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22618 HWY 99 STE 107_RedactedSNOHOMTSH CO. FIRE ° ill l�lIII u(p l g ksGKw�y 9 Serving Brier, Edmonds, and 12425 Meridian Ave S Mountlake Terrace Everett, WA 98208 Phone (425) 551-1200 www.FireDistrictl.org Fax (425) 551-1272 LOCATION: 22618 Highway 99 Suite 107 98026 BUSINESS NAME: OSC= al�Pnta��^� �i'� PHONE: MAILING ADDRESS: 22618 Highway 99, Suite 107, Edmonds, WA 98026 BUSINESS OWNER: HOME PHONE:' EMERGENCY-1: U O Lep - KEY ACCESS-2: EMAIL: PERSON CONTACTED: 'NAME OF INSPECTOR: ` 1• FIRE SYSTEMS: FE l Date Last Serviced: HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS itM�l�N�i �l �t Y► HOME PHONE: 4257431000 HOME PHONE: S;Ir- iv7 FIRE REVENTION INAFECTIION REPORT EDMONDS ❑ BRIER ❑ MOUNTLAKE TERRACE UNINCORPORATED FREQUENCY I STATION & SHIFT 2016* 20-B SCHEDULED DATE DUE ► Mar 2016 UFIR / 593 CURRENT CITY YES NO BUSINESS LICENSE INITIAL INSPECTION DATE ►o /b 1..�. 2... 3 5 6.._:.._. 7 5 I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X 1 st RE -INSPECTION 2nd RE -INSPECTION EXTENSION FINAL RE -INSPECTION VIOLATIONS DATE DUE: DATE DUE: GRANTED TO: DATE DUE- CITED: PERSON - �y ... ._. ___..._ ......,..�. 19 L6 PERSON v® _._� _.._._ CONTACTED: € CONTACTED: PERSON CONTACTED: € � SfhD FlEr'�fCA �'7aC_../N. .. S '77, INSPECTOR: A lIkArpl INSPECTOR: INSPECTOR, 12 DATE: DATE:D_ATE•_ 3` . VIOLATIONS VIOLATIONS:,:_• ; CITATION ISSUED�` //�� J PRE -CITATION 1 ... 21_......_._ 5. ._. .. __.__... �........._._._.5 ... .._.__._—. LETTER SENT— NUMBER: _...,a. 4 ? CODE 6 - , 2 6 DATE: SECTION- S URN 3 7 3 7 RETRECEIR RECEIVED RECEIPT I s # ..�...._........ DISPOSITION: ...._..,. �.w�.._.._.._. ...._ .......,...... 4 { 8 4 _ _ �8 DATE:: • ' _ 7 LETTER NEEDED ❑ YES ❑ NO LETTER NEEDED ❑ YES ❑ NO EXPLANATION OF CODE . � G L PERMITS: 1. Obtain a perm it from the Fire Department: I.F.C. 105.1 2. Maintain hazardous materials/processes according to your Department permit requirements: I.F.C. 105.1 3. Renew expired Fire Department permit. I.F.C. 105.1.2/105.3.1 4. Conspicuously post Fire Department permit in appropriate location: I.F.C. 105.3.5 5. Obtain business license 6. Obtain permit from Building Department for: FIRE PROTECTION: 7. Remove all foreign material from the sprinkler heads or replace the sprinkler heads: I. FC.901.6.1 8. Nothing shall be placed on or hung from sprinkler piping: I.F.C. 901.6.1 9. Install approved cover(s) on the Fire Department sprinkler connection: I.F.C. 901.6.1 10. Remove all.storage from around sprinkler system control valves: I.F.C. 901.6.1 11. Repair sprinkler system deficiencies: I.F.C. 901.6.1 12. Remove all items that might block access to sprinkler control valves or Fire Department hose connections: I.F.C. 901.6.1 13. Lower the storage to a minimum of 18" below the sprinkler head deflectors: I.F.C. 315.3.1 14. Annual confidence test must be performed on sprinkler system(s) by a qualified person, and documentation must be provided to Fire Marshal: I.F.C. 901.6.1 15. Fusible link or sprinkler head must be replaced on hood and vent extinguishing system: I.F.C. 904.11.6.3 16. Hood and vent extinguishing system must be serviced semi-annually by a qualified person: I.F.C. 904.11.6.2 17. Remove all accumulations of grease from the range hood, fillers and connecting grease flue and institute periodic cleaning to prevent such accumulation in the future: f.FC.609.3.3.1 18. Spray booth filters shall be maintained and changed in accordance with: I.F.C. 1504.3 19. Remove all items or conditions, which might interfere with proper use of fire hydrant: I. FC.507.5.4 20. Repair fire alarm system: I.F.C. 907.8.5 21. Fire alarm system shall be tested and maintained annually: NFPA 72 Documentation shall be provided to Fire Marshal: I.F.C. 907.7.2 2 le fire extin uishers: I.F.C. 906.1 3. The fire extinguishers) must be inspec e a y: NFPA 10 24. he fire extinguisher(s) must be servicedhecharged by a qualified person: NFPA 10 25. Fire/life safety systems must be tested and maintained, documentation must be provided to the Fire Marshal: I.F.C. 901.6.1 26. The dry standpipe shall be hydrostatically tested every five years: I.F.C. 901.6 27. All devices in approved locations: I.F.C. 907.1 EXITING: mtain exit pat wav i 3 29. Maintain ezit sign illumination: I.FMrecMono 30. Prow a roved signs indicatingtravel to fire exits: I.F.C. 1011.1 31. Provide approved signs indicating the fire exit(s): I.F.C. 1011.1 32. Exits shall not be blocked or obstructed in any way, and the required width of aisles leading to exits shall be maintained: I.F.C. 1030.2 33. Properly repair the panic hardware on the exit door(s): I.F C. 1008.1.10.1 34. Exit doors shall be openable from the inside without the use of a key or any special knowledge or effort. Exit doors shall not be locked, chained, barred, latched, or otherwise rendered unusable. All locking devices shall be of an approved type: I.F.C.1008.1.9 35. In group A-3, B, F, M & S occupancies, in all churches main exit door(s) may have key -locking hardware if an approved sign is posted, stating, "This Door To Remain Unlocked During Business Hours": I.F.C. 1008.1.9.3 36. Provide a minimum of 36" of clear aisle width: I.F.C. 1018.2 37. Provide a minimum of 44" of clear aisle width: I.F.C. 1018.2 38. Every building of three or more stories shall have approved stairway identification signs posted: I.F.C. 1022.8 39. All assembly occupancies shall have occupant load posted in conspicuous place: I.F.C. 1004.3 40. Overcrowding of a room or building shall not be permitted: I.F.C. 107.5 ELECTRICAL: 41. Install approved covers on the open electrical service panel(s) or junction box(es): I.FC.605.6 42: A junction box with an approved cover is required at every splice. Therefore, provide such boxes: I.F.C. 605.6 43 Maintain a minimum of T clearance in front of electrical panels: I.F.C. 605.3 44. Provide documentation that electrical wiring, panels, etc., have been inspected and approved by Washington State electrical inspector: I.F.C. 605.1 45. Electrical wiring and equipment in any vapor area shall be explosion -proof type approved for use in such hazardous location: I.F.C. 1503.2.1/3403.1/2201.5 46. Extension cords shall not be used as a substitute for permanent wiring: I.F.C. 605.5 47. The current capacity of an extension cord shall not be less than the rated capacity of the appliance or fixture served by that cord: I.F.C. 605.5.2 48 Extension cords shall be maintained in good condition without splices, deterioration, or damage: I.F.C. 605.5.3 49. Extension cords shall be of the grounded type when serving grounded appliances or fixtures: I.F.C. 605.5.4 FIRE SEPARATIONS: 50. Discontinue blocking or wedging open fire doors: I.F.C. 703.2 51. Repair the fire door(s) so they close completely and in proper sequence: I.F.C. 703.2703.2.3 52. If an open fire door is necessary for ventilation or convenience, a hold open device approved by the Fire Marshal must be used: I.F.C. 703.2.2/I.B.C. 715.3.7.2 53. All required occupancy separations, area separation walls, and draft stop partitions, shall be maintained as specified in the International Building Code: I.F.C. 701.1f703.1 54. Repair the damaged plaster with a fire -resistive material equivalent to the surrounding surfaces: I.F.C. 703.1 FLAMMABLE LIQUIDS, GASES. AND HAZARDOUS MIJERIALS: 55. Reduce the quantity of flammable liquids: CHAPTER 57 56. Flammable liquids not exceeding 120 gallons may be stored in an approved storage cabinet. Such cabinet shall be conspicuously labeled in red letters: "Flammable -Keep Fire Away": CHAPTER 57 57. Remove the accumulation of combustible residues from the walls, floor and ceiling of the spray room area: CHAPTER 25 58. Dispensing devices shall be of an approved type. Class I -A flammable liquids shall not be dispensed from tanks, drums, barrels, or similar containers by gravity. Approved pumps taking suction from the top of the container shall be used: CHAPTER 57 59. Hose nozzle valves used at self-service stations for dispensing of Class I flammable liquids shall be listed automatic closing: CHAPTER 23 60. When damage to LP gas systems from vehicular traffic is a possibility, precautions against such damage shall be taken, therefore provide posts or a protective barrier to prevent such damage: CHAPTER 61 61. All compressed gas cylinders in service or storage shall be secured to prevent falling or being knocked over: CHAPTER 57 62. Oil burning equipment shall be of an approved type: I.F.C. 603.1.2 63. Install/repair woodworking refuse removal system: CHAPTER 28 64. Post signs stating location of emergency pump shutoff: CHAPTER 23 65. Post "NO SMOKING" sign(s) on LPG tank: CHAPTER 61 66. Remove and safely dispose of damaged or leaking containers of flammable hazardous material: CHAPTER 57 67. Use, dispensing, storage and handling of hazardous materials shall be in accordance with I.F.C. Chapter 57 and your Fire Department permit: CHAPTER 50 68. Provide Material Safety Data Sheets (MSDS): CHAPTER 50 69. Provide Hazardous Material Inventory Statement (HMIS): CHAPTER 50 70. Provide Hazardous Materials Management Plan (HMMP): CHAPTER 50 STORAGE: 71. Remove all flammable or combustible storage from the unfinished attic area: I.F.C. 315.3.4 72. Remove all combustible material from beneath the structure: I.F.C. 315.3.4 73. Lower the storage to a minimum of 24" below the ceiling: I.F.C. 315.3.1 74. Lower the storage to a minimum of 18" below the sprinkler head deflectors: I.F.C.315.3.1 75. Remove all combustible or hazardous material: I.F.C. 315.1 76. Unlawful to park or store any fueled equipment in any dwelling unit, office, exit way or location that would create a fire or life hazard: I.F.C. 315.1 77. Boiler rooms, mechanical rooms, and electrical panel rooms shall not be used for storage: I. F.C. 315.3.3 78. Any exterior door that has been rendered non-functional in an approved manner by the Chief shall be posted in an approved manner with the words, "This Door Blocked": I.F.C. 504.2 79. Dumpsters and containers with an individual capacity of 1.5 cubic yards or greater shall not be placed within 5 feet of combustible walls, openings, or combustible roof eave lines: I.F.C. 304.3.3 80. Remove and properly dispose of the combustible tall grass, brush and other debris: I.F.C. 304.1.2 MISCELLANEOUS: 81. Strictly enforce "NO SMOKING" restrictions: I.F.C. 310 82. Post "NO SMOKING" signs: Washington Clean Air Act of 1985 and I.F.C.310.3 83. Discontinue the practice of illegal outdoor burning: I.F.C. 307.1 84. Secure this vacant building to reduce the fire hazard: I.F.C. 311.1 85. All decorative materials are required to be of flame retardant material or treated to provide flame resistant characteristics: I.F.C. 806/807 86. Any owner, operator, occupant or other responsible person who shall fail to take immediate action to abate a fire hazard when ordered or notified to do so by the Fire Chief, shall be guilty of a misdemeanor: I.F.C.109 87. Post and maintain the correct street address number in an approved manner: I.F.C.505 88. Post and maintain the correct suite or unit designator: I.F.C. 505.1 89. Striping and "Fire Lane - No Parking" signstmarkings shall clearly indicate where the approved fire lane is located I.F.C.503.3 90. Provide a key box for emergency access to the building: I.F.C. 506.1 91. Provide appropriate access to the building: I.F.C. Section 503 S-4i'l 1/0 CITY OF EDMONDS BUSINESS LICENSE APPLICATION- COMMERCIAL CITY CLERK'S OFFICE, ICE:B BUSINESS DIVISION 121 5TH AVENUE NORTH, EDMONDS, WA 98020 PHONE: 425.775.2525 - -- - -- - wmpreze zne appiication 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. BUSINESS NAME �SC� /- Ye47/m 'r BUSINESS ADDRESS 7i2 6t� W,-, �" street V,/0 Suite No. Zip MAILING ADDRESS Street or PO Box Suite No. City, State/and Zip Code BUSINESS PHONE NO. ��) ��� Joel el WA STATE TAX ID NO. (UBI NO.) 60 2- 7 qS 3v BUSINESS E-MAIL PROPERTY OWNER BUSINESS WEBSITE Name EMERGENCY NOTIFICATION (For Premise Access In Emergency):Phone Number Last Name First Na a MI �) -'hone No. Last Name First Name NATURE OF BUSINESS %6w �-� c C%,� {i MI Phone No. z NUMBER OF EMPLOYEES SQUARE FOOTAGE OF BUSINESS SPACE SOD 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 O SERVICES O WHOLESALE &S�OTHER AMUSEMENT DEVICES ON PREMISES? OYES �/ �/� �r"��� G ("/n % c e NO IF YES, TOTAL NUMBER LIQUOR SOLD ON PREMISES?: OYES C1 N0 U�� GAMBLING? O YES NO CIGARETTES SOLD ON PREMISES? O YES Ci NO FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED?: O YES EfNO IF YES, PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES: PROPOSED OPENING DAY OF BUSINESS Men/ �j %yid �j,� BUSINESS HOURS DAYS OPEN O SUNDAY 0 MONDAY O TUESDAY &WEDNESDAY O THURSDAY C! FRIDAY O SATURDAY PARKING SPACES ON SITE: TOTAL ACCESSIBLE FOR PERSONS WITH DISABILITIES DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES? h YES O NO / PREVIOUS BUSINESS USE AT THIS ADDRESS %D'I p�fa - I SOLE PROPRIETORSHIP NAME MI Last First ADDRESS Street Apt. No., Unit No. City. Slate and Zip Code HOME PHONE NO. () DOL NO. (DRIVERS LICENSE NO.) OR OTHER 10 NO. DATE OF BIRTH CITY AND STATE OF BIRTH COUNTRY OF BIRTH PARTNERSHIP -PARTNERS NAME Last First MI ADDRESS Street ApL 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 2 NAME Cast First MI ADDRESS Street Apt. No., Unit N0. 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 e 7 % C �'°"n ' v / - , �1 FEDERALTAX ID NO. j rA f A,"'1 " &0 �� � PHONE NO, /� / ��!'90f CORP. ADDRESS �r � r , '' � � �� Street Suite, Apt., Unit No. City, State and Zip Code CORPORATE OFFICERS: Last Name First Name MI Title Date of Birth DOL No. (Drivers License No.) or Other ID No. . LOCAL CONTACT �) Last Name First Name MI Title Phone No DOL No. (Drivers Lie. No.) or Other ID No APPLICANTv/ aanr" Sinnan ra // ^ title Date PLANNING DEPT. O APPROVE O DISAPPROVE DATE SIGNATURE ZONING CODE CONDITIONAL USE PERMIT COMMENTS - BUILDING DEPT. O APPROVE D DISAPPROVE DATE SIGNATURE OCCUPANT LOAD BUILDING PERMIT OCCUPANCY GROUP COMMENTS - FIRE DEPT. O APPROVE L7 DISAPPROVE DATE SIGNATURE U.F.I.R. COMMENTS POLICE DEPT. O APPROVE O DISAPPROVE DATE SIGNATURE COMMENTS Inc 1 B913 CITY OF EDMONDS 121 5TH AVENUE NORTH • EDMONDS, WA 98020 • (425) 775-2525 www.edmondswa.gov CITY CLERK February 21, 2012 Good Life Chiropractic-Oscare Health Center 22618 Highway 99 Ste 107 Edmonds, WA 98026 Dear Business Owner: DAVE EARLING MAYOR The City Clerk's Office received your business license renewal form and $50.00 check for your business located at 23931 Highway 99. Because you have now relocated your business to 22618 Highway 99, a new business license application is required. Business licenses are issued to the business address, as the physical address is what is reviewed to be sure City Codes are met. The fee for a new business license is $125.00. (The annual renewal will be $50.00.) Therefore, we are returning your check in the amount of $50.00 that was submitted to renew your license at 23931 Highway 99. In addition, enclosed is a business license application to obtain the new information for your new location. Please complete the application and return it along with your check in the amount of $125.00 and a floor plan of the Suite you are in to the following address: City of Edmonds Attention: Business License Division 121 5 h Avenue North Edmonds, WA 98020 Thank you for your time. I hope you are very happy in your new location and that you have much success. Yours truly, Huda Olsen Accounting Assistant Enclosures Incorporated August 11, 1890 Sister City - Hekinan, Japan 50'-0" 3l�= 11'-7114' (4 4 11' 7 314" j`F��� 6 9/16" ST. EXIST. EXIST. EX I T EX RM #3 TR t RM #2 TREAUM #1 EXi5'H L-6- AITHZ'-0" 2'-6"ell 93� ®� T °H 44 H FS NEW 40 GAL ELEC. WATER7'-6° EX UNEAR COUNrER,=NNEcrHALL WAITING EXIsTE l,rt CWLINE. AN2" H © ,{4° H " !0,/ 2''6" 2'-6- N 2'-V �1 DOCTOR'S RM #1 DOCTORS RM #1 (D WO RM ST. EM) I . - FXIILL 21 "Dx4 8'-0 3/4" 8'4 718" 8'-10 7/16" ; -0 9/16" IEW 1/2" H C.SC6t Ke-, 4eo 1+il Czv� -leer' FOR MOP LIN�Wl1 2zbt �- j-1,�h�.►�,,� a9 to-7 ' 10 THE NE7RE J WALLA LOOR PLAN I. . L SNOHOMISH CO. Serving Brier; Edmonds Mountlake Terrace,and FIRE the Town of Woodway DISAAM T www.FireDistrictl.org LOCATION: 22618 Hwy g$ k BUSINESS NAME: OSCafe Health Center MAILING ADDRESS: BUSINESS OWNER: Hui, Sukjae EMERGENCY-1: Lee S KEY ACCESS-2: PERSON CONTACTED: ��f ff (41? NAME OF INSPECTOR: FIRE SYSTEMS: 12425 Meridian Ave S Everett, WA 98208 Phone (425) 5514200 Fax (425) 551-1272 107 PHONE: 4257431000 HOME PHONE: 4257431000 HOME PHONE: 4257787771 HOME PHONE: FIRE PREVENTION INSPECTION REPORT ❑ EDMONDS ❑ BRIER ❑ WOODWAY ❑ MOUNTLAKE TERRACE El UNINCORPORATED FREQUENCY I STATION & SHIFT 731 20 B SCHEDULED DATE DUE ► 03/01/12 UFIR ► 503 3 106 CURRENT CITY YES i NO BUSINESS E ❑ LICENSE INITIAL INSPECTION DATE FE!� HAZARDS FOUND AND LOC TIONS / 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 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 8 4 8 DATE: DISPOSITION: 7 LETTER NEEDED ❑ YES ❑ NO LETTER NEEDED ❑ YES ❑ NO 8 1' FIRE DEPARTMENT COPY --- 9 r : CITY OF EDMONDS BUSINESS LICENSE APPLICATION— COMMERCIAL FEE: $125.00 CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION Inc. 1%9121 5' AVENUE NORTH, EDMONDS, WA 98020 PHONE: 425.775.2525 OFFICE USE ONLY BL# Customer# 1 SIC u 9 Year 0� Class SHD Date Paid s TR# 17�/ Fee Paid .� � Mailed Delete 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 1 if business closes. BUSINESS NAME BUSINESS ADDRE MAILING ADDRESS She cli.) - Street �orPO Box �T�] Suite No. City, State and Zip Code�J BUSINESS PHONE NO. �`1(I1V—i1 1 M( WA STATE TAX ID NO. (UBI NO.) C o l O'�'F a i 3 5' BUSINESS E-MAIL PROPERTY OWNEF EMERGENCY NOTIFICATION (For Premise Access In Emergency): MYn Me-', A 206 ,bit -60 S-S Last Name First Name -MI Phone No. OH KYO/06 /1 -4 444=465S- last Name First Name Mi Phone No. NUMBER OF EMPLOYEES _SQUARE FOOTAGE OF BUSINESS SPACE [bon Sig. k TYPE OF BUSINESS - PLEASE CHECK THE APPROPRIATE CATEGORY: O CONSTRUCTION O FINANCE, INSURANCE, REAL ESTATE O LANDSCAPE, HORTICULTURAL ❑ MANUFACTURING O NON-PROFIT 0� RETAIL O SECONDHAND DEALER IM SERVICES O WHOLESALE O OTHER AMUSEMENT DEVICES ON PREMISES? O YES ANO IF YES, TOTAL NUMBER LIQUOR SOLD ON PREMISES?: O YES 'p NO GAMBLING? DYES )I NO CIGARETTES SOLD ON PREMISES? O YES )r1NO I FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED?: O YES NO IF YES, PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES: PROPOSED OPENING DAY OF BUSINESS ©2- �-t✓ BUSINESS HOURS W Am Ua P/" DAYS OPEN O SUNDAY 19MONDAY ;(TUESDAY g(WEDNESDAY %THURSDAY �FRIDAY 81 SATURDAY PARKING SPACES ON SITE: TOTAL 3 ACCESSIBLE FOR PERSONS WITH DISABILITIES Ye S DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PE/R�SONS WITH I -DISABILITIES? � �rAYES ONO ' PREVIOUS BUSINESS USE AT THIS ADDRESS Dim {n a A k A C lA �fil C--t'C/1 io-e SOLE PROPRIETORSHIP LE C ADDRESS S E t ' '�/I r/ M� Street Apt No„ Unit No. HOME PHONE DOL NO. DRIVERS LICENSE N OQ�T�dE�i DATE OF DIRT.iiiij ITY AND STATE OF BIRTH.COUNTRY OF 81 PARTNERSHIP • PARTNER 1 ,NAME Lest 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 2 NAME Last First Mt ADDRESS Street Apt. No,. Unit No. City, State and Zip Code HOME PHONE NO.(_ I DOL NO. (DRIVERS LICENSE NO.) OR OTHER ID NO. DATE OF BIRTH CITY AND STATE OF BIRTH COUNTRY OF BIRTH CORPORATION NAME OF CORPORATION FEDERAL TAX ID NO. CORP.ADDRESS PHONE NO.(� Street Suite, Apl., Unit No. City, State and Zip Code CORPORATE OFFICERS: Last Name First Name MI Title Date of Birth DOL No. (Drivers License No.) or Other ID No. LOCAL CONTACT Last Name First Name MI Title Phoneo. DOL No. (Drivers Lic. No.) or Other ID No. APPLICANTEGI\� �l RC>� J-.' _ Name — Printed Signature Title Date 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 C wn r 1 -M 1I1 al �1 <�1 al QI a1 ....y�,.��14 FE] rol •w7• - r no••a _ I•• � r � rt • �l 10 DWTOR DO A 0 � 0 al Y a L , � a1 / NEW 21'WY11'N42'H J MOPSINK INSTALL NEW V2' HW & 112' CWUNE FORMOPSINKAND 2' WASTE LINE WI 1-112' V TO CONNECT TO THE EXISTING WASTE LINE @ REST RM . RUN THRU WALLAS SHOWN OR CUT CONCRETE SLAB FOR NEW 2'0 WASTE LINE AND CONNECT TO THE EXISTING WASTE LINE MAINTAIN A MINIMUM 2% SLOPE FLOOR PLAN AREA 1,000 SF SECURE SILL PLATES W1 POWER ACTIVATE FASTERNRS @ 24.O.C.:100 A PULLOUT MIN. TYPICAL FOR ALL NEW PARTITIONS 30oz-60MW) of ou rrn ,, - 9-4 LEGEND ® NEW PARTITION •4.3l4' WALL: 518' TYPE'X' GWB EA -SIDE 2x4 STUDS ®16.O.C. [� EXISTING STRUCTURE F� TO EXIST BEING REMOVED PARTITIONS Q S'�':mclev He4A, Q2 Novn St e Ls © ?41) Itst,-n T. Don,9AL1 Acupunca I 22C r,(1L-(c o 'cP r m/dq—j' , -r" k�o(4 09 3. Add.— a 1 M• d- r A7V B E M d JA"r /W P 4-�A6 C is n/o 1N !�A-�L• S ug�' F} `c c,KN�rQA S P,QI S f},ourn✓(A A-001 r77•