2010-05-03 HEX# 10-003 Exhibit KEX ii cc1�
(For office use only)
FWRL # 20- _0__ -! O� 6L
BUSINESS LICENSE APPLICATION
Please type or print clearly in dark ink-
*ew Application ❑Update Application/Address Change
Federal Way Business CT Outside Contractor Home Occupation ❑Other
SECTION A — Business Information - PtPasP cnMn,AfP ail i„f„r. of; --
Business Name
WA State UBI # (1-800-647-7706)
-7bs- alb.
Business Address (Street/Suite# - Physical Location) Are you currently occupying this address? Yes ❑No
30-60-6 A" _ Nvz-S
City
State
w K
Zip
(1.10 63
Business Phone #:
`a.5 3 - (o 6 1 -
Mailing Address #
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City p
t'C.t�-�u-•Q, W U,
State
L.aJ y,
Zip
t� 0 0�.�
Business Fax #:
3 t - � a a
Is this a Non -Profit Organization established for educational,
Number of persons employed in Federal Way:
religious, or charitable purposes? ❑Yes tHNo
#_ _ Full Time # ` Part Time
Is there Liquor served on the premise? ❑Yes AlNo
Is there Gambling activities? ❑Yes j$No
If yes, State Liquor License #
If yes, State License #
SECTION B — Description. of Business — describe in detail your business activities -including
which category - retail, wholesale, or services.
M0.�v,e r e��e
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SECTION C — Business Ownership -Attach additional pages if necessary.
❑Sole Proprietor ❑Partnership OCornnrmfion 'Ml imitt3cl i iat,ility "Kann -profit rlrlthnr
Company Name
(As registered with WA State): Cc c-41,
Number of Owners, Partners,
or Corporate Officers:
Date Business began
or will be in in FW:
Name: Jit
.
Driver License#/State:Birthdate:n'�
Sw►�i>J 1� Utz z�
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Home Address (Street/PO Box, City, State, Zip)
Telephone Number: % Owned:
Name:
Title:
D iver License#/State:
Birthdate:
Home Address (Street/PO Box, City, State, Zip)
Telephone Number:
% Owned:
Name of Emergency Notification/Contact:
Telephone No.. -
SECTION D — Business Location - Some improvements to your business may require separate
permits. riease contact line community Development permit counter at (253) 835-2607 for more information.
King County Parcel #: Are you making tenant improvements? Yes ❑No
IO
Building. �6ingle Tenant Floor Space Used Name of Business Center (if applicable):
OMultiTenant for Business Sq. Ft.): SO !7 Sat �4
Does building/premise have If Yes, monitored by City alarm registration no,
a security alarm system? DYes I 'No
JCt, I IVw L: - nacatUUUS IVIUMU 115 - I-tequtrea Dy the t;tty of I-eaeral way ana Fire uepartment.
Does your facility currently report to the Federal Way Fire Department under Sara Title III? DYes JVNO
Does your facility currently use or store flammable materials? ❑Yes A 1No
if yes, please list.
What types of hazardous materials and /or waste are used, stored, handled, processed, or generated by your
business? If additional space is needed, please attach a separate sheet(s) of paper_
What quantity (in gallons) of the above substance is stored on site at any given time?
(Excluding consumer commodities for household use packaged in quantities of less than five (5) gallons)
SECTION F — Home Occupation - if you are applying for an Adult Family Home or In -Home
Daycare please contact Community Development Department at 253-835-2607 for additional requirements.
Name all family members who reside at the home and work in the business, include yourself:
b
Name ofApartment/Townhouse Complex:(If applicable)
Complete Floor Space of Residence:
5
Will there be any outside storage of goods, display of materials or outside activity? ❑Yes P(No
If Yes, please explain:
Will the business require the use of heavy equipment, power tools or power sources not common to a residence?
❑Yes No , If Yes, pleas e ex Ip ain: .
Will there be any pick up or delivery by commercial vehicles? DYes o
If Yes, please explain type and frequency:
Will there be any visits to the home by clients, employee or delivery services? MYes ❑No
If Yes, please explain the number of deliveries expected: per week per month
Are there any conditions produced by the home occupation such as noise, vibration, smoke, dust, odor, heat, or glare
which would exceed that normally produced by a single residence, or which could create a disturbing or objectionable
condition in a neighborhood? ryes ❑No If Yes, please explain type and frequency:
SECTION G— Temporary Business Activity - Temporary Licenses are granted for a specific
penoa, ana are not to exceea vu aays in a calenaar
Description of Temporary Business/Activity:
Specific Dates of Temporary Activity:
Is site layout of area/structures provided? ❑Yes ❑No Signed Consent of Property Owner must be attached for
(including ingress and egress of area) approval. Copy of lease agreement is acceptable.
SECTION H — SIGNATURES
I (we) the undersigned, declare under the penalties of perjury and the denial of a license or revocation of any license
granted, that 1(we) am (are) the applicant(s) or authorized representative(s) of the firm making this application and that the
answers contained, including any accompanying information have been examined by me (us) and that the information set
forth is true, correct, and complete. I also understand that I am responsible for notifying the City Clerk, in writing, of any
change in location or mailing address within thirty days. All licenses are nontransferable. 1 understand my place of
business must comply with all federal, state, and local codes and ordinances.
X
of
Application prepared by (please print)
Title
Title
/ / e52t
Date
Phone Number
For offjce use only �7
Amount Received: (� Check No.: _ Date Received: r Receipt No..
Business License #: �" (U � \� 0 ('0 SIC CODE: Date License Issued:
Driver and Plate Search - Driver Information
Page I of 2
PtC: Name:
�-
SSN: Date of Birth:
SWAIN,ROY ANTHONY
Gender: M
Height: 5' 8"
Weight: 165 Eye Color: Blue(BLU)
Street: 11510 SW 326TH ST
City: JIFEDERAL WAY IState: WA
Zip Code: 1198023 -
County: King Country: USA
Out of State: Return to WA: CDL: 00000000
Restrictions: Motorcycle Endorsement: No
Last Trans: 32 - License Renewal
-- j�
Expires: 7/29/2013 Last Update: 16/17/2008 1.01:06 PM
No Driver History found
No Comments found
Street City County State Address Type Request Date Last Update
510 SW 326TH ST FEDERAL WAY King WA Historical (Std) 8/27/2003
PIC �j Transaction Code IlPrevious Transaction Codell Transaction Date I
https://transact.wa.gov/DOL-DAPS/DriverShow.asp'P1c=S WAINRA422M9&SessionID=... 4/26/20I0