18915 SOUNDVIEW PLF \j e-W 'Phl�ce-
RECEMED
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CITY OF EDMONDS
Cl Building
MAY 10 2018BUSINESS LICENSE APPLICATION 0 Engineering
FEE: $125.00 0 Fire
13 Planning
DMONDS CjW CU 0 Police
"*CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION
AVENUE NORTH, EDMONDS, WA 98020 PHONE 425.775.2525 L
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. Please advise of any change In status. Now license required it
business changes location or ownership. Notification to City of Edmonds required If business closes. License expires December 31" each year. Renewal
must be submitted orlor to January 31" to avoid late fees.
BUSINESS
BUSINESS
MAILINGADDRESS
Street or PO Box # Suite City, State, Zip Code
BUSINESS PHONE�Q� WA STATE TAX ID # (UBI) I G I D I q
BUSINESS E-MAIL Y\,&A4�kV7A\1) a—ZIABUSINESS WEBSITE
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BUSINESSO NER /MAIN CONTACT. -4
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PROPERTY OWNER :�'a
PREVIOUS BUSINESS AT THIS
NUMBER OF EMPLOYEES SQUARE FOOTAGE OF BUSINESS
TYPE OF BUSINESS — PLEASE CHECK APPROPRIATE CATEGORY:
OPENING DATE:
0
CONSTRUCTION
BUSINESS HOURS:
11
FINANCE, INSURANCE, REAL ESTATE
•
LANDSCAPE, HORTICULTURAL
DAYS OPEN:
•
MANUFACTURING
•
NON-PROFIT
o SUNDAY o WEDNESDAY
•
RETA IL
Lj MONDAY u THURSDAY
•
SECONDHAND DEALER
•
SERVICES
ciTUESDAY ci FRIDAY
•
)IQ
WHOLESALE
OTHER YA.iw-
o SATURDAY
AMUSEMENT DEVICES ON PREMISES7 YES— NO,2�_F YES, TOTAL NUMBER —LIQUOR
SOLD ON PREMISES? YES_ NOX
GAMBUNG?
YES_ No A, CIGARETTES SOLD ON PREMISES? YES NO )C'
FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED? YES— NO-X IF Z, PLEASE PROVIDE A LIST OF MATERIALS AND QUANTITIES:
PARKING SPACES ON SITE: TOTAL SPACES:�= ACCESSIBLE SPACES FOR HANDICAP PARKING ----5
DES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES? YES— NO—,)!C
APPLICANT
NAME
TITLE Printed Name DATE
Dw
K%Jvd
SOLE PROPRIETORSHIP
NAME "A'DIC2n I A\ r
LAST Z�oa
FIRST MIDDLE INITIAL
ADDRESS lE4VkAA :74
STREET- W-WMAPTIUNIT4, GnMMTEqJP CODE -
HOMEPHONE�--�—
�—�NERS LICENSE OR IDS& STATE
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DATE OF—Bf��f �31 (46WITYISTATIE OF WRTHBA hU845, I "AA —COUNTRY OF WTH A
NAME
LAST FIRST PADDLE INITIAL
ADDRESS
STREET SUrMAPTIUNIT III CrrYfSTATE/ZIP CODE
HOME PHONE( I ------DRIVERS LICENSE OR ID S & STATE
DATE OF SIRTH _CITYISTATE OF BIRTH_COUNTRY OF
PARTNERSHIP - PARTNER 2
NAM
LAST FIRST MIDDLE INITIAL
ADDRESS
STREET SLKTEfAl5tA—)Nff # CITYISTATEIZIP CODE
HOMEPH RIVER'S LICENSE OR ED # & S
CORPORATION/ LLC or PLLC
NAME OFCORPORAT FEDERALTAXID#
CORPADORESS
Street SuNa,ApL Unit# CRY, Stste and Zip Code Phone Number
CORPORATE OFFICERS:
Last Name First Nam MI Tide oftofftlh DdWs Lioense or Other V# I Stab
LOCALC
LastName First Nam L41 Tide Diftofelft
DrIver's License or Otw CW / State Phone Number
r— I
CITY USE ONLY:
BUILDING DEPT. F7 APPROVE ED DISAPPROVE DATE —SIGNATURE
OCCUPANT LCAD— BUILDING PERMIT OCCUPANCY GROW
COMMENTS
ENGINEERING
APPROVE
DISAPPROVE DATE —SIGNATURE
FIRE DEPT
APPROVE
DISAPPROVE DATE SIGNATURE
U.F.1,R.
COMMENTS
PLAPINNG DEPT.
APPROVE
DISAPPROVE DATE —SIGNATURE
ZONING CODE CONDITIONAL USE PERMIT.
POLICE DEPT. APPROVE DISAPPROVE DATE SIGNATURE_
COMMENTS
1171 im 1-1,v
KX1124NALLIVED
MAY 10 2018
CITY OF EDMONDS EDMONDS CiTy CIUK
QUESTIONNAIRE FOR ADMINISTRATIVE HOME OCCUPATION PERMIT
too,
Yes No
1. ZLJ Will the home occupabon be carried on exclusively by a family member(s) residing in the dwelling unit?
2. 0 13"Will there be employees working at or visiting the subject property, who are not family members residing at the residence?
3. Ll ar"Will there be customers or clients visifing the property?
4. EVIL] Will the home occupation be conducted entirely within the structures on the site, without any significant outside activity?
If no, please explain:
5� El
01**�Will there be heavy equipment, power tools, or power sources associated with the home occupation?
If yes, please list types:
6. 0 OKWIII vehicles be used in conjunction with the home occupation?
If yes, please list all types, including gross vehicle weight of trucks:
7. 0 llr�Will there be deliveries made to the property by commercial vehicles in excess of 20,0GO gross vehicle weight,
(example: standard UPS truck)?
If yes, please explain:
8. U dr000'Will the home occupation create noise or vibration?
If yes, please explain:
9. 0
Er'o'Will the home occupation produce dust, odors, or smoke?
If yes, please explain:
10. El J"'Will the home occupabon create any glare on public streets and neighboring properties, such as from lighting, welding, etc.?
If yes, please explain:
11. L] 9"Will flammable and hazardous materials be handled or stored on the property?
If yes, please explain:
12. Ll ak"Will materials in conjunction with the home occupation be stored outside of the dwelling?
If yes, please explain how and where:
13. 0 03 Will there be a sign on the property in conjunction Mth 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 K false or misleading information is
provided. Violation of any of the conditions and requirements of ECDC Chapter 20.20 MI result in the loss of his/her business license
and the forfeiture of any fee paid.
APPLICANT