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105 5TH AVE S (2)_Redacted FIRE INSPFI FIRE PREVENTION INSPECTION REPORT ]EDMONDS BRIER ❑ MOUNTLAKE TERRAGE;;.�' ❑ UNINCORPORATED` FREQUENCY STATION & SHIFT LOCATION: 105 5 th Avenue S 98020 BUSINESS NAME: PHONE: SCHEDULED Cline Jewelers 4256739090 DATE DUE ► MAILING UFIR ► ADDRESS: 544 203 105 5th Avenue S, Edmonds, WA 98020 BUSINESS OWNER: HOME PHONE: Cline, Jerry EMERGENCY-1: HOME PHONE: CURRENT KEY ACCESS-2: Cline, Andy HOME PHONE: 2068717979 CITY YES NO EMAIL: BUSINESS ' ] LICENSE ��` El "PERSON CONTACTED: INITIAL INSPECTION DATE NAME OF INSPECTOR:Aw FIRE SYSTEMS: FE 2/14 �1 z UIAMk%StCbQMAQ0(IJ0CATIONS / COMMUNICATIONS 2 2 ,y 3 ;3: 4 4 5 5 6 6 7 7 IIII��III I o s 4-11 rgoE Serving Brier, Edmonds, and 12425 Meridian Ave S Mountlake Terrace Everett, WA 98208 Phone (425) 551-1200 www.FireDistrictl.org Fax (425) 551-1272 I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X 1st RE -INSPECTION 2nd RE -INSPECTION FINAL RE EXTENSION -INSPECTION VIOLATIONS DATE DUE: _..._ _ ._. _ ._. _....__._.. _. ... _.. ... DATE DUE: _,.., _.,,,.,. _.___.... GRANTED TO: DATE DUE:. CITED: PERSON CONTACTED: PERSON CONTACTED: PER7'SON ^ CONTACTED: INSPECTOR: INSPECTOR: 6 INSPECTOR: - Z DATE: DATE: ._..___.._..._. DATE: 3 VIOLATIONS VIOLATIONS � _ PRE -CITATION _ _ _ CITATION ISSUED " ' '� —" 1 15 1 5 LETTER SENT NUMBER: 4 CODE 5 ti 2 6 2 6 DATE: SECTION: 3 7 RETURN RECEIPT RECEIVED � s 3 37 _..®_ DISPOSITION: 4 8 4 DATE: 7 LETTER NEEDED ❑ YES ❑ NO �_-m®.. ._..... LETTER NEEDED ❑ YES ❑ NO 8 Y FIRE PREVENTION �A '�' Serving Brle1; Edmonds, and - tN25 Meridian Ave S INSPECTION REPORT . - CO. Mountlake Terrace FIRE Everett, WA 98208 El ❑ BRIEREDMOS ❑BRIER DISTR T Phone ?425) 551-1200 Fax AKE TERRACE ❑ UNINCOMOUNTRPORATED ❑UNINCORPORATED wwwFireDistrictl.org (4..5) 551-1272 LOCATION: FREQUENCY I STATION & SHIFT 105 5.th Avenue S 0,6020 Annual 17-.A BUSINESS NAME: Cline Jewelers PHONE: 4258739090 SCHEDULE DU�' May 2014 _ MAILING UFIR E44 203 ADDRESS: 105 51[h AVenUe S, Edmonds, WA 98020 BUSINESS OWNER: Cline, Jerre HOME PHONE: EMERGENCY-1: Cline, Andy HOME PHONE: 2068717979 CURRENT, --- KEY ACCESS-2: HOME PHONE: CITY Y S NO 1 I Q BCENSES EMAIL: 1 PERSON CONTACTED: INITIAL INSPECTION DATE / NAME OF INSPECTOR: I � 2- FIRE SYSTEMS: FED_ HAZARDS FOUND AND LOCATIONS / COMMUNICATION 1 1 2 2 3 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: INSPECTOR: INSPECTOR: INSPECTOR: 2 DATE: DATE: DATE: 3 VIOLATIONS 1 5 VIOLATIONS 1 5 PRE -CITATION LETTER SENT CITATION ISSUED NUMBER: 4 I 12 6 2 6 DATE: CODE SECTION: 5 3 7 3 7 RETURN RECEIPT RECEIVED 6 4 $ 4 $ DATE: DISPOSITION: 7 LETTER NEEDED ❑ YES ❑ NO LETTER NEEDED ❑ YES ❑ NO g FIRE DEPARTMENT COPY FIRE PREVENTION Serving Brier; Edmonds SNOHOMISH CO. 12425 Meridian Ave S IN PECTION REPORT `' FIRE Mountlake Terrace,and Everett, WA 98208 MDMONDS ❑BRIER the Town of Woodway ST Rr T FireDistrictl.org Phone (425) 551-1200 ❑ WOODWAY ❑ MOUNTLAKE TERRACE www Fax (425) 551-1272 ❑UNINCORPORATED FREQUENCY STATION & SHIFT LOCATION: 105 5th Avenue S 365 17 B ' BUSINESS NAME: Cline Jewelers PHONE: 4256739090 DATE DUE SCHEDULED► 05I01i11 MAILING 105 5th Ave S UFIR ► 544 5203 ADDRESS: Edmonds 98020 1 BUSINESS OWNER: `line, Andy HOME PHONE: 2068717979 AG 1IVE EMERGENCY-1: Cline, Jerry HOME PHONE: 2068199734 CURRENT KEY ACCESS-2: HOME PHONE: CITY YES NO BUSINESS LICENSE PERSON CONTACTED: INITIAL INS ECTION DATE 1 ��lLll NAME OF INSPECTOR: C-b S FIRE FE 01! rl SYSTEMS: ANNUAL HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 1 0 1 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: 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 , s, 3 7 RETURN RECEIPT RECEIVED 6 4 8 4 8 DATE: DISPOSITION: 7 LETTER NEEDED ❑ YES ❑ NO LETTER NEEDED ❑ YES ❑ NO I ' 8 i FIRE DEPARTMENT COPY 11 `z--c) CITY OF EDMONDS BUSINESS LICENSE APPLICATION— COMMERCIAL FEE: $125.00 C� CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION 121 5T" AVENUE NORTH, EDMONDS, WA 98020 PHONE: 425.775.2525 OFFICE USE ONLY BL# Customer# SIC Year Class SHD Date Paid TR# Fee Paid Mailed Delete t9 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. BUSINESS NAME BUSINESS ADDRE MAILING ADDRESS 105 S �� Ave S • Street or PO Box Suite No. City, State and Zip Code BUSINESS PHONE NO. ( 10-5) b / 3- 9o9v WA STATE TAX ID NO. (UBI NO (9 C7 © '_3j-7O 391 i s BUSINESS E-MAIL and GD C Uh'Ie t bLAJP_. ter & BUSINESS WEBSITE __ Ilr,e ,I C W 'C,►eYS • c v PROPERTY OWNER ( ) Name Phone Number EMERG NCY NOTIFICATION (For Premise A s in Emergency): CG Last Nbue C. First Parne MI Phone No. 0 Last Name Firs me Mi .Phone No. NATURE OF BUSINESS rfj� NUMBER OF EMPLOYEES SQUARE FOOTAGE OF BUSINESS SPACE 12,50 TYPE OF BUSINESS - PLEASE CHECK THE.APPROPRIATE CATEGORY: O CONSTRUCTION O FINANCE, INSURANCE, REAL ESTATE. O LANDSCAPE, HORTICULTURAL O MANUFACTURING O NON-PROFIT DETAIL O SECONDHAND DEALER O SERVICES O WHOLESALE O OTHER AMUSEMENT DEVICES ON PREMISES? O YES 9>qO IF YES, TOTAL NUMBER LIQUOR SOLD ON PREMISES?: O YES . •�40 GAMBLING? O YES O NO CIGARETTES SOLD -ON PREMISES? O YES dq<O FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED?: O YES -)�NO IF YES, PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES: PROPOSED OPENING DAY OF BUSINESS r:0i0 15T BUSINESS HOURS DAYS OPEN O SUNDAY ONDAY i ff UESDAY \ ,,ea WEDNESDAY V THURSDAY RIDAY �SATURDAY PARKING SPACES ON SITE: TOTAL ACCESSIBLE FOR PERSONS WITH DISABILITIES DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIB E TO PER ONS TH rDISABILITIES? S ONO. PREVIOUS BUSINESS USE AT THIS ADDRESS t! rt ADDRESS ' Sbeet ApL No.. UNINa Cky,SLM aM➢p Code HOME PHONE NO.L I DOL NO. IDRIVEPSLICENSE NO) OROTHER IDNO. DATEOFBIRTH CrtYANOSTATEWSIRTH COUMRY OF BIRTH PMTNERSMP-PARINFRI NAME Lao P OHESS FiNI MI StleM ADL NO.. UDS No. CRY, Sole erMDp Cade HOME PHONE NO.I 1 DOL NO. IDRVERS LICENSE NO.) OR OTHER ID NO. DATE OF BIRTH CJTY AND STATE OF BIRTH COUNTRY OF BIRTH _ PARTNERSHIP -PARTNERS NAME Lad - - First MI ADDARS S Slrtel APtakx.wi1NP ,GIN-s%ftom 1p CDde HOME PHONE NO.0 00. NO. HDRMERS LICENSE NO.) OR OTHER D NO. DATE OF GIRTH CRT AND STATE OF BIRTH COUNTRYOFBIRTH �nt�/I(MMfEOERPL I��//.//.�a��'Y NAWOFCOR TION I a kiyCN(�T+ANriliG TA%IDNO II CgiP.ADOREss rJ 'IA 1A vP- -SOIM, L LA PHONE NO.6�L 09 •lSaeal Hp1dpu ny13ao CORPORATE MICERS. uRa Elm MI Me DWOIB OOL NO.IPir48limiw N0 IXOVw DNa izi rNa^me` IOLAL CONTACT t .\\bP Lz LaLZf ame Rral Wma TRIO Na DovNo,jOnvors a o. 0. FLANNINGOEPT, OAPPROVE ODISAPPR E GATE SIGNATURE ZONINGCCDE CpHORDDDV. USEPERMR COM1TENTS BUILDDHGDEPT, OAPPROVE OOIGAPPROVE DATE SGNATURE OCCUPANTLOAp BVILOING PFJUMT OCCIRANCYG�UP COMMENTS FOEDEPT. DAPPR ODISMPROVE DATE SIGNATURE U.F.1.0. CCMMEN S POLICEDEPT. OAFPROVE ODISAPPROVE DATE SIGNATURE coanow $ r� C � iKe, Wol r .oW 004 f AD&)