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CITY OF EDMONDS
BUSINESS LICENSE APPLICATION— COMMERCIAL
FEE: $125.00
CITY CLERICS OFFICE, BUSINESS -LICENSE DIVISION
�"�•la9° 121 5' AVENUE NORTH, EDMONDS. WA 98020 PHONE: 425.775.2525
OFFICE USE ONLY
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INSTRUCTIONS: Please complete the application In full and attach the faquired floor plan. Middle Initial or name required of all
parties concerned. If no middle name; please indicate by writing NMN. Sign and return application with fee. Please advise of -
Any change In status. New license required if business changes location or ownership. Notification to City of Edmonds required
if'business closes.
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BUSINESS ADDRE
MAIUNG ADDRESS 'P. o . 'Box 1911c Fd aid IA A q to &0
Street or PO Box Suite NcL City, State and Zip Code
BUSINESS PHONE NO. (J�L# S 1 23$ - 412 13 WA STATE TAX ID NO. (UBI NO.) _ to03 — 1'74 ^ -7 ?.3
BUSINESSE-MAIL S.'%;n k.loizBUSINESSwEBsrrE At'.IN�-7 `
PROPERTY OWNER - WQevor Sr o=P^ly-oli TG cow AS — Leaunq, c.6 q G2 (�•d �5)
Name V U Phone Number
EMERGENCY NOTIFICATION (For Premise Access in Emergency):
Last Name) FIrst Name MI Phone No.
Last Name First Name MI Phone No.
NATO"URE OF BUSINESS CI>�1 11� 4� o r •Wr 42r f� t9i)CLf' 1 nQed i - f r9G� l✓bt�
NUMBER OF EMPLOYEES 3 SQUARE FOOTAGE OF BUSINESS SPACE 79,1
TYPE OF BUSINESS - PLEASE CHECK THEAPPRpPRIATE CATEGORY-
0 CONSTRUOTiON ' O FINANCE. INSURANCE, REAL ESTATE. ' O LANDSCAPE, HORTICULTURAL O MANUFACTURING O NON-PROFIT
,O RETAIL O SECONDHAND REALER "ERVIGES O WHOLESALE O.OTHER
AMUSEMENT DEVICES 0103kiMISES? .O YES kwo . IF YES. TOTAL NUMBER
LIQUOR SOLO ON PREMISE9?:• OYES • 6i'NO.' GAMBUNG? O YES 0#0 CIGARETTES SOLD ON PREMISES? OYES JVNO
Fi_AMMABIP OR HAZARDOUS MATERIALS USED OR STORED?: O YES ENO IFYES; PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES:
PROPOSED OPENING DAY -OF BUSINESS BUSINESS HOURS !I C) avN • UCJ oM
DAYS OPEN O SUNDAY MONDAY 9 TUESDAY (7 WEDNESDAY AMUR$DAY . W FRIOAY - O SATURDAY
PARKING SPACES ON SITE TOTAL ACCESSIBLE FOR PERSONS WITH DISABILITIES
DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES?. pN YES O NO
PREVIOUS BUSINESS USE ATTHIS ADDRESS r1 Q '4
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