533 ELM WAY (2).PDF11111111111111
13949
533 ELM ST
,C,LTY 0
CITY of EDMONDS B U SA"F - S LICENSE APPLICATION
AI
DAft LICENSE NO.
Civic Center Edmonds, Washington 9t
Cit'y Clerk Phone 775-2525
STREET FILE TYPE OF BUSINESS ANNUAL FEE AFTER FEB. 15
CLASS YEAR LIC. EFFEC. DATE REASG. LIC. NO SPEC Ej (A) HOME OCCUPATION $15.00 $ 22.50
ASTRUCTIONS:
All iterns must be completed
or application will not be ac-
cepted.
Sign and return application
with fee. Renewals received
after February 15 must pay
penalty in addition to fee.
NEW BUSINESSES AFTER
JULY 31, 112 FEE.
NAME OF FIRM
4-Plex Apartment
MAILING ADDRESS
.
B
0 1
1 it 1� I-
I I I I
I I
RECEIPT NO,
DATE PAI
PRINT 'X'
IN SPr BOX
-C.
1-911-1
FOR ISSUE or:
C 0 R 11 E C 1 E D
FEE PAID
PENALTY PAID
I
I
LICENSE W11H
-
__L_j
LC' AC I ION.
(B) BLISINESSWITH $20.00 $ 30.00
1 TO 3 EMPLOYEES
0 (C) BUSINESSWITH $22.00 $ 33.00
4 TO 9 EMPLOYEES
0 (1)) BUSINESSWITH10, $75.00 $112.50
on monE EMPLOYEES
X1 NEWAPPLICATION (LA)
0 RENEWAL
(LB)
0 CHANGE
(LC)
PLEASE MAKE ANY NECESSARY CHANGES) 0 DELETE
(LD)
U INESS PHONE
NQ.
OF EMPLOYEES
NATURE OF BUSINESS
Four-Plex
BUSINESS ADDRESS INDIVIDUAL PARTNERSHIP CORPORATION
533 Elm Street (S) (P) (C)
OWNERS NAME HOME ADDRESS
Neckas, Christina
5047 S.W. 97th Seattle, 14A 98136
HOMEPHONE 1,,OATE OF BIRTH PL/ACE OF BIRTH 4(,, SO IAL SECURITY NUMBER
4_z-X.17- 0.7, zz 5- _�, __z
EMERGENCY NOTIFICATION (1) NAME & TELEPHONE
(PLEASE LIST TWO) (2) NAME & TELEPHONE
--112 1'7z-"
I V
WASHINGTON STATE TAX NO.. //X"'j APPLICANT'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
4 APPROVE 0 DISAPPROVE
DATE
LAND USE CODE
ZONING CODE
SIGNATURE
55,1
CONDITIONAL
USE PERMIT
COMMENTS
E:=
BUILDING DEPARTMENT
.7
DATE
U,�PPROVE 0 DISAPPROVE
SIGNATURE -HI
Building El
Permit 0
Hotel/Motel (L)
Apt. Bldg. (A)
0 Office Bldg. (0)
Occupancy 171 Restaurant (R)
COMMENTS: Group 0 Hosp/Nurs Home (H)
CAPACITY: (NO. UNITS, APTS. OFFICES, SEATS, BEDS, STUDENTS) 0 School (S)
FIRE DEPARTMENT DATE F. 1. R.
-1k/1 APPROVE 0 DISAPPROVE SIGNATURE
vll� Fo-Fo-F-0
COMMENTS:
POLK' E DEPARTMENT
16--A_�PROVE 0 DISAPPROVE DATE SIGNATURE
COMMENTS:
PUBLIC WORKS DEPARTMENT
0 APPROVE ED DISAPPROVE DATE SIGNATURE
COMMENTS:
PLEASE RETURN TO CITY