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CITY OF EDMONDS
BUSINESS LICENSE APPLICATION —HOME OCCUPATION
FEE: $65
CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION
121 5T" AVENUE NORTH, EDMONDS, WA 98020 PHONE: 425.775.2525
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MAY
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UTIL BILL
OFFICE USE ONLY
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3
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Year
9
Class
SHD
Date Paid
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INSTRUCTIONS: Please complete the application in full and attach the additionally required Administrative Home Occupation
Permit application. 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.
BUSINESS NAME NI,JIJ 1 El
BUSINESSADDRESS ��Z3 I�EY STP_f5GV
Street \\ Suite No. Zip Code
MAILINGADDRESS \OL-J 'OkL-Gy S_TR— E�T E:DM0Q0 S .s LK--* C1£ CZ0
Street or PO Box Suite No. City, State and Zip Code
BUSINESS PHONE NO. (.200 ) ZJF63 . (07-9- - WA STATE TAX ID NO. (UBI NO.) (o029292_44
BUSINESS E-MAIL MAIN- I-tt • 60W) BUSINESS WEBSITE
PROPERTY OWNER (200 ) 3�3 •%Z ��
Name Phone Number
EMERGENCY NOTIFICATION (For Premise Access in Emergency):
"CF , 'p, l) A, M 1 k ( 2 Cro) 2 .3 i
Last Name First Name MI Phone No.
Last Name First Name Mi Phone No.
NATURE OF BUSINESS P\Q L.Lt_-C F-N M � L_y AiDMF-;
NUMBER OF EMPLOYEES I SQUARE FOOTAGE OF BUSINESS SPACE 1602
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 O WHOLESX
ALE OTHER ADLu ��I�tLy --fib" G
FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED?: O YESNOIF YES, PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES:
AS &MIJ NS Xm 6-7 67T L I CtENXC-
PROPOSED OPENING DAY OF BUSINESS BUSINESS HOURS 24
DAYS OPEN SUNDAY MONDAY. � TUESDAY WEDNESDAY �THURSDAY )�!RIDAY S
ATURDAY
ADDRESS
Sneer Apt No. Unit No. Cily. Sets and Zip Cole
HOME PHONE NO DOL NO. OORIVERS LICENSE NO.) OR OTHER ID NO.
DATE OF BIRTH CITY AND.STATE OF BIRTH COUNTRYOFSIRTH
PARTNERSHIP-PARTNERI
NAME
Lad
First
MI
ADDRESS
Brad
Apt No., Unit No.
City, State and Zip Cole
HOME PHONE NO( 1
DOL NO (DRMERS UCENSE NO.)OR OTHER 10 NO.
DATE OF BIRTH
CITY AND STATE OF BIRTH
COUNTRYOFBIRTH
PARTNERSHIP -PARTNER]
NAME
Lasl
First
MI
ADDRESS
Street
Apl. No.. Unit No.
City. Stets and ZIP Code
HOME PHONE NO.(
DOL NO. (DRIVERS LICENSE NO.) OR OTHER ID NO.
DATE OF BIRTH
CITY AND STATE OF BIRTH
COUNTRY OF BIRTH
/�� CORPORATION
NAMEOFCORPORATION Al%36le5 CY{ GA&0 QIEL'�) Ap", LLC. FEDERALTA%ID
CORPORATE OFFICERS:
Lad Name Find Name MI Title Dale or Ginn DOL No.(DRrcrs License No.) or OlM1er ID No
K'4�LLW% kK:I' "TPr _,�_ meinNImAK
LOCAL CONTACT MAP
(�
Last Name
Find! Name
MI Ties
Pecne No,
DOL No. (Drivers Lie. No.) or Ctnd lD No.
CITY USE ONLY:
PLANNING DEPT.
D APPROVE
O DISAPPROVE
DATE
SIGNATURE
ZONING CODE
CONDRIONALUSEPERMIT
COMMENTS
BUILDING DEPT.
0APPROVE
0DISAPPRCVE
DATE
SIGNATURE
OCCUPANT LOAD-
BUILDING PERMIT
OCCUPANCY GROUP
COMMENTS
FIRE DEPT.
CIAPPROVE
ODISAPPROVE
DATE
SIGNATURE
UF,IR.
COMMENTS
POLICE OUT.
0APPROVE
0DISAPPROVE
DATE
SIGNATURE
COMMENTS