120 W DAYTON ST STE D4 (2)1ZU w DaS7- Sr- D N
q( ddo 07 —
CITY OF EDMONDS
BUSINESSiLICENSE APPLICATION- COMMERCIAL
FEE: $125.00
CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION
121 5' AVENUE NORTH, EDMONDS. WA 98020 PHONE: 425.775.2525
OFFICE USE ONLY
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INSTRUCTIONS: Please complete the application In full and attach the required floor plan. Middle Initial or name required of all
parties concerned. If no middle name, please Indicate by writing NMN. Sign and return application with fee. Pismo advise of
any change to status. Now license required If business changes location or ownership. Notification to City of Edmonds required
If business closes.
BUSINESS NAME Wibu-Systems'USAInc.
BUSINESS ADDRESS 120 West Dayton Street 0-4 98020
Street Suite No. Zip Code
MAILING ADDRESS PO Box 1687 0-4 Edmonds, WA 98020
Street or PO Box Suite No. City, State and Zip Code
BUSINESS PHONE NO. ( 425 ) 775-6900 WA STATE TAX ID NO. (UBI NO.) 602119 550
BUSINESS E-MAIL info@wibu.us BUSINESS WESSITE wwW.Wtbu.us
PROPERTY OWNER Port of Edmonds ( 425 t 774-1511
Name Phone Number
EMERGENCY NOTIFICATION (For Premise Access in Emergency):
Buchheit Marcellus ( 206) 355-3930
Last Name First Name MI Phone No.
Buchheit-Ekdahl Lisa ( 206) 914-7141
Last Name First Name Mi Phone No.
NATURE OF BUSINESS Wholesale of computer security and software license products (CodeMeter,
WibuKey etc.) to US and Canada customers, technical support
NUMBER OF EMPLOYEES 7 SQUARE FOOTAGE OF BUSINESS SPACE 1215
TYPE OF BUSINESS - PLEASE CHECK THE APPROPRIATE CATEGORY:
O CONSTRUCTION O FINANCE, INSURANCE, REAL ESTATE O LANDSCAPE, HORTICULTURAL O MANUFACTURING O NON-PROFIT
O RETAIL O SECONDHAND DEALER O SERVICES CKWHOLESALE O OTHER
AMUSEMENT DEVICES ON PREMISES? O YES CXNO IF YES, TOTAL NUMBER
LIQUOR SOLO ON PREMISES?: O YES OPIO GAMBLING? O YES QNO CIGARETTES SOLO ON PREMISES? DYES IX NO
FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED?: O YES MNO IF YES, PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES:
PROPOSED OPENING DAY OF BUSINESS 2010-Sep-01 BUSINESS HOURS 6 AM to 8 PM
DAYS OPEN O SUNDAY OLMONDAY QTUESOAY a WEDNESDAY A THURSDAY 10 FRIDAY O SATURDAY
PARKING SPACES ON SITE: TOTAL (shared) ACCESSIBLE FOR PERSONS WITH DISABILITIES (shared)
DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSI8LE TO PERSONS WITH DISABILITIES? IXYES O NO
PREVIOUS BUSINESS USE AT THIS ADDRESS (unknown)
NAME
Last First MI
ADDRESS
Street Apt No., Unit No. City. State and Zip Code
HOME PHONE NO I ) DOL NO. (DRIVERS LICENSE NO.) OR OTHER ID NO
DATE OF BIRTH CITY AND STATE OF BIRTH COUNTRY OF BIRTH
PARTNERSHIP -PARTNER 1
NAME
Last
Fist
MI
ADDRESS
Street
Apt No., Will No.
City, State and Zip Code
HOME PHONE NO (j
DOL NO. (DRIVERS LICENSE NO) OR OTHER ID NO.
DATE OF BIRTH
CITY AND STATE OF BIRTH
COUNTRY OF BIRTH
PARTNERSHIP - PARTNER 2
NAME
Last
First
MI
ADDRESS
Street
Apt, No.. Unit No.
City. State and Zip Code
HOME PHONE NO
DOL NO. (DRIVERS LICENSE NO.) OR OTHER 10 NO
DATE OF BIRTH
CITY AND STATE OF BIRTH
COUNTRY OF BIRTH
NAME OF CORPORATION Wibu-Systems USA Inc. FEDERAL TAX ID N091-2124740
CARP ADDRESS 120 West Dayton Street. Ste D4t Edmonds WA 98020 PHONENO 2�5-6900
Street Suite. Apt, Unit No, City, Slate and Zip Code
CORPORATE OFFICERS
Last Name First Name MI Title Date of Dinh DOL No (Drivers Lioense No.) at Other ID No
Buchhelt Marcellus President & CEO 1962-Aug-16 BUCHHMS385NW
LOCAL CONTACT (see President & CEO)
Last Name First Name MI titie Piton DOL No. (Drivers Lk. No.) or Other ID No
APPLICANT Marcellus Buchhelt President & CEO a10
Nam -Printed Cum Title 08N
PLANNING DEPT
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O DISAPPROVE
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ZONING CODE
CONDITIONAL USE PERMIT
COMMENTS
BUILDING DEPT.
O APPROVE
O DISAPPROVE
DATE
SIGNATURE
OCCUPANT LOAD
BUILDING PERMIT
OCCUPANCY GROUP_ —
COMMENTS
FIRE DEPT,
(I APPROVE
n DISAPPROVE
DATE
SIGNATURE
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COMMENTS
POLICE DEPT.
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