422 MAIN ST.PDF11111111111111
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When recorded mail to:
City Clerk
City of Edmonds
121 Fifth Avenue North
Edmonds, WA 98020
200112101017
12/10/2001 04L44 PM Snohomish
P-0005 RECORDED County
SPACE ABOVE THIS LINE FOR RECORDER'S USE
RECORDER'S NOTE: Assessor's Parcel No. — , � (A q(��;Ccw
pORTIONS OF TI-IIS DOCUMENT Project No.& Name: - T��cz_ '/ oc-c4(,
ARE POOR QUALITY FOR SCANNING.
ENCROACHMENT AGREEMENT
EP1q1VD& P,4,47- 0,--- i3l-&- &5-
This ENCROACHMENT AGREEMENT ("Agreenic
CITY OF EDMONDS ("City") and
is entered into between the
("Owner[s]'), in accordance with Chapter 18.70 of the Edmonds Community Development
Code.
T,ex-Rryovoir; 7—
,,#Owner is the owner of that certain real property located at
K-Wff 1Y, - t - - g /k / 5
p within the City of Edmonds, Washington,
Assessor's Parcel Number 0 0 q3,q# 0 15-60 (, C, (, and more particularly described in Exhibit
"A" attached hereto and incorporated herein by reference. Business owner, 4
Killer is the business owner of that certAn real
property noted above.
2. The Easement. The City currently owns an existing easement over, under, and
across Owner's property for street, alley, sidewalk, other ( '-,Kxn c) V't` 7" �- i il,,� sdv)�ake)
which is described in Exhibit "B" attached hereto and incorporated by reference.
3. The Encroachment. The City hereby covenants and agrees and grants its
pennission to Owner or Business Owner to allow
to remain in a portion of the City right-of-way/easement. 9plat map showing the location of the
encroachment is attached as Exhibit "C" and incorporated by reference.. This Agreement is
subject to the following terms and conditions:
- a. The encroachment shall be installed and maintained in a safe and sanitary
condition at the sole cost, risk, and responsibility of the owner and its successors in interest.
b. The Owner shall agree at all times to indemnify and hold the City free and
harmless from any and all claims, demands, losses, damages or expenses resulting from the
-I-
construction, maintenance, use, repair or removal of the structure installed hereunder, including
any loss, damage or expense arising out of (1) loss or damages to property and (2) injury to or
death of persons.
C. The Owner must remove or relocate any part of the encroachment within
ten (10) days or such other time as specified in the notice after receipt of it from the City
Engineer, or the City Engineer may cause such work to be done and the reasonable cost thereof
shall constitute a lien upon the property.
d. Whatever rights and obligations were acquired by the City with respect to
the easement shall remain and continue in full force and effect and shall in no way be affected by
city's grant of permission to construct and maintain the encroachment structure.
4. Entire A2reemen . This Agreement constitutes the entire agreement between the
parties with respect to the subject matter hereof and supersedes and replaces all other
agreements, oral or written, between the parties with respect to the subject matter.
5. Notices. Any notice which is required or may be given pursuant to this
Agreement shall be sent in writing by United States mail, first class, postage pre -paid, registered
or certified with return receipt requested, or by other comparable commercial means and
addressed as follows:
�0 If to the Cit :
City Engineer
City of Edmonds
121 Fifth Avenue North
Edmonds, WA 98020
If to the Owner:
lei &del-3r-,+6'k?-5
which addresses may be changed from time to time by providing notice to the other party in the
manner described above.
6. Waiver . City's consent to or approval of any act or omission by Owner shall not
constitute a waiver of any other default by Owner and shall not be deemed a waiver or render
unnecessary City's consent for approval to any subsequent a ct by Owner. Any waiver by City of
any default must be in writing and shall not be a waiver of any other default concerning the same
or any other provision of the Agreement.
-2-
Me
200112101 -0-1.1
7. Successors and Assigns. This Agreement shall be binding and inure to the
benefit of the parties hereto and their respective legal representatives, successors, and assigns.
Owner agrees to incorporate this agreement by reference in any subsequent deeds to the
property, but any failure to do so does not invalidate this provision.
8. Capacity. Each party represents that the person(s) executing this Agreement on
behalf of such party has the authority to execute this Agreement and by such signature(s) thereby
bind such party.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement on this
day of 0Qj- , 20_0�_.
OWNER(S):
By: k;;63� By:
STATE OF WASHINGTON
COUNTY OF SNOHOMISH
This day, personally appeared before me, --(CA, VV% Ty'\ � I ryN, I � kos—L
to me known to be the person(s) who executed the within and foregoing -document and that
(helshelthey) the same as (hislherltheir) free and voluntary act
and deed for th therein mentioned.
.47 t%OTA/�
+ UBL%G
L -0.0%.4p
-W-A
My Commission expires: !�� -aD
CITY OF DMONDS
By:
ENGINEERING DIVISION
G:\SHAMTEMP\13LULDft4GUfANMUMncroachA&rm.dm -3-
"'001121 full o-17
Aw
I
13
------------------------------ MetroScan
Snohomish : -------------------------
Owner
:Turner Arm
RTSQ
:03E27N23 -SE
CoOwner
APN
:00 4344 015 006 01
Site Addr
:422 Main St Edmonds 98020
OldParcel
:4344 015 006 01 08
Mail Addr
:PO Box 458 Edmonds Wa 98020
Parcel ID
:108996S
Rec Date
:01/22/1996 Deed
Structure
:$137,700
Price
:$225,000 Loan
Land
:$219,300
Aud Fee#
LnAmt
Total
:$357,000
ActualUse
:Retail Store
Levy Cd
:00210
Lender
:
2001 Tax
:$4,540.08
Vest Type
:Sole And Separ IntTyp:
Phone
Bldg Name
:Comstock Jewelers / Shoe Repair
%Owned
:50
Land Use
:530 Com,Retail,General Merchandise
Volume
:1 Page :26
NbrhdCode
:500
Easmnt
Zoning
:Bc
Census
ZoningRest
:
Tract
:505.00Block :4
Sub/Plat
:Edmonds Plat Of
Map Grid
:454 FS
Legal
:EDMONDS PLAT OF BLK 015 D-01 - LOT
BedrOOMB
Bath F3H
Stories
Fireplace
Spa
Units :1
Bldg SF :4,438
1st SF :4,438
2nd SF
3rd SF
4th SF
BsmntSF :672
LotAcre
Lot SF
Heating :Sus Htr
Roof
View
WtrFront:
Year Blt :1959
EffYrBlt :1972
BldgGrad Avg
BldgCond Avg
WaterSrc :Public
Sewer :Sewer
EXHIBIT A
2001 12101Y%17
13-1-
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ANVE
641
90
JDAYTON'
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S. E.
ALDER ST
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GOVT LOT 2 B S.E.'1/4, OF S:E V4-".
SEC. 23,T2tN., R.3E.W.M.
1". 200,
400112101-017
When recorded mail to:
City Clerk
City of Edmonds
121 Fifth Avenue North
Edmonds,.WA 98020
CONFORMED COPY
200112101017
12/10/2001 04:44 PM Snohomish
P.0005 RECORDED County
SPACE -ABOVE THIS LINE FOR RECORDER'S . USE
Assessor's Parcel No. 4 -�54 qGG;CC(,(S
Project No. &.Name: J
ENCROACFIMENT AGREEMENT
This ENCROACHMENT AGREEMENT ("Agreement") is entered into between the
CITY OF EDMONDS ("City") and A- C/-* e
("Owner[s]"), in accordance with Chapter 18.70 of the Edmonds Community Development
Code.
1. The Pro lerty. Owner is the owner of that certain real prope . rty located at
qz-Z- -/,IA)A 5-1- f;WO-�AdS within the City of Edmonds, Washington,
Assessor's Parcel Number C-90 y3qq -�C, ('
, and more particularly described in Exhibit
"A" attached hereto and in�-o-iporated herein by reference. Business o er, /L(
wn
is the business owner of that certain real
property noted above.
2. The Easemefit. The City currently owns an existing easement over, under, and
across Owner's property for street, alley, sidewalk, other
which is described in Exhibit "B" attached hereto and incorporated by reference.
3. The Encroachment. The City hereby covenants and agrees and grants its
permission to Owner or -Business Owner to allow
to remain in a portion of the City right-of-way/easement. plat map showing th I e location of the
encroachment is attached as. Exhibit "C" and incorporated by. reference. This Agreement - is
subject to the following terms and conditions:
a. The encroachment shall,be installed and maintained in a safe and sanitary
condition at the sole cost, risk, and responsibility of the own er and its successors in interest.
b. The Owner shall agree at all times to indemnify and hold the City free and
harmless from any and All claims,. demands, losses, damages or expenses resulting from the
-I-
construction, maintenance, use, repair or removal of the structure installed hereunder, including
any loss, damage or expense arising out of (1) loss or damages to property and (2) injury to or
death of persons.
C. The Owner must remove or relocate any part of the encroachment within
ten (10) days or such other,time as specified in the notice after receipt of it from the City
Engineer, or the City Engineer may cause such work to be done and the reasonable cost thereof
shall constitute a lien upon the property.
d. Whatever rights and obligations were acquired by the City with respect to
the easement shall remain and continue in full force and effict and shall in no way be affected by
city's grant -of pennission to construct and maintain the encroachment structure.
4. Entire Agreement. This Agreement constitutes the entire agreement between the
parties With respect to the subject matter hereof and supersedes and replaces all other
agreements, oral or written, between the parties with respect to the subject matter.
5. Notices. Any notice which is.req'uired or.may be i
given pursuant to this
Agreement shall be sent in writing by United States mail, first class, postage pre -paid, registered
or certified with return receipt requested, or by other. comparable commercial means and
addressed as. follows:
0 If to the Ci :
,City Engineer
City of Edmonds
121 Fifth Avenue North
Edmonds, WA 98020
If to the Owner:
kt� A- ;5�11L
which addresses may be changed from time to time by providing notice to the other party in the
manner described above.
6. . Waiver. City's consent to or approval of any act or omission by Owner shall not
constitute a waiver of any other default by Owner and shall not be deemed a waiver o . r render
unnecessary City's consent for approval to any subsequent act by Owner. Any waiver by City of
any default mutt be in writing and shall not be a waiver of any other default concerning the same
or any other provision of the Agreement.
-2-
7. Successors and Assigns. This Agreement sh ' all be binding and inure to the
benefit of the parties hereto and their respective legal representatives, successors, and assigns.
Owner agrees to incorporate this agreement by reference in any subsequent deeds to the
property, but any failure to do so does not invalidate this provision.
8. Capaci . Each party represents that the person(s) executing this Agreement on
behalf of such party has the authority to execute this Agreement and by such signature(s) thereby
bind such -party.
IN WITNESS WHEREOF, the parties hereto haveexecuted this Agreement on this
day of 20 C
OWNER(S):
By:
By:
STATE OF WASHINGTON )
COUNTY OF SNOHOMISH
This day, personally appeared before me, --rc), in rYA I-e-A'
to me known to be the person(s) who executed the within and foregoing d6cument and that
elshelthev) e same as (hislherltheir)
firee and voluntary act
and deed for th therein mentioned.
4oTA&
Notary -Public
22, 7.1p..
OF' Typed or Printed Name
"4111 Ills
My Commission expires:
CITY OF DMONDS
B y: 7/c _
E]�GINEERING DIVISION
Cr�SHAU\TEW\BUILDINGUiANDOUAacro=hAgm.doe . 1 -3-
------------------------------ MetroScan
Snohomish
-------------------------
Owner
:Turner Ann
RTSQ
:03E27N23 -SE
CoOwner
APN
:00 4344 015 006 01
Site Addr
:422 Main St Edmonds 98020
OldParcel :4344 015 006 01 08
Mail Addr
:PO Box 458 Edmonds Wa 98020
Parcel
ID :1089965
Rec Date
:01/22/1996 Deed
Structure :$137,700
Price,
:$225,000 Loan
Land
:$219,300
'Aud Fee#
LnAMt
Total
:$357,00 0
ActualUse
:Retail Store
Levy Cd
:00210
Lender
2001 Tax :$4,540.08
Vest Type
:Sole And Separ IntTyp:
Phone
Bldg Name
:Comstock Jewelers / Shoe Repair
%Owned.
:50
Land Use
:530 Com,Retail,General Merchandise
Volume
:1 Page :26
XbrhdCode
:500
Easmnt
Zoning
:Bc
Census
ZoningRest
: -
.
Tract
:505.00Block :4
Sub/Plat
:Edmonds Plat Of
Map Grid :454 F5
Legal
:EDMONDS PLAT OF BLK 015 D�01 LOT
Bedrooms*
Bldg SF -.4,438
LotAcre
Year Blt :1959
Bath F3H
ist SF :4,438
Lot SF
EffYrBlt :1972
Stories
.2nd SF
Heatin 9 :Sue Htr
BldgGrad :Avg
Fireplace
3rd SF
Roof
BldgCond .:Avg
Spa
4th SF
View
WaterSrc :Public
Units
:1 BsmntSF :672
WtrFront
Sewer :Sewer
AW
7L'
0 IS9
PS,
4
'V'
I d1AME3
_4
Im
JDAYTON'
s
ALDER ST
5
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co 6
GOVT LOT 2- a S.E.1/4, OF* S.E V4-1-
SEC. 23,T2tN., R.3EAM.
I". 20d
ENCROACHMENT PERMIT ROUTING FO
1�
PERMIT
DATE APPLICATION RECEIVED:
ADDRESS OF.PUBLIC USE:
PROPERTY OWNER:'
F-1
in
ONCE YOUR REVIEWIS COMPLETE, PLEASE ROUTE TO THE NEXT
DIVISIONIDEPARTMENT ON THE LIST.
PLEASE ROUTE IN THE ORDER SHOWN
\1, P F-
PLANNING DIVISION Date Stamp Received:
PUBLIC WORKS Date StAmp-Reiceived.
ENGINEERING DIVISION i4ife-s-fi-i4-Received:
DS ADMIENISTRATION Date Stamp Received:
r
APPR OVAL SIGNA TURES AND REMARKS OR COMMENTS ARE TO BE MADE
UNDER THE "DEPARTMENTAPPROVALS"SECTION ON THE PERMIT.
RAengrWormsTricroachment permit routing
A?
0'V E D Af
0
All
St. I
PROPERTY OWNER
ENCROACHMENT PERMIT APPLICATION
aF--�
— '321/ -,/.? / /
PROPERTY OWNER MAILING ADDRESS: 'Pr'. e ex
BUSINESS NAME for Conmierical applications: $te ACI e.- —
"I CA-o-15
ADDRESS OF PUBLIC USE: q ?—L Aou- A, 54 Edgwmds 11 W-4- 9<6--0 1-->d
Describe the portion of public space, City right-of-way or easement area to be utilized (i.e., overhead space of
sidewalk, 10 foot City utility easement along north property line, etc):
Describe the type of encroachment or use desired (i.e., fence 6 feet by 150 feet, awning 3 feet wide by 7 feet
long, etc.): . aq ��' �A—s — ::� e> r, P / -T 'O'A
Specify the length of time for use (i.e. awning for life of building, espresso cart for summer months, etc.),
L -�-r 041 &-k-5)^rs-5
NOTE: The issuance of this permit is understood by the applicant to be ofa temporary nature and that no vested right is granted.
INDEMNIYY- The applicant understands and by hislher signature to this application, agrees to hold the City of Edmonds
harmless from any injuries, damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made
against the applicant or the City of Edmonds, or any of its departments or employees, including but not limited to the defense or
any legal proceedings including defense costs, court costs, and attorney fees by reason of granting this permit. In addition, the
application understands that the City shall be provided a Certificate of Insurance to indemnity and hold harmless the City of
Edmondsfrom all claims andlor property damage, and naming the City ofEdmonds as an additional insured.
CODE APPLICATION: By signing the application below the applicant warrants that s1he has read or had the opportunity to read
Chapter 18.70 of the Edmonds Community Development Code and s1he understands that all terms of the adopted ordinance are
incorporated herein as ifsetforth infull and this application andpermits therefore are subject to the terms of that Chapter.
V
W-6
Encroachho.docjlglO/00
. CRITERIA OF PERMIT APPROVAL
The applicant shall follow the noted conditions on the building permit. For applications that do not require a
building permit the following criteria shall be maintained at all times.
> Provide safe pedestrian travel for sidewalk encroachments. Maintain a clear zone of 44 inches minimum.
See definition of clear zone below.
> Exterior light fixtures, banners and flags must be a minimum of 7 feet above City right-of-way.
> Maintain clear landings on the exterior side of all required exit doors of 44 inches or no less than width of
door, measured toward the street.
> No projections into City alleys are permitted unless the projection exceeds 15 feet above pavement
surface.
> Do not block illumination from City light fixtures or hang objects from City light standards.
> Architectural projections from buildings must be approved by the Design Board and conform to Uniform
Building Code requirements. A building permit shall be required for such projections.
> Maintain 3 feet of clearance around fire hydrants, standpipes, manholes, water meters, blowoffs,
cleanouts and valve&
> Bistro dining tables and chairs must be placed in accordance with City Ordinance No. 3293.
> Merchandise racks, espresso carts, flower planters, benches must not be located within the "clear zone".
> Ramps require a separate building permit and must conform to UBC standards.
Clear Zone Definition: Clear Zone refers to an area 7 feet in height and 44 inches in width providing a
level, safe walking surface along the public sidewalk (i.e. measuring 44 inches from edge of street tree grates
or newspgper stands toward place of business and from the ground up to a height of 7 feet).
------------------ DEP.AR
Planning Division Approved By
Remarks or Comments:
ALS --- FOR CITY USE ONLY -------------------
- I G Q- - Date 11-3-10
Public Works Approved B Date
Remarks or Comments:
Engineering Division Approved By Bond Date A�411�1-
Remarks or Comments: -A�77VAO WW14seAW 4- 7' h6ww- 01a9wilte,
Certificate of Insurance Verified By_
Easement Agreement sent to City Clerk
ENCROACHMENT PERMIT# ISSUANCE DATE
RELEASED BY RECEIPT #
BUILDING PERMIT # RECORDING #
Encroachho.docjlg 10/00
AWRD, CERTIFICATE OF LIABILITY INSURANC�wjm MK
NDE-1
DATE (MWDDfYY)
10/10/01
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Soundview Insurance Agency Inc
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO Box 6249
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
Lynnwood WA 98036
Phone:800-803-7000 Fax:425-712-1058
INSURED
INSURER A: Travelers Casualty
INSURER B:
Kinder Britches Inc
Keith & Tammy Miller
422'Main St
Edmonds WA 98020
INSURER C:
INSURER D:
I INSURER E:
I
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFE TIVE
DATE (MM/DD �(Y)
POLICY EXPIRATION
M
DATE ( M/DD1YY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 500000
FIRE DAMAGE (Any one fire)
$300000
A
X COMMERCIAL GENERAL LIABILITY
I-680-464L130-3
08/12/01
08/12/02
CLAIMS MADEFX� OCCUR
MED EXP (Any one person)
s5000
PERSONAL & ADV INJURY
$500000
_7
GENERAL AGGREGATE
$1000000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/013 AGG
$1000000
1-1 POLICYF—j JERC0j F-] LOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS LIABILITY
EACH OCCURRENCE
$
OCCUR EICLAIMS MADE
AGGREGATE
$
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
I A I u--F--r0TF7
TVVOLRY' LIMITS I I ER
EMPLOYERV LIABILITY
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
OTHER
A
Business Owners
1-680-464L130-3
08/12/01
08/12/02
PROPERTY 55120
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
It is understood and agreed that the City of Edmonds is named as F-ry ED
R C
an Additional Insured. OCT 15 2001
PERMIT COUNTER
CERTIFICATE HOLDER Y I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
CITYOFS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAJL 4 5 DAYS WRITTEN
City of Edmonds NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Building Eivision IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
121 5th Ave N
Edmonds WA 98020 REPRESENTATIVES.
I I Tony Conti U ELAA �,k3L&� I Y / PI
ACORD 25-S (7/97) @ACOR11 CORPORATION 1988
Partial Sign Review Completed Oct. 2001 for Russell Sign Company
Chanda Earhart Assistant Planner
KINDER BRITCHES:
Sign Area Permitted Sinn Area Proposed Sign Height Permitted Sign Height Proposed
Window Graphics #1 [2] 14 feet [3]
Storefront from 5th Ave. I
Window Graphics #2 [4] 151 14 feet [6]
Storefront from Main St.
Projecting Sign #1 16 square feet 1.43 square feet 14 feet [7]
Storefront from 5th Ave.
Projecting Sign #2 16 square feet 0.51 square feet 14 feet [8]
Storefront from Main St.
Wall Sign #1 191 14.75 square feet 14 feet [l 0]
Storefront from 5th Ave.
Wall Sign #2 [11] 14.75 square feet 14 feet [12]
Storefront from Main St.
Further Information Needed:
1 . Measured length of the storefront frontage along 5th Ave.
2. Total square footage (in feet) proposed for window graphic #1 along the window on 5th Ave.
3. Measured height from the sidewalk/ground level to the top of the window graphics on 5th Ave.
4. Measured length of the storefront frontage along Main St.
5. Total square footage (in feet) proposed for window graphic #2 along the window on Main St.
6. Measured height from the sidewalk/ground level to the top of the window graphics on Main St.
7. Measured height from the sidewalk/ground level to the top of the projecting sign #1 on 5th Ave
8. Measured height from the sidewalk/ground level to the top of the projecting sign #2 on Main St
9. Measured length of the storefront frontage along 5th Ave.
10. Measured height from the sidewalk/ground level to the top of the wall sign #1 on 5th Ave.
11. Measured length of the storefront frontage along Main St.
12. Measured height from the sidewalk/ground level to the top of the wall sign #2 on Main St.
storefront window.
storefront window.
APPLICATION
for
The City of Edmonds $WE SEWIM PFAMT
NEW CONSTRUCTION qO1_0 AEPAIRS 0 EASMAWTT No . ..........................................
7400
OWNER .................. HUbbar.d�-S.Wamzon ... Bldg - - ------------------------------- CONTRACTOR .................................................................................................. PER31IT No . ......................
ADDRESS .............. 422 ... Ma.i-n ... S-t ............................................................ LEGAL DESCRIPTION: LOT No . .....................................
...... .. ..... .. .. -- - ......... BLOCK No. - ..........................................
Uj
LU
U)
NAMEOF ADDITION ............................................................................................
Dye Tested On Sewer
June, 1972
Approved:
DATE................................................ By ............................................ .........................