307 BELL ST STE 104F11-111111 30
0 T9 : OR -
13CE L i� S7- / 1) q
CITY OF EDMONDS RECEIVED
USINESS LICENSE APPLICATION- COMMERCIAL
FEE: $125.00 'j,"ViL 171 2 0 12
CITY CLERK'S OFOCE. BUSINESS'LICENSE DIVISION
,ac. 121 5�' AVENUE NORTH, EDMONDS, WA 98020 PHONE: 425.775.2525
EDINIONDS MY CLERK
OFFICE USE ONLY
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Class
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INSTRUCTIONS: Please complete the application In full and attach the required floor plan. Middle Initial or name required of all
parties concerns& If no ndddle narne, please Indicate by writing NMN. Sign and return application with fee. Please advise of -
any change In status. New license required If business changes location or ownership. Notification to City of Edmonds required
Wbusiness doses. 7.
BUSINESS NAME
BUSINESS ADDRE
MAILING ADDRESS
Street or PO Box, Suite No. 7FAti-Stateand Zip Code
BUSINESS PHONE NO. (14)C I L11 f7NV'� WA STATE TAX ID NO. (UBI NO.)
BUSINESS E-MAIL &A I-- (MBUSINESSWEBsrrE 'Calk
4JUA 14 tj& [Lr I IL4 r%IIAA 4.-. .
kOPEfiTY OWNER b)d�:— I<J))% 0 1 nl," U
EMERGENCY NOTIFICATION (For Premise Access In Emergency):
I t Nto ) . * . 174 PA - .,
Last Name First Name MI Phone N6.
NATURE OF BUSINESS
NUMBER OPEMPLOYEES; S
WARE FOOTAGE OF BUSINESS SPACE
TYPE OF BUSINES$ - PLEASE CHECK7111E APPROPRLATF, CATEGORY -
a CONSTRUCTION ' 13 FINANCE, INSUkANCE, REAL ESTATE. - 0 LANDSCAPE. HORTICULTURAL (3 MANUFACTURING - (3 NON-PROFFT
.13.RETAJL (3- SECONDHAND 0 &.LER C3 SERVIQES 13 WHOLESALE 13OTHER
AMWEM9 NT DEV lCiES*014-PRE MISES? C1 YtS qNO . IF YES. TOTAL NUMBER
ON PREmism:. i3YEs GAMBLING? 0
LiQuok SOLD YES Alb CIGARETTES SOLDON PREMISES? 0 YES -0-Na-
FLAMMABLE OR HAZARDOUS MATERi)kLs USED'OR STORED?: 13 YESPIOCIF YESi PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES:
PROPOSED OPENING DAY -OF BUSINESS BUSINESS HOURS
DAYS OPEN 0 SUNDAY 0 MONDA�.Y 0 TUESDAY 0 WEDNESDAY 0 THURSDAY OFMDAY -0SATURDAY
PARIONG SPACES ON SITE* TOTAL kc>
—ACCESSIBLE FOR PERSONS WITH DISABILITIES
AN ENTRANCE ACCES81BLE TO PERSONS WITH DISABILITIES?, T.
DOES THE BUSINESS CONTAIN PYES 0 NO
PREVIOUS BUSiNESS,USE AT THIS ADDRESS
I
I
,Y�
SOLE PROPRIETORSHIP
NAME A'C Q )
Lag First MI
el=mADDRESS 5<u�
Sheet Apt. No., Unit W. -CRy, State -and 7JP Code
HOME PHONE NO. (d��) DOL NO. (DRIVERS LICENSE NO.) OR OTHER ID NO, I
DATE OF BIRTH,-j fX�ITY AND STATE OF BIRTH— COUNTRY OF BIRTH
PARTNERSHIP - PARTNER I
NAME
Last. First Ml
Shm . A4
HOME PHONE NO.( —:..�Ol- NO. PRIVERS LICENSE
DATE OF BIRTK—CITY-AND STATE OF BIRTH
I
PARTNERSHIP - PARTNER 2-
—'y. Qwtu aim &W �v
OT414t ID NO.
COUNTRYOFBIRTH
HOME PHONE NO.( DOL NO. (DRIVERS LICEN�E NO.)6R&n;ER-IDN6.
DATE OF BIRTH —CrrY AND STATE OF BIRTH -_COUNTRY bF BIRTH
�AME OF
CORP. AC
street
coRpomtE OFFICERS:
Last Name I Rrs't Name
MI TItl*8
and
TAX ID NO.
PHONE NO.L
_J_
DOL No. (Drivers License No.) or Other-113 No.
LOCAL CONTACT —11, 1 . (
Last Name First Name MI Ti Phone No. DOL No. (Drivers Lic. No.) or Other 167N—o
MEOW
,.CfTY,USE-QNLY*.
CF-AF!PROVE!�-.(3-qISAPPR0V6- I)Af�.—
SI-
_TURF
CONDITIONALUSEPER
COMMENTS" . ......... .... .. . ....... .
SU14DING:PEPT, CIAPPROVE 0 DISAPPROVE DATE
6IGh�-� RE�.
OCCLPAW LOAD. BUILDING PERMIT,
-I. —OCCUPANCY GROUP'
FIRE DEPT. '.13 APP�VE 13 DISAPPROVE DATE
SIGNATURE w.
CDMMENT�_
POLICE DEPT. 0 APPROVE: 0 DISAPPROVE DATE
SIGMATURIk*
Comi;,EiiTi
I
LL
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CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98 020 (425) 771-0215
FIRE DEPARTMENT
;' it.0,0.9'
LOCATION: 307 Bell St
BUSINESS NAME: Skin Solutions
MAILING 307 Bell St u104
FIRE PREVENTION
SAFETY SURVEY
104
PHONE: 4257751779
ADDRESS: Edmonds 93020
BUSINESS OWNER: Wentzel, Julie HOMEPHONE: 4257714059
4257755604
EMERGENCY-1: Spee,Doug HOME PHONE:
KEY ACCESS-2: HOME PHONE:
FREQUENCY
STATION& SHIFT
730
17
SCHEDULED
09/0-1/10
DATE DUE 0'
LIFIR P. 557
9202
e- INITIAL INSPECTION DATE
PERSON CONTACTED: I
NAME OF INSPECTOR: I
i 1mc: F- Iz
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE 11,
VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
7
8
8
Ist 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:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3..
\11OLATIONS
1 5
VIOLATIONS
1 5
PRE-CRATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
7
4
18
4
8
DISPOSITION:
8
LETTER NEEDED [] YES E] NO
LETTERNEEDED [_� YES NO
;r
FIRE DEPARTMENT COPY