1050 5TH AVE S (4)_RedactedIr
CITY OF EDMONDS
BUSINESS LICENSE APPLICATION - COMMERCIAL
FEE: $125.00
CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION
y 121 5TH AVENUE NORTH, EDMONDS, WA 98020 PHONE 425.775.2525
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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. 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_ 1 V CJY-(Ae^ L LO,
BUSINESS ADDRESS O J l J t Cd ((yn�_WA (3 90 2 0
-7 a Street , _ Suite # City. State, Zip /Coode n
MAILING ADDRESS ' 1 a 2-4 5c-)in kr� Lane-, ` ,�1� � I'-� (A)A 'i q Z.�-
���// __ �yStreettoor PO tBox # suite # Cil , Sta(e, Zip Code
BUSINESS PHONE( (awlD It � O I O — J 1 Z WA STATE TAX ID # (UBI) 4001271 1 3111,73
BUSINESS E-MAIL Y-%n nV C�10(( )� _ N LDYYbUSINESS WEBSITE L� LL1VI
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BUSINESS OWNER / MAIN CONTACT 15t,44,, C) N �[' r r 7�{ i �n (� - ^! Z
c �] Phone Number
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PROPERTY OWNER �JQ NiG1 Y L� l .' dC ���� f ?l%�D 1 `l b'7
Name Phone Number
EMERGENCY NOTIFICATION (For Premise Access in Emergency):
�V ILA 7—drY'1 r '242((Y
Last Name First Name MI Phone Number
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Last Name First Name MI Phone
,Number
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NATURE OF BUSINESS (Provide a Detailed Description of Business Activities, Products & Services): E?!L� ES I Y 3 alri et
021> tx.n r r/Ot�n -rv>O.In� bul I5;;L(no
SPACE ALTERATIONS TO BE MADE: YES _NO7)� DESCRIPTION
PREVIOUS BUSINESS AT THIS
NUMBER OF EMPLOYEES
SQUARE FOOTAGE OF BUSINESS
TYPE OF BUSINESS - PLEASE CHECK APPROPRIATE CATEGORY:
❑ CONSTRUCTION
❑ FINANCE, INSURANCE, REAL ESTATE
❑ LANDSCAPE, HORTICULTURAL
❑ MANUFACTURING
❑ NON-PROFIT
❑ RETAIL
❑ SECONDHAND DEALER
❑ SERVICES
❑ WHOLESALE
OTHER Teo-Q V,&
PROPOSED OPENING DATE:
BUSINESS HOURS:
DAYS OPEN:
❑ SUNDAY ❑ WEDNESDAY
❑ MONDAY ❑ THURSDAY
❑ TUESDAY ❑ FRIDAY
❑ SATURDAY
AMUSEMENT DEVICES ON PREMISES? YES NO)� IF YES, TOTAL NUMBER LIQUOR SOLD ON PREMISES? YES NO-X-
GAMBLING? YES_ NO --/ CIGARETTES SOLD ON PREMISES? YES N
FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED? YES NO-X- IF YES, PLEASE PROVIDE A LIST OF MATERIALS AND QUANTITIES:
PARKING SPACES ON SITE: TOTAL SPACES ACCESSIBLE SPACES FOR HANDICAP PARKING
DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES? YES NO
APPLICANT
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