7707 LAKE BALLINGER WAY7707 LAKE BALLINGER WAY
CITY of EDMONDS BUSIIWS LICENSE APPICATIO'N
�' • ` Civic Center •Edmonds, Washington 98020 DATEICENSE NO.
City clerk Phone 775-2525 STREE''L
FILE
TYPE OF BUSINESS ANNUAL FEE
AFTER FEB. 15
❑ (A) HOME OCCUPATION
$ 15.00
$ 22.50
CLASS
YEAR
C. EFFEC. DATE
REASG. LIC. NO.
SPEC.
INSTRUCTIONS:
n
b
❑ (B) Bt SI NESSWIIH
$20.00
$ 30.00
• All items must be completed
RECEIPT NO.
DATE PAID
3EMPLOYEES
or :-application will not be ac-
2 �
/ � g
TW
IN SPEC. BOX
�(C) BUSINE5S WITH
4 TO 9 EMPLOYEES
$22.00
S 33.00
cepted.
FOR ISSUE OF
• Sign and return application
FEE PAID PENALTY PAID
0
CORRECTED
WITH
❑ (0) BUSINESS WITH 10
OR MORE EMPLOYEES
$ 75.00
$ 1 12.50
with fee. Renewals received
�Q 1
'LC'
after February 15 must pay
NEW APPLICATION
(LA)
penalty in addition to fee.
❑ RENEWAL
(LB)
NEW BUSINESSES AFTER
❑ CHANGE
(LC)
JULY 31, 1/2 FEE.
(PLEASE MAKE ANY NECESSARY CHANGES) ❑ DELETE
(LD)
NAME OF FIRM /� JS P_ -_'7> REss/N6, =rvc.) V_W C_ BUSINESS PHONE NO. OF EMPLOYEES
r-C-C1..a V Eo
MAILING ADDRESS NATURE OF BUSINESS X,.r J 198L
fCC__64 A)e? A L ,/>,c&'T A r `
Ed MF9NL�5 , WA q 8O ;�,O (� G�A.r�� HDM,SWSI FIRE DEPT.
BUSINESS ADDRESS 7 711 4�, 3Aj_z_11l/6r1e WXN6. INDIVIDUAL PARTNERSHIP CORPORATION
S#Alg- A5 MOve 0 (S) 0 (P) 5Z(C)
OWNERS NAME HOME ADDRESS a2002 AICNMON6 6C-Acd V k .
T$� L%// 1-5OAJ 5 C LE tw, S/ 7 7
HOME PHONE DATE OF BIRTH PLACE OF BIRTH SOCIAL SECURITY NUMBER
Sys- 30-3
EMERGENCY NOTIFICATION (1) NAME & TELEPHONE
(PLEASE LIST TWO) (2) NAME & TELEPHONE
WASHINGTON STATE TAX NO. 310 1 O APPLICANT'S SIGNATURE
DO NOT WRITE BELOW THIS LINE
STAFF REVIEW: 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 LAND USE CODE ZONING CODE
V APPROVE ❑ DISAPPROVE
SIGNATURE
CONDITIONAL USE PERMIT
COMMENTS m m
BUILDING DEPARTMENT DATE (7 (S
Tfoo'APPROVE ❑ DISAPPROVE SIGNATURE _ 1.
COMMENTS:
® CAPACITY: (NO. UNITS, APTS. OFFICES, SEATS, BEDS, STUDENTS)
FIRE DEPARTMENT DATE
xAPPROVE ❑ DISAPPROVE SIGNATURE
COMMENTS:
Building
❑
Hotel/Motel
(L)
Permit
❑
Apt. Bldg.
(A)
®❑
Office Bldg.
(0)
Occupancy
❑
Restaurant
(R)
Group
❑
Hosp/Nurs Home
(H)
®
❑
School
(S)
CT AP E DEPARTMENT DATE -Z'�' ' G SIGNATURE
APPROVE ❑ DISAPPROVE
COMMENTS:
P�.� LIC WORKS DEPARTMENT
it APPROVE ❑ DISAPPROVE DATE -�? �'� SIGNATURE
COMMENTS:
mil_ L A r• nu ..
APPLICATION
for
CARD No . ..........................................
The City of Edmonds
SIDE SEWER PERMIT
OUTSIDE 0 INSIDE 0 REPAIRS 0
EASEMENT No. ............................................
OWNER
.
4.11
........
...........................................
I .... CONTRACTOR ..... ....... ..... Ilits....._...........................
........................ PERMIT No.
HOUSE No .........
.... ...............................
STREET 4 — s
AVENUE LOT No. 4!7� 4'r�.t,
............. ..............................
I/ 4-0 13 1
13LOCK No .
NAME ADD.......
.......................................................... .
Date
BACKFILL WORK ORDER ISSUED ............................................ DEPOSIT, $ ..........................
SEWER WORK ORDER ISSUED ....
Approved:
DATE...& .....
APPROVED
&G,8 - lqu