8525 186TH ST SW (3)_RedactedIIII�lIII SZ5- sirsw
., '} EDMONDS
BUSINESS LICENSE APPLICATION — HOME OCCUPATION Building
� � Engineering
FEE: $100.00 Fire
Planning
CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION Police
121 5TH AVENUE NORTH, EDMONDS, WA 98020 PHONE 425.775.2525
_.._.----OFFICE USE ONLY
BL#
Customer #
SIC Year Class Sector 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 if business changes location or ownership. Notification to City of Edmonds required if business closes. License
expires December 31" each year. Renewal must be submitted prior to January 31" to avoid late fees.
BUSINESS
BUSINESS
MAILING ADDRESS 50iW"lW r,
f Street or PO Box # Suite # ( j I
City..jSune, Zip CodeBUSINESS PHONED`']1 ajC,� O��rt WA STATE TAXIDD# (UBI) I (r, (('l 1 l.I� I 1 1 � g®BUSINESS E-MAIL Wi�N 1�U61NESS WESSIITEE-144�'�L I �. { la "-1
PROPERTY OWNER i' i C.Vi fY�f�1 r 1�1� tiL1� t iA?C r 'z.'X0 --n li,, 1
EMERGENCY NOTIFICATION (For Premise Access in
Last
Last Name
Name
NATURE OF BUSINESS (Provide a Detailed Description of Business Activities, Products & Servtoes)
St° c U-1 U S- -Q� l , ONn t nek.J'gkX Z d \ . S CC
., Uv i r-1 Cd
SPACE ALTERATIONS TO BE MADE YEStiJ NO --A%— DESCRIPTION
PREVIOUS BUSINESS AT THIS ADDRESS- PS
NUMBER OF EMPLOYEES----Q_ SQUARE FOOTAGE OF BUSINESS SPACE__
TYPE OF BUSINESS — PLEASE CHECK APPROPRIATE CATEGORY
CONSTRUCTION
FINANCE, INSURANCE, REAL ESTATE
LANDSCAPE, HORTICULTURAL
MANUFACTURING
NON-PROFIT
RETAIL
SECONDHAND DEALER
SERVICES
WHOLESALE
OTHER
Number
PROPOSED OPENING DATE. ►I(�%11 4(2%15 pM
BUSINESS HOURS - it oo r1 � — 6 •Q'D [ 1
DAYS OPEN,
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
1%THURSDAY
iAFRIDAY
SATURDAY
AMUSEMENT DEVICES ON PREMISES? YES NO IF YES, TOTAL NUMBER LIQUOR SOLO ON PREMISES? YES NO
GAMBLING? YES_ NO --)AL CIGARETTES SOLD ON PREMISES? YES NO 1
FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED? YES No IF YES, PLEASE PROVIDE A LIST OF MATERIALS AND QUANTITIES:
Applications may be mailed in with a check, brought in person, faxed to 425-771-0266 or emailed to business.IlcensgQedmondswa.sov
with a valid phone number. We will call you for a Visa or MasterCard payment.
ADORESS
STREET SUITPAPTRINITF GRY/STATMPCODE
HONE PHCNEI I _DRIVER'S LICENSE OR 10 o S STATE_
PARTNERSHIP -PARTNER 7
NAME
LAST
FIRST
MIDDLE BUT
ADDRESS
STREET
SUITEIAPTIUN1Ti
CTTYISTATENUPGODE
HOLE PHONE(
1
DRIVERS' LICENSE OR ID F B STATE
DATE OF OWN
CT'ISTATE OF BIRTH COUNTRY OF BWTN
PARTNERSHIP- PARTNER Y
NAME
LAST
FIRST
MICOLEINITIAL
ADDRESS
STREET
SUITEAPTNNITR
CIIYSTATEUDP CODE
HOME PHONE(
1
DRIVER'S LICENSE OR ID• l6TATE
DATE BIRTH
ITY TATE FBIRTH
COUNTRYOFBRTH
CORPORAITON/I LLC or PLLC
N;
LF+'`1"�
�Z- Nplo3sb
NAME OFCORPORATIIONy
F,(EDDER/A�LgTMOk
[y f
CORP ADDRESS DS/S' �LLI� Jl. JW
SbM
Suile. Apt "A
,IC y, Sbte aM LP Cmie PM eNumMr
CORPORATE OFFICERS
Limit Wme ,). \ FlM"
'T
LOCALCONT`ACT
MI Toe
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04reCs Lcense or Othw ID YI SMe
Pbane Numw
CITY USE ONLY.
BUILDING DEPT. APPROVE DISAPPROVE
OCCUPANT LOAD _ BUILDING PERMIT_
1&1GINElARG Q APPROVE 0 DISAPPROVE DATE _SIGNATURE
ARE DEPT Q APPROVE O DISAPPROVE DATE SIGNATURE
PLANNING De" 0 APPROVE 0 DISAPPROVE
POLICE DEPT 1:3 APPRCVE Q DNAPPROVE DATE SIGNATURE_
CITY OF EDMONDS
QUESTIONNAIRE FOR ADMINISTRATIVE HOME OCCUPATION PERMIT
Yes No
1. IS ❑ Will the home occupation be carried on exclusively by a family member(s) residing in the dwelling unit?
2. C! 4 Will there be employees working at or visiting the subject property, who are not family members residing at the residence?
3. ❑ 12 Will there be customers or clients visiting the property?
4. 52( ❑ Will the home occupation be conducted entirely within the structures on the site, without any significant outside activity?
If no, please explain:
5. ❑ 9"' Will there be heavy equipment, power tools, or power sources associated with the home occupation?
If yes, please list types:
6. ❑ V Will vehicles be used in conjunction with the home occupation?
If yes, please list all types, including gross vehicle weight of trucks:
7. ❑ l" 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:
8. ❑ t1 Will the home occupation create noise or vibration?
—/ If yes, please explain:
9. ❑ lY Will the home occupation produce dust, odors, or smoke?
If yes, please explain:
10. ❑ Q Will the home occupation create any glare on public streets and neighboring properties, such as from lighting, welding, etc.?
If yes, please explain:
11. ❑ Will flammable and hazardous materials be handled or stored on the property?
If yes, please explain:
12. ❑ N( Will materials in conjunction with the home occupation be stored outside of the dwelling?
If yes, please explain how and where:
13. ❑ Ig) Will 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: ," tPA,,�
Name (Printed)
Signature
b/1-7115