110 JAMES ST 104_1_RedactedRECEIVED
1 ID 3-4M t5 S+- I0�
8 16 2U$ CITY OF EDMONDS
BUSINESS LICENSE APPLICATION — COMMERCIAL
f Q S CrrY CLERIC FEE: $125.00
CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION
121 5T" AVENUE NORTH, EDMONDS, WA 98020 PHONE 425.775.2525
Building
Engineering
3 Fire
Planning
police
OFFICE USE ONLY
BL#
Customer #
S
SIC
I Year
v
;�s
Sector
Data Paid
, 1Paid
TR#
OL�Illa f(
Mailed
Deleted
INSTRUCTIONS: Please complete the application in full and attach the required floor plan. Middle Initial or name required of all parties concerned. I
middle name, please Indicate by writing NMN_ Sign and return application with fee. Please advise of any change in status. New license require
business changes location or ownership. Notification to City of Edmonds required If business closes. License expires December 31" each year. Rent
must be submitted prior to January 311" to avoid late fees.
BUSINESS NAME rS ,e r ■ l' r, ��� ( �- � oao)
BUSINES
MAILING
Street or PO Box #
BUSINESS PHONE( 3 :1 } 6acs a L401-1
BUSINESS
BUSINESS OWNER i MAIN CONTACT
NOTIFICATION (For Premise
Last
Last Name
First Name
First Name
Suite # City, State, Zip Code j
WA STATE TAX ID # (URI) toO j
_08U01 �&B
1 ti om
Phone Number
- MI Phone Number
MI Phone Number
NATURE OF BUSINESS (Provide a Detailed Description of Business Activities, Products & Services);
SPACE ALTERATIONS TO BE MADE. YES�NOA DESCRIPTION
PREVIOUS BUSINESS AT THIS ADDRESS NUMBER OF EMPLOYEES SQUARE FOOTAGE OF BUSINESS SPACE 109
TYPE OF BUSINESS - PLEASE CHECK APPROPRIATE CATEGORY:
CONSTRUCTION
FINANCE, INSURANCE, REAL ESTATE
LANDSCAPE, HORTICULTURAL
MANUFACTURING
NON-PROFIT
RETAIL
SECONDHAND DEALER
SERVICES
WHOLESALE
OTHER
PROPOSED OPENING DATE: t
BUSINESS HOURS: ,
DAYS OPEN; fit1 g -ew-9
❑ SUNDAY O} VEONESDAY
iMIONDAY THURSDAY
TUESDAY RIDAY
DL_SATURDAY
AMUSEMENT DEVICES ON PREMISES7 YES NO%IF YES, TOTAL NUMBER LIQUOR SOLI? ON PREMISES? YES NO_K_
GAMBLING? YES.— NO ()�_ CIGARETTES SOLD ON PREMISES? YES NO
FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED? YES NO� IF YES, PLEASE PROVIDE A LIST OF MATERIALS AND QUANTITIES -
PARKING SPACES ON SITE: TOTAL SPACES [r ACCESSIBLE SPACES FOR HANDICAP PARKING
DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES? YES K NO
APPLICANT
� (" ► CC-,t jv -
TITLE- Pa ---- �i.C3Y��I -•---- -.�DA
Applications may be mailed in with a check, brought in person, faxed to 425-771-0266 or emai led to bti inemlioen mend a. c
NAME A'ci \Y, y
LAST FIRST MIDDLE INITIAL
HOME
#8
PARTNERSHIP - PARTNER 7
NAME
LAST
FIRST
MIDDLE INITIAL
ADDRESS
STREET
SUITEIAPT/UNIT#
CITYISTATVZIP CODE
HOME PHONE(
1
DRIVERS LICENSE OR ID#B STATE
DATE OF BIRTH
CITYISTATE OF BIRTH COUNTRY
OF BIRTH
PARTNERSHIP - PARTNER 2
NAME
LAST
FIRST
MIDDLE INTIAL
ADDRESS
STREET
SUITEIAPTIUNIT 9
CITYISTATeZIP CODE
HOME PHONE(
1
DRIVERS LICENSE OR ID 985tATE
DATE OF BIRTH
CITYISTATE OF BIRTH _
COUNTRY OF BIRTH
NAME OFCORPO%bi
CORP ADDRESS
CORPORATION(LLC or PLLC
FEOERALTA%ID#
I
Steer
CORPORATE OFFICERS -
Last Name First Name
Suite. Apt Unit# City. StaeanpZipCOEe Phone Number
MI MISS Oaleof Birm Dria License or Other lD9 I State
LOCAL CONTACT
Last Name Firer Name
Mr Title Dale W BrM
I
Drivers Ucenne or ONer O#IStele
Phone Number
CITY USE ONLY
BUILDING UBET. = APPROVE 0 DISAPPROVE DATE — SIGNATURE
OCCUPANTLOAD
WILDING PERMIT
OCCUPANCYGROUP
COMMENTS
ENGINEERING
Q
APPROVE
Q DISAPPROVE
DATE
SIGNATURE
FIRE DEFT
APPROVE
DISAPPROVE
DATE
SIGNATURE
U E I.R..
COMMENTS
PUNNING DEFT.
APPROVE
Q DISAPPROVE
DATE-
SIGNATURE
ZONINGCODE
CONDITIONAL USE PERMIT_
COMMENTS
_
POLICE DEPT
APPROVE
Q DISAPPROVE
DATE
5IGNATURE_..
CD ', r 1
C
12'-
TR
I T-
BF
v
12•
118'= i'•O'
D A' S'
POWER/SIGNAL PLAN
SCALE: 1 /8'= V-O"
MOINS„HNLAM
NOTE!
THIS PRELIMINARY SPACE PLAN REPRESENTS OUR UNDERSTANDING OF THE SPACE PROGRAM REQUIREMENTS AND
INCLUDES OUR INTERPRETATIONS OF LOCAL BUILDING CODE REQUIREMENTS. THE FINAL CONSTRUCTION DOCUMENTS ARE
SUBJECT TO REVIEW AND COMMENTS FROM THE LANDLORD AS WELL A$ LOCAL GOVERNMENTAL AGENCIES. CHANGES TO
THE PLAN MAYBE REQUIRED TO ADDRESS COMMENTS AFTER REVIEW OF THE PLANS THROUGH THE PLAN CHECK PROCESS -
ALL SPUARE FOOTAGES NOTED ARE PRELIMINARY AND ALSO MAY CHANGE WHEN THE SPACE PLAN IS FINALEZED.
POWER SIGNAL NOTES
PROVIDE NEW DUPLEX ELECTRICAL OUTLET AT THIS LOCATION.
PROVIDE NEW DEDICATED DUPLEX FOR TENANT PROVIDED COPIER,
O
PROVIDE NEW PHONE/DATA OUTLET FOR TENANT PROVIDED COPIER.
-s'
®
RELOCATE QUAD OJTLET FR0M ABOVE COUNTER TO TB"AFF. PROVIDE
PHONE/DATA OUTLET AT THIS LOCATION.
5
RETROFIT BLANK OUTLETS TO ELECTRICAL/PHONE/DATA,
8
PROVIDE DUPLEX OUTLET FOR TENANT PROVIDED REFRIGERATOR IF ONE
DOES NOT EXIST.
LEGEND
E.
EXISTING
_1• N
NEW
110v. DUPLEX RECEPTACLE, MOUNTED VERTICALLY AT +18'
A.F.F., U O.N.
DEDICATED 11Ov./2O AMP DUPLEX RECEPTACLE, MOUNTED
VERTICALLY AT +18' A.F.F., U O.N.
11OY. DUPLEX RECEPTACLE, MOUNTED 6' ABOVE COUNTER
OR SPLASH.
11Ov. FOURPLCX RECEPTACLE, MOUNTED AT +18" A.F.F„ U.O.N.
C0MBINATDN TELEPHONE/DATA OUTLET MUD RING,
WALL -MOUNTED AT 18" A.F,F„ U.O.N. PROVIDE PULL
ROPE TO ABOVE ACCESSIBLE CEILING SPACE.
BLANK PLATE
TEST FIT
CENTER FD8 F#IIQETY_& pEPIlESSION
I10-JAMES STREET,_SUITQ04 EDMONDS _WA