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665 EDMONDS WAY (2)FIRE PREVENTION 41 Serving RKer Edmonds, and 12425 Meridian Ave S Mountlak Terrace Everett, WA 98208 Phone (425) 551-1200 www.FireDistrictl.org Fax (425) 551-1272 LOCATION: 665 Edmonds Way 98020 BUSINESS NAME: Grow With Us Day Care (3) MAILING ADDRESS: 665 Edmonds Way, Edmonds, WA 98020 BUSINESS OWNER: Jansen, Jeanine EMERGENCY-1: KEY ACCESS-2: Jansen, Jeanine EMAIL: ).,'.PERSON CONTACTED: 7t _J� KIAKAM ^C IKICDC�YnM PHONE: 4257713800 HOME PHONE: HOME PHONE: HOMEPHONE: 4257736588 A- 17 FIRE SYSTEMS: (FA=9/15�E 16 I-L!r- lz INSPECTION REPORT 0 EDMONDS 0 BRIER 0 MOUNTLAKE TERRACE [3 UNINCORPORATED FREQUENCY STATION & SHIFT Amntwl SCHEDULED DATE DUE 11' May 9016 FIR ll� 253 CURRENT . I CITY YES NO BUSINESS M El LICENSE I I INITIAL INSPECTION DATE -7 J'. 0at&kastc8eMcedoc'Ametq5-/ COMMUNICATIONS All 2 2 3 3 4 4 5 -- ----- 5 6 6 7 I AGREE To cbRRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X lst RE -INSPECTION 2nd RE -INSPECTION EXTENSION FINAL RE -INSPECTION VIOLATIONS DATE DUE: DATE DUE: GRANTEDTO: DATE DUE: CITED: PERSON PERSON PERSON CONTACTED: CONTACTED: CONTACTED: 1 INSPECTOR: INSPECTOR: TOR: 2 3 DATE: DATE: _IP��PE VIOLATIONS VIOLATIONS'� Z� PRE -CITATION d_TATI(5N ISSUED 5.__ SENT�__ 4 __LETLELR _!�41V�ER: CODE 5 2 6 2 6 DATE: SECTION: RETURN RECEIPT 3 7 3 7 RECEIVED I 6 DISPOSITION: 4 '8 d 4 18 DATE: 7 LETTER NEEDED. C] YES [I NO I LETTER NEEDED [] YES Cl NO a Cenification Given -y" 1.3 S C 0 z i')'%10 In-'s RED YELLOW WM E CONFIDENCE TEST 102.3361h Ave XV,.1;uiU�F,T.ynnwurm1,WA VX03611%. A. REPAIRS �425) 771-1166 Fax (425) 771-4422 ...... AT FIRE ALARM SYSTEMS (One System per Report) Occupancy Name. Gf1mv With Us (3) _ Occupancy Address: 665 Edmonds Way, Edi-nonds Building Owner- 61-Ow With Uq LnMinVII Ct:'Aff Phone Number: (4-75) 712�1261 Owner Agent: Mpuruw Phone Number: (425) 712-1261 Date of Inspection: 04/21/2016 Inspection Type: V Annual Quarterly Tosters Name: M.-ii My SFD Certification Mumber.' scp..N�6�1.� Monitoring: Rarriur Firc Phone 9: 1800=47.3-7233 Account 0: 2-4-t§074 FACP ManUfacturev: SilenL Kni,.Ihi Model fj: 5208 Location: Officv of Initiating CIFCUIJS: 4 of Gigna� CivcuiW Notes: ALARM SYSTEM FUNCTIONALITY 10 U% /A All not1fir-ation circuits operational? ��_I All circuits checked for electrical supervision? All,wylliary equipment operotes (elevators', fi, na, dampers)? Key to pariel aVailabln? Operating instructions at panel? Troublo Indicators function propertV Test record posted at panal? ,Signals received at rmvaal station? Operazor A( Problems Found: Corrections Made: Date Corrected: 0 r Corrected By: SFD Certification This cortifip-s that this fire and life safety system has been properly inspected �ov rel[Iahifty to cover the Items listed In this report and Is consistent with Seattle Fire, Department Fire n 0 Code standards, and that discrepa ted and have been reeported in the building Owner/Manager for cor;&Ive a -on, Signature of T le Phone 11, Signature of 26W -SYSTEM DEVOCES MODEL# TOTAL TESTED SATISFACTORY? Yes No N, /A Horn/Strobes 'StIlibc.- 5 51 Sirebe Only 6 6 (42- Horn Only Speaker/Strobes Speaker Only Sounder Base RMIA Ll hlanualftfls Photo Smoke Detectors Ion Smoke Detectors Combination Smoke/Heat 1350 Rate of Rise Heat 200' Rate of Rise Heat 135' Fixed Temp Heat 200' Fixed Ternp Heat Duct Smoke Detectors Detector Rernote IndicatorB Rernote Annunciators Elevator Recall Output Fan Pressurization Door Holders Door Unlock Cuptains/Roll-do-wn Doors Fire Fighter Phones Main FACP Trouble with AC off? No Battery backup operational? No Battery voltage (no load) volts Battery voltage (full lead) ZAj�,Volts Charge circuit voltage -21.3 volts Battefy Size 2&d In PanelType: V Trouble with AC off? Yes No Battery backup operational? Yes No Battery voltage (no load) volts Battery voltage (full load) volts Charge circuit Vokage volts Battery S9ze PanM Type: T[roub% with AG off? Yes No Battery backup operational? yes No Battery voltage (no boad) volts Battery voltage (fu;l load) Charge circuit voftage --volts voks Battery Size PanelType: Trouble with AC off? Yes No Battery backup operational? Yes No Battery voltage (no load) volts Battery voRage (full load) volts circuR vog�age Erge acahtl:ery Size 'XW P D con RED YELLOW WHITF_ 0ONP1004C i� TE' ,T FIRM ALARM V1j'Z7ZU-V'j'q1> (One System per Repar�') CCCUPORCY NEiMG-. Grot4 Willi Uo.Lenzin- Occupancy Address: 065 BUilding Owner: Wirll L I-, I WWI' Phone Nzy,,rnber; Owner Agent: IiLIT(:111,15�)N Phone Number: -142-5,' 1 Date of Inspection: G �Ri", 4P_ 0 15 gnspeeilan Type- v Annual Quag�e5l;y Testers Name. Kiai Day SFO Cortiftntion Number: SCP- -t >or FACP Vannufasturer: '-ilent [,�ni�_,Iit Model #: Location- i # of Initiating Circuits. -4 # of Signal Circuits: I Notes: iALARM SYSTEM FUNCTIONALITY I Yes I No I MA i AJI notification circuits operadonal? I I All circ tilts checked for dectrical supervision? i AH auxiliary equipment operates (eievators, farts, damperz)? tf,mw rin immrvai =wnilrwhdlj�l Operating inotrilationma st pones? Troubic ind!=fors Turittion propL�dy? ToM rccord posted cl panaS? Signals received at central station? Operator 1� %—OFFOCKED bMy--_ Corrections Made, Date SF0Cerdf1ca.U_nn#,* IThis certitles thrit this tim and W9 safety system has bee -An proparty irspectofl �ro? ve4;aWli �y 1 to cover the ;tems !stud in this report and is "n5lstent wiah Seattie F;re Dc�pav-wylon, Five .04 F!4g lokillow-1-4 Ow nor/Manager faT A i Signature of ","oster: Phone C_. azae SIgnature of Ovrner:- SYSTEM DEVICES MODEL# VOTAL TESTED SATIMFACTORY? Yes P40 NIA Hoi,nlStrobes Strobe Only 6 6 Horn only SpeakeriStrobes I W Speaker Only 6-C"And0f 18.11. 1 : I - - L manual Pulls 14 rnoto mmoKe oerectors Combination ernowHeat 1351 Rate of Rise Heat 4 L4 200' Rate of Rise Heat 135' Fixed TGrnp Heat, 200* Fixed Temp Heat DuCt Smakc- DdWetbte, Detector Remote indicators Rornote Annunciators Elevator Recall Output Fan PrGswrization Door Holders Door Unlook Curtains/Roil-down Doors Main FACP V, Trouble with AC off? Vie-, No Q Battery barkup operational? es No Banery voltage (no load) Battary valtage (full goad) voks Charge circuit welt -ago T—I attery Size 0 __J_L_V_A I,- Volts ]A,_ _)_j u( V-1 PanelType: Tro u ble. w ith AC off? ye�- No Baftery backup operational? You; No BatEary voltage (no load) volts Battory voltage (full load) volts Chaqj:!;� circuit voltago Volta Battery siza Panel Type: Trouble with AC off? Y= No Battery backupoperational? Y'U s No Uattery voltage (no load) volts Battery voltage (full load) V&ts Charge circuit voltcgo VC35 Gattery Size PanelTypq- I Trouble with _AG clif? Y aa N P Battery bachup wurationO? Yiv* No Battery vokago (no load) Volts- B,Moty volfage (full load) volts Chorgc circuit v4ltago Rattary Siza I FN Sei-yhig Bilet; Ediiiofids, aiid 12425 MeiidiatiAve S Moutitlake Tei-mce EVerett, WA 98208 Ph6ne (425) 551-1200 C.7 JL'"JL%.# A wwwFireDistrictLorg Fax (425) 551-1272 FIRE PREVENTION INSPECTION REPORT -9-E-OMONDS 0 BRIER ' El MOUNTLAKE TERRACE [I UNINCORPORATED 0' FREQUENCY STATION 1, SHIF'***) 665 Edmonds Way 98020 Annual 17-D I LOCATION: Grow With Us Day Care (3) 4257713800 SCHEDULEDMay 2015 BUSINESS NAME: PHONE: DATE DUE 253 MAILING 665 Edmonds Way, Edmonds, WA 98020 LIFIR ADDRESS: Jansen, Jeanine BUSINESS OWNER: HOME PHONE: Jansen, Jeanine 4257736588 EMERGENCY-1: HOME PHONE: URRENT �ITY KEY ACCESS-2: HOME PHONE: YES NO ."�j BUSINESS 0 F EMAIL: LICENSE —1 ERS N CONTACTED:, INITIAL INSPECTION DATE NAME OF INSPECTOR: 70/ 7 I Kt 1) y Z:) I t=M6: FA�9/14 FE HAZARDS FOUND AND LOCATIONt COMMUNICATIONS 2 2 3 3 4 4 5 5 6 6 7 7 I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X 1st RE -INSPECTION 2nd RE -INSPECTION FINAL RE -INSPECTION EXTENSION VIOLATIONS DATE DUE: D E DUE: GRANTEDTO: DATE DUE: PERSON CITED: PERSON PERSON CONTACTED: CONTACTED: CONTACTED: 1 INSPECTOR: INSPECTOR: INSPECTOR: 2 DATE: E: DATE: 3 VIOLATIONS VIOLATIONS PRE -CITATION CITATION ISSUED 1 5 1 5 LETTER SENT NUMBER: 4 CODE 5 2 6 6 DATE: SECTION: RETURN RECEIPT 3 7 3 7 RECEIVED DISPOSITION: .4 18 4 18 DATE: LETTER NEEDED 0 YES 0 NO LETTER NEEDED F] YES NO FIRE DEPARTMENT COPY Certification Given RED YELLOW WHITE CONFIDENCE TEST! 1.9013 9uilv E. Ly=�%A"J. WA P'NC136 U.SA. I REPAIRS1 FIRE ALARM SYSTEMS (One System per Report) Occupancy Name: Grow V1i1hTT9Lwniir Occupancy Address: 665 Edmonds Way, Ednionds Building Owner: Uroiv WiThUs Lcarning C.cntcr Phone Number: (425) 712-12eyl Owner Agent: M"lurcen Phone Number: (42-5) 712-1261 Date of Inspection: 0911W-014 Inspection Type: v Annual Quarterly Testers Name: TunyP SFD Certification Number:,' scp. OCffS Monitoring: BarriurFi- Phone#: IK(OO-47.1-7233_ Acccvjnt#:--24-'4074 FACP Manufacturer:'Wont Knight _ Model #: 520.1 Location: Officc # of Initiating Circuits: of Signal Circuits: I Notes; ALARM SYSTEM FUNCTIONALITY Yes No NIA All notification circuits operational? All circuits checked for electrical supervision? All auxiliary equipment operates (elevators, fans, dampers)? Key to panel available? Operating Instructions at panel? Trouble Indicators fumtion property? Test record posted at panel? Signals received at central station? Operator Problems Found: Corrected By: Corrections Made: Date Corrected: SFD Certification This certifies that this tire and I to cover the Items listed In thls Code standards, and tha Owner/Manager for corr=1 Signature of Tester: Signature of Ownen system has been proporly Inspected tor rallability d Is consistent with Seattle Fire Department Fire are noted and have been reported to the building Phone #: M SYSTEM DEVICES MODEL # TOTAL TESTED SATISFACTORY? Yes No N/A Horn/Strobes Stmbes 5 Strobe Only 6 6 Horn Only I J,,S Speaker/Strobes Speaker Only 6cmAndar Baser Bells Manuel Pulls 4 Photo Smoke Detectors 9 Ion SMOI&S, 0019Ctors Combination Smokeffleat 135* Rate of Rise Heat 4 2000 Rate of Rise Heat 135' Fixed TGmp Heat 200* Fixed Temp Heat Duct Smoke Detectors Detector Remote Indicators Rernote Annunciators Elevator Recall Output Fan Pressurization Door Holders Door Unlock Curtains/Roll-clown Doors, Fire Fighter Phones Main FACP Trouble with AC off? Yes No Battery backup o"rational? ��o Battery voltage (no load) 9o�_77-- volts Battery voltage (full load) voks I Charge circeKoltage volts I Battery Slze(lz � qtkq Q,\) L � PanslType: Trouble w Ith AC off? Yes No Battery backup operational? Yes No BaftsrV voltage (no load) volts Battary voltage (full load) volts Charge circuit voltage volts Battery Size ParielType: Trouble with AC off? Yes No Battery backup operational? Yes No Battery voltage (no load) Volts Battery voltage (full load) volts Charge circuit voltage volt Battery Size PanelType: Trouble with AC off7 Yes No backup operational? Yes No -Battery Battery voltage (no load) - volts Battery voltage (full load) - volts Charge circuit voltage volts I Battery Size -, A elk AM U. 01 19033 36hAv- V� �Iute E. Lj4mmaoA IMA32036 U !:.A f�Q-5)771-11ZG Fw:�'42-9771-44-1' Occupancy N ame: Building Owner. Owner Agent: Certification Given RED YELLOW WHITE CONFIDENCE TEST REPAIRS FIRE ALARM SYSTEMS . (One SWem per Repon) Grow Wid, us 0" -- Occupancy Addrims: 66S Edrfth& Way, Edman&- 13 Grow With Us Lcaning Cbittr Phone Ntvnber: (425�1%2-'-"" Mallrccn Date of Inspection: M-10-1013. Testers Name: Phone N Lenber (425) 112-1261 Inspection Type: ( Annual Quarterly SFD Cartification Number: Scp-);.-�� Monitoiring:'Re,y,r,�, Fi'm Phone#: (!&co 9-7.3 -1233 Account #..AL/, FACP Manufacturwr,��- Model #: S��!Z Location.—�... # of Initiating Circuits: #of Signal Circuits: Notes: ALARM SYSTEM FUNCTIONALITY Yes No NIA AD notification circuits operational7 All circuits chocked for eleotrical supervision? All auxiliary equipment operates (elevators, fans, dampers)? Kayto pAhel avallAble7 Operating 1h%V1Jct1QhT, at Pahal? Trouble indicators foictian prepedy? V Test record posted at panel7 Signals received at central station? Operator Problems Found: A ADVE Corrections Made: Date Corrected: Corrected By.— SFD Certification #: This certifies that this fire and life safety system has been properly inspected for reliability to cover the items Iii sted in this report and is consistent with Seattle Fire Department Fire Code standards, and that discrepancies are noted and have been reported to the building Owner/Manager for corrqctiv"cfidn.) Signature of Tester: ' Signature of Owner:. Phone#:24G 35�, -**16o' SYSTEM DEACES MODEL# TOTAL TESTED SATISFACTORY? Yes No NIA HornlStrabes Strobe Only Ca Ham Only SpeakerMtrober, Speaker Only Sounder Base Befla Manual Pull& Photo smoke Datectors Ion Smoke Detectors Combination Smokell-leat 135' Rate of Risa Heat 200' Rate of Rise Heat 135' Fixed Tamp Heat 201Y Fixed Tamp Heat Duct Smoke Detectors Detector Remote Indicators Remote Annunciators Elevator Recall Output Fan Pressurization Door Holdem Door Unlock CurtainsRoll-domm Doom Fire Fighter Phones 1>1< Main FACP /1-11 PanelTvpe: Trouble with AC oW? No Battery backup aperationaI7 No Battery voltage (no load) 22�jvoltg Battery voltage �ull load) a['% I volts Charae circuit Voltage volts Battery Gi 7& #,, i,, r PanelTVpe: Trouble with AC aM Yes No Battery backup operationaI7 Yes No Battery voltage �na lead) Vohs Battery voltage (full load) volts Charge circuit voltage volts Battery Size ouble with AC off? Yes No Battery backup operational? Yes No Battery Voltage inn load) volts Battery voltage (full load) volts Char;ge circuit Voltage volts Battery Eg za PanelTvpe: Trouble with AC off? Yes No Battery backup operational7 Yes No Battery voltage ina load) volts Battery voltage (full load) V 01US Charge circuit voltage volts Battery Size I FIRE PREVENTION rV Se '' in�gi ie;:Edih6nds .12425 Meridian Ave S INSPECTION REPORT SNOHOMISH CO. _Ml''�"'hlk� . )� �'!' 6unt a e Terraceand FIR Everett, WA 98208 J�EDMONDS 0 BRIER the Town of Woodway DISTRI Phone (425) 551-1200 El WOODWAY 0 MOUNTLAKE TERRACE www.FireDistrictl.org Fax (425) 551-1272 0 UNINCORPORATED I'- FREQUENCY STATION & SHIFT'*) LOCATION: 665 Edmonds Wy 366 I 20 A BUSINESS NAME: Gr w With Us Day Ca .0 re PHONE 4257713E;()() SCHEDULED DATE DUE l' 05,t01/13 MAILING 665 Edmond Wy UFIR I, 233 5103 ADDRESS: Edmonds 98020 BUSINESS OWNER: Jansen, Jeanine HOME PHONE: 4257736588 EMERGENCY-1: Andersen, Scott HOMEPHONE: 4257722640 'CURRENT YES NO KEY ACCESS-2: HOME PHONE: CITY BUSINESS LICENSE PERSON CONTACTED: INITIAL INSPECTION DATE 1-7 NAME OF INSPECTOR: FIRE, FD,Lk&�FA 511 FE LOL SYSTEMS: ANNUAL HAZARDS FOUND AND LOCATIONS/ C_Wh4UNIeA __fl__ ONS 2 2 3 3 4 4 5 5 6 6 7 7 I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS lst RE -INSPECTION 2nd RE -INSPECTION EXTENSION (,-'—FINAL FfE-INSPECTION VIOLATIONS DATE DUE. DATE DUE. GRANTED TO, DATE DUE: CITED: PERSON PERSON PERSON CONTACTED:::::::: CONTACTED: CONTACTED: INSPECTOR: INSPECTOR: INSPECTOR: 2 3 DATE: "A DATE: DATE: ��5 VIOLATIONS PRE -CITATION CITATION ISSUED 1 n4tIONS 1 5 LETTER SENT NUMBER: 4 V-1 CODE 5 2 6 2 6 DATE: SECTION: RETURN RECEIPT 3 7 13 7 RECEIVED 6 DISPOSITION: 4 8 4 I 8 DATE: 7 LETTER NE�PED E] YES 1� NO LETTER NEEDED F] YES NO 1 8 FIRE DEPARTMENT COPY FIRE PREVENTION S� ing Brier, Edmonds 12425 Meridian Ave S INSPECTION REPORT SNIOHOMI M�iintlake Terraceand- FIR Everett, WA 98208 .... El EDMONDS O.PRIER -II,; .the Town of Wood ay - I DISTR T Phone(425)551 -1200 DWOODWAY 0 MOUNTLAKE TERRACE w,,WW.FireDistrictl.org Fax (425) 551-1272 0 UNINCORPORATED FREQUENCY STATION & SHIF") LOCATION: 66 Edmonds Wy 366 20 -C I BUSINESS NAME: Grow With Us Day Care PHONE: 4257713800 SCHEDULED DATEDUE 05101/11 MAILING W 665 Edmond Wy UFIR " 233 5103 ',ADDRESS: Edmonds 98020 BUSINESS OWNER: Jansen, Jeanine HOMEPHONE: 4257736588 EMERGENCY-1: Andersen, Scott HOMEPHONE: 4257722640 "CURRENT KEY ACCESS-2: HOME PHONE: CITY YES NO BUSINESS LICENSE - PERSON CONTACTED:. C (41 INITIAL INSPECTION DATE NAME OF INSPECTOR: FIRE FE 01 i I" SYSTEMS: 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 lst 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 kl' 6' 2 6 DATE: CODE SECTION: 5 3 7 3 7 RETURN RECEIPT RECEIVED' 6 4 8 4 8 DATE: DISPOSITION: LETTERNEEDED [] YES NO LETTERNEEDED [] YES NO 8 FIRE DEPARTMENT COPY j. r ,�-33 000 oSao3 CITY OF EDMONDS BU, SINESS LICENSE APPLICATION— COMMERCIAL FEE: $1125.00 CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION Inc. 5.9 121 5' AVENUE NORTH, EDMONDS, WA98020 PHONE: 425.775.2525 C-1 OFFICE USE ONLY P BL# Customer# 100;2 1-7 f 3-5 C I.-'2A( LYear go H I Cgs I SHD I Date Paid --'� -'M III TR# ab-39e? Fee Paid 1 IR6, 1 Mailed Delete 1 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 licenserequired if business changes location or ownership. Notification to City of Edmonds required If business closes. BUSINESS NAME 6;1--b LJ 0 '4A I <> Y-11`1 , BUSINESS ADDRESS �a (a z:T <,J yn � n el J 6,-q 2-z> Street Suite No. Zip Code MAILING ADDRESS 2- 3 3 2- J+w�-j C? Sti-eet or PO Box Suite No. City, State and Zip Code -� I , — -:� -5 �-] - BUSINESS PHONE NO. ( L17S) -7 —39 00 WA STATE TAX ID NO. (USI A.fl& 0 ( BUSINESS E-MAIL 1A � ali-, st t,- L)1� /QcoP"e,,-s4"kUSINESSWEBSITE C-A "eka'y' C7 PROPERTY OWNER 5�Wiyn[)Njz, jj�" Z22;--) �7 -7 EMERGENCY NOTIFICATION (For Premise Access in Emergency): C) r M a-,- I Last Name First Name MI Phone No. knAers,e,irN S F- Last Name First Name Mi Phone N6. NATURE OF BUSINESS PA , I A 'C&re, -- A-6 e '-> c-/-/`-.,- -�o ) Z-- NUMBER OF EMPLOYEES I SQUARE FOOTAGE OF BUSINESS SPACE 2- Z �? 9 TYPE OF BUSINESS - PLEASE CHECK THE APPROPRIATE CATEGORY: • CONSTRUCTION 0 FINANCE. INSURANCE, REAL ESTATE f7l LANDSCAPE, HORTICULTURAL 0 MANUFACTURING 0 NON-PROFIT • RETAIL 0 SECONDHAND DEALER 0 SERVICES 0 WHOLESALE m6THER. C �Nl Vel - C—CA-y-f-I AMUSEMENT DEVICES ON PREMISES? 0 YES 04116 IF YES. TOTAL NUMBER LIQUOR SOLD ON PREMISES?: 0 YES vr�O GAMBLJNG? CI YES 640' CIGARETTES SOLD ON PREMISES? 0 YES 8�1410 FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED?: 0 YES PAO IF YES, PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES: PROPOSED OPENING DAY OF BUSINESS BUSINESS HOURS -3 6 'a4�n 472 DAYS OPEN 0 SUNDAY &60NDAY IJIUESDAY &WEDNESDAY 0-rHURSDAY S-F-kIDAY 0 SATURDAY PARKING SPACES ON SITE: TOTAL ACCESSIBLE R PERSONS WITH DISABILITIES DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES? XPTES 0 NO PREVIOUS BUSINESS USE AT THIS ADDRESS n () V) E--- SOLE PROPRIETORSHIP NAME Last First MI ADDRESS Street Apt No., Unit No. City, State and Zip Code HOME PHONE NO. NO. (DRIVERS LICENSE NO.) OR OTHER ID NO DATE OF BIRTH CITY AND STATE OF BIRTH COUNTRY OF BIRTH -PARTNERI First ADDRESS Street Apt. No., Unit No. City, State and Zip Code HOMEPHONENO( I DOL NO. (DRIVERS LICENSE NO.) OR OTHER ID NO. DATE OF BIRTH CITY AND STATE OF BIRT COUNTRY OF BIRTH PARTNERSHIP - PARTNER 2 a Last First MI ADDRESS Street Apt. No.. Unit No. City, State and Zip Code HOME PHONE NO.( DOL NO. (DRIVERS LICENSE NO.) OR OTHER ID NO. DATE OF BIRTH CITY AND STATE OF BIRT COUNTRY OF BIRTH NAME i CORP. CORPORATE OFFICERS, Last Name —T'A A " e i" LOCAL CONTACT--)A,4 r, -t Last Name First Name CORPORATION V-1 YO 76 TS- PHONE MI Title Date of Birth DOL No. (Drivers License No.) or Other ID No. Name I'MI Title Phone No, DOL No. (Drivers Lic. No.) or Other 10 No. APPLICANT ecft� -A 1? 1 5 162 9 Name —Printed Igna,lure Title PLANNING DEPT. 0 APPROVE 0 DISAPPROVE DATE ____;SIGNATURE ZONING CODE CONDITIONAL USE PERMIT COMMENTS BUILDING DEPT. 0 APPROVE 0 DISAPPROVE DATE SIGNATURE OCCUPANTLOAD BUILDING PERMIT --------QCCUPANCY GROUP, COMMENTS FIRE DEPT. 0 APPROVE 0 DISAPPROVE DATE- SIGNATURE U.F.I.R. COMMENTS POLICE DEPT. OAPPROVE 13DISAPPROVE DATE -----,SIGNATURE Frne Pan wAu coNsmx*xw RRE RAM WAU CONS7RW770M Fax**LAI� ",M WAY (45 EDrO c-4zow um:Ti-i Us' LvAwm� ce4rmz.,s ARE 447ED WALL CONSMLCTM lho drjcm wig *mfta win be mquimd to. be repaW and dancedW9-d by 0 CLASER=VGM a Ws stft1w, Steft rto&m d PW&Ufofw -t IV CEM-3N& t no o=OSW)OW WX be **mind wcwft to ffie jnftftl�ofto ad" Cade. 720-R).FT 07af 1.9 53 0 T�4- I I "AWV% 30! 3L* - 7i I ! rw-, rE—),77T r"w4 "%gum& 30027 - - ProvWw D Number FULL CE11LD CAM CENTER LICENSE Early Learning. SM22 88PS Provider Number Ja coMlimm vMh and purnad Wthe laws of &0 SWC of*washirktm in mecting The fawamm heMM9 recparce=" 'Of thle Dwwbnea of Emely L==Mg (DEL� a cMd cm H== is bereby Vwted to the Child Cam Caaw nanud belaiv. FlatImformstles an thc " I Of d& MeOmM mg. 14166442-4M or (1-%&48-cbod*. GROW Wfflff Ust INC D/13/A — GROW VVfflff US 21313 34TR AVE W is Hoinsed to makitain a duld dM center at city of EDMONDS zip code 98M pounty of BNOOP-Answ- SUcafWaddnglon, for the.care of chfldm bctwm ft 40 of I yR - through 12 YU kdwiiM but not to cKoad 49 ;bfldmm LAmiudcw if amr, 71& b biwd on Augmit 4,20W and v*cs.on DOW at I&V -�18shbooll, fts 30* day of Jot DIRL Uciiw�r om PridNs" 425-439-4926. 425-4384822 Tdq*m Number Tc1qhwe Nbmbor NME Thk gw" is got bMdWOW Me b v*IU e* fw an by the MMVMNRXB) to it b ipued sW ot the bedion asafte& Umed.by Adbortty Of ChROW 43.215 R"I" CO& OfWUbh*t1M