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402 OLYMPIC AVE
APPLICATION
for
The City of Edmonds SIDE SEWER PERNaT R1907To"".7 .........................................
NEW CONSTRUCTION ID/ REPAIRS
..... co",
,/J.- PERMIT No
CONTRACTOR &Ilk& -0ee'�� ........ ...... .......... 314
OV,rN . ...... .......... i ............ ............................... ........ ----
BLOCK No . ........ melf ... . .....................
......................................
6Ae"lild iEGAL DESCRIPTION: LOT No . ........ .
ADDRESS ...... ......... ..........
..... ......... .......
..................
ME OF ADDITION ..... .. y ......... r ...................................
NA ...... .. f ........
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Approved:
......... �,Z ......... By
DATE ...........
APR
CITX OF EDMONDS
'SIDE SEWER PERM
WATEP'SEWER DEPARTMEIVT
PERATIT
(,Cal,, "01-�1107 for side s
inspections
ecti Will be Provide within 24 hou,,BEFORE Covering any port.
00 le,"ver
ADDR,j�SS LOCAT101V OJF CONSTRY after request. Ion If the construction
PROPERT" LITGAL DIESC _TCTIOIV ------------------------ 0 sat 11.1 or holiday inspections.*)
_UIVIION ... ---- -------- - --------------------- --------- --- --------------------------------------- ------ --------
--------------- ---- - --------------------------- ---------- - - --------- ----------------- -- - ----------- .... ----------- ------------------------
--------------------------- ..... I ---------- -------- ----------------------------------------- --- ------ ... ----- ------ ........ --------- --------------------------
COXTRACTOR's --------- 014WER - - ----------- ---------- ---------------
CES&Permis,- NAME & ADDP ....... ---------------------------------------------------- ------------------- -------------- -------
sYstem "on "s granted ....... ........... ---------- --------- ----- - --------- ----------------- ------------ -
in alc�rdance Wjh -ai� ------ ------------- -------------
of - -- - ---------- �l 19 f --------------
!WTION IS CALLED TO THE POLLOWINa: ordinances - --------- or rePair and/or connection of --------------------------------------------------
NOTE No, I —The owners 0 a Sid
Side sewer " f the Property e ,
NOTE NO 2 in street area. InaY obtai -,ewer to the 'city Sanitary
NOTE No' —All work D n a PernUt to
Perfomed o not cover any construct s Sewer
3 --- Obtain full inform t., City right of Portion Of sewer b,�' w" inside property
-waY requires an I re it has be
NOTE NO. 4—Top Of 511 a 'On reg d' - rivazion of R, en InsPeIne. A licensed Side Sewer Contractor Inus
de sewer ar Ing Ordiname 1 cted.
haxper than �, rnust hav e 1.16.()3,, 9 t-of-Way p
Perrnitted. d Regulations ermit obt
NOTE No. 6 wor governing s- "'nable frorn the City �rj
NOTE NO. 5—s will be I at least 30 inches Iv,ragaen at Property ji )de seu"ers w (Instruct
Trenches in street t be en2P]oyed to C
k which I Must be water settled ne and 12 inches inside property ,,,; rinit.
__It is aY develo and surface hen YOU get ,o, gineer's office.
Unlawful to alter P within Ile Year If street restored
����IPe in t or do any 0 of -r"Pleti.n. Ininimu"
0 the m th to original Condition. Cont be grade Of 2%. NO bends in grade
ractors shall responsible for failure due to im
DISAPPROVED 0 Dat,_ er woric than is Provided for in the perrait, or to do any work On the tnain. sewer or Proper
APPROV-ED 'Er Date-,._ -------------------- - By� ---- --------- Date-- its appurtenances exc to in -
Remarks: ....... . .. - -------- ------ ----------- ........... Date
--------------- ------- - -- - -- 0 - ------------------- BY ----
BOT11 ------- - --- ----------- ----------------- -----------
---------------- -- ----
nnit C�Vies AWST Be ------- --- ------- --- ------- ------ ----------
Signedy ---------- - ---- -----------------
Jwuer of r"I ----- -----------
trucl ..........
111,Aalled Twner -i-, Ontracting 9' Cons Ji ---------- ---------
0 -- )11 PRIOR To Request Por ITI,
In accord i��i��,,- �,;ro,,.:
ance with aU go ni�, hereby certify th
g 6on-Sir, i: ��spectiolj
.'rern"19 Ordinac Ionl at the Side sewer in
'lees Of the City Of Edrn011dS. stallation constructed under this perrnit
Dated this,,_,
Check HEPORE You dig for: Water 0, Gas Ej, Tel .... day of .. ...... ......................
epholle 0
Power Ell sewer 0, Oth ---- 1 19 ------
0
"'IV 0
CITY of EDMONDS
BUOESS LICENSE APPLICATION DA LICENSE NO.
A�
—7
C ivic Center Edmonds, Washington 98020
ANNUAL FEES
City Clerk Phone 775-2525
QTDM:T
PENALTY AFTER FEB. 15
[:11
HOME OCCUPATION
4STRUCTIONS:
CLASSIYEAR
13%#E@FW—t)&k
$10.00 (A) ADDITIONAL $5.00 0
All items must be completed
0 SMALL BUSINESS
or application will not be ac-
RECEIPT N
DATE PAID
AL-
PRINTX
$15.00 (B) ADDITIONAL $7.50 0
cepted.
c
IN SPEC. 13ox
FOR ISSUE OF
0 Business with 10 or
Sign and return application
FEE PAID
PENALTY PAID
CORRECTED
more employees ADDITIONAL $25.00 0
with fee. Renewals received
L
LICENSE WITH
LC'ACTION.
$50.00 (C)
after February 15 must pay
Q� NEW APPLICATION (LA)
penalty in addition to fee.
t] RENEWAL (LB)
NEW BUSINESSES AFTER
D CHANGE (LC)
JULY 31, 1/2 FEE.
(PLEASE MAKE ANY NECESSARY CHANGES) 0 DELETE (LD)
NAME OF FIRM
) I c Ks (-) �j
MAILING ADDRESS
BUSINESS ADDRESS
�4 0 --L
OWNERS NAME
iIIJTiRLS
HOME PHONE DATE OF BIRTH
-7 . — ")
EMERGENCY NOTIFICATION:
(PLEASE LIST TWO)
BUSINESS PHONE
Zo (40 17 + — O'�- 0-3
NATURE OF BUSINESS
M 047eQ t4 47
INDIVIDUAL
(S)
HOME ADIjR�9S-
PLACE OF BIRTH
//A vr� t)
(i) NAME & TELEPHONE
(2) NAME & TELEPHONE
WASHINGTON STATE TAX NO. APPLICANT'S SIGNATUR
STAFF REVIEW:
NO. OF EMPLOYEES
PARTNERSHIP CORPORATION
EKI (P) = (C)
DO NOT WRITE BELOW THIS LINE
SOCIAL SECURITY NUMBER
'77 -Y- I
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
�A APPROVE 0 DISAPPROVE
wi'ri+ CvjjbjTj0o5 L�jc,-Tp6 SIGNATURE
IIJ C-u— FIL-z-
COMMENTS
LAND USE CODE ZONING CODE
I PSI I I-;, I F- 1-
CONDITIONAL USE PERMIT
BU LDING DEPARTMENT DATE I 1 -79
Building
0
B APPROVE 0 DISAPPROVE SIGNATURE—
Permit
0
Hotel/Motel
Apt. Bldg.
(A)
ET I I I I El
Office Bldg.
(0)
COMMENTS:
Occupancy
0
Restaurant
(R)
Group
0
Hosp/Nurs Home
(H)
CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS)
Fi7z- -
0
School
(S)
,FIF3E DEPARTMENT DATE /Z-/ S 17 � U. F. 1. R.
APPROVE 0 DISAPPROVE SIGNATURE sAviC:u:±t2"
COMMENTS:
POPCE DEPARTMENT DATEAR -�5 -21 SIGNATURE
8-"APPROVE 0 DISAPPROVE
COMMENTS:
PUBLIC WORKS DEPARTMENT
0 APPROVE 0 DISAPPROVE DATE SIGNATURE �,Oi e�?�
Comm
PLEASE RETURN TO CITY CLERK