22618 HWY 99 STE 106 (2)_RedactedServing Brier, Edmonds, and 12425 Meridian Ave S
FIRE PREVENTION
IN CTION REPORT
sN HOm� E1
O S CO.
FIREMountlake Terrace
Everett, WA 98208
EDMONDS
❑ BRIER
DISTR T
Phone (425) 551-1200
AKE TERRACE
❑ UNINCORPORATED
UNINCORPORATED
wwwFireDistrictl.org
Fax (425) 551-1272
FREQUENCY
STATION &SHIFT
LOCATION:/618 Highway 99 Suite 106 98026
2016'
20-B
BUSINESS NAME: Joo Family Clinic
PHONE: 454099247
SCHEDULED
DATE DUE ► Mar 2016
• MAILING
UFIR ► 593
ADDRESS: 22618 Highway 99, Suite 106, Edmonds, WA
98026
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1: JOo, Misook/
HOME PHONE: Z4252685565
01 CURRENT
KEY ACCESS-2:
HOME PHONE: = '
CITY YES NO
EMAIL:
BUSINESS
LICENSE
E]
PERSON CONTACTED:
INITIAL INSPECTION DATE
.ti
NAME OF INSPECTOR:
FIRE SYSTEMS: FE S/ 6
Date
ast Serviced: '
HAZAR
FOUND AND LOCATIONS / COMMUNICATIONS
y
.3
.
3
4
5
5
•
6
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-
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION 2nd RE -INSPECTION EXTENSION FINAL RE -INSPECTION VIOLATIONS
DATE DUE: �T DATE DUE: — GRANTEDTO: DATE DUE: CITED:
PERSON PERSON PERSON
CONTACTED: CONTACTED: CONTACTED:
INSPECTOR: INSPECTOR: i INSPECTOR: 1,2
DATE: DATE: 3
VIOLATIONS VIOLATIONS - PRE -CITATION CITATION ISSUED � ___
-,
1 5 - 1 5 LETTER SENT NUMBER:
_ .. _.,.._ _. _.. . pp
- 1 i CODE 5
2 _ - �6 2 16 DATE: SECTION: - - - -
..... ....___...... ,_..._-,_ _ .. I._.. .._..-.___ ___...-� _......_._._._-__.._..
I RETURN RECEIPT
3 17 3 7 RECEIVED s
DISPOSITION:
4 8 4 8 DATE:
LETTER NEEDED ❑ YES ' ❑ NO LETTER NEEDED .❑ YES ❑ NO 8
FIRE PREVENTION
Brier; Edmonds
12425 Meridian Ave SWA
INSPECTION REPORT
srroxonRisx co.Serving
'FIREMountlake Terrace,and
Everett, 98208
❑BRIER S
❑BRIERthe
Town of Woodway
SThtfT
Phone (425) 551-1200
❑WOODWAY
❑ MOUNTLAKE TERRACE
www.FireDistrictl.org org
Fax (425) 551-1272
❑ UNINCORPORATED
FREQUENCY
STATION & SHIFT
r, LOCATION: 22618 Hwy 99
106
730
20 6
BUSINESS NAME: Italian Custom Tailor
PHONE: 4257440722
SCHEDULED
DATE DUE ► 03/01/12
MAILING 22618 99 #105
uFIR ► 524 3 106
ADDRESS: Edmonds
98026
BUSINESS OWNER: Ahn, Chang
HOME PHONE: 4255129602
EMERGENCY-1: Mood, ,tl
HOME PHONE: 4253619420
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
'
LICENSE
i'
PERSON CONTACTED: n
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
J
FIDE
FE I_
SYSTEMS:
ANNUAL
I"
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
/
2
2
3
3
4
4
5
5
6
I
+
6
7
7
I 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
6
4
18
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8
FIRE DEPARTMENT COPY
13
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CITY OF EDMONDS
INESS LICENSE APPLICATION- COMMERCIAL
FEE: $125.00
CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION
121 5' AVENUE NORTH, EDMONDS, WA 98020 PHONE: 425.775.2525
OFFICE USE ONLY
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Customer#
SIC
Year
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SHD
Date Paid
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Fee Paid
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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 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 locations ownership. Notification to City of Edmonds required
if business closes. � —Z-5- jj/ t`� 7
BUSINESS NAME JOD
BUSINESS ADDRESS .2416 ! 0a 11ttNY
tr
Street /, / Suite No. Zip Code
MAILING ADDRESS ,221 O�? ARY&V 9� /Ob Edmonds , AM 9ePo.2A -,39T
or PO Box ' Suite No. City, State and Tip Code
BUSINESS PHONE NO. -2$7/.2- 1/7 WA STATE TAX ID NO. (UBI NO.) _9 0.3 —..2 il V " 1440
BUSINESS E-MAIL h I 00 T&WC, C,OM BUSINESS WEBSITE .10V c I r n C . conj
PROPERTY OWNER Solo kan Rote 0. L.(_ C (206 ) 711— / V C0
Name Phone Number
EMERGENCY NOTIFICATION (For Premise Access in Emergency):
J00 Misook- .298- r�6�
Last Name First Name MI Phone No.
Jo Sangtiyou (_`-) 26e-?/?
Last Name First N- -m` MI Phone No.
NATURE OF BUSINESS ��iYl i U %�QA 1 C 111Q_
NUMBER OF EMPLOYEES SQUARE FOOTAGE OF BUSINESS SPACE
TYPE OF BUSINESS - PLEASE CHECK THE APPROPRIATE CATEGORY:
O CONSTRUCTION O FINANCE, INSURANCE, REAL ESTATE O LANDSCAPE, HORTICULTURAL O MANUFACTURING O NON-PROFIT
O RETAIL O SECONDHAND DEALER SERVICES O WHOLESALE O OTHER
AMUSEMENT DEVICES ON PREMISES? O YES )CNO IF YES, TOTAL NUMBER
LIQUOR SOLD ON PREMISES?: O YES )(NO GAMBLING? O YES XNO CIGARETTES SOLD ON PREMISES? O YES >(NO
FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED?: O YES XNO IF YES, PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES:
PROPOSED OPENING DAY OF BUSINESS _ M yl 0 �� .10 f 3 BUSINESS HOURS eAM — 4P ph
DAYS OPEN W SUNDAY b(MONDAY XTUESDAY X WEDNESDAY P(THURSDAY 9FRIDAY >QSATURDAY
PARKING SPACES ON SITE: TOTAL _'T ACCESSIBLE FOR PERSONS WITH DISABILITIES \/ S
DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESS113LE TO PERSONS WITH DISABILITIES? )<YES O NO
PREVIOUS BUSINESS USE AT THIS ADDRESS Re-f -A l'
SOLE PROPRIETORSHIP
NAME
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 BIRTH COUNTRY OF BIRTH
PARTNERSHIP -PARTNER I
NAME
Last First MI
ADDRESS
Street Apt. No., Unit No. City. State and Zip Code
HOME PHONE NO ( ) OOL NO. (DRIVERS LICENSE NO.) OR OTHER ID NO,
DATE OF BIRTH CITY AND STATE OF BIRTH COUNTRY OF BIRTH
PARTNERSHIP -PARTNER 2
NAME
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 BIRTH COUNTRY OF BIRTH
CORPORATION
NAME OF CORPORATION 0O
/,1-A-k t i I V C j n! C , L L C FEDERAL TAX ID NO. �� — 11O ? 3 tT (
CORP ADDRESS � 2 O IOp/1 W y 49 W/04 , ands. Am -A— P3?S- PHONE NO.
Street Suite, Apt., o. City. State and Zip Code
CORPORATE OFFICERS:
Last Name First Name
Joo M;SoOk
MI Title RCW 42.56I i I i i I !I I IPersonalI nformation for DL or SSN
LOCAL CONTACT JOo SwwAyoG1'I'tj Zpa-27/7
Last Name Firdt N e MI Title Phone No. DOL No. (Drivers Lic. No.) or Other ID No
APPLICANT M'I S OO k JO 0 �Jembey' 7
Name - Printed Signature Title ate
PLANNING DEPT. O APPROVE O DISAPPROVE DATE SIGNATURE
ZONING CODE CONDITIONAL USE PERMIT
COMMENTS
BUILDING DEPT. O APPROVE O DISAPPROVE DATE SIGNATURE
OCCUPANT LOAD BUILDING PERMIT OCCUPANCY GROUP
COMMENTS
FIRE DEPT. O APPROVE O DISAPPROVE DATE SIGNATURE
U.F.I,R.
COMMENTS
POLICE DEPT. O APPROVE O DISAPPROVE DATE SIGNATURE
COMMENTS
Joo Family Clinic, LLC
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(9 x 13) (9 x,7)-
Storage I Restroom
(12 x 9)
.Exam Room
#'2
nk
(13x9)
Exam Room
#1
r (7 x 9) . (7 x 6)
nk Staff Greeting
Meeting Desk
Room
-20)
,,.��'� Waiting Rooin.°Area.
1 2 3 4 5 6 7 8 9 10 11 12
(17x7)
Exam Room
#3
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