Loading...
22618 HWY 99 STE 115_RedactedFIRE PREVENTION Serving Brier, P-imurtdc and 12425 Meridian Ave S INSPECTION REPORT SN©H4MIS1i CO. EJ'EDMONDS FIRE t Mountlake Terrace Everett, WA 98208 ❑ BRIER `'' Phone (425) 551-1200 ❑ MOUNTLAKE TERRACE DIT R T www.FireDistrictl.org Fax (425) 551-1272 ❑UNINCORPORATED L-7 22618 Highway 99 Inside Market Suite 115/116 98026 FEEOUENGY sTAT�BN & SHIFT LOCATION: Annual G 1. Koo's Grill and Bobsarang resturant 2069998191 SCHEDULED Mar BUSINESS NAME: PHONE: DATE DUE MAILING 22618 Highway 99, Edmonds, WA 98026 UFIR / ADDRESS: BUSINESS OWNER: Han, Jae HOME PHONE: 1�ZGjC l�j Hill, Kyung ✓ 4 �" 4+5"- EMERGENCY-1: HOME PHONE: CURRENT KEY ACCESS-2: HOME PHONE: CITY YES NO % NO EMAIL: h I k BUSINESS LICENSE X LICENSE L PERSON CONTACTED: INITIAL INSPECTION DATE NAME OF INSPECTOR: �� ✓ J J `� i Date Last Serviced: Ekp! 6c\ n 7 HAZARDS FOUND AND LOCATIONS / 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 In our continuing effort to promote fire safety and prevention within the community, your fire department conducts regularly scheduled "Fire Safety Survey Inspections" of all businesses and multi -family occupancies in the Cities covered by Snohomish County Fire District 1. You are to be congratulated on the relative good condition of your occupancy in regards to fire safety. Above you will find the item(s) that were noted during our inspection which require attention to bring them into compliance with the minimum standards adopted by the above jurisdictions. Any overlooked hazards or violations of the fire regulations does not imply approval of such conditions or violation. If you require additional information or to schedule a re -inspection for Edmonds, call (425) 775-7720; for Mountlake Terrace or Brier, call (425) 744-6231. CITY OF EDMONDS BUSINESS LICENSE APPLICATION — COMMERCIAL FEE: $125.00 CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION �r 121 5T" AVENUE NORTH, EDMONDS, WA 98020 PHONE 425.775.2525 ❑ Building O Engineering ❑ Fire ❑ Planning ❑ Police OFFICE USE ONLY BL# Customer # SIC Year Class SHD Date Paid TR# Fee Mailed 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 31't each year. Renewal must be submitted prior to January 31u to avoid late fees. BUSINESS NAMEIlr�s�LjA,J��� BUSINESS ADDRESS eta t �ittt�Y 9�%' A 115ZN1an� [ VJA 9i 0,.20< n SI- or�t�/�—t , � b �) /Suuito #-`—���`�''' ily, ate, Zip Code MAILING ADDRESS A7A,2 ! l'16 Q �/ C.. W 4t1 > LX h Oil WA �?, O3 a �— Slreet or P Box # Suite # �— —T— City, Srate. Zip Code BUSINESS PHONE( `O,/ WA STATE TAX ID # (UBI) O Df BUSINESS E-MAIL7 Y`5o 4� Mf 1 )�A 60 - 6D in BUSINESS WEBSITE lL BUSINESS OWNER I MAIN CONTACT IA, T. �QQ t �L33 Na Phone Number PROPERTY OWNER hpohan 1ntkk,{-LLC _ r A7,L Name Phone Number NOTIFICATION (For Premise Access in Emergency): Last Name Q First Named' MI Phone Number Last Name First Name MI Phone Number NATURE OF BUSINESS (Provide a Detailed Description of Business Activities, Products S Services); SPACE ALTERATIONS TO BE MADE: YES —NO— DESCRIPTION PREVIOUS BUSINESS AT THIS ADDRESS �- NUMBER OF EMPLOYEES_ SQUARE FOOTAGE OF BUSINESS SPACE TYPE OF BUSINESS - PLEASE CHECK APPROPRIATE CATEGORY: ❑ CONSTRUCTION ❑ FINANCE, INSURANCE, REAL ESTATE ❑ LANDSCAPE, HORTICULTURAL ❑ MANUFACTURING ❑i NON-PROFIT •� RETAIL ❑ SECONDHAND DEALER ❑ SERVICES ❑ WHOLESALE ❑ OTHER PROPOSED OPENING BUSINESS DAYS OPEN: JSUNDAY Cl NDAY t/WEDNESDAY JTHURSDAY WUESDAY �ISATURDAY. (f FRIDAY AMUSEMENT DEVICES ON PREMISES? YES NOX IF YES, TOTAL NUMBER LIQUOR SOLD ON PREMISES? YES NO_ GAMBLING? YES_ NO-)( - CIGARETTES SOLD ON PREMISES? YES NO —)(FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED? YES NO4- IF YES, PLEASE PROVIDE A LIST OF MATERIALS AND QUANTITIES: PARKING SPACES ON SITE: TOTAL SPACES_ ACCESSIBLE SPACES FOR HANDICAP PARKING SOLE PROPRIETORSHIP NAME VaV . 1 �lyi M 1 it ST f �FIRST MIDDLE INITIAL ADDRESS STREET SUITE/APT/UNIT # HOME PHONE( DRIVERS LICENSE OR ID # & STATE DATE OF BIR CITY/STATE OF BIRTH COUNTRY OF BIRTH PARTNERSHIP - PARTNER 1 NAME LAST FIRST MIDDLE INITIAL ADDRESS STREET SUITE/APT/UNIT # CITY/STATE/ZIP CODE HOME PHONE( I DRIVERS LICENSE OR ID # & STATE DATE OF BIRTH CITY/STATE OF BIRTH COUNTRY OF BIRTH PARTNERSHIP - PARTNER 2 NAME LAST FIRST MIDDLE INITIAL ADDRESS STREET SUITE/APT/UNIT # CITYISTATE/ZIP CODE HOME PHONE( I DRIVER'S LICENSE OR ID # & STATE DATE OF BIRTH CITY/STATE OF BIRTH COUNTRY OF BIRTH LLC or PLLC NAME OFCORPORATION. FEDERALTAX D# CORP.ADDRESS L Street Suite, Apt. Unit # City, State and Zip Code Phone Number CORPORATE OFFICERS: Last Name First Name MI Title DateofBirth Drivers License or Other tD# /State LOCALCONT Last Name First Name MI Title DateofBirlh License or CITY USE ONLY: BUILDING DEPT. APPROVE 0 DISAPPROVE DATE SIGNATURE OCCUPANT LOAD BUILDING PERMIT OCCUPANCY GROUP COMMENTS ENGINEERING Q APPROVE DISAPPROVE DATE SIGNATURE FIRE DEPT. APPROVE DISAPPROVE DATE SIGNATURE U.F.I.R. PLANNING DEPT. Q APPROVE Q DISAPPROVE DATE_ SIGNATURE ZONING CODE CONDITIONAL USE PERMIT COMMENTS POLICE DEPT. APPROVE = DISAPPROVE DATE_ SIGNATURE COMMENTS { l Serving Brier, Edmonds, and Mountlake Terrace www.FireDistrictl.org Y 12425 Meridian Ave S Everett, WA 98208 Phone (425) 551-1200 Fax (425) 551-1272 FIRE P E-VENTION INS TION REPORT DMONDS ❑ BRIER ❑ MOUNTLAKE TERRACE ❑ UNINCORPORATED FREQUENCY STATION & SHIFT LOCATION: 22618 Highway 99 Inside Market Suite 115/116 98026 Annual 20-B BUSINESS NAME: Koo s Grill and Bobsaran resturant g PHONE: -296999' SCHEDULED DATE DUE ► Mar 2016 MAILING UFIR 1 161 106 ADDRESS: 22618 Highway 99, Edmonds, WA 98026 BUSINESS OWNER: Han, Jae HOME PHONE: L� r` t ' J EMERGENCY-1: Kirp So Win HOME PHONE: CURRENT ` CURRENT KEY ACCESS-2: HOME PHONE: CITY YES o BUSINESS EMAIL: LICENSE ❑ PERSON CONTACTED: rx INITIAL INSPECTION DATE NAME OF INSPECTOR: u FIRE SYSTEMS: FE 11/15 HD UL 00 10/15 Date Last Serviced-. HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 2_..__ 2 3 3 4 4 _ 5_. _ - ---_ _._. _._---- --. ..___ �_.--------___ _—__-__-- - 6 5.__.._.. _..._.-_ 6 7 7. I AGREE TO -CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X 1st RE -INSPECTION DATE DUE: .,_,^—,,,_,• PERSON _ CONTACTED: INSPECTOR: DATE: 2nd RE -INSPECTION DATE DUE: EXTENSION GRANTED TO: d FINAL RE -INSPECTION DATE DUE: VIOLATIONS CITED: -• PERSON CONTACTED: INSPECTOR: PERSON CONTACTED: INSPECTOR: 2 3 DATE: DATE: VIOLATIONS 1 2 3 , 5 6 7 _ VIOLATIONS"' �. 1 5 PRE -CITATION LETTER SENT CITATION ISSUED NUMBER: 4 2 6 DATE: CODE w SECTION: e 3 7 RETURN RECEIPT RECEIVED 8 4 8 4 8 DATE: DISPOSITION: 7_ LETTER NEEDED ❑ YES ❑ NO LETTER NEEDED ❑ YES ❑ NO 8 VV CITY OF EDMONDS BUSINESS LICENSE APPLICATION -- COMMERCIAL FEE: $125.00 roe IFS. CITY CLERK'S OFFICE., BUSINESS LICENSE DIVISION 121 5 AVENUE NORTH, EDMONDS, WA 98026 PRONE 425.775.2525 ❑ Building ❑ Engineering O Fire D Planning ❑ Police Oft 4 OFFICE USE ONLY BL# ICustomer # 3.03a - SIC I 6101,70 Year If I Class 1 b SHD 110(o I bete Paid bUty0'35 �M# -fts Fee 12vi I Malled I Deleted INSTRUCTIONS: Please complete the application in full and attach the required floor plan. Middle Initial 3r 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 It business changes location or ownership. Notlflcation to City of Edmonds required If business closes. Llcenseexptres December 31'` each .year. Renewal must be submitted prior to January 31" to avoid late fees. BUSINESS NAME Bc�bsaro�,7� '2 twro'0t BUSINESS ADDRESS}" Hwy 49 # ))� �! U -nds , L 9 b 'St et Sufte # W Stale, 2Jp Code MAILING ADDRESS �lihP qmq 7f 4115' Ei4mWds r OA ar po BmrN stele if City. Stare, Ztp Code BUSINESS PHONES 'ha 3 ,� �19L WA STATE TAX 10 # (UBI) 6 D 1. $ Q Il 9 % / rad"�3 ghwt- loaf `� BUSINESS E-WWI. i/ �) BusINE83 WEBSITE l � , D BUSINESS OWNER/MAIN CONTACT Ky ae, r�lr �� (L ?v- 1 �f-,tT —151f Nam" Phan Number Name 0, , I Phone Number EMERGENCY NOTIFICATION (For Premise Access in Emergency)i Lest Name FW NVne MI Phone Number Last Name First Name MI Phone Numtvv NATURE OF BUSINESS (Provide a Detailed Description of Business Activities, Products & Servlcssg SPACE ALTERATIONS TO BE MADE: YE3 NO-V_ DESCRIPTION PREVIOUS BUSINESS AT THIS ADDRESS. it% t \\� NUMBER OF EMPLOYEES SQUARE FOOTAGE OF BUSINESS SPACE PROPOSED OPENING DATE �o TYPE OF BUSINESS - PLEASE CHECK APPROPRIATE CATEGORY: ❑ CONSTRUCTION BUSINESS HOURS: ❑ FINANCE, INSURANCE, REAL ESTATE ❑ LANDSCAPE, HORTICULTURAL DAYS OPEN: ❑ MANUFACTURING / ❑ NON-PROFIT �O SUNDAY rfl WEDNESDAY V RETAIL ag' AtONDAY Id THURSDAY ❑ SECONDHAND DEALER . ❑ SERVICES Nd TUESDAY �O FRIDAY ❑ WHOLESALE %d SATURDAY n ❑ OTHER r AMUSEMENT DEVICES ON PREMISES? YES NO 1F YES, TOTAL HUMSEP _ LIQUOR SOLD OT} PREMISES? YES NO—y— GAMBLING7 YES,_ NO—Y— CIGARETTES SOLD ON PREMISES7 YES NO fi FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED? YES NO__�/ IF YES, PLEASE PROVIDE A LIST OF MATERIALS AND QUANTITIES: PARKING SPACES ON SITE: TOTAL SPACES ACCESSIBLE SPACES FOR HANDICAP PARKING DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES? YES NO NAME APPLICANT fR ` Name 1 TE DATE,_1 '\ �u Zl CP SOLE PROPRIETORSHIP NAME LAST FIRST MIDDLE INITIAL ADDRE33 STREET SUrrE/APTIUNIT # CITYISTATE/ZIP CO DE HOME PHONE( ) DRIVERS LICENSE OR ID # & STATC DATE OF BIRTH CIIY/STATE OF GIRTH COUNTRY OF BIRTH CASE " FIRST U MIDDLE INITIAL ADDRESS STREET SUrWAPTIUNIT # CITY/STATEW CODE HOME PHONE( ) DRIVERS LICENSE OR ID # & STATE f DATE OF BIRTH CITY/STATE OF BIRTH COUNTRY OF BIRTH - PARTNERSHIP - PARTNER 2 TtiT -L 0 4- LV... 1 MIDDLE INITIW /a FRO.? STREET SUIFIVAPTIUNIT #. CITY/STATEOP CODE HOME PHORIVER'S LICENSE OR ID # & STATE 0ve {{�� � � � (��(��;;��--�� GUKI'UKAIIUNI LLG or rLLG NAME OFCORPORATION, 1(&L-160'111Y10T K'b`'�`wv,& Lctddl�iFZU FEDERALT�A?XnD# !�r�t�- 3 4LLU9 O CARPADORESS �"s HWj i 7 i4'1�tj Ekla't:As. �� 7004 ( 4- ) 4L'7-0 hod steel Suite, Apt. Unit # City, State and Zlp Code Plane Number CORPORATE OFFICERS: LastNanw First Name MI Tills Dateof9Mlh • �; , KTn, wa>', o. �w p,�srler�t,�sf�, y � LOCAL CONTACT t Last Name First Namo MI Tills Dateof iith DrMc{e Lfcorlso or Other D# /Slate Phone Number CITY USE ONLY: BUILDING DEPT. CI APPROVE —I CI DISAPPROVE DATE SIGNATURE OCCUPANT LOAD BUILDING PERMIT OCCUPANCY GROUP COMMENTS ENGINEERING Q APPROVE C] DISAPPROVE DATE SIGNATURE FIRE DEPT. Q APPROVE 1:3 DISAPPROVE DATE —SIGNATURE-- Comm PLANNING DEPT. Q APPROVE Q DISAPPROVE DATE SIGNATURE ZONING CODE CONDITIONAL USE PERMIT COMMENTS POLICE DEPT. 0 APPROVE Q DISAPPROVE DATE —SIGNATURE.— co c�v Ba0c -c-t - Resi(o,'a,A 2zd'l8 14W`l q4 #1Is- 'rt/� C �mC)�,-�s too" 9� 6 z-C ,, Kevin Zweber From: Won Kim [wonray53@gmail.com] Sent: Friday, November 27, 20151:59 PM To: Kevin Zweber Subject: Re: Babsarang Restaurant Inspection 22618 Hwy 99 babsarang ! Ready for inspection On Mon, Nov 16, 2015 at 7:59 AM, Kevin Zweber <kZweber ,firedistrictLorg> wrote: OK, the fire suppression system for the rear Hood needs to be complete also. Extension cord problem was in numerous locations. Kevin From: Won Kim [mailto:wonray530gmail.com] Sent: Friday, November 13, 2015 7:48 AM To: Kevin Zweber Subject: Re: Babsarang Restaurant Inspection 22618 Hwy 99 Thank you ! I Fix the extintion cord, But fire extinguisher waiting for company soon as done will call you Thank you again Babsarang On Thu, Nov 12, 2015 at 6:51 AM, Kevin Zweber <kZweber(a,firedistrictl.org> wrote: i Sir, Sorry for the delay in emailing. A Business License Inspection was conducted at the above address and following safety hazards were noted: Type I Fire Suppression Hood needs semi-annual service K Type Fire Extinguisher needs annual inspection/service 2A10BC Fire extinguisher needs annual inspection/service Extension cords use through out occupancy - extinsion cords are not allowed per the Internation Fire Code. Strip cords may be used but must be circuit protected and cannot be plugged into each other. Please inform me when these items have been corrected. If you have any questions or need help, please contact me. Kevin Zweber Captain/Deputy Fire Marshal Snohomish County Fire District 1/ City of Edmonds 425-775-7720 RT AAA" & 1 Hood and Duct Services, Inc. 6100 12th Ave. S. Phone (206) 726-0940 Seattle,WA 98108 Fax (206) 767-2607 Occupancy Name: _ Occupancy Address: Responsible Person: Building Owner: COMPLETE Certification Given: RED ❑ YELLOW WHITE ❑ FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD Ifi • High Pressure Hood Gleaning . SYSTEM TEST REPORT • Fire Suppression Installation & Service CONFIDENCE TEST REPAIRS ❑ • Fire Extinguisher Sales & Service • Range Hood and Fan Service & Repair • Filter Sales & Service DATE: / f -PiWf N` °L City, State, Zip: W Phone Number: !toZ-S- %-7Or%—T 00 Phone Number: Building Owner Address: ICity, State, Zip: Testers Name (Please Print): Pt% eir 6T?e,161,w7eK U o• SFD Certification Number: S//►CP- ` v System Alarm? Yes (� Nor—� ntral atii9 n�� M�onitoring? Yes [� No ❑ Monitoring company name: 14 ctippn C 4e� V , a Control Panel manufacturer: (r(P (N1k(Q''iO VRtlModel Numberr:' `r FX �. t go Location of Alarm Panel: o S . 4 • Extinguishing System Manufacturer • l7I Size_,, - U.L. 300 System? Yes [30N'o ❑ U.L. 300 Compliant? Yes E5No ❑ Chemical Type: Wet E!5Dry ❑ stem't Location / Height of Range hood: o W 0 0 tJ� of Is pressure gauge indicator in operable range? Yes c!�- No ❑ 7 12 year hydro date of cylinder. Is there chemical inside of the cylinder? Y Yes No ❑ Were hand ortable extin uishers ro erl serviced. P- g. i P_ P y ?_ NA ❑. Yes No Q�. Weigh CO2 or nitrogen cartridge_ NA ______.__._. -_ Were all cooking surfaces protected? If not, give owner full . _❑.. Yes [� No ❑ No visible signs of a system fire or system tampering if __ _ - _ _, . ____ ---.— -- - Check all i in and conduit. Are all piping and conduit P p 9 P p 9 signs check no). Yes No ❑ `-- Ye-- immobilized with Yes No � NOD — information. Was opera tin procedure verbal) even to restaurant personnel? -----g P - Y g--. -- P.-_ - • -- Yes No - .-. - hangers and brackets? Was UL 300 compliance explained to owner or manager? Yes �No ❑ Are all protective covers present on nozzles? Yes [� No ❑ Gas shuts down upon system activation? NA[� Yes Q�No ❑ Are all nozzles checked in the proper position? Yes No Electric power shuts down upon system activation? NA❑ Yo6M— No ❑ Does system have adequate volume and/or nozzle coverage? Yes No ❑ Range hood tied to building alarm panel? --- NA ❑ - Yes [x No ❑ Are all appliances inside of the hood protection area? Yes E21"-No ❑ Range hood activation signal received at building alarm panel? NA❑ Y*� No ❑ Have fuse links been replaced? Yes [�r No ❑ Class K extinguisher present? Yes 2-'�No ❑ Was system operational from terminal link? Was system operational from manual remote? Was system and micro switch operational? Is system visible and free from obstruction? Is the inspection and service tag on the cylinder? Yes[ No❑ Grease buildup in group: Yes E?r" No ❑ Light Medium / Heavy, recommend cleaning NA❑ Y No Date of last cleaning AB Yes No Are cleaning intervals within NFPA standards? �y— Yes ❑ No Yes No ❑ Previous Confidence Test Company & Technician ProblemsF9und (If additional room is needed, please add a separate sheet) \ 11 ' C�Jriv{ — r C r ff P (4 Corrections Made: Date Corrected: Corrected By: has declined SFD Certification Number: This certifies that this fire and lif safe Ste as b prop inspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code standards. Discrepancie r a hav been r rted t ding Owner/Responsible Person for corrective action. Signature of Tester: f Phone # (206) 726-0940 Testing Agency: R&T Hood and Duc rvlces nc. Mailing Address: 610012th Ave. S., Seattle, WA 98108 The owner is to perform and keep a written record of the following "quick check" fire system inspection to verify the following: 1. The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight. place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and current. 2. The manual pull stations are unobstructed and in clear view and are labeled for 6. If any deficiencies are found, appropriate corrective action shall be taken immediately. intended use. 9. A record of the monthly inspections is to be kept reflecting the date inspected, inititals of 3. Insure that all tamper seals are intact and that system is in a ready condition. person performing the inspection and any corrections required. 4. Observe system, checking that no obvious physical damage or condition exists r that might prevent operation. AUTHORIZED 5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE r,nr nrnwnTu rur r.r.nv CITY OF EDMONDS BUSINESS LICENSE APPLICATION— COMMERCIAL FEE: $125.00 CITY CLERK'S OFFICE, SUSINESS•LICENSE DIVISION rn�. ta9° 121 5T' AVENUE NORTH, EDMONDS, WA 98020 PHONE: 425.775.2525 OFFICE USE ONLY BL# Customer# SIC g Year kola ass SHD Date Paid _ T"3y3 Fee 1 fo1. Mailed Delete INSTRUCTIONS: Please complete the application In full and attach the required floor plan. Middle InIdai 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 Moses. BUSINESS NAME BABSA RUCr it 6S M 6lRa Al r BUSINESS ADDRESS ��6l8 yIFNWRy 9� 1/5 98Oa6 MAILINGADDRESS 22 6!8 Nl(r)IWAY QI j/5 EDMONDS, 04 oa6 Street or PO Box Suite No. City, State and Zip Code BUSINESS PHONE NO. (�f �, 3Y t`G — ' '� R 0 WA STATE TAX Iq NO. (UBI NO.) ,, BUSINESS E-MAIL NIA BUSINESS WEBSRE of R PROPERTYOWNER Bolt b►RN PG/FZA ( Vo2;' Y#00 Name Phone Number EMERGENCY NOTIFICATION (For Premise Aocess in Emergencyr L/IIl s�Fritq�C. ll�• ,f��'6�'3 -�o Last Name First Name MI Phone No. Last Name First Name MI Phone No. NATURE OF BUSINESS - xORERN ��Sr#UJ1!*AIr NUMBER dF•ENIPLOYEES SQUARE FOOTAGE OF BUSINESS SPACE / TYPE OF BUSINESS - PLEA$4 CHECK.THE•APPRQPRIATE CATEGORY: O CONSTRUCTION O FINANCE; IIVSUR/WCE- REAL ESTATE• ' O LANDSCAPE. HORTICULTURAL O MANUFACTURING • O NON-PROFIT ARETAIL O•• SF-CONDHAND DEALER O SERVIC,ES O WHOLESALE O.OTHER AMUSEMENT DEVICES'ONPkEMISES? .d Y9S i(NO . IF YES, TOTAL NUMBER LIQUOR SOLD ON PREMISES?: O YES . pf ti6 GAMBLING? O YES O NO CIGARETTES SOLD ON PREMISES? OYES ONO FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED?: O YES JKNO IF YES, PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES: PROPOSED OPENING DAXOF BUSINESS r4 t!/¢' %fir i a�%G BUSINESS HOURS DAYS OPEN O SUNDAY ' O MONDA1Y O TUESDAY O WEDNESDAY O THUR$DAY O FRIDAY -O SATURDAY PARKING SPACES ON SITE: TOTAL --ACCESSIBLE FOR PERSONS WITH DISABILITIES DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES?. XYES ONO PREVIOUS BUSINESS USE AT THIS ADDRESS KD t r-" yE s F SOLE PROPRIETORSHIP NAME K fM ti o Al last Frst EMI ADDRESS_ 1�3 / Al. 04.0 vt `i sNoRFCL,(uFs . PJA Street Apt No., Unit No. rHu 421.1. HOME PHONE _OU Yl DOL NO. (DRIVERS LICENSE NO.) OR OTHER 10 NO. t DATE OF 81 ITY ANb STATE OF BIRTH COUNTRY OF BIRTH KOR!} -PARTNERI NAME Last• First MI ADDRESS Street Apt. No., Unft No. City, Slate and Zip Cade - 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 •Flirt MI . ADDRESS Street Apt, No., Unit No. City, Slate and Tip Code HOME PHONE NO.( 1 DOL NO. (DRIVERS LICENSE NO.) OR OTHER -lb NO; ' DATE OF BIRTH CITY AND STATE OF BIRTH COUNTRY OF BIRTH NAME OF CORPORATION FEDERAL fAX 10 NO. CORP. ADDRESS PHONE NO.0 Street Suite. Apt. Unit No. City; State and Zip Code CORPOWE OFFICERS: Last Name Flrst Name MI Title Date of Birth, DOL No. (Drivers License No.) or OtherlD No. LOCAL CONTACT Last Name First Name MI. Title Phone o. DOL No. (Drivers Uc. No.) or Other ID.No. Name• —Panted F - _ 54+fe Title Data USBQNLY:, t . f�IAMNINta'Et�Y "[1AP�ROVE..O.13iS4PROYE • 1. 'DATE- '"" r' :$IGIV%CTU,{�• r' icG_.-i . _ Zf)NIf�GCODE: CONDfffONALUS�PERliitfT t'. t• CO'MMtB• rs t9UIM:DING OEPT, O"APPROVE ❑ DISAPPROVE DATE StGNATURE—__ OCCUPANT LOAD: a ' BUILDING PERMIT OCCUPANCY GROUP dOWENTS ; 'FIRE DEPT. 'O APPROVE O DISAPPROVE DATE _SIGNATURE .Comm r� POLICE DEPT. O•APPROVE • 0 DISAPPROVE DATE. SIGNATURE '