120 W DAYTON ST STE B4>�V2Z[�'j�y"SPI��"Re'/�'R,I•;st�v"'C^ d[ bJe�/ti �TFOariN- t w tamer... l nti�'a.'t y.;�,f •I
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V :,''FIRE PREVENTION
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SNOHONIISH CO. Serving Brier, Edmonds, and
12425 Meridian Ave SMountlake
SPECTION REPORT
IEDMONDS
FIRE �'�. l�'� Terrace
Everett, WA 98208
BRIER
❑BRIER
DISTRT
Phone (425) 551-1200
❑ MOUNTLAKE TERRACE
❑UNINCORPORATED
www.FireDistrict].org
Fax (425) 551-1272
FREQUENCY
STATION & SHIFT
LOCATION: 120 West Dayton Street Suite B4 98020
2017
17-B
BUSINESS NAME: Emerald City Model and Talent
PHONE: 4252484565
SCHEDULED DATE DUE Se 2017
II'P
MAILING
UFIR / 591
ADDRESS: 120 West Dayton Street, Suite 134, Edmonds, WA 98020
BUSINESS OWNER: C.. A 5A ��lit nJ A-1
HOME PHONE: �Z i741, - Lj
EMERGENCY-1:
HOME PHONE:
CURRENT
KEY ACCESS-2:
HOME PHONE: 17
CITY NO
EMAIL: �50•�A"�'lJEA, �w.=1�I(�C,�l`^7.Co�
BUSINESS
jYES
LICENSELICENSEEl
PERSON CONTACTED: �•� A. —%. •
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
��� �i q11 "
FIRE SYSTEMS: FE 6/13
Date Last Serviced:
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1
1
2
2
3
3
4 - I4
5 l 5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS.,) -._ —I
1st RE -INSPECTION
2nd RE -INSPECTION
F AL E-IN/ ff ON
,DATE
ELfEN VIOLATIONS
DATE DUE:
DUE.
GFIANTEDTO- DATE DUE: CITED:
PERSON
PERSON
'PERSON
CONTACTED,
CONTACTED:
CONTACTED,
INSPECTOR:
INSPECTOR.
INSPECTOR: 2
DATE:
DATE:
'-�` 3
DATE:
VIOLATIONS
VIOLATIONS
PRE CITATION CITATION ISSUED
1 < 5
1 - 5
LETTER SENT NUMBER: 4
CODE 5
2 , 6
2 6
DATE. SECTION
RETURN RECEIPT
3 7
3 7
RECEIVED
_ 1
DISPOSITION:
a
7
4 B
4 8
DATE: - -
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
_
YEAR 2012
- DA
City of Edmonds 12/ 2/201
City Clerk's Office BUSINESS LICENSE RENEWAL LICENSE
... 121 5th Ave. N. LICENSEgL-009154
:Edmonds, WA 98020 INSTRUCTIONS: NUMBER
'Telephone 425-775-2525 The Business License Renewal fee is $50.00.
Non-profit organizations are fee exempt.
., PJEIV'F-,
-4 Please advise if license will not be renewed.
-> New license required if business changes address or ownership.
4 Please complete all particulars in full. Sign and return with fee. .M 3 1 2012
r -> If the license is not renewed by February 15, a penalty fee of $25.00 is assessed
in addition to the license renewal fee. EDMO_ A _ C M
EMERALD CITY MODEL AND TALENT
PO BOX 6129
nin nennc ne•
'� CITY
USE ONLY
G
DATE PAID
RECEIPT NUMBER
FEE PAID
PENALTY PAID
LICENSE MAILED
BUSINESS RECORD DELETED
BUSINESS
LICENSE RENEWAL - REVIEW •'
•BELOW,•' •
'NAME OF FIRM _.__ ..._
1
BUSINESS PHONE # iNO.OF EMP . I WA STATE TAX I.D. #
_ -EMERALD-CITY MODEL AND TALENT .._ _ _ _ _- _ _ _ __
' 425) 248 4565 ___ I_-1 _! t - i 601237010 . _ _j.
_
__.
'BUS. ADDRESS NO �STREET -� - - - ZIP - IS TE NO. { NATURE OF BUSINESS
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_ _._ ._W DA_YTON,ST.
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jMAILING ADDRESS NO. -^
STREET OR P.O. BOX ' - SUITE/APT. CITY
STATE- ZIP (SQUARE FOOTAGE ��
-PO BOX 6129
_. _
ONDS . _ WA ...98026-0129 .. a !i _ 850 .
_
BUSINESS E-MAIL___..
.. _._ - -- - -- --- -- - - -' "i ,BU BSITE
john.harb@comcast.netemeraldcitymodElandtalent
com____
❑ (S) SOLE�PROPRIETORSHIP -_._..__FIRST
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'DATE OF BIRTH _ I CE OF BIRTH
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. PHONE NUMBER.:.._
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,CORPORATE MAILING ADDRESS
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ICORPORATE OFFICERS
.I. •TITLE
.
'DATE OF BIRTH
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' ;LOCAL CONTACT -LAST NAME
FIRST MI RTITLE
PHONE NUMBER
;EMERGENCY NOTIFICATION NAME -� -' ` -
I(1) HARB EASA
PHONE --
( 425 ) 248-4565
FOR.PREMI$E:AC,CESS
.
IN'EMERGENCY'.
PAULA
APPLICANT'SIGNATURE S X
ESS
�� Q/- DATE , y�i
TITLE
FIRE PREVENTION
Serving k-ier; Edmonds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
Mountlake Terrace, and
TIRE
Everett, WA 98208
❑ EDMONDS
❑BRIER
the Town of Woodway
DISTR T.
Phone (425) 551-1200
❑ WOODWAY
❑ AKE TERRACE
www.FireDistrictl.org org
Fax (425) 551-1272
UNINCORPORATED
❑UNINCORPORATED
FREQUENCY
STATION & SHIFT
LOCATION: 120 W. Layton Street
134
731
17 D
I
BUSINESS NAME: Edmonds Insurance, Inc.
PHONE: 4257446338
SCHEDULED 09101l11
DATE DUE ►
MAILING 633 Alder St
UFIR ► 591 9202
ADDRESS: Edmonds
98020
BUSINESS OWNER: Rost, Linda
HOME PHONE: 4256727366
ACTIVE
V EMERGENCY-1:
HOME PHONE:
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
El 11
LICENSE
PERSON CONTACTED:^
1
INITIAL INSPECTION DATE
NAME OF INSPECTOR: �� -� v
/ - r- 7 •- l I
' FIRE
FE i/
SYSTEMS:
AN N UA
1
1
i t
J
HAZARDS FOUND AND LOCArTIONNSy/COMMUNICATIONS- c-�
2
2
3
3
4
4
1
5
5
6
6
7
7
A
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:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
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
5
4
8
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8
FIRE DEPARTMENT COPY