23114 100TH AVE W (2)FIRE PREVENTION
-.Serving Brier, Edm6nds, and 12425 Meridian Ave S INSPECTION REPORT
SNOHOMISH CO OEDMONDS
M duntla.ke Terrace.;_ Everett, WA-98208 0 BRIER
FIRE Phone (425) �51-1200 [3 MOUNTLAKE TERRACE
[I UNINCORPORATED
DIST T www.FireDistrictl.org -�'i Fax (425) 551-1272
0' FREQUENCY STATION & SHIFT
LOCATION:
23114 100 th. Avenue W 98026 2016* 20-C
BUSINESS NAME: PHONE: SCHEDULED
Clip-R-Snip 2065462121 DATE DUE 0 Feb 2016
MAILING
LIFIR 0 557 54
ADDRESS: 23114 100th Avenue W, Edmonds, WA 98026
BUSINESS OWNER' HOME PHONE:
Laffoon, Lori
EMERGENCY-1: Laffoon Lori HOME PHONE: 4253476123
KEY'ACCESS-2: HOME PHONE: YES NO
EMAIL: -11 El
INITIAL IN
PERSON CONTACTED: SPECTION DATE
NAME OFINSPECTOR:
'FIRE SYSTEMS: FE7/1,3'':
natp I nc�t St3riArerj-,-
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2 2
3
3
4
.5�
6
6
7�
7
I AGREE TO CORRECTtHE'ABOVE VIOLATION(S) IN THE NEXT 30 DAYS
lst RE -INSPECTION 2nd RE -INSPECTION -INSPECTION
DATE DUE: I , . :. I . EXTENSION FINAL RE VIOLATIONS
DATE DUE: GRANTEDTO: DATE DUE:' CITED:
_�ERSON PERSON
CONTACTED: C PERSON
CONTACTED:
INSPECTOR: INSPECTOR: 2
INS!E�TO�,.
DATE: DATE: DATE: 3
VIOLATIONS VIOLATIONS:-: PRE -CITATION CITATION ISSUED
5_ 1 5 LETTER SENT NUMBER: 4
CODE 5
2 6 2 6 DATE: SECTION:
RETURN RECEIPT
3 7 3 7 RECEIVED 6
DISPOSITION:
4 18 4 DATE: 7
LETTER NEEDED YES 0 NO LETTER NEEDED YES, NO;i �1;
�V A I
CITY OF EDMONDS
BUSIIKNE',:�S LICENSE APPLICATION — COMMERCIAL
FEE: $125.00
CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION
121, 5 T�'AVCNIJE NC,,-,TH; EDMONDS, WA 98020 PHONE 425.775.2525
13
Building
0
Enginee6ng
o
Fire
0
Planning
CI
Police
FICE USE ON�.Y
BL#
Cus-,crr S:,� i Yaw C!ass SHD Date Paid
=�Oqto I n&O (4 !M-i
.01% 1
TRW
1M3(d_Gn4
Fee
11,2-:;
Mailed
1
I Deleted
INSTRUCTIONS: Please complete tr,.e appiicai`f,.� in ful� and attach zhe required floor plan. Middle initial or name required of all parties concerned. If no
middle name, please indicate by wrlt"",,.c ;.,rid r-zi:urn applics-ion with fe�. Please advise of any change in status. Now license required If
I
business changes location or owners' -hip. Norai�;azion -io City of Edmonc.'�-. requiredh' --usiness closes. License expires December 311"each year. Renewal
must be submitted prior to JF nuary _ � -;,3 av �&-_=
BUSINESS NAME CI)A + PIRSCHER 4LR(_'=,__'EC'_S, !NC
BUSINESS ADDRESS 2 31 1,� i 0 E]DMQ1%TDS,WA 98020
Sli, tat Suite # City. State, Zip Code
MAILINGADDRESS PO 130" SHORELINE,,WA 98155
cul!,l City, State, Zip Code
BUSINESS PHONE( 2 0 6 3F13-3_E6�.i 1/VASTATETAXID#(UBI)j6 10 10]13 12 19 1 8 1 6 1 2
BUSINESSE-"L. makikoo@24q-, ac. BUSINESI,'. wmrm www. cdaarch. com
BUSINESS OWNER /MAIN CONTACT _*v-& , ': _kc ( 206 1368-9668
1�a a Phone Number
PROPERTYOWNER Carl a-.-.--"
EMERGENCY NOTIFICATION (Fo� Prernise Ac-.--;s ir
RAME AR PROPERTY
Last Name
Last Name
NATURE OF BUSINESS (Provide F. Deze.;�,F.: j.plic of �,,:�incF:; ACtUv!t:es.,?racuc1s
ARCHITECTURAL
Number
Phone Numbe:
( 206 1364-1377
Phone Number —
A RAMP TO THE ENTRANCE DOOR FOR DISABLE ENTRANCE
SPACE ALTERATIONS TO BE MADE: YE.�, 0 DESCA-PTION
0 ��.al i increr -..,qav NE,, C1 0 0
PREVIOUS BUSINESS.-,T'FF-.iSA,)rREE;'-,
NUMBER OF EMPLOYEES S-1-UARE FOOTAGE OF BUSINESS SPACE 1,280 SQ FT
TYPE OF BUSINESS- PLEASE C-;FCK
• CONSTRUC71ON
• FINANCE, INSURANCE REAL'_-ST
• LANDSC�.PT, HORT
• MANUFACTURING
• NON-PROFjT
• RETAIL
r
.j SECONDHAND DCAI LEO,
IX SERVICES
• WHOLESALE
• OTHER
PRO?OSED OPENING
BUSINESS HOURS: 8 - 5
DAYS OPEN,
ii SUNDAY 13'WEDNESDAY
ly, NIONI)AY ErTHURSDAY
X TUESDAY [Y. FRIDAY
D SATURDAY
AMUSEMENT DEVICES ON PREMISES? YCS____ �n� _" _IF.'E=S,TOTA1_.1`lUMBER LIQUOR SOLD ON PREMISES? YES— NO X
GAMBLING? YES NO X CIGARL_� YES NO X
FLAMMABLE OR HAZARDOUS MATERIAI'�,:-�,-D G,. S". ()�FC? VES_ .140 X IF YES, PLEASE PROVIDE A LIST OF MATEWALS AND QUANTITIES:
PARKING SPACES ON SITE: TOTAL ACCESSIBLE SPACES FOR HANDICAP PARKING
DOESTHE BUSINESS CONTAINAN TiNIT," ACr. E ".-0 PERSONS WITH DISABILITIES) YES— NO_�_IBUT
N,�NME Mak-'ko Pirsch_�-. A-PPL!CANT
ed "na S1 . lure
TITLE- Vice DA-E r
NIL (01),-3
IN RAMP
LAST FiRST MIDDLE INITIAL
ADDRESS
STREET SUITE1APT;UN!-r C!Ty!STATE!ZIP CODE
HOME PHONE( I .--ORWERS LICENSE OR ID # & STATE
DATE OF
C ITY/STATE C F
PARYNER
, SHNP — PAR lNEP
OF
NAME�—
LAST FIRST MIDDLE INITIAL
ADDRESS
STREET SUITE/AP-f,'UN-iT # CITY/STATE/ZIP CODE
HOME PHONE( I ----D.-�,'..IERSLiCENSEORIC)#&STATF—
DATE OF BIRTH (JTY/S--,uTF �� -- BIR7,� - —C.OUNTRY OF BIRTH,
NAME
LAST
ADDRESS
STREET
PARTNERSH:,� NER 2
FIRST MIDDLE INITIAL
SUITE/AP!'AjN�T i; CITY/STATE/ZIP CODE
HOME PHONE(
i�!vER'SUCENSE
OR iD # & STATE
DATE OF BIRTH
.!TY1 --�JP
SIRTH COUNTRY OF BIRLH_
NAME OFCORPORATION CDA
CHEIZ z1�RC-.-.
ECTS , INC FEDERALTAXID# 91-1070052
23114 10-2
—TrMO\-'DS,WA 98155
206 368-9668
CORRADDRESS
City. Swe and Zip Code
Phone Numner
CORPORATE OFFICERS:
Last Name
rsi
Iml tie DateofBirth
Driver's License or Other ID# /State
PIRSCHER
D E N T 11/27/15
PIRSCCF501B
PIRSCHER
3MN %77cL a.t
�R 4-71�- 3'k
PIRSCM*463JM
LOCALCONTAC37 PIRSCHER
A-SlIVE
Last Na�,ne
r.st
Rld TMP nsfe,f-R;r,�
Driver's Jce�se c: C,
"boneNumber
CITY USE ONLY:
BUILDING DEPT.
D APP, C'�
'L'--
Dl,��\PPROV;:
DATE
SIGNATURE—
OCCUPANTLOAD
'UIL,)w!G
PL'IMIT
OCCUPANICY GROUP
COMMENTS
ENGINEERING
3:�.'\?PROV---
DATE—
----S!GNATURF
FIRE DEPT.
A,-, P
DiS.'.PPROVE
DATE
SiCNATURE
U.F.I.R
COMMENTS
PLANNING DEPT.
c;
PPROVE
DATE
SIGNATI.�RE—
ZONING CODE
',JSEPER[\AiT—
CGiviNIENTS.
POLICE DEPT. C,.�-.,-,PPR0Vz DATE
COMMENTS
S I G.-14 A T UR E
Lr
L
fl
T Ilp i
A
-t7A
ti m
-----------------
A"
&VAr
El
Dw
op
CPA + PIR5C—HER ARCHITECT5 OFFIC
__4 1111flm
.23114 100 AVE H
NVS�4A
Epmo
CPA . FMCIM �M
FLOOR PLAN
HAZAR F LIND AND LOCATIONS/ COMMUNICATIONS
)2
3
4
Y2;'
I AGREE TO CORRECT THE AbOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1 st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTEDTO:
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
5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4 \1
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
REC�IVED
4
8
4
18
DATE:
DISPOSITION:
;\� LETTER NEEDED E] YES [I NO
LETTER NEEDED [] YES NO
FIRE DEPARTMENT COPY.
SN0110MI �,Sei-ving Bilet: Edinonds
Mountlake Tei-t-aceand
FIRE the Town of Woodway
DISFM
, T www.FireDistrictl.org
LOCATION: 23114 1 00th Avenue
BUSINESS NAME: Clip-R-Snip
MAILING 23114 1 GOTh Ave W
M-
12425 Meildian Ai,e S
Evet-ett, WA 98208
FIRE PREVENTION_
INSPECTION REPORTJ
I�EDMONDS
0 BRIER
Phone (425) 551-1200
Fax (425) 551-1272
E]WOODWAY
[I MOUNTLAKE TERRACE
[1 UNINCORPORATED
PHONE: 2065462121
ADDRESS: Edmonds 98020
x
BUSINESS OWNER: Laffbon,Lori HOME PHONE: 4253476123
EMERGENCY-1: L,affoon, Lori HOME PHONE: 4253476'123
KEY ACCESS-2: HOME PHONE: --
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS:
FREQUENCY
STATION & SHIFF"
731
20 A
I
SCHEDULED
DATE DUE 02/01/13
LIFIR 0 557'
2053
ACTIVE
CURRENT
CITY YES NO
BUSINESS .�
LICENSE Xj
INITIAL INSPECTION DATE
F7 /I
FE -7 f -,k I
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
4
4
5
5 ----
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
I St RE -INSPECTION
DATE DUE o,
2nd RE -INSPECTION
DATE DUE:
7
EXTENSION
GRANTED TO:
FINAL RE-INS� VTN
DATE DUE:
VIOLATIONS
CITED:
FtHbUN
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
LATIONS,
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
18
4
18
DATE:
DISPOSITION:
LETTER NEEDED E] YES El NO
LETTER NEEDED E] YES I--] NO
FIRE DEPARTMENT COPY