210 5TH AVE S STE 203(57411 iqL)r- zo 3.
FIRE PREVENTION
Serving Brier, Edmonds, and 12425 Meridian Ave S INS . PECTION REPORT
Mountlake Terrace Everett, WA 98208 DEDMONDS
0 BRIER
Phone (425) 551-1200 [3 MOUNTLAKE TERRACE
[3 UNINCORPORATED
www.FireDistrictl.org J Fax (425) 551-1272
F FREQUIENCY
STATION& SHIFT
LOCATION:
210 5 th Avenue S Suite 203 98020
2016
17-C
BUSINESS NAME:
WMM"ffem-Pmpefty-MgffMt :C- r5 wor
PHONE-
425&7Q2@=
SCHEDULED
DATEDUE 'Apr2016
MAILING
7-ER
591 202
ADDRESS:
210 5th Avenue S, Suite 203, Edmonds, WA
98020
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
IDAve, -Mt4Loe,
HOME PHONE: W-22-9-2-75
KEY ACCESS-2:
L'Alici+
HOME PHONE:
YES NO
EMAIL:
'&6o - 7m - 2o I S_
1:1
1:1
PERSON CONTACTED:
I
INITIAL INSPECTION DATE
NAME OF INSPECTOR: -L r
1
6- 2.�- 16
FIRE SYSTEMS: FE
RMt%V�§R'9114fltOEATIONS COMMUNICATIONS
y I
2
2
3
4
4
5
6
. ......
5
6
7
7
I AGREE TO.CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
IstRE-INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTEDTO:
FINAL . RE-iNSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
INSPECTOR:
PERSON
CONTACTED:
INSPECTOR:
PERSON
CONTACTED.
2
3
INSPECTO
DATE:
DATE:
DATE:
VIOLATIONS
5
VIOLATIONS:,
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
...RECEIVED _
6
4
.4
8
DATE:
DISPOSITION:
7
LETTER NEED ED YES NO
LETTER NEEDED YES NO
8
FIRE PREVENTION
CITY OF EDMONDS SAFETY SURVEY
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
4�' S t
LOCATION: 210 5th Ave S
BUSINESS NAME: Windermere Property Mgmnt
MAILING 210 5th Ave S #203
ADDRESS: Edmonds
BUSINESS OWNER: Gill, Lori
EMERGENCY-1: Hoff, Greg
KEY ACCESS-2:
203
PHONE: 4256722000
FREQUENCY
STATION & SHIFT
731
17 B
SCHEDULED
DATE DUE 11�
04/01/11
LIFIR 0 591
4202
98092
HOMEPHONE: 2063963247
HOMEPHONE: 4256721118 Zo � 550 C) 39 fo
HOME PHONE:
INITIAL INSPECTION DATE
PERSON CONTACTED: "Jel�z I
NAME OF INSPECTOR: I I — 0
FIRE FE ly 10
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
rJo
ENTER CODE ONLY ONCE lo
VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
7
8
8
'Ist RE -INSPECTION
DATE DUE:
2nd RE-INSPECTFON
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
DATE:
DATE:
DATE:
3
VIOL IONS
1 15
VIOLATIONS
1 5
PRE-CITA11ON
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
FIRE DEPARTMENT COPY
0 C) 0 el qf
tSL*0
CEIVED CITY OF EVIVIONDS ECON 1EY
jRUE .4 44
V47BUSINESS LICENSE APPLICATION— COMMERCIAL
N 0 6 2010 FEE: $125.00 1 Ir PLAN
CITY CLERK'S OFFICE, BUSINESS'LICENSE DIVISION- POLICE
121 5' AVENUE NORTH. EDMONDS, WA98020 PHONE: 42 .775.:k5�i_ UTIL
5 2 25
81LL
FDMONDS CITY CLERK
OFFICE USE ONLY
BL#
Customer#
=1539-1,
sic
i CA
65 IL
Jyear
-,LPLDIISSP��q_(1401
Date Paid
I TR#7 r3__�S
1 0
Fee P�iW
I Mailed
Delete
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 NMN. Sign and return application with fee. Please advise of `
Any change In status. New license required if business changes location or ownership. Notification to City of Edmondi required
if'business i:loses.
BUSINESS NAME
BUSINESS ADORE
MAILING ADDRESS
Street
.100-11
Street or PO Box
�-q A i -An
- do
13USINESS PHONE NO.
BUSINESS E4vAAIL N" & .6 W'
PROPERTY OWNER
NOTIFICATION (For Premise
Last
NATURE OF BUSINESS
Suite No. Zip Code
& 4-
Suite No. City, State and Zip Cbde
WA STATE TAX IQ NO. (UBI NO.) - ton-21 -3.18
�4& -BUSINESS WESSiTEWD eAftWnd&-001V7
I � -- 1.9 9 IV
Phone Number
in Emergency):
3qb 4g3.-Ij
10YA
t Name Phone No.
'JyL 4 9A,
IName Mi Phone No.
P
NUMBER OF EMPLOYEES SQUARE FOOTAGE OF BUSINESS SPACE zo
TYPE OF BUSINESS - PLEASE CHECK.THE APPROPRIATE , CATEGORY-
OCONSTRU&1`16N >(Fl"NANC�E,'I-NSU.R�AN-CE,'.REAL'E'S'T'ATE:- OLXNDSCAPE. HORTICULTURAL CIMANUFACTURING 0 NON-PRORT
C3 RETAIL* El SECONDHAND DEALER 0 SERVICES 0 WHOLESALE, OOTHER
AMUSEMENT DEVICES N-PREMISES? C! YES 0. IF YES, TOTAL NUMBER
LIQUOR SOLD ON . PREMISE97:- 0 YES 140 G - AMBLING? 13 YES 0,NO CIGARETTES SOLD -ON PREMISES? 0 YES - XNO -
FLAMMABLE OR HAzARDous mATERiALS USEDbR STORED?: CI YES NO IFYES, PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES:
PROPOSED OPENING DAX OF BUSINESS 20- BUSINESSHOURS 6!3 0
DAYS OPEN 0 SUNDAY �WONDAY -ffikTUESDAY )*WEDNESDAY >rrHURSDAY >FRIDAY - 0 SATURDAY
PARIONG SPACES ON SITE: TOTAL ACCESSIBLE FOR PERSONS WITH DISABILITIES '14S
DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONrrVTTH DISABILITIEST O*ES 13 NO'
1—,r j;% i A fhf f
PREVIOUS BUSINESS USE AT THIS ADDRESS L76A-4 V VV Uf I I Uko,
SOLE PROPRIETORSHIP
i
Last First MI
ADDRESS
Sheet Apt No., Unit No. CIIIY� State and Zip Code
HOME PHONE NO. DOL NO. (DRIVERS LICENSE NO.) OR OTHER CD NO.
DATE OF BIRTH ____2CITY AND STATE OF BIRTH COUNTRY OF BIRTH
PARTNERSHIP - PARTNER I
NAME
Last. first
MI
ADDRESS
Sheet Apt No.. Unit No. City. State and Zip Code
HOME PHONE NO-( DOL NO. (DRIVERS LICENSE NO.) OA OTHER 10 NO. —
DATE OF AND STATE OF BIRTH
_�SOUNTRY OF BIRTH
PARTNERSHIP -PARTNER 2-
1"TFT_TF=
Last First MI
ADDRESS
Sheet Apt No, UnitNo. City, State and Zip Code
HOME PHONE NO.( DOL NO. (DRIVERS LICEN�
ENO.')OROTAER"IbNO..
OATEOFBIRTH_ ______SITY AND STATE OF BIRTH -C mTRYbFBIRTH
NAMEOFCORPCIRAJION �`Rpq4TiON. -2.
FEDERAL TAXID NO- 15(o -4
&a- , q&y-
41 PHONE
CORP. ADDRESS NO-(9*)
Street Suite, Apt'. Unit No. City; State and Zip Code
CORPORATE OFFICERS:
Last ND'Lnq Firsi,Name MI Til Datb. of Birth DOL No. (Drivers License No.) or Other*ID No..
1,264&
LOCAL CONTACT
Last Name First Name MI. T(Ue Phone Nc�
DOL No. (Drivers Lic. No.) or Other ID. No.
APP LICANT.-:
Aww
Nanva.— Printed- Title Date.
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PLANNING &OT''
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APOROVE
.13 DISAPPROVE
DAfE.
ZONING CODE�__,
CONDITIONAL US5 P
COMMENTS`:
BUILDING:EiEPT.
0-APPR . 0 . VE .
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DA . TE
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OCCbRANT LOACL
- .- --BUILDING
PERMIT
—OCCUPANCY GROUP
dOlIAMENTS
'FIRE DEPT.
-0 APPROVE.
0 DISAPPROVE
DATE
SIGNATURE
U. F.L
.CX)MMENTS
POLICE DEPT.
DAPPROVE
0 DISAPPROVE
DATE
SIGNATURE'
Comm
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