21206 72ND AVE W 9pgs Redacted21206 72ND AVE W
CITY of EDMONDS ESS LICENSE APPLICATION LICENSE NO.
Civic Center • Edmonds, Washington 98 0
City Clerk Phone 775-2525 STREET FILE ANNUAL FEES
,--4 1-4 Cl H • E OCCUPATION
'NSTRUCTIONS:
All items must be completed
or application Will not be ac-
ce.pted.
Sign and return application
with fee. Renewals received
$ 0 (A)
EI SMALL BU S' `
$15.00
❑ Business ' 10 or
more loyees
PENALTY AFTER FEB. 15
ADDITIONAL $5.00 ❑
ADDITIONAL $7.50 ❑
ADDITIO $25.00 ❑
0.0(C) v
after February 15 must pay - Z 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 c o m " BUSINESS PHONE NO. OF EMPLOYEES
-7 _ _
I�G t fT 1L , - J Cn Ct� `I /V •�
MAILIN ADDRESS NATURE OF BUSINESS
IJ0 C./I AL t'i
CLASS
YEAR LIC.
EFFEC. DATE REASG.
LIC. N0.
SPEC.
I
RECE T NO.
DATE PAID
PRINT 'X'
IN SPEC. BOX
FOR ISSUE OF
CORRECTED
FEE PAID
PENAL PAID
LICENSE WITH
'LC' ACTION.
BUSINESS ADDRESS -
INDIVIDUAL PARTNERSHIP
'CORPORATION
OWNERS 1NAME j�
L' �- P �-(U l
HOME ADDRESS
7�1 1'
c, r CN 1 J 17i e'
/ 1, J i ! C
HOME PH91 JE DATE F BIRTH P C� F BIRTHJ
EMERGENCY NOTIFICATION: (1) NAME & TELEPHONE 2 —
`r -" 7 -E
(PLEASE LIST TWO) (2) NAME & TELEPHONE
WASHINGTON STATE TAX NOS I, �� C' 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 u t)-.I LAND USE CODE
u�APPROVE ❑ DISAPPROVE
ZONING CODE
SIGNATURE
CONDITIONAL USE
PERMIT
COMMENTS
m
r BUILDING DEPARTMENT
I 0 APPROVE ❑ DISAPPROVE
DATE 1 � , I
Building
p Hotel/Motel
(L)
SIGNATURE
Permit
❑ Apt. Bldg.
(A)
❑ Office Bldg.
(0)
COMMENTS:
Occupancy
❑ Restaurant
(R)
Group
❑ Hosp/Nurs Home
(H)
CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS)
1:i >_
❑ School
(S)
FIRE DEPARTMENT
DATE -G - 4�i
U.F.I.R.
,{S-APPROVE ❑ DISAPPROVE
SIGNATURE
COMMENTS:
PO
rLICE DEPARTMENT
y
� APPROVE ❑ DISAPPROVE
DATE _ SIGNATURE
COMMENTS:
PUBLIC WORKS DEPARTMENT
DATE
❑ APPROVE ❑ DISAPPROVE
SIGNATURE —C
CLC�NrT�
COMMENTS:
,
PLEASE RETURN TO CITY CLERK
i
i
�,a
TYp BUSINOLICENSE APPLICATION
CITY OF EDMONDS
250 5TH AVENUE NORTH
EDMONDS, WASH. 98020
TELEPHONE (206) 775-2525
luTREET Fil F
INSTRUCTIONS
PRINT APPLICABLE LICENSE CLASS, FEE AND PENALTY PAID
IN ANNUAL FEE BOX AT RIGHT. PENALTY DUE ON RENEWALS
RECEIVED BY CITY CLERK AFTER FEBRUARY 15.
NEW BUSINESS: COMPLETE ALL LICENSE APPLICATION BOXES.
LIC. RENEWAL: REVIEW LICENSE INFORMATION BELOW. PRINT
CORRECTIONS AND ADDITIONS AT RIGHT.
SIGN AND RETURN APPLICATION WITH FEE (AND PENALTY).
LICENSE WILL BE MAILED TO YOU UNLESS YOU ARE NOTIFIED
TO APPEAR FOR APPLICATION REVIEW.
LICENSE RENEWAL
=.REVIEW BELOW INFORMATION, PRINT CHANGES AT..RIGHT: -
f ,_ A . ) 0�Oi rJ
ATE OF BIRTH I PLACE OF BI
q lZJ / 4 � I �, fc, , i
,OME -ADDRESS
ANNUAL FEES
TYPE BUS. CLASS FEE PENALTY
HOME A $10.06 $5.00
SMALL B 15.00 7.50
*GENERAL C 50.00 25.00
'OVER 10 EMPLOYEES, OR EMPL WORK
OVER 120 MAN -MONTHS PER YEAR.
CLASS FEE PAID PENALTY PAID
BUSINESS IDENTIFICATION
,LISINESS NAME
0/1 ,s�c,nT,�
:ATURE OF BUSINESS
BUSINESS PHONE
1-7
-7 �-Cj /
;ASH. STATE TAX NR:
EMPLOYEES
ORGAN.
OCCUPANCY
TYPE ORGANIZATION
IF BUSINESS IS: TYPE CAPACITY
HOTEL/MOTEL L
NR OF ROOMS/UNITS
C - CORPORATION
APT. BLDG. A
NR OR APTS
L - LTD. PART
OFFICE BLDG. 0
NR OF OFFICES
P - PARTNERSHIP
RESTAURANT R
NR OF SEATS
S - SOLE OWNER
HOSP./NURS., HOME H
NR OF BEDS
SCHOOL S
NR OF STUDENTS
EMERGENCY NOTIFICATION
NAME AREA TELEPHONE
l) _pRWL 1HJ-Mn5— -2,L 7-74._;L%13
,2) 3A;.1 r4120L ��(,-(�117
OFFICIAL USE ONLY
F.I.R. CODE'
BLDG.
PERMIT
OCCUP.
'.U. PERMIT
LAND USE
ZONING
STAFF ACTION^
REVERSE APPL. NO.: `-! t 6 6
SIDE
DATE:
APPLICATION FOR'.
NEW ❑ LIC. LICENSE
7� BUS. RENEW YEAR
LICENSE NUMBER ^� ACTIOj� LA NEW BOS.
LB LID- RENEWAL.
LC
NGE
TE
CLASS::YEAF.EFFEIDATE 1./REASG, LIC. N0. SPEC
F
RECEIPT NO. DATE PAID L
PRINT 'X'
• 3 �- r ,t IN SPEC. BOX
FEE PAID PENALTY PAID FOR ISSUE OF
CORRECTED
4-0i�v i LICENSE WITH
'' I 'LC' ACTION.
LICENSE APPLICATION -AND CHANGES r.
PLEASE PRINT CLEARLY
2. APPLICANT
LAST NAME, FIRST INITIAL lm nQQAI
P
DATE OF BIRTH PLACE OF BIRTH
AY YE, STA�
MO;
? S� L �'IT
HOME ADDRESS
BLDG. NUMBER
STREET -
810
APT. NO.
CITY
STATE
ZIP CODE
f,_A0'h0 IlJIoS It I I I I I I I I IR
A��Zv
3. BUSINESS IDENTIFICATION
BUSINESS NAME (FULL)
C N -T I t, a ly 1 17 1
NATURE OF BUSINESS (DRUG STORE, CPA, ETC)
BUSINESS PHONE '
QI L7 rsN -T I eyT I g 1 ` c.
1-7 5 II I fq
WASH. STATE TAX NR. ANTICIPATED TYPE OF OCCUPANCY
(REGISTRATION) NR. EMPLOYEES ORGAN. TYPE CAPACITY
'z C7 C O I 0
F— ENTER APPLICABLE TYPES AND CAPACITY T T T
/4. BUSINESS.ADDRESS
BLDG. NUMBER STREET APT. N0.
--IZIU
L11-LICENSE MAILING ADDRESS
BLDG. NUMBER
I STREET h
APT. NO.
i I
2 W
CITY
STATE
ZIP CODE
0010 I S I I I I I I I I I I I
W I A
YUZO
5. EMERGENCY NOTIFICATION (IN EVENT OF FIRE, BURGLARY,
ETC.)
TELEPHONE
LAST NAME, FIRST INITIAL
AREA CODE
(1)
14 10 lin IP I S N P
2. 0 11
10 4 12 -li l
LAST NAME, FIRST INITIAL
AREA CODE
TELEPHONE
(2)
Iti I I LiLi kTi I I I I I I I 1Z
U
-] 1, f
CODE
1
COND. USE PERMIT
—IL-1-I
— 55 OFFICIAL USE ONLY
UNITS ._ BUS. 71
LAND USE'
BLDG. PERMIT
OCCUP. GRP.
ZONING
I 1 Y CLERK'S BE
r ;
NATURE SIGNATURE
\APPROVED DISAPPROVED ,DATE BUS. TITLE. _
E :E TURN TO CITY` L.ER11C
DATE 519a
FAA
BUILDING DEPART Applicant Fill
PERMIT APPLICATIUIi� Inside Heavy Lines'
NAME (OR NAME OF BUSINESS)
W MAILING ADDRESS
0 CITY TELEPHONE NUMBER
C,.V C r..
NAME
W ADDRESS
F
E 1 CITY - TELEPHONE NUMBER
NAME
0 ADDRESS'
1/V
It CITY TELEPHONE NUMBER
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U STATE LICENSE NUMBER CITY LICENSE NUMBER
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Legal Description of Property (Show Below or Attach Foul Copies)
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PUBLIC RIGHT OF WAY PER ORDINANCE NO.
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EXISTING RIGHT OF WAY
PROPOSED RIGHT OF WAY
DEFICIENCY OF RIGHT OF WAY
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STREET/UTILITY WORK REQUIRED
$YES ❑NO
PERMIT FOR WORK IN PUBLIC R/W
9YES ONO
UNDERGROUND WIRING REQUIRED
RYES El NO
CONNECTION TO SANITARY SEWER
®YES ❑NO
SEPTIC TANK PERMIT REQUIRED
❑YES �I NO
SEPTIC TANK PERMIT NO.
SEE MEMO DATED
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REMARKS
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CHECKED BY
METER SIZE BUILDING SUPPLY SIZE
fI' IY4.y MI►J
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SIGN AREA ENV. REVIEW
ALLOWED I PROPOSED I COMPLETE[ EXEMPT
REMARKS
VARIANCE OR CU [PLANNING REVIEW BY IDATE
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❑ GAS
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NON-RESIDEN TIAL
❑ SIGN
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ADD DEMOLISH
0 RETAINING
SPECIAL INSPECTOR
a ALTER a EXCAVATE
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FENCE
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REQUIRED. ,
❑ YES NO
PLAN CHECKED BY
❑ R[PAIR � PRE -MOVE
IINSP.D
swim
POOL
REMARKS
Z NUMO[R OP STORIES
NUMBER
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DWELLING
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4 NATURE dir WORK TO BE DONE
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••Apph,rnt, on hchalf of his or her spouse, heirs, assigns and
suti:c%wrs In mte:c%i, ajgrvv, to indemnify, defend and hold harmless
the City of 1 dnlonds, Washington, its officials, employees, and
agents from any and all k1aims for damages of whatever nature,
armnh dre.atly or nulrl rlly [nun. the issuance of this permit. Issu-
ance of .tin% prnnu s11.111 11„1 be deemed to modify, waive or reduce
any le,luu,•nn'nt „f any city ordinance nor limit in any way the
('II�'a .J �!i' • I„ ,•,Il.,r, r .�n� ��nlinanrr prnvisinn.•.
MECHANICAL
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
' / LOT COVERAGE
/O SIDE aD REAR
OF CONSTRUCTION CODE HEIGHT
— N I`i 7L 2 5 el
AREA OCCUPANCY OCCUPANT
GROUP i LOAD
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
VALUATION
FEE
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/ROK f. MIGULETUN
r'- WAYNE JONt
tUYU H. Ntt-:ON
Rea, W&dd&eaw ce j`�-� aC aee'-t tC. ENGINEERS • SURVEYORS • PLANNERS
324 Main Street o Edmonds, Washington 58020 • Q061 775.3434
LEGAL DESCRIPTION
FOR
LaPIERRE
PARCEL 1
May 19, 1977
Job No. 5098B
Lots 1 & 2, Forshee's Upland Tracts according to the plat thereof recorded in
Volume 13 of Plats on page 57, records of Snohomish County, Washington.
EXCEPT that portion of said lot 2 lying north.of the easterly production of.the
south line of lot 3 in said plat and lying westerly of a line parallel -v4ith and
165.0 feet easterly as measured along the north line of said lots 2 b 3, of the
west line of said lot 3;
ALSO, that portion of Tract 2 Solner's Five Acre Tracts according to the plat
thereof recorded in Volume 7 of Plats on page 25, records of Snohomish County,
Washington lying northerly and westerly of a line which begins at a point on
the north line of said Tract 2, S88052114"E 585.0 feet from the northwest corner
of lot 3 of said Forshees Upland Tracts; thence SO°25'10"W, parallel with the -
west line of Tract 2, a distance of 125.00 feet; thence S69°28'5,1"W 291.38 feet
to the west line of said Tract 2 at the southeast corner of lot 1 of said
Forshees Upland Tracts and the terminus of the line herein described;
Situated in Snohomish County, Washington.
PARCEL 2 L ?; r- 1978
All of. Tract 3 and that portion of Tract 2, Solner's Five Acre Tracts according to
the plat thereof recorded in Volume 7 of Plats on page 25, records of Snohomish
County, Washington lying southerly and easterly of a line which begins at a point
on the north line of Tract 2, S88052'I1I"E 585.0 feet from the northwest corner of
lot 3 of Forshees Upland Tracts according to the plat thereof recorded in Volume 13
of Plats.on page 57, records of said County; thence SO°25'10"W, parallel with the
west line of said Tract 2, a distance of 125.0 feet; thence S69°28'51"W 291.38 feet
to the west line of said Tract 2 at the southeast corner of lot l of said Forshees
Upland.Tracts and the Lelminus of the line herein described.
Situated in Snohomish County, Washington.
PARCEL 3
Tract 4, Solner's Five Acre Tracts, according to the .plat thereof recorded in
Volume 7 of Plats on page 25, records of Snohomish County, Washington.
EXCEPT the west 100.0 F,.ot of the north 216.0 feet; and
1 1 1 • 91'� i 1
Date
l 44kess
�i
Street Right -of -Way -.Existing
REQD
Access Easements Existing' /Ald,E
REQD --
Utility. Easement Existing �S
.� Jbgj�up READ
Lot per Subdivision Plat Assessor Map
zSite
Plan' Checked for Accuracy
62--ZR-7 r
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Underground Wiring Regd.
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Check Accuracy of Legal Description-,Zq..7
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Environmentally Sensitive Area,1�
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Envirornnental Checklist Reqd.
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Flood Hazard Zone
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Shoreline Management Area
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Slope, Soil, Vegetation
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Stream, Creek, Drainage Basin
-Existing .Zon-ing Per -Code
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Amenitie.s-Design Board Approval Regd.
S ADB # Approval* "5
Board of Adjustment Approval Reqd.
-L%U
Review By: q/,
Date:
Existing Water Main Size
Water Main Reqd.
x Service Line Reqd.
w Hydrant Size Existing
F' Hydrant Reqd. Per Fire Code Size
Detector Check Meter Reqd.
3
Cross Connection Inspection
Fire Department C orients
Water Meter Charge Reqd. 466aw3l?
Review by: Date: /- - 7 9
oepLic ianx liesign tipprovea Late:
Septic Tank Permit Reqd. Permit No.
Sanitary Sewer Availability Proj.
a Drawing No. File No.
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Side Sewer Availability��
w Sanitary Sewer Connection Fee Reqd.
Review By: %' Date: % _ 3 ' 72
1!
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Open Ditch Existing_ Reqd.
Culvert Reqd.
s �4
Catch Basin Reqd. In rate on Site Plan
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Shoulder drainage wintai.n co lection on swale open runoff
.Mm-ihole . re d
q ��. Indicate on Site Plan
Soil Conditions and Ground Water Field Checked .
Review by. �,� Date
Street Paving Reqd. %��,cv �� ,f�,y��/
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Curb and Gutter Reqd.
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Sidewalk Reqd.
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Curb Cut for Driveway Reqd.
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Right -of -Way Construction Permit.Regd. rc
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Bond Reqd. for Public Improvements
Street Name Sign Reqd.
Other Signing Reqd.
Q Pre Permit Site Inspection made on
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BY: SS ER
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ENGINEERING
1.4 Special Requirements listed in memo to Com�unity Development Department,
Building Division
BY Date
o All items filled in on Building Permit Application
r.
BY Date
a' Drawings Stamped and Notations de
w BY
Date
Approved by Public Works Department
Revised: lv 10-1977
CITY of EDMONDS
200 Dayton Street • Edmonds, Washington 98020 • Telephone (206) 775-2525
Department of Pubiic Works
DATE: /- 3- % a1
TO:
TRANSMITTING:
AS YOU REQUESTED: FOR YOUR FILE:
FOR YOUR INFO-, REVIEW & COMMENT:
AS WE DISCUSSED: COMMENT F, RETURN:
FOR YOUR APPROVAL: FOR APPROPRIATE ACTION: -
REMARKS: ,12�0,,&L�T.� cam. 7uT3L/G
T C-55 7.-W.la-,c
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PUBLIC WORKS DEPARTMENT
BY.
MEMO TO
FROM
SUBJECT:
•
Date J-.3-79
Building Division
Community Development,Department
Engineering Division
Public [,forks Department
` rD
After review of the subject building permit application, we have the
following comments:
/V% Coordination of the location of any structure with respect to
7' utilities, streets, property lines and driveway grades is the
responsibility of the contractor.
The contractor is required to keep the abutting streets cleaned
�of dirt and debris caused by the construction.
The "Right -of -[Jay Construction Permit" is required, from the
Engineering Division of Public Works, for any work within the
Public Right -of -Way or public easement.
Driveway slope not to exceed 14%.
Connection to sanitary sewer required.
Septic Tank Permit required, submit design.
Fire hydrant required, submit design.
Site, drainage per.code #jCj See approved plans
Curb Sidewalk Paving required.
Bond required for public improvements. Submit cost estimate.
Underground wiring required.
Approved Engineering Plans required.when,applicable.
For Fred F. Herzberg, P.E.
City Engineer
Rev. 7/78
Department of Public Works