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APR 2 7 2018 CITY OF EDMONDS
BUSINESS LICENSE APPLICATION - COMMERCIAL 0
cin FEE: $725.00 0 FHk
CITY CLERK'S OFFICE, BUSINF..SS LICENSE DIVISION � Pfnnnrnq
7 i'Wna
121 5TM AVENUE NORTH, EDMONDS, WA 98020 PHONE 425,775 2525
_ OFFICE USE ONLY _
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INSTRUCTIONS; Please complete the application In lull and attach the required floor plan. Middle initial or name required of all parties concerned. It 1 0
twiddle name, please indicate by writing NMN. Sign and return application with fee. Please addlss of any change in status. A4ew ikM~ required if
but Iness changes location or ownership. tiomation to City of Edmonds required If business closes. 1_icense expires Docornber 31" each year. Renewal
must be auhmltted prlor to Mortuary 31" to avoid hate tsea-
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BUSINF.•SS ADDRL:Ss---------------
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Last NA c First Name ARS Phone Number
Last Nsrrle 6nst Name Sall Pixxre Numi] F
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NATURE OF 8USINESS-{Provide a Qytailed DesctrpWrn of Business Ar, livi0es, Products 6 Sanroea) -. /.1Z'rrP Jf IL _ / /j' f_'f�. fIA'3e. FeN!
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SPACE ALfERAIiONS TO BE MADE YES NO ✓ DESCRIPTION
PRFMUS SU,5iNE,3S AT Tk1S ADDRESS
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A%IUSI MFNT DEVICES ON 9RFMISFS7 YES -__ � NO%_ i; Y{.S TOtAI NUMBER _ LIQUOR SOLD ON PREMISES? YES P40
GAMBLINW) YES_ ._ Np s/ CIGAREI IES SOLD ON PRE MiSE.S7YES _ NO ti! _...-
F I AMMABLE OR HAZAROOUS MATFRtALS USED OR STORED7'(ES NO r' IF YES. PLEASE PROVIDE A LIST OF MATERIALS AND QUANTITIES:
PARKING SPA: ES: ON SrTE TOTN. SPACESi � ACCESSIBLE SPACES KAI HANDICAP PARKING
iiOES Tilt: BUSINESS CON FAIN AN ENTRANCE ACCESSIBLE TO PER SONS WITH DISABILITIES? YES ✓ HC
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RECEIVED
APR 27 2018
SOLE PROPRIETORSHIP
NAME_ _ EDMOIVB_S cm am
FIRST —" MIDDLE INITIAL
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STREET FLIICOPiINJII9 CIrv1STAiSIZIP COOL - - -
HOW. PHDNG(_, 1 ,_ DRIVERS LICENSE OR ID Ed STATE
DATE OF Bill T11_ _CITY/STAIECFBIRIM COUNTRY OF BIRTH
PARTNERSHIP wPARTPIIEIR 1
NAME
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COMMENTS
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APPROVE
DISAPPROVE DATE __.__SIGNATURE_...
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PLANNING DEPT
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4RECEIVED
APR ?72018 Washington State Department of Health
EDIPWU's Crff cum
Secretary
By Elie authority of R W 18.06 this person
danika Cheryl Yuko odama
is granted a
East Asian Medicine Practitioner License
Stafus
ACTIVE
E fe(7 ive JDate
0510712017
Do not let your credential expire!
You must make sure the Department of Health has
your renewal before your license expires. It is a
violation of the law to practice without a current
license and you may be subject to disciplinary action.
A timely postmark on your renewal will not prevent
an expired credential.
Renewals sent by mail cake about two weeks to
process.
Initial Issuance
12/27/201 a
Credential Number
AC 60201872
Expiration Date
05/28/2018
Personal Copy of Your Credential
Washington State Department of Health
BN (lie autPaOrky of RCw 118.06 [his person
Oanika Cheryl Yuko Qdama
is granted a
East Asian Medicine Practitioner License
SMUT . CrederVad Nu1'r0ei
ACTIVE AC $4 of m
w4. Exi);re;i¢n pate
05/2312018
You are responsible for knowing all laws and rules related to East Asian medicine practitioners.
Sign tip now to receive notifications when laws and rules change:
http:l/fistserv.wa.gov/cgi-bin/wa?S U B EO I =ac u puncture &A=1
You can view the current RCWs and WACs at:
http://www.d vh.wa.gov[LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/
E astAs is rt Med i cine P ract i t i over[Laws
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