1 $46.22. 'Inasmue to the $18.811s qvin.g
N "N'T. at 4SCAUlt%',
lien 'claim, I I*v6 deducted th
*or.to your
.,22 and.tendor raw- +
0 'he #h
total f Aheck.fori.
.7, s4l'
'J
t
UldL ypu kindly* reccormect thb v&Ur , to, this; Imopsirty our . ... ..
a
Wo
r
ril"t convenlenceI; The adcomt, e=IA In. vW kAxii, �nti -pis'
son. tillts
4 -tuch -tize that I rent or t
h
u . f6r your,:. sia" aiitan6e', $A thU. a&
Y
vo
4.
4
tw
trait 6'
ID=ld Rqgh,
D Og
RH:
Jobn. Wallace
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).
'December 11, 1969
Mr. James A. Murphy
Edmonds City Attorney
1411'Fourth Avenue Building
Seattle, Washington
Re: Wat r Account No. 59-421 for
23450 78th Avenu
West E�monds
Dear Jim:
For your infol
Respectfully,
CITY OF EDMO14DS
FONALD L. WHALEY
Asst. Director of Public -Works
.RLW:eau
Enclosures
December 11, 1969
Mr. Donald Hugh Hodges
1109 Hoge Building
Seattle, Washington 98104
R*; Vater Account No, 50""'427 for
234�0 7#;_4� Aass,,__ -Edmonds
Dear Mr. Hedg*a;
Thank you for your diecks for'pa'yi"rint -on w6ter account for
23050 78tb Avenue WOst, gdm�ii4s.
F'6fl-tha- ledger for sub�;act account *bows the
'The enclosed cop)
broakdowu for deter"ininj tht"ampou6t duo foir'-four, mi6uths pri6r to'tbe
shutoff date. This amiunt City's charge came to $37.11i,
Your checks of Movember.284"1969, and De6e I isb4r" a t 1069, for a total' Amount
of $37.41 have been given to �th6� Water Billing Do . per I tment, which leave' a
8
$.30 credit to this account.
RLW: eau
Enclosure
,Cc: Donald C. Lawson, City Suoervisor
James A. Murphy, City Attorney
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APPLICATION CARD No . ......................................
for
The City of Edmonds tET FIL SIUDE SEWER PERMT 4pl""&A E M E N T N
OUTSIDE INSIDE Fj REPAIRS 0
OWNER.... 9.0.1V CONTRACTOR ........................................................... .......... ............................. PERbUT No.
HOUSE No. ....Z.3 .... vn`5�-.-P ................ zer& .... 'AMONT'll I -LOT No. 1. 3 .......... ........ BLOCK No. ---.77777:77� ....................
0A1 ............... ........................................
j NAME ADD. -V-15� ... ---------
Date Approved:
BACKFIEL WORK ORDER ISSUED ...... ............................. DEPOSIT, $ .................... ........................
SEWER WORK ORDER ISSUED ................................... ...... DATE ................................................ By ............................................. .....................
f V6ATE RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
(_ * f
E r') ZOXOV) n O_
MAILING ADDRESS 41
' �� _1 4 5 D 1 18 h V E LAI)
CITY ZIP TELEPHONE
NAME
CITY ZIP I TELEPHONE
STATE LICENSE NUMBER
PERMIT
NUMBER
JOB
ADDRESS /j')
PLAT NAME/SUBDIVISION NO.
SUITE/APT#
LOT NO. LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Requited
EXISTING PROPOSED
Street Use Permit Required
Inspection Required
Sidewalk Required
REQUIRED DEDICATION FT
Underground
WirtnQ required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
,--I
I
I
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CBL# I-^
( U r_P26Sj1r'4k/
ENGINEERING REVIEWED BY
ff/W
FIRE REVIEWED BY
CHECKED 13Y I VAKIANUt UK
V06—�6q
— 19 i_i� — &
PROPERTY TAX ACCOUNT PARCEL NO.
00'441tQ5
00001:��Oo
M NEW
RESIDENTIAL
PLUMBING I MECH
F1 ADDITION
COMMERCIAL
COMPLIANCE OR
MIXED USE
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
FENCE
CYOS
( X FT.)
ri DEMOLISH
TANK
OTHER
VARAGE
RETAINING WALL
FIRE SPRINKLER
'CG ARPORT
ROCKERY
FIREALARM
rrYPE OF USE, BUSINESS OR ACTIVITY) EXPLAI :
)
Enc-tost-
C_O,-rPor+'
NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
'Z,,. I _- . — '. -
HEATSOURCE I LOTSLOPE% I VESTED DATE
PLAN CHECK NO:
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THISPERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CON!ITRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEktST-,- AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WO"MEN'S C�M211�NSATION INSURANCE AND RCW 18:27.
SG T E� OR AGENT): DIE 111NED,' ) C) r
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DATE
q1-7 1-2ev
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DATE
U.
H IN. OR ADB# I INSPE rION SEPA
RE)DW COMPLETED I EXEMPT
C1 YES Nk/
ZONE SIGN AREA HEIGHT W N
I ALLOWED PROPOSED ALLOWED PROPOSED
S STUO
TUDY�r [3
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT)
LL
ALLOWED PROPOSED
FRONT-1�7 REAR
FRONT L/RSIDE REAR
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ko CAx.
1
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4 , z
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PARKING
LOTAREA
PLANNING REVIEWED BY DATE'�
RE QD PROODIED
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j
OCCUPANT
GROUP j
SPECIAL INSPECTION! CONSULTANT OCCOPANT
REQUIRED 13YES LOAD
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
$ /) J/—]
Description.,
Plan, Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-022
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
rn
Plan Chk. Deposit
Receipt #
Total Amt. Due
1 Receipt #
APPLICATION APPR6VAC
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
F�41_S SIGNATAE qjDATE
6/14111 j qll�dd
ATTENTION t I EXT. 1333 q
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FILE - Y
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK -OWNER - GOLD - ASSESSOR
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES