10720 Vancil Rd SE, Apt B-104 C ITY O F YE LM OFFICIAL USE ONLY
�O'� ��A�~`'� 105 Yelrn Ave. W. ReCBY35.00
q q Yelm, WA 98597 Comm Dev.Dept.
a �� (360) 458-8437 OFFICE Bldg Dept. I Iy I f
(360) 458-4348 FAX Insp.Date
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Lic.No.
YELM APPL6CA1'ION FOFt
WASHINGTOP7 BIJSItVESS LICEtVSE ����
Upon receipt of the license application and $35.00 payment, the City of Yelm will conduct an inspection of
the premises for building and fire code conformance. Upon approval from the Yeim Building Department
of said premises, the City Clerk's Office wil( process the application and mail license to applicant at
address listed below.
Applicat0�n as hereby rnatle for a �usiness License for the City of Ye6�
�. NEW�IISIlVESS � NAME CFIAMGE/MA9L6�1(9 ADDFiESS CIi�4NGE ONLY
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�USINESS N�4ME
N��'URE OF �t1SINESS � u �� t cL� �j d�
�USSNESS LOCA'9"IOt�I ADD9iESS .!
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Ma41LING ADDI2ES�
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EMA�L.AD�iiESS " C ��'�
�lNT9CIPATED OPENING DATE �� `(/ ` 1c5�
DAVS � FIOURS O OPERATION �"�f'� " ��`/ �� �l'.�� l� � � �
owN�t��s� -/r �
Adcdress_ _�G���� � rYi �,/� C7����
TELEPHONE
�� ��SY%r(���5� CI� .�(���� ����� c�Z'�
(Business) ��-� � �3�� (Home/Emergency)
CONTfZACTOR'S REGBSTFZAT90N NO.
(if applicable)
THURSTON CO. HEALTH APPROVAL NO.
STATE OF WASHINGTON STER BUSINESS LICENSE NO. (UBI}��� -Z(p Ce, �, / �,e
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Signature�'��J --G�`f ' Date � � `—���
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S�.�t� Busin��� Re�+�r�.s Da�abase D+�t�il
TAX REGISTI�ATIOM MO: 60�4i�667G ACCOUNT DPEMED: 01�'Oi j2015 12:O�D:�UQ AM
UBI: 603�66676 AtCOUNT CLOSED: OPEN
ENTITY N�kME: MOOFtE AAROfM 7
�USINESS NAME: h1UORE MOBILE ME�CHaMIC
MAILIMG ADDRE55: BUSINE55 LO�CATION:
10720 YANLIL RD SE APT B 104 10720 YaNCIL RD SE APT B 1 U4
YELM,W A 9$597-8320 'fELM,V'�A 98597-8320
EI�TITY TYPE: SOLE PRDPRIET()R RESELLER PERMIT NO: N,fA
PERMIT EFFECTIYE: N,�ik
M#ICS CODE: 811111 PERMIT E}CPIRES: N/'A
N#ICS DEFINITIUM: GEMERAL AUTOMOTIYE REP�IIR
Ft�R NDM-�DM�1 EF��1�4L USE�N LY
01/14,��015 9:23 AM
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��f THFp�� CITY OF YELM OFFICIAL USE ONLY
�q 9�, 105 YELM AVE W Fee�tec'd By
� Ry YELM WA 98597 ►tece�Pt#
360-458-3244 �ate xec'd
Application forwarded to PD
APPLICATION FOR Date
YELM Approved
WASHINGTON PEDDLERS LICENSE� Disapproved
for solicitors FEE $25.00 By�
"Solicitor"means any person who goes from house to house,or place to place,in the city selling or taking orders for,
or offering to sell,or taking orders for goods,wares or merchandise,for present or future delivery or for the making,
manufacturing or repairing of any article or thing whatsoever for present or future delivery,except a person selling to a
merchant for resale.
APPLICATION INFORMATION
NAME ,/��t.�j,,�'j L.} ��e�`i
First M.I. Last
PHONE���'��,!� PERMANENT HOME ADRESS'�/��� ;��/�'i j (J� ��'-
CITY �� STATE L��,� ZIP � .���� �
WASHINGTON STATE DRIVERS LICENSE NO. /"t,�li�;� L'Q�' J��� �'�
DATE OF BIRTH � � HEIGHT�WEIGHT � � SEX� F
EYE COLOR � �� HAIR COLOR {„z� �,�—��
SOCIAL SECURITY NO. � �" ���
�
EMPLOYMENT DURING THE PAST YEAR(Please include business name.address,contact person and phone no.)
,��3�z�� 1 �- �-l�/�- 1 -✓� ��-���SC� ���.r�
���� ��t�� L��,� �-� -���-�- ���° ��`� -���� ���
PERSONAL REFERENCES: At least two Washington State property owner(not related to applicant)who will
rertify as to the applicant's good character and business responsibility,or,other evidence as to the good character of
the applicant as will enable an investigator to properly evaluate applicant's character and business responsibility.
NAME ADDRESS PHOIVE NO.
� �� �`� � � � � �
. a � !Z i w � ` ��� s � �
M LOY USI SS INFORIVIATION:
NAME • �.
OWNER Ct i" PHONE NO.���'����
BUSINESS ADDRESS: � r C/ {/��"y ,1"� S'
LENGTH OF TIME LOCATED AT LISTED ADDRESS
STATE ID TAX ID#�� � ���� ��
HEALTH PERMIT(S)(IF APPLICABLE)
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COPIES OF[NSURANCEBOND COVERING BUSINESS
LENGH OF TIME YOU EXPECT TO BE DOING BUSINESS IN YELM
LENGH OF TIME YOU HAVE WORKED FOR THIS EMPLOYER
PLEASE PROVIDE A BRIEF DESCRIPIPTION OF:
THE GOODS/SERVICES BEING SOLD: ./�i'.t,�/SiIC?TC f�(° lg'�L/{ G��/2 CF'�
�'�C't r��",^_���r°h�i'���° > �t�.CD i'LC��C�t 4�
PLACE WHERE GOODS ARE MANUFACTURED OR PRODUCED:TP�/a//
LOCATION OF GOODS AT THIS TIME: �
\
— � /a'1
NIETHOD OF DELIVERY: �L%°�.., � e�
APPLICANT INFORMATION: Please provide a statement as to whether or not the applicant has been convicted
of any crime,misdemeanor,or violation of any municipal ordinance,the nature of the offense and the punishment or
penalty assessed.
The above information is truthfu and accurate to the best of my knowledge.
� fc�—°° S? _ �" � ���
p uant's gnature Date
At the time of filing the application,a$25.00 fee sha11 be paid to the City Clerk/Treasurer's
office. If approved, such license shall expire on the thirty-first day of
December in the year in which such license is issued.
The City of Yelm is an equal opportunity provider
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