23815 80TH AVE W.PDFIIIIIIIIIIIIII
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23815 80TH AVE W
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CITY of EDMONDS BUSIWKS LICENSE APPLICATION
Civic Center - Edmonds, Washington 98021W -Ma-ct! DATE LICENSE NO.
City Clerk Phone 775-2525 a, Q ku A j
TYPE OF BUSINESS ANNUAL FEE AFTER FEB. I
(A) HOME OCCUPATION $15.00 $ 22.50
]CLASS I YEAR I LIZ� 1C. NO.IsPrCT—LA
INSTRUCTIONS: 1111, 1
NO.
• All items must be completed RECEIPT DATE "PAIPD IN SPE
or application will not be ac- I e, PRINT 'X C. BOX
cepted. P LTY FOR ISSUE OF
/Ef PAID ENA A D CORRECTED
• Sign and return application I I LICENSE WITH
. with fee. Renewals received zz�,�, /i I 'LC'ACTION.
E) (B) BUSINESSWITH $20.00 $ 30.00
1 TO 3 EMPLOYEES
E] (c) BUSINESSWITH $22.00 $ 33.00
4 TO 9 EMPLOYEES
El (D) BUSINESS WITH 10 $75.00 $112.50
OR MORE EMPLOYEES
after February 15 must pay 5a NEW APPLICATION (LA)
penalty in addition to fee. 0 RENEWAL (LB)
NEW BUSINESSES AFTER 0 CHANGE (LC)
JULY 31, 112 FEE. (PLEASE MAKE ANY NECESSARY CHANGES) 0 DELETE (LD)
NAME OF FIRM BUSINESS PHONE NO. OF EMPLOYEES
Marion A. Squibb Secretarial Services � 771-8190 1 --g— (
MAILING ADDRESS NATURE OF BUSINESS IRL EIVED
23815 - 80th West
Edmonds, WA 98020 Sec-r-�� ServiAAR I I
BUSINESS ADDRESS INDIVIDU L P A R T N E%'S' HA hP" S I ItTER UP 0E_'R_ TX T 10 N
C_
rameas at- - ve,,2.3
LIU = (S) (P) (C)
OWNERS NAME HOME ADDRESS
Mer+er,�. Squibb 11"1t,V1&TW 23815 80th West, Edmonds, WA 98020
OCIAL SECURITY NUMBER
776-5404 4/27/25 Everett, WA 539-12-2425
HOMEPHONE DATE OF BIRTH PLACE OF BIRTH
EMERGENCY NOTIFICATION (1) NAME& TELEPHONE Janice Bogen 771-2297
(PLEASE LIST TWO) (2) NAME& TELEPHONE Richard Squibb - 771-8499
WASHINGTON STATE TAX NO. C 600 390 170
APPLICANT'S SIGNATURE
DO NOT WRITE BELOW THIS LINE V
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 LAND USE CODE ZONING CODE
V. APPROVE 0 DISAPPROVE SIGNATURE
CONDITIONAL USE PERMIT
COMMENTS = E= 921
B*DING DEPARTMENT DATE
VAPPROVE 0 DISAPPROVE SIGNATURE
COMMENTS:
I I I I UAVAUI I Y: (NO. UNITS, APTS. OFFICES, SEATS, BEDS, STUDENTS)
Building
0
Hotel/Motel
(L)
Permit
0
Apt. Bldg.
(A)
F1 I I I I I
L_J
Office Bldg.
(0)
Occupancy
0
Restaurant
(R)
Group
0
Hosp/Nurs Home
(H)
[-V;�
0
School
(S)
FIRE DEPARTMENT DATE 3 - tee- s I- U. F. 1. R.
APPROVE 0 DISAPPROVE SIGNATURE f:ee_L_ 69
COMMENTS: X7
PgLYE-DEPARTMENT
E"PPROVE DATE SIGNATURE
El DISAPPROVE
COMMENTS-
LIC WORKS DEPARTMENT -7
t) Z�
APPROVE ED DISAPPROVE D ATE SIGNATURE
COMMENTS:
PI EASE RFT"R-N TO C.JTV rf FRV
a
The City of Edmonds
APPLICATION CARD No . ......................................
for
SEDE SEWER PERYaT
OUTSIDE INSIDE E] REPAIRS EASEMENT No . ........................... ..........
-/- / Z) /') '-
OWNER ........................... CONTRACTOR ...... lj.& ........................... PERMIT No.
STREET
HOUSE No. ................................ AVENUE LOT No. . ......... BLOCK No . ...............................................
ell
NAME ADD. ...... --l%P-:.e--*;�--.
Date Approved:
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ .............................................
SEWER WORK ORDER ISSUED .......................................... DATE ---
APpROVEO
241963
JL2
.................................. ............
2- -3 9 15-
C�TY OFEd-V—,o—j—,q—D—S
13UILDING DEPARTMENT
WORK - - "vc:""
ADDRESS --
OWNER
APPROVED ATE;:er
BLDG. OFFIC�
IAL
PERMIT NU4B—E7R-
Lor 7
138,36-j
N SS , 36' 5,/" w
Imp-
fi
CITY COPY
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(�_). Any person or entity-reque sting a
copy should conduct an independent
inquiry regarding the information shown on
th-e -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
empl-o-yees or officerS, shcall be liable for the
information given on this map(s), nor for
any one representation provided based
upon'said map(s).
M