120 5TH AVE S STE CFeb 1417 03:26p
A Venner
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425 774-1356
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Serving Brier, Edmonds, and
Mountlake Terrace
mvw.FlreDistrlctl. org
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
❑ EDMONDS
❑ BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FIREOUENCY
STATION & sl
LOCAnON: 120 5 th Avenue S Suite C 98020
2017
17-A
BUSINESS NAME: Christian Science Reading Room PI roNE:
4257783553 SCH DOLED Jan 2017
IAAJUN6
UFIR 1 541 202
ADDRESS: 120 5th Avenue S, Suite C. Edmonds, WA 98020
BUSINESS OWNER: HOME PHONE:
ErAERGENCY-i: First Church of Christ HOME PHONE:
4257784007 CURRENT
KEY ACX F.S..- 9• JJ� r I t �} f ( ^nvrvir rnvrvt:
1� L �� '�
-it crrY
BUSINEES
c
EMAIL: `��1�� ` 4 L .� L-(� pt � ,�;rj�
�I,
LJ
PERSON CONTACTED.
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE SYSTEMS: FE 5/13
Date Last Serviced:
H,ZA1AS FOUND AND LCCATIONS I COMIAUPJICAT ONS
5c 1 acL �,......
3
4
5
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
In our continuing] effort to promote fire safety And Prcvantion within the community, your firs dcRartmcril VVFIJuGt3
regularly scheduled "Fire Safety Survey Inspections" of all businesses and multi -family occupancies in the Cities
r-.avered by Snohomish County Fire District 1.
You are to be congratulated on the relative good condition of your occupancy in regards to fire safety. Above you
will find the item(s) that were noted during our inspection which require attention to bring them into compliance
with the minimum standards adopted by the above jurisdictions.
Any overlooked hazards or violations of the fire reeulations does, not imply Arprnval of Ouch conditions or violation.
If you require additional information or to schedule a re -inspection for Edmonds, call (425) 775-7720; for
Mountlake Terrace or Brier, call (425) 744-6231.
Feb 1417 03:26p A Venner 1 I 425 774-1356 p.1
a; I
Ft re Pe Par0 vL
FIRE PREVENTION
Serving Brief: Edmonds, and
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
EDMONDS
FIRE
Mountlake Terrace
Everett, W.4 98208BRIER
TwwwFireDistrictl.
Phone (425) 551-1200
❑ MOUNTLAKE TERRACE
❑UNINCORPORATED
DISTR
org
Fad (425) 551-1272
FREQUENCY
STATION & SHIFT
LOCATION:
120 5th Avenue S Suite C WWI)
2 Year
14 17-B
BUSINESS NAME:
Chribl an Scicrwc Rrading F nam
PHONE: 421,M83555
SCHEDULDATE DUEED► Jan 2014
MAILING
UFIR 1
ADDRESS:
120 53Lh A\mnuc S, Sui!C C, Edmn&-, VVA t�°D20
BUSINESS OWNER:
HOME PHONE:
E�GENCY
E 1:
First oiUr(;h of Christ
HOME PHONE: 4,j57734.W7
CURRENT
KEY ACCESS-2:-
c4Ww "V'h•
HOME PHONE:
CITY YES NO
BUS
❑
EMAIL:
t rA
PERSON CONTACTED:
INITIAL INSPECTI N DATE
NAME OF INSPECTOR:
FIRE SYSTEMS:
FE .!�_1_13
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
to 4:t
2
2
3
3
4
4
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:
1
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
9
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
Q
6
4
6
DATE:
DISPOSITION:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8
FIRE DEPARTMENT COPY
SNOHOMISH CO.
y FIR
STS'
Serving Brier, Edmonds
Mountlake Terrace, and
Tthe Town of Woodway .
www FireDistrict]. org
LOCATION: 120 5th Avenue
BUSINESS,�NAME: Christian Science Rk. ding Room
';'MAILING
MAILING 5551 mata .. - SSt
ADDRESS: Edmonds
BUSINESS,' OWNER: First Church of Christ
EMEROFNCY-1: *-�Pa-y�twar& -
KEY ACCESS 2: ZBrich, Peter
PERSON CONTACTED:
NAME OF INSPECTOR:
FIFE
SYSTEM O-
U
q
S
12425 Meridian Ave S
Everett, WA 98208
'Phone (425) 5514200
Fax (425) 551-1272
C �
PHONE: 4257783553
986'20
HOME PHONE: 4257784007
Zd,6 -7,3)4,7, 9� l _
HOME PHONE: 42577843�2
HOME PHONE: 4257712973
FIRE PREVENTION
INSPECTION REPORT
❑ EDMONDS
❑ BRIER
❑ WOODWAY
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY STATION & SHIFT
731 17 O
h
SCHEDULED
DATE DUE ► O1IQ1;'12
UFIR ► 541 1202
ACTIVE
URRENT CITY YES No
BUSINESS ,
LICENSE El R
INITIAL INSPECTION DATE
FE 5 /If
ANNUAL ,
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1
t
1
2
2
3
3
4
4
5
5
6
6
•a
7
i
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED: •i
PERSON
CONTACTED:
1
INSPECTOR-
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
c^�
1 16
VIOLATIONS
1 5.
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
6
4
6
DATE:
DISPOSITION:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
e
FIRE DEPARTMENT COPY
---- -- ----
--
r BUSIHESS UICEMSE APPLICATM — CO MEMAL Building
(SEE: $129.00 Fireineerin®
CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION Planning e
121 5T" AVENUE NORTH, EDMONDS, WA 98020 PHONE 425.775.2525
OFFICE USE ONLY
�L# Customer SIC Yea' Class Sector Date Paid TRA Fee PJdailed Deleted
Al ?� - - off=
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 NNN. Sign and ragturn application with fee. Please advise of any change In staters. New license required It
busirtuss changes Poca Lion or ownership. Notification to City of li:dmonds required If business closes. License expires December 31" each year. Renewal
must be submitted rio to Jsnuv7 31" to avoid late fool.
BUSINESS NAME____.Y�
BUSINESS ADDRESS -_ �� _aO� �\IVA
Strecal Suite # City, State, Zip Code
e � `��i F 11 �1
_AkMAILING ADDRESS �1 �i K�' ' N irU \ 1 �_WA
Street or PO Box {/ Stifle It Ckty, Stata, Zip Code
�` �t ��
BUSINESS PHONE[ iJ 1 r LI 11t `Q` " WA STATE TAX ID # (UBI} �� �4 '5 1 1 1
i (n i C" �I ✓h
BUSINESS E-MAIL V \ `A G,I, e rdA S e kb` - SINF-SS WEBS�ITE—L�M6! &
BUSINESS OWNER/MAIN CONTACT 1 ' �q 1 L1o -9�4 t
Name Phone Number
EMERGENCY NOTIFICAT N (For Premise Acoess I Emergencyj,
Last yqfflu Firpi Namo MI Phone Number
.�� — - / �C�itt3 � 4Ce- T
Lest Name Fleet O&W6 MI Phone Number
MATURE OF BUSINESS (Provrdea Detailed Dessripfiam of Business Activities, Pro4uCte 8 Servtces):
, 2 l
Ark M
SPACE ALTERATIONS TO BE MADE: Y8 NO� DESCRIPTION
PREVIOUS BUSINESS AT THIS AD(DRESeU• }LV
NUMBER OF EMPLOYEES: SQUARE FOOTAGE OF BUSINESS SPACE_
TYPE OF BUSINESS e PLEASE CHECX APPROPRIATE CATEGORY;
L CONSTRUCTION
F FINANCE, INSURANCL. REAL ESTATE
n LANDSCAPE, HORTICULTURAL
r-1 MANUFACTURING
-1 NON-PROFIT
U RETAIL
❑ ECONDHAND DEALER
sCRVICIS
WHOLESALE
OTKER
PROPOSED OPENING
BUSINESS HOURS.
�V rf1Y�
DAYS OPEN
r SUNDAY � WEDNESDAY
MO 4JAY THURSDAY
SDAY FRIDAY
U SATURDAY
AMUSEMENT DEVICES ON PREW S? YES- NO !�IF . TOTAL NUMBER LIQUOR SOLD ON PREMISES? YE5 NO Z—
GAMBLING9 YES_ NO,-� CIGARETTES SOLD ON PREMISES? YES— N0Je_-::—
FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORE07 YES F YES, PLEASE PROVIDE A LIST OF MATERIALS AND QUANTITIES.
PARKING SPACES ON SITE: TOTAL
SPACES FOR HANDICAP PARK
I
DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE Td PERSdNS WrTH DISABILITIES? YES-1 NO
- APPLICANT
ee
NAME C cam. _' =
9 �P �dN�010 ure
TITLE ` DATE
Appileations may be malW In wDah a check, birought In person, ffaned to 42S-771L-0266 or erinailed to �us(n�ss lieens� paleveoalc9�e
twith a valid phone number. We will Sall you for a Visa or MasterCard payment. -
r . a
SOLE PROPRIETORSHIP
LAST FIRST MIDDLE INITIAL
ADDRESS
STREET SUnVAPTIUNIT# CITYISTATE2\(P,CODE �%� �'
/ATEOF
NE 1 DRIVERS LICENSE OR ID # & STATE b _ L. +-yam --
RTH __ ����Cr�rYISTATE OF BIRTH, 1� j- U-aa �� 1 COUNTRY OF BIRTH_U =S-A _ __
PARTNERSHIP — PARTNER
NAME
LAST FIRST -- MIDDLE INITIAL T
ADDRESS_ - _ --
STREET SUITEIAPT/UNITf1 s CrMSTATEIZIP CODE
HOME PHONE( I DRIVERS LICENSE OR ID # & STATE-
DATE OF BIRTH CITYISTATEOF BIRTH __ _ COUNTRY OF BIRTH
PARTNERSHIP - PARTNER 2
NAME,_,_ - - --_ -
LAST FIRST MIDDLE IN ITIAL
ADDRESS
STREET SUITEIAPT(UNIT # CITYISTATEIZIP CODE
HOME PHONE( 1 DRIVER'S LICENSE OR ID # B STATE
NAME OFCOI
CORP.ADDRESS-A-6 C-)
Street Suite, Apt Unit 0
PtI.LC
-- FEDERAL TAX ID#
City. State and Zip Coda Phone Number
CORPORATE OFFICERS:
Lest Name First Name MI Title Dateofeirlb Driver's L(cense or Other ID#/State
LOCAL CONTACT -,- - - -- - -
Last Name Fast Name MI Title Daulairlh
Drivar's Lrceai: s or other Do (State — Phone Nambor
CITY USE ONLY:
BUILDING DEPT.
0 APPROVE
0
DISAPPROVE DATE
_ SIGNATURE
OCCUPANT LOAD
BUILDING PERMIT
OCCUPANCY GROUP—
COMMENTS -
ENGINEERING
® APPROVE
CD
DISAPPROVE DATE
--SIGNATURE—,--
FIRE DEPT.
0 APPROVE
M
DISAPPROVE DATE
SIGNATURE -s
U.F.I,R._
COMMENTS
PLANNING DEPT.
Q APPROVE
Q
DISAPPROVE DATE
--- — SIGNATURE -
ZONING CODE, _
-
CONDITIONAL USIE PERMIT
COMMENTS
POLICE DEPT ® APPROVE
COMMENTS
M DISAPPROVE DATE SIGNATURE ___-
ma�s��
FIRE PREVENTION
Serving Brier, Edmonds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
FIRE.
Mountlake Terrace, and
-Everett, WA 98208
❑BRIER s
❑BRIER
_._
STRlf�,T
the Town of Woodway
FireDistrictl.org
Phone (425) 551=1200
.
❑ M O NTLAY
❑ MOUNTLAKE TERRACE
www
Fax (425) 551-1272
❑ UNINCORPORATED
FREQUENCY
STATION & SHIFT
LOCATION:
122 5th Avenue
S
365
17 D
,1 BUSINESS NAME:
Twist Vlnyasa Yoga
PHONE: 2068908503
DATE DUE SCHEDULED 01101/72
MAILING
122 5th Ave S Unit A
UFIR ► 591 1202
ADDRESS:
Edmonds
98020
BUSINESS OWNER:
The Mitchell Group
HOME PH�:`�,2060908508
ACTIVE
.0
- 1 �
EMERGENCY-1:
Coast Mgmnt
HOME PHONE: 42 3393638
CURRENT
KEY ACCESS-2:
Mitchell, Jennifer/Stan
HOME PHONE: 2062�6?508
CITY YES NO
BUSINESS
LICENSE
PERSON CONTACTED:
r
'
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE
FIE _i_
SYSTEMS:.
ANNUAL
1
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1
1 '
2'
2
.Y
3
3
4
4
j
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE, %I
;
2nd RE -INSPECTION
DATE DUE-
'
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED'
PERSON
CONTACTED: '
PERSON
CONTACTED: �. tq
-+.a..
PERSON
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE: 4
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
8
4
18
DATE:
DISPOSITION:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8
FIRE DEPARTMENT COPY