22315 HWY 99 STE OZZ,31
OFEDMONDS
CITY
1A%r,C1FJVE PUSINESS LICENSE APPLICATION
COMMERCIAL
DEC 2 2016 FEE: $125.00
Ago CITY CLERK'$ OFFICE, BUSINESS LICENSE DIVISION
4,4'.o *'
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. AOTH AVENUE NORTH, EDMONDS, WA 98020 PHONE 425.775.2525
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0171TIV1,111170 FC11 It 1 t;jj2M OFFICE USE ONLY
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ustomer#
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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. ffno
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't each year. Renewal
must be submitted prior to January 31" to avoid late fees.
BUSINESS NAME Eq.-I MA1481 MagAu-: LLC
BUSINESS
Street
City, State. Zip
WA
MAILING ADDRESS 22 S/5— lZM141ww -?�9. 0 Zbn/7A11) 5: IAIA
Street or PO Box Suite City, State, Zip Code
WA STATE TAX ID # (UBI)
BUSINESS PHONE(UL 1 1610141101:514 -15 1;�]
BUSINESS E-MAIL 9cw i �a-nzL;� a in ot (in yr, BUSINESS WEBSITE
BUSINESS OWNER / MAIN CONTACT 8M en
Name Phone Number
EMERGENCY NOTIFICATION (For Premise Access in
Last Name First Name MI
Name MI Phone Number
NATURE OF BUSINESS (Provide a Detailed Description of Business Activities, Products & Services):
Mm&::L e,71*Fr SAMP, A4,ipg-gy ONU S/&V&-�
SPACE ALTERATIONS TO BE MADE: YES--Q— DESCRIPTION
PREVIOUS BUSINESS AT THIS ADDRESS —
NUMBER OF EMPLOYEES -
SQUARE FOOTAGE OF BUSINESS
TYPE OF BUSINESS - PLEASE CHECK APPROPRIATE CATEGORY:
0 CONSTRUCTION
L-1 FINANCE, INSURANCE, REAL ESTATE
Li LANDSCAPE, HORTICULTURAL
n MANUFACTURING
L1 NON-PROFIT
4A RETAIL
* SECONDHAND DEALER
* SERVICES
r] WHOLESALE
13 OTHER
PROPOSED OPENING DATE 17-111 2&t(-
BUSINESS HOURS: 140!60 .4A4 )70 7.1
DAYS OPEN:
Mr SUNDAY A WEDNESDAY
GeMONDAY & THURSDAY
JILTUESDAY e FRIDAY
14SATURDAY
AMUSEMENT DEVICES ON PREMISES? YES----CN9—IF YES, TOTAL NUMBER LIQUOR SOLD ON PREMISES? YES— t42-
GAMBLING? YES�-- Ni!�— CIGARETTES SOLD ON PREMISES? YES W—
FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED? YES—(0 IF YES, PLEASE PROVIDE A LIST OF MATERIALS AND QUANTITIES:
PARKING SPACES ON SITE: TOTALSPACES e� ACCESSIBLE SPACES FOR HANDICAP PARKING 2—
DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES? YES 1�— NQ_
APPLICANT
NAME —
Printed Name .Signature
TITLE_ 1316619EQ DATE 11 0 ( (I.,
Applications may be mailed In with a check, brought in person, faxed to 425-771-0266 or emailed to business.licenseC&edmondswa.itov
with a valid phone number. We will call you for a Visa or MasterCard payment.
k
SOLE PROPRIETORSHIP
NAME
LAST FIRST MIDDLE INITIAL
ADDRESS
STREET SUITE/APT/UNIT# CrrY/STATEIZIP CODE
HOME PHONE( DRIVERS LICENSE OR ID # & STATE
DATE OF BIRTH CITYISTATE OF BIRTH —COUNTRY OF BIRTH
PARTNERSHIP - PARTNER I
NAME
LAST
FIRST
MIDDLE INITIAL
ADDRESS
STREET
SUITEfAPT/UNIT#
CITY/STATEIZIP CODE
HOME PHONE(
I
—DRIVERS LICENSE OR ID * & STATE
DATE OF BIRTH
CITY/STATE OF BIRTH - -- - COUNTRY OF BIRTH
PARTNERSHIP - PARTNER 2
NAME
LAST
FIRST
MIDDLE INITIAL
ADDRESS
STREET
SUITEJAPTIUNIT #
CITY/STATEIZIP CODE
HOME PHONE(
I
—DRIVER'S LICENSE OR ID # & STATE
DATE OF BIRTH
CITYISTATE OF BIRTH
—COUNTRY OF BIRTH
CORPORATION/ LLC or PLLC U, C
NAME OFCORPORATION.— 1AJ R2,80-8� flAV,1)-)'WAC7-f10AW'1 FEDERAL TAX D#
CORP.ADDRESS 99, 0 6oz!206�'Ps"WA (&4)
Street Suite, Apt Unit# City, State and Zip Code Phone Number
CORPORATE OFFICERS:
Last Name First Name MI Title D IBIrlh Driver's License or Other ID# /State
A la� -a 6wewel? 167'0*3167-2- AU:�E�&A>A 2=!gQ-
LOCAL CONTACTMI - �q6 7 PT) ). -1 /9 7-L-
7,� Idle 5
Last Name First Name MI Title DateofB!rth
EE
Driupr'-q I loansp or Other IDS/ State Phone Number
CITY USE ONLY:
BUILDING DEPT. APPROVE DISAPPROVE DATE SIGNATURE—
OCCUPANTLOAD BUILDING PERMIT.
OCCUPANCYGROUP
COMMENTS
ENGINEERING APPROVE DISAPPROVE DATE SIGNATURE —
FIRE DEPT. APPROVE DISAPPROVE DATE SIGNATURE—
U.F.I
COMMENTS
PLANNING DEPT. APPROVE DISAPPROVE DATE SIGNATURE
ZONING CODE CONDITIONAL USE PERMIT COMMENTS
POLICE DEPT. APPROVE DISAPPROVE DATE SIGNATURE
COMMENTS
4
RECEIVIED
DEC 2 �2016
IDMONDj
FAX COVER SHEET Unaaw
- --------------
Send to: City Of Edmonds
From-, Nori Coulon
Attention: Cbelsea Merritt
Date: 1212/16
Office Location:
Offlee Location: Capstone Commercial RE
Fax Number: 425-771-0266
Phone Number: 206-321-0415
RE: Plum Tree Plaza Suite 0 Site Plan
Pages- 2 including cover page
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ZI PIC�L$e C�)Illrneilk
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Hello Chelse.a-
The following page is a site plan showing Suite 0 at Plum Tree Plaza located at 22315
Highway 99 N., Edmonds, WA for the purpose of a business license for Taj Mahal
Handicrafts Marble, LLC- We do not have a separate floor plan for the space. Please let
me know if you need any other information.
Thank you,
Nod Coulon
Property Manager/Broker
Capstone Commercial Real Estate Advisors
206-321-0415
nori@capstonerea.coni
Plum Tree Plaza
Site Plan
t
N
-S&
N
DEC 2 2016
EDMONAS crr
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FIRE PREVENTION
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Serving Briei: Edmonds, and
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FIRE DEPARTMENT COPY