403 MAIN ST STE ALlo3 /�7A=-J Jr S77c Iq FIRE PREVENTION
INSPECTION REPORT
SNOHOMISH CO. Serving Brier, 12425 Meridian Ave S
0 EDMONDS
Mountlake Terraceand Everett, WA 98208 0 BRIER
F, IRE e Town of Woodway Phone (425) 551-1200 0 WOODWAY
[I MOUNTLAKE TERRACE
DISTR - T wtw. FireDistrict]. org Fay (425) 551-1272 0 UNINCORPORATED
LOCATION: 403 All " FREQUENCY STATION & S—H—IFF)
Main Street A 365 17 A
SCHEDULED
BUSINESS NAME: Chrisfine!s PHONE: DATE DUE 1` 01101112
MAILING 403 Main St UFIR � 521 1202
ADDRESS:
Edmonds 98020 (c) LAD-,S- -7
�USINESS OWNER: HOME PHONE: 13 ACTIVE
Olsen, Christine
EMERGENCY-1: %3 �1� HOME PHONE: 42, CURRENT
KEY ACCESS-2: Uida HOME PHONE: CITY YES NO
BUSINESS
LICENSE El 1:1
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3 "A
3
4
4
5
5
6
6
7
7
1 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
4
8
4
18
DATE'
DISPOSITION:
7
LETTER NEEDED C] YES N
11,� LETTER NEEDED [:] YES E3 NO
r
8
FIRE DEPARTMENT COPY
rj�o \)rL;�
" r4'
CITY OF EDMONDS
[0 Building
�IJSINESS LICENSE APPLICATION - COMMERCIAL 3 Engineering
APR 2 8 21111 FEE: $1-25.00 U Fire
*� 0 Planning
CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION 1:1 Police
AVENUE NORTH, EDMONDS, WA 98020 PHONE 425.775.2525
F_ OFFICE USE ONLY
BL#
Customer #
SIC
PAW.200
I Year
Class
1b
I Sector
I Date Paid
I TR# ,#,ed
�Mailed
I Deleted
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 Edmonds required if business closes. License expires December 315'each year. Renewal
must be submitted prior to January 318'to avoid late fees.
BUSINESS N 0 -D rl 12 J-) e EL-N
OVIN6 A t1^1M 6,br1pK1,D_f WA 1901-0
BUSINESE D3 �& S. T.
Street _66ife4- City. State. Zio Code
MAILING ADDRESS /I 2-"'p F I- e5 W -5 9 Z) -2-4
Street or PO Box # Suite City, State, Zip Code
13USINESS PHONE( 3 Kr) I' ?-'7f? WA STATE TAX 10 # (UBI) 6 o 3
BUSINESS E-MAIL USINESSWEBSITEdr; -4,o y
BUSINESS OWNER / MAIN CONTACT
- j( I —A (TS LI!: /�L_
� f 244
Name
Phone Number
EMERGENCY NOTIFICATION (For Premise Access in Emergency):
z X' - 4 4-.,q SS 6 /7—
A L-C 7Y AQ /-'Yq �4
n.
Q6-0 i
Last Name First Name
MI
Phone Number
j5' C-14 M &-(- IE- S'
r: .
(3 -6 0 1
Last Name First Name
NATURE OF BUSINESS (Provide a Detailed Descripfion of Business Activities, Products
MI
& Services);
Phone Number
rl I D - C-C- A47?' 0 f7'0 'E A-A,1 2,0 -144 C.
/I /t.;r ,q d-
F V 6-4-J) r H 1,4 CS
J77b /LZ At,'-7y �'j
SPACE ALTERATIONS TO BE MADE: YES_NQ2<' DESCRIPTION
PREVIOUS BUSINESS AT THIS ADDRESS ".5-rILAICA17 0,0 & t.&r' 66AIXI C-4117
—6
NUMBER OF EMPLOYEES SQUARE FOOTAGE OF BUSINESS SRAC
TYPE OF BUSINESS - PLEASE CHECK APPROPRIATE CATEGORY:
• CONSTRUCTION
• FINANCE, INSURANCE, REAL ESTATE
• LANDSCAPE, HORTICULTURAL
• MANUFACTURING
0
NON-PROFIT
W
RETAIL
U,O'
SECONDHAND DEALER
•
SERVICES
•
WHOLESALE
•
OTHER
PROPOSED OPENING
BUSINESSHOURS, // "*� - 6
,%- L 41
DAYS OPEN: L
),2 Z74
W'SLINDAY U WEDNESDAY
• MONDAY lirTHURSDAY
• TUESDAY FfFRIDAY
VSATURDAY
CO-
Lt:;?
AMUSEMENT DEVICES ON PREMISES? YES— NO4,_"' IF YES, TOTAL NUMBER LIQUOR SOLD ON PREMISES? YES— NO_t,"
GAMBLING? YES— NO -I,-' CIGARETTES SOLD ON PREMISES? YES— N0_4�f
FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED? YES— NO-k-f IF YES, PLEASE PROVIDE A LIST OF MATERIALS AND QUANTITIES:
1, J, 1-7 . 11 1 1 - A
PARKING SPACES ON SITE: TOTALSPACES I ACCESSIBLE SPACES FOR HANDICAP PARKING�. -S7/L-1r67_
DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES? YES-1Z NO—
Applications may be mailed In with a check, brought In person, faxed to 42S-771-0266 or emailed to business.licenseg)edmondswa.gov
with a valid phone number. We will call you for a Visa or MasterCard payment.
SOLE PROPRIETORSHIP
NAME 1,AS S' C. /L— // /� A-e ---j , q H I?.
LAST FIRST MIDDLE INITIAL
ADDRESS K 7--Z SW , V P n -D Ae, AS JA)A
STREET SWTEAPTIUNIT # CITY/STATE/ZIP CODE
4�-
HOME PHONE( 30 2-7 /V�-DRIVERS LICENSE OR ID # & STATE 6 C-A LSS14 7 3 7- P1
DATEOFBIRTH %&=2==CITY/STATEOF BIRTH- &,OS AW6if-e-65, C ��COUNTRYOF BIRTH
PARTNERSHIP - PARTNER I
NAME
LAST
FIRST
MIDDLE INITIAL
ADDRESS
STREET
SUITE/APTJUNIT #
CITY/STATEIZIP CODE
HOMEPHONE(
I
DRIVERS LICENSE OR ID # & STATE
DATE OF BIRTH
ITY/STATE OF BIRTH —COUNTRY
OF BIRTH
PARTNERSHIP - PARTNER 2
NAME
LAST
FIRST
MIDDLE INITIAL
ADDRESS
STREET
SUITE/APT/UNIT#
CITYISTATEIZIP CODE
HOMEPHONE(
I
DRIVER'S LICENSE OR ID # & STATE
DATE OF BIRTH
CITY/STATE OF BIRTH
OUNTRY OF BIRTH
CORPORATION/ LLC or PLLC
NAME OFCORPORATION -FEDERALTAXID#
CORPADDRESS
Street Suite, Apt. Unit# City, State and Zip Code Phone Number
CORPORATE OFFICERS:
Last Name First Name MI Title DateofBirth Driver's License or Other ID# /State
LOCAL CONTACT
Last Name First Name MI Title DateofBirth
Driver's License or Other ID# /State Phone Number
CITY USE ONLY:
BUILDING DEPT APPROVE DISAPPROVE DATE SIGNATURE—
OCCUPANTLOAD BUILDING PERMIT OCCUPANCY GROUP
ENGINEERING
APPROVE DISAPPROVE DATE
SIGNATURE —
FIRE DEPT,
APPROVE DISAPPROVE DATE
SIGNATURE—
U,F.I.R
COMMENTS
PLANNING DEPT.
APPROVE DISAPPROVE DATE
SIGNATURE
ZONING CODE
CONDITIONAL USE PERMIT
COMMENTS
POLICE DEPT. APPROVE DISAPPROVE DATE SIGNATURE —
COMMENTS
RECEIVED gxrr
APR 2 8 2017
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