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403 HOWELL WAY
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CATION
CITY of EDMONDS B`,jji,j,1NESS LICENSE APPLI
DA1116 LICENSE NO.
Civic Center Edmonds, Washington
W
City Clerk Phone 775-2525 , w1k,''
t- I TYPE OF BUSINESS ANNUALFEE AFTER FEB. 15
151 - —
0 (A) HOME OCCUPATION
$15.00
$ 22.50
,NSTRUCTIONS:
Y'Si
33
I * I I I
I I 1 1
—7F? �(B) BUSINESSWITH
$20.00
$ 30.00
All iterns must be completed
RECEIPT NO.
DATE PAID
A�
1 TO 3 EMPLOYEES
or application will not be ac-
PRINTW
IN SPEC. BOX
C] (C) EILISINESSWITH
$22.00
$ 33.00
cepted.
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0-2 f 1251,j;172
FOR ISSUE OF
4 TO 9 EMPLOYEES
0 Sign and return application
FEE PAID PENALTY,PAID
C, 0
CORRECTED
LICENSE WITH
'LC'ACTION.
[I (D) BUSINESS WITH 10
OR MORE EMPLOYEES
$75.00
$112.50
with fee. Renewals received - I jo 1
D
NEW APPLICRjq�'NE (-L'�f
after February 15 must pay
penalty in addition to fee.
0 RENEWAL
A FIR k483)
NEW BUSINESSES AFTER
0 CHANGE
JULY 31, 1/2 FEE. (PLEASE MAKE ANY NECESSARY CHANGES) 0 DELETE
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(LD)
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NAME OF FIRM
BLISIN7SS PHONE
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MAILING ADDRESS
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NA§RE OF BUSINESS
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BUSINESS ADDRESS INDIVIDUAL PARTN%1 4P CORPORATION
1-103 /k/c, L 0 e k/,1,t( (S) (P) (C)
OWNERS NAME HOME ADDRESS
o J1 el_,� /7 0 0? , t- S LZ 0
SOCIAL SECURITY NUMBER
5-3 1 — q 9 c�
3 r,50,
HOMEPHONE DATE OF BIRTH PLACE OF BIRTH
c 3,2 o 7
EMERGENCY NOTIFICATION (1) NAME &TELEPHONE t, 2 2, 3 9
(PLEASE LIST TWO) (2) NAME & TELEPHONE S1 e 0
WASHINGTON STATE TAX NO.ypL,-,: /ew 4,i)eessAPPLICANT'S SIGNATURE
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 DAT LAND USE CODE ZONING CODE
[9 APPROVE 0 DISAPPROVE 7 T05 1 LI I
SIGNATURE
CONDITIONAL USE PERMIT
COMMENTS
LDING DEPARTMENT DATE
BU - I
Building
.
E?' APPROVE 0 DISAPPROVE
SIGNATURE 14 ROeV:C 5
Permit
0
0
Hotel/Motel
Apt. Bldg.
(L)
(A)
I I I I 1
0
Office Bldg.
(0)
COMMENTS:
Occupancy
0
Restaurant
(R)
Group
0
Hosp/Nurs Home
(H)
CAPACITY: (NO. UNITS, APTS. OFFICES, SEATS, BEDS, STUDENTS)
0
School
(S)
FIRE DEPARTMENT DATE !� - IF- Z9 :? U. F. 1. R.
,X APPROVE 0 DISAPPROVE SIGNATURE 5�� 014� -1
COMMENTS:
POL DEPARTMENT DATE SIGNATURE
eVA'�PPROVE 0 DISAPPROVE A ez-
COMMENTS:
PU LIC WORKS DEPARTMENT
P. E SIGNATURE
Ltl APPROVE CJ_ DISAPPROVE DAT
COMMENTS:
PLEASE RETURN TO CITY CLERK
e�, 0
CITY of EDMONDS BU( D LICENSE NO.
fESS LICENSE APPLICATION
Civic Center Edmonds, Washingt I IW
City Clerk Phone 775-2525 AN AL FEES PENALTY AFTER FEB. 15
0 HOME OCCUPATION
CLASS YEAR L C. IFFEI, DATE JREASG. LIC. NO.ISPEC.1
INSTRUCTIONS: llt� (A) ADDITIONAL . 0 0
items must be completed 0 SM:ALL BUSI
RECEIPT NOJ/, DATE PAID A— 00
or application will not be ac- ,--I RINT X $15.00 (B) DITIONAL $7.50 0
cepted. IN SPEC. 3 s wi r
FOR ISSUE 13ox El Business with r
OF
Sign and return application FEE PAID PENALTY PAID CORRECTED more e ees ADDITIONA 0 0
LICENSE WITH 00 (C
with fee. Renewals received 'LC' ACTION. .00 (C)
af ter February 15 must pay 7S NEW APPLICATION (LA)
penalty in addition to fee. El RENEWAL (LB)
NEW BUSINESSES AFTER D CHANGE (LC)
JULY 31, 1/2 FEE. (PLEASE MAKE ANY NECESSARY CHANGES) 0 DELETE (LD)
NAME OF FIRM BUSINESS PHONE NO. OF EMPLOYEES
RAY INDUSTRIESt INC. 776-3186 1 8
MAILING ADDRESS NATURE OF BUSINESS
403 HOWELL WAY 98020 ELECTRONICS MANUFACTURING
EDMONDS, WA. I
BUSINESS ADDRESS
INDIVIDUAL (Y�WN
ERSH I P
CORPORATION
403 HOWELL WAY
(S)
(C)
OWNERS NAME
HOME ADDRESS
23303
wo I
HOME DATE OF BIRTH PLACE OF BIRTH SOCIA E ITY NUMBER
Rg'-IS87 I 1 1 91-0 4
EMERGENCY NOTIFICATION: (1) NAME & TELEPHONE 776-2587
(PLEASE LIST TWO) (2), NAME& TELEPHONE LONSTMCE DUKE 774-0224
WASHINGTON STATE TAX NO. C578-82108
STAFF REVIEW:
APPLICANT'S SIGNATURE
DO NOT WRITE BELOW THIS LINE
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 -3;;
-9 APPROVE 0 DISAPPROVE SIGNATUREi4
COMMENTS
BUILDING DEPARTMENT DATE 3 1516(
9-APPROVE 0 DISAPPROVE SIGNATURE.-- H -q_c-4eVe_5
COMMENTS:
CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS)
FIRE DEPARTMENT DATE
N-APPROVE El DISAPPROVE SIGNATURE
COMMENTS:
PO,L4CE DEPARTMENT
DATE SIGNATURE
P'APPROVE 0 DISAPPROVE
COMMENTS:
PUBLIC WORKS DEPARTMENT
1-1 APPROVE E3 DISAPPROVE DATE SIGNATURE
LAND USE CODE ZONING CODE
1 1 1117
CONDITIONAL USE PERMIT
Building
El
Hotel/Motel
(L)
Permit
1:1
0
Apt. Bldg.
Office Bldg.
(A)
(0)
Occupancy
El
Restaurant
(R)
Group
13
Hosp/Nurs Home
(H)
0
School
(S)
NWERMW�RMUI
COMMENTS:
PLEASE RETURN TO CITY CLERK