1029 MAPLE ST_RedactedFjjjj[[jjr/0Zq lnl�Oltt__ sT
CITY OF EDMONDS
BUSINESS LICENSE APPLICATION — HOME OCCUPATION ❑ ❑ EBuding
nEngnes
gineering
FEE: $100.00 ❑ Fire
' •� ^' CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION ❑ Planning
❑ Police
121 5TM AVENUE NORTH, EDMONDS, WA 98020 PHONE 425.775.2525
OBE USE -ONLY
BL#
Customer #
SIC
I rYIear
Class
SHD
I Date Paid
TR#
Fee
Mailed
Deleted
INSTRUCTIONS: Please complete the application in full and attach the required Questionnaire for Administrative Home Occupation Permit 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 It business changes location or ownership. Notification to City of Edmonds required if business closes. License
expires Decem 31 t each year. Renewal must be submitted prior to January 31 to avoid late fees.
BUSINESS NAME e-i-1-� W �1 q 11+ lD e 5 i +�1 S
BUSINESS
MAILING
C1 A441 Ole_ <+-
mA pl � �(-•
W 01 NO
PT)DnCI S, WA • q 70.20
•gyp/ Street or PO( Box N Suite # - City, State, Zip Code
BUSINESS PHONED �iRY t 3a� / • -/ I 1 1 WA STATETAX ID # (UBI) � 0 �Ja 0�_ 1_ G� � !� /1
BUSINESS EMAIL b W 1 a b c�,Jma 1 • (� Wi BUSINESS WEBSITE._bP h w ri -*+des I • C rvi T
PROPERTY OWNER W ►!! h+16+;d01q V) 1 W) 111 A W1 jl✓J^ A/() r NZS, 3Z9 �i ! L SL
Name Phone Number
NOTIFICATION (For Premise Access in En
4Z5-, L(4 5" .ESL 4
�n o mrsr Name M1 Phone Number
WYi Sh'}' IAA✓�r�'M-1 K) B-di�' r NZS�1 3zq - GI / G�
Last Nam First Name I /�,,� ,.PhooneNumber L
NATURE OF BUSINESS (Provide a Detailed Description of Business Activities, Products & Services): /`fY 4_ 410 Ce4 LT I ir M
o•
SPACE ALTERATIONS TO BE MADE: YES_NO�N ESCRIPTIO
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
Fe-115THER
0
PROPOSED OPENING DATE: 1 ! T�
BUSINESS HOURS: N 1 A
DAYS OPEN: M A
❑ SUNDAY ❑ WEDNESDAY
❑ MONDAY ❑ THURSDAY
❑ TUESDAY ❑ FRIDAY
❑ SATURDAY
AMUSEMENT DEVICES ON PREMISES? YES NO L--IF YES, TOTAL NUMBER LIQUOR SOLD ON PREMISES? YES NO 4--
GAMBLING? YES_ NO-4.,1-11'GARETTES SOLD ON PREMISES? YES NO
FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED? YES NO YES. PLEASE PROVIDE A LIST OF MATERIALS AND QUANTITIES:
APPLICANT
Q� ,,jam --=.._..
NAME k7C� L . - WA h -f - �ia�zlvy�a W
TITLE �%P� 1 C DATE Signature
f- 1 AHldvnnK) &reh A-,
ST FPST MUDDLE NRNL
/Ylti�le 54-• Edmunds, w✓+
PARTNERSHIP- PARTNER 1
NAME
LAST
FVUTT
MIDDLE INNIAL
ADDRESS
STREET
SUNEIAPTNNR#
CRYSTATErID CODE
HOME PHWEI
1
DRIVERS' LILENSE OR U# S STATE
DATECFBIRTH
CRYISTATE OF BIRTH COUNTRY OF BNTH
PARTNERSHIP -PARTNER 2
NAME
43F
FIRST
MIDDLE INITIAL
ADDRESS
STREET
SDTEIAPTNINIT#
CRY/STATE4VP CODE
HOME PHONE(
I
DRIVER'S LICENSE OR D##STATE
DATE OF 8RT1
r"MINATE OF MRTN COUNTRY OFNRTH
NAME OFCORPORATION
CORRADORESS
CORPORATION/ LLC or PLLC
FEDERALTMDIA
SBaM
CORPORATE OFFICERS:
Leal Name Fee Name
SWb.Aµ"S OW.SMbaeEZ4CWe Fl,me Number
MI Title WNWEA Drrveh Um wmer O#/&eu
LOCAL CONTACT
Leal Name Fee Name
MI TWO DaemGmh
( 1
0#eafe License u ONer p#ISLM
Phme Number
Cm USE ONLY:
BUILDING DEPT.
APPROVE
DILPPROYE DATE
SIGNATURE
OCCUPANTLGAD
WILDINGPERMR
OCCUPANCYOUOUP
COMMEN S
ENGINEERING
Q APFRWE
Q
OISAPPi%aVE MTE
SIGNATURE
FIRE DEPT.
APPROVE
0
DISAPPROVE DATE
SIGNATURE
U.F.I.R.
COMMENTS
PLANNINGOEPT.
Q MPROVE
Q
DSAPPRWE MTE
SIGNATURE
ZONING CODE
_
CONDRpNAL USE PERMIT
COMMENTS
POLICE DEPT.
0 mFFROJE
Q
OSAPPRWE MTE
SIBfMTUfO:
COMMENTS
CITY OF EDMONDS
QUESTIONNAIRE FOR ADMINISTRATIVE HOME OCCUPATION PERMIT
Yes No
1. iJ ❑ Will the home occupation be carried on exclusively by a family member(s) residing in the dwelling unit?
2. ❑ U�I'Will there be employees working at or visiting the subject property, who are not family members residing at the residence?
3. 0 111, Vill there be customers or clients visiting the property?
4. p�0 Will the home occupation be conducted entirely within the structures on the site, without any significant outside activity?
If no, please explain:
5. ❑ 1111'"Will there be heavy equipment, power tools, or power sources associated with the home occupation?
tf yes, please list types:
6. ❑ ❑ Will vehicles be used in conjunction with the home occupation?
If yes, please list all types, including gross vehicle weight of trucks:
7. U,-❑ Will there be deliveries made to the property by commercial vehicles in excess of 20,000 gross vehicle weight,
(example: standard UPS truck)?
If yes, please explain:/ 5 4r ► ' C 1-4.
B. ❑ ill the home occupation create noise or vibration?
If yes, please explain:
9. ❑ 12"'WiII the home occupation produce dust, odors, or smoke?
If yes, please explain:
10. ❑ Q-4II the home occupation create any glare on public streets and neighboring properties, such as from lighting, welding, etc.?
If yes, please explain:
11. ❑
1111-"'Will flammable and hazardous materials be handled or stored on the property?
If yes, please explain:
12. ❑ C9 ill materials in conjunction with the home occupation be stored outside of the dwelling?
If yes, please explain how and where:
13. ❑ tg- '\Arill there be a sign on the property in conjunction with the home occupation?
If yes, please describe:
The undersigned applicant for a business license certifies that the information provided within this application is correct and accurate.
The applicant acknowledges that his/her business license is subject to suspension or revocation if false or misleading information is
provided. Violation of any of the conditions and requirements of ECDC Chapter 20.20 will result in the loss of his/her business license
and the forfeiture of any fee paid.
APPLICANT: LD C. "C
Name (Printed)
Signature
Date