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CITY OF EDMONDS �-
BUSINESS LICENSE APPLICATION— COMM ERCIAB C EIVED
FEE: $125.00
CITY CLERK'S OFFICE, BUSINESS•LICENSE DIVISION 'FEB 10 2012
114,1890 121 5' 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.
BUSINESS NAME I4ar6o4&r Tvtveste"em+- Mama jerheri+j LLC
BUSINESS ADDRESS I 10 TA VM et S+. 111 98 O 2 0 '
Street Suite No. Zip Code,
MAILING ADDRESS 2722 Col by Ave- 520 e"'t147 WA 98201
Street or PO Box Suite No. City, State and Zip *14Code„.I.� 6 Z S� 20.12
BUSINESS PHONE NO. I'I( 2 S 1 7 41- — 15 ? % WA STATE TAX ID NO. (UBI NO.) 6 02. D & 9 702—
BUSINESS E-MAIL eri icA (9hpv loon✓ i nveA, c lvj BUSINESS WEBSITE h A.
PROPERTY OWNER _ e F CA -• L L. C. t 4 Z. 5)% Lfd— 9& 6 0
Name Phone Number
EMERGENCY NOTIFICATION (For Premise Access in Emergency):
hill Erika L 2( 0& ), 522-4248
Last Name First Name MI Phone No.
gerkeh'koff FFAns 0 y( 2S )�45'-10LI8
Last Name First Name Mi Phone No.
NATURE OF BUSINESS R_e 9 1 S i-c ✓e d i hye SfVrn e vtt• -adt i s r R.
NUMBER OF EMPLOYEES 3 SQUARE FOOTAGE OF BUSINESS SPACE • 1 j 4 O 2-
TYPE OF BUSINESS - PLEASE CHECK.THEAPPROPRIATE CATEGORY:
O CONSTIfUCTIONINANCE, INSURANCE, REAL ESTATE. ' O LANDSCAPE, HORTICULTURAL O MANUFACTURING O NON-PROFIT
D RETAIL O SECONDHAND DEALER O SERVICES O WHOLESALE. ❑.OTHER
AMUSEMENT DEVICES'ON•PRE ISES7 .d YES 9<0 . IF YES. TOTAL NUMBER
LIQUOR SOLD ON PREMISES?:. OYES • @7 f0.GAMBLING? O YES IR<O CIGARETTES SOLD -ON PREMISES? O YES 040
FJ AMMA13LE OR HAZARDOUS MATERIALS USED 'OR STORED?: ❑ YES L -90 IF'YES; PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES:
PROPOSED OPENING DAB! OF BUSINESS 0 Z / 2% 1 2- BUSINESS HOURS 9 a Vv, — 1 P m
DAYS OPEN O SUNDAY Q*ONDAY afUESDAY O' IgIIEDNESDAY r9 fH-URSDAY O'FRIDAY • O SATURDAY
PARKING SPACES ON SITE: TOTAL Z. ACCESSIBLE FOR PERSONS WITH DISABILITIES
DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES?. 0r`YES O NO
PREVIOUS BUSINESS'USE AT THIS ADDRESS 7"k e- Hv 4e I C7 Vo u P
ADDRESS
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SIGNATURE'
Usable
Common
Rentable
Usable
Common
Rentable
10
2,987
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Usable 1,252
Common 150
Rentable I=
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Rentable
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Common 181
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