1160 EDMONDS STi
n
CITY OF EDMONDS —
y` ` - BUSINESS LICENSE APPLICATION — HOME OCCUPATION
FEE: $100.00 ❑ Building
❑ Engineering❑ Fire
CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION ❑ Planning
121 5TH AVENUE NORTH, EDMONDS, WA 98020 PHONE 425.775.2525 ❑ Police
OFFICE USE ONLY
L# Customer # SIC I Year clam I can --- ray _
INSTRUCTIONS: Please complete the application in full and attach the required Questionnaire for Administrative Home Occupation Permit. Middle initial
or name required of all parties concerned. If no middle name, please indicate by writing NMN. Sign and return application with fee. Please advise of any
change in status. New license required If business changes location or ownership. Notification to City of Edmonds required If business closes. License
expires December 31'I each year. Renewal must be submitted prior to January 31' rn Muni,, I... f—
BUSINESS
BUSINESS
MAILING At
BUSINESS
BUSINESS I
PROPERTY
EMERGENC
Last
or
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NOTIFICATION (For Premise Access in Emergency):
JO1e a City, State, Zip 4� fF
Code
WA�S�TA�TE�T/A,%X'ID # (�U,B`Iy)�'�) V � OEL7OH]
,_ r • r80 4SSWEBSITE A[�{
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Pe NNumber���
Last Name First Name MI Phone Number
NATURE OF BUSINESS (Provide a Detailed Description of Business Activities,. Products & Services):
/1 -- I L•_ I t I _ a r. r
SPACE ALTERATIONS TO BE MADE: YES_kd'Y DESCRIPTION U
,
PREVIOUS BUSINESS AT THIS
NUMBER OF EMPLOYEES SQUARE FOOTAGE OF BUSINESS
TYPE OF BUSINESS - PLEASE CHECK APPROPRIATE CATEGORY:
❑
CONSTRUCTION
❑
FINANCE, INSURANCE, REAL ESTATE
❑
LANDSCAPE, HORTICULTURAL
❑
MANUFACTURING
❑
NON-PROFIT
❑
RETAIL
❑
SECONDHAND DEALER
SERVICES
WHOLESALE
❑
OTHER
PROPOSED OPENING DATE:
Ot
BUSINESS HOURS:
DAYS OPEN:
hSUNDAY
WEDNESDAY
MONDAY
THURSDAY
TUESDAY
FRIDAY
0 SATURDAY
AMUSEMENT DEVICES ON PREMISES? YES NO IF YES, TOTAL NUMBER
GAMBLING? YES_ NO --MATE
CIGARETTES SOLD ON P ISES? YES N \%LIQUOR SOLD ON PREMISES? YES NO
FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED? YES NO V IF YES, PLEASE PROVIDE A LIST OF MATERIALS AND QUANTITIES: I S.
m
Signature
.,
0
w
HOME PHONE j V DRIVER'S LICENSE OR ID # S STATER f�—' —[J I — 4
DATE OF BIRTH i� bDCITY/STATE OF BIRTH , COUNTRY OF BIRTH
PARTNERSHIP - PARTNER 1
NAME
ADDRESS
LAST
FIRST
MIDDLE INITIAL
STREET
SUITE/APT/UNIT #
CITY/STATE/ZIP CODE
HOME PHONE(
1
DRIVERS' LICENSE OR ID # & STATE
DATE OF BIRTH
CITY/STATE OF BIRTH COUNTRY OF BIRTH
PARTNERSHIP - PARTNER 2
NAME
ADDRESS
LAST
FIRST
MIDDLE INITIAL
STREET
SUITE/APT/UNIT #
CITY/STATE/ZIP CODE
HOME PHONE(
1
DRIVER'S LICENSE OR ID # & STATE
DATE OF BIRTH
CITYISTATE OF BIRTH COUNTRY OF BIRTH
CORPORATION/ LLC or PLLC
NAME OFCORPORATION. FEDERAL TAX D#.
CORP.ADDRESS ( )
Street Suite, Apt. Unit# City, State and Zip Code Phone Number
CORPORATE OFFICERS:
Last Name First Name MI Title DateotBirth Driver's License or Other D # /State
LOCAL CONTACT
Last Name First Name MI Title Dateof Birth
If
Driver's License or Other D # /,Stale Phone Number
CITY USE ONLY:
BUILDING DEPT.
APPROVE
0 DISAPPROVE
DATE
SIGNATURE
OCCUPANT LOAD
BUILDING PERMIT
OCCUPANCY GROUP
COMMENTS
ENGINEERING
Q APPROVE
Q DISAPPROVE
DATE
SIGNATURE
FIRE DEPT.
0 APPROVE
0 DISAPPROVE
DATE
SIGNATURE
U.F.I.R.
COMMENTS
PLANNING DEPT,
Q APPROVE
Q DISAPPROVE
DATE
SIGNATURE
ZONING CODE
CONDITIONAL USE PERMIT
COMMENTS
POLICE DEPT. 0 APPROVE Q DISAPPROVE DATE SIGNATURE
COMMENTS
CITY OF EDMONDS
QUESTIONNAIRE FOR ADMINISTRATIVE HOME OCCUPATION PERMIT
Yes No
1.X ❑ Will the home occupation be carried on exclusively by a family member(s) residing in the dwelling unit?
2. ✓✓✓❑ Will there be employees working at or visiting the subject property, who are not family members residing at the residence?
3. ❑ Will there be customers or clients visiting the property?
4. ❑ Will the home occupation be condo ted entirely within the strucjures on the site, without any significant outside activity?
/. j, If no, please explain:. lu� f Ise 1�, to IdlieA Oz4a'1jeS
5. ❑ Will there be heavy equipment, power tools, or power sources associated with the home occupation?
If yes, please list types:
6. ❑ Will vehicles be used in conjunction with the home occupation?
If yes, please list all types, including gross vehicle weight of trucks:
7. ❑ Will there be deliveries made to the property by commercial vehicles in excess of 20,000 gross vehicle weight,
(example: standard UPS truck)?
If yes, please explain:
8. ❑ Will the home occupation create noise or vibration?
If yes, please explain:
g. ❑ Will the home occupation produce dust, odors, or smoke?
If yes, please explain:
10. ❑ X, Will the home occupation create any glare on public streets and neighboring properties, such as from lighting, welding, etc.?
If yes, please explain:
11. ❑ k Will flammable and hazardous materials be handled or stored on the property?
If yes, please explain:
12. ❑ YWill materials in conjunction with the home occupation be stored outside of the dwelling?
If yes, please explain how and where:
13. ❑ Will there be a sign on the property in conjunction with the home occupation?
If yes, please describe:
The undersigned applicant for a business license certifies that the information provided within this application is correct and accurate.
The applicant acknowledges that his/her business license is subject to suspension or revocation if false or misleading information is
provided. Violation of any of the conditions and requirements of ECDC Chapter 20.20 will result in the loss of his/her business license
and the forfeiture of any fee paid.
APPLICANT
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