21202 72ND AVE W 3 pgs Redactediiiiiiii lill 11
14973
21202 72ND AVE W
1,TY p
CITY of EDMONDS B ESS LICENSE APPLICATION D 2 LICENSE NO.
RZ Civic Center • Edmonds, Washington 9
City Clerk Phone 775 2525
STREET
FILFF
ANNUAL FEES
❑
HOME OCCUPATION
INSTRUCTIONS:
CLA S
YEAR
LIC. EFFEC. DATE REASG. LIC. NO.
SPEC.
$10.00 (A)
• All items must be completed?
I
SMALL BUSINESS
or application will not be aC-
RECEIPT NO.
DATE PAID
PRINT 'X'
$15.00 (B)
cepted.
C
IN SPEC. BOX
FOR ISSUE OF
E
Business with 10 or
• Sign and return application
EE PAID
PENALTY PAID
CORRECTED
more employees
with fee. Renewals received
,
WITH
LICENSE LC' ACTION..
$50.00 (Ci)
after February 15 must pay
penalty in addition to fee. .
NEW BUSINESSES AFTER
JULY 31, 1/2 FEE. (PLEASE MAKE ANY NECESSARY CHANGES)
NAME OF FIRM BUSINESS PHONE
212th Street Plaza 775-2723
PENALTY AFTER FEB. 15
ADDITIONAL $5.00 ❑
ADDITIONAL $7.50 ❑
ADDITIONAL $25.00 ❑
)(a NEW APPLICATION (LA)
❑ RENEWAL (LB)
❑ CHANGE (LC)
❑ DELETE (LD1
NO. OF EMPLOYEES
one- /
MAILING ADDRESS NATURFCeneraYvEcontractors,L-Investors
21202 72nd Avenue West
Edmonds, Washington- 98020
INDIVIDUAL PARTNERSHIP
CORPORATION
202 72nd Ave. W Eelmo ds-98020
(S) (P)
(C)
OWNERS NAME et-
A-lbert -L . L Pier e CTe - r - W -Corley
HOME ADDRESS
---�afferre
A;b. -La Pierre 721 212th S.W. Edmonds
OME PHONE
DATE OF
IRJH
PLACE OF BIRTH
IA
�3
E I Y UMBER
(A Imo--- " 4-1 0
10 1
0b
Sask. Canada
-64fM
-k
EMERGENCY NOTIFICATION:
(1) NAME & TELEPHONE -
.(PLEASE LIST TWO)
(2) NAME & TELEPHONE DI-n - Wal r 7.76-8929
WASHINGTON STATE TAX NO. APPLICANT'S SIGN
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 L-
[i�ROVE ❑ DISAPPROVE DATE � �1 ``�JJ� cl LAND USE CODE ZONING CODE
SIGNATURE � � d-t� c
CONDITIONAL USE PERMIT
COMMENTS m
BytLDING DEPARTMENT —
DATE /
L APPROVE ❑ DISAPPROVE
Building
Permit
❑ Hotel/Motel
L
( )
SIGNATURE
❑ Apt. Bldg.
(A)
)Office Bldg.
(0)
COMMENTS:
Occupancy
❑ Restaurant .
(R)
Group
❑ Hosp/Nurs Home
(H)
CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS)
❑ School
(S)
FIRE DEPARTMENT DATE LI - ZU - 79 U.F.I.R.
APPROVE ❑ DISAPPROVE SIGNATURE01
S ® p a O LQli1 L1�J
COMMENTS:
POLICE DEPARTMENT G i
1: 'APPROVE ❑ DISAPPROVE DATE - 7 _ SIGNATURE
COMMENTS:
PUBLIC WORKS DEPARTMENT
❑ APPROVE ❑ DISAPPROVE DATE SIGNATURE.
COMMENTS:
PI FAr'r nr-_I-IIRt`I rn (CITY (''I f 11-4V
Mo
CITY of EDMONDS BU ESS LICENSE APPLICATION DA1& LICENSE NO.
-= Civic Center •Edmonds, Washington
City Clerk Phone 775.2525
STREET FILE
A AL FEES
❑ HOME OCCUPATION
INSTRUCTIONS:
CLASS
YEAR
LIC. EFFEC. DATE
REASG. LIC. NO.
SPEC.
$10.00 (A)
• All items must be completed
pD
r
i rf
❑ SMALL BUSINESS
or application will not be ac
RECEIPT NO.A
DATE PAID
PRINT 'X.
$15.00 (B)
cepted.
IN SPEC. BOX
❑ Business with 10 or
• Sign and return application
FEE PAID'
-,,
PENALTY PAID
FOR ISSUE OF
CORRECTED
more employees
with fee. Renewals received
1 �Q rIL
LICENSEION.WITH
$50.00 (C)
after February 15 must pay
penalty in addition to fee.
NEW BUSINESSES AFTER
JULY 31, 1/2 FEE. (PLEASE MAKE ANY NECESSARY CHANGES
PENALTY AFTER FEB. 15
ADDITIONAL $5.00 ❑
ADDITIONAL $7.50 ❑
ADDITIONAL $25.00 ❑
9 NEW APPLICATION
(LA)
❑'RENEWAL
(LB)
❑ CHANGE.
(LC)
❑ DELETE
(LD)
NAME OF FIRM BUSINESS PHONE NO. OF EMPLOYEES
La Pierre Realty 776-2300 & 775-2723 $
MAILING ADDRESS NATURE OF BUSINESS
21202 72nd Avenue West
Edmonds Washington 98020 Real testate
BUSINESS ADDRESS INDIVIDUAL PARTNERSHIP CORPORATION
21202 72nd Ave. West Edmonds Washington (S) 0 (P) 0 (C)
OWNERS NAME HOME ADDRESS
Albert L La Pierre 7214 72nd Ave. West Edmonds Washington
,j t{pIVI,E eNE IWMW
TH PLACE OF BIRTH((44 11 Forget Sask B.C. '
EMERGENCY NOTIFICATION: (1) NAME & TELEPHONE
(PLEASE LIST TWO) (2).NAME & TELEPHONE Frnest J. LiPiprrp
— 4- 0
/,,Q,pSTAPT�flT
WASHINGTON. STATE TAX NO. LA- w-- 94_lpU APPLICANT'S SIGNATURE
DG 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 ^f'y—� �� - % / LAND USE CODE ZONING CODE
ROVE ❑ DISAPPROVE SIGNATURE
CONDITIONAL USE PERMIT
COMMENTS m
B (LDING DEPARTMENT DATE �� ? Building
rQ APPROVE [].DISAPPROVE ❑ Hotel/Motel (L)
- :SIGNATURE Pew Imo„❑ Apt. Bldg. (A)
V f 7 Office Bldg. (0)
Occupancy ❑ Restaurant (R)
COMMENTS: Group ❑ Hosp/Nuys Home (H) .
® CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS) m ❑ School (S)
-FIRE DEPARTMENT DATE -ZZ % U.F.I.R.
❑ APPROVE E( DISAPPROVE SIGNATURE (SE FW14ae—
POL}2E DEPARTMENT
APPROVE ❑ DISAPPROVE
DATE
PUBLIC WORKS DEPARTMENT �-q,
APPROVE ❑ DISAPPROVE DATE — SIGNATURE lfd'
COMMENTS:...
PI FACE R�TI Infil T/1 (-ITV (I FRK