110 W DAYTON ST STE 205_Redactedl s-o - w--0r4y7--()AJ-s L5-7-9----.2eb-7
CITY OF EDMONDS
BUSINESS LICENSE APPLICATION— COMMERCIAL
FEE: $125.00
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CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION
//nc. 1a9� 121 5T" AVENUE NORTH, EDMONDS. WA 98020 PHONE: 425.775.2525FDMONS CITY CLERK
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OFFICE USE ONLY
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Class
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 location or ownership. Notification to City of Edmonds required
If business closes.
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BUSINESS ADDRESS // G LJ `�( 5* yaex �% - S
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Street or PO Box Suite No. City, State and Zip Code
BUSINESS PHONE NO. ( Y10t� ^) WA STATE TAX ID NO. (UBI NO.) O o I �'/'�'SIFS 21L
BUSINESS E-MAIL Gzu__en Lik atevaictiohid, &.,j BUSINESS WE13SITE I�l���`�^C�.il�iM�fY1L�Li<�p� • L
PROPERTY OWNER PC rE Rf ICIMCwl.s L5 771�_ CS'!�
Name Phone Number
EMERGENCY NOTIFICATION (For Premise Access in Emergency):
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Last Name hFirst Name MI Phone No.
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NATURE OF BUSINESS I
Name
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NUMBER OF EMPLOYEES 9� SQUARE FOOTAGE OF BUSINESS SPACE
TYPE OF BUSINESS - PLEASE CHECK THE APPROPRIATE CATEGORY:
Mi Phone No.
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O CONSTRUCTION O FINANCE, INSURANCE, REAL ESTATE O LANDSCAPE, HORTICULTURAL O
O RETAIL O SECONDHAND DEALER (3 SERVICES O WHOLESALE (BOTHER
AMUSEMENT DEVICES ON PREMISES? O YES IN NO IF YES, TOTAL NUMBER
LIQUOR SOLD ON PREMISES?: O YES )o NO GAMBLING? O YES $4 NO CIGARETTES SOLD ON PREMISES? O YES 4 NO
FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED?: O YES 1K NO IF YES, PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES:
PROPOSED OPENING DAY OF BUSINESS e�. /6�u��" BUSINESS HOURS A', 3V, S h�
DAYS OPEN O SUNDAY JO MONDAY §(TUESDA 51 WEDNESDAY i(THURSDAY FRIDAY O SATURDAY
PARKING SPACES ON SITE: TOTAL ACCESSIBLE FOR PERSONS WITH DISABILITIES & S'
DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES? O YES P(NO
PREVIOUS BUSINESS USE AT THIS ADDRESS C-CT; CO--
SOLE PROPRIETORSHIP
NAME
Last First MI
ADDRESS
Street Apt. No., Unit No. City, Stale and Zip Code
HOME PHONE NO. NO. (DRIVERS LICENSE NO.) OR OTHER ID NO.
DATE OF BIRTH CITY AND STATE OF BIRTH COUNTRY OF BIRTH
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NAME 13-f- h ✓" /"'
Last !� ,) First MI
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Street City, State No.. Unit No. CState and Zip Code
HOME PHONE NO LEI' '1$ ) / p li l - KS I DOL NO. (D ID NO.
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DATE OF BIR CITY AND STATE OF BIRTH COUNTRY OF BIRTH
PARTNERSHIP - PARTNER 2
NAME J vrbwr�f, /VM/V
Last n First A MI
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Street / 7 Apt. No., Unit No. City, a and Zip Code
HOME PHONE NO.() 9Lrl '�J >ti DOL NO. (DRIVERS LICENSE NO.) OR OTHER ID NO
DATE OF BIRTH CITY AND STATE OF BIRTH ea/tR."4" 1 COUNTRY OF BIRTH
CORPORATION
NAME OF CORPORATION FEDERAL TAX ID NO.
CORP. ADDRESS iPHONE NO.(�
Street Suite, Apl, Unit No. City, State and Zip Code
CORPORATE OFFICERS:
Last Name First Name
MI Title
Dale of Birth DOL No. (Drivers License No.) or Other ID No.
LOCAL CONTACT
Last Name First Name MI Title Phone No DOL No (Drivers Lic No) or Other ID No
APPLICANT T0116 '1 X I) ,
Name - Printbd Signature Title Date
PLANNING DEPT.
❑ 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
I i I
Harbor Square Business Park
Suite 205
110 W, Dayton
Rrimonds, WA 98020
(AZ '
RC-
SNOHOMIS11 CO. ('
FIRE
DISTY
Serving Brier, Edmonds:'-.
Mountlake Terrace,and
the Town of Woodway
WI*T www.FireDistrictl.org
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
4.
FIRE PREVENTION
INSPECTION REPORT
]EDMONDS
❑ BRIER
❑ WOODWAY
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY STATION & SHIFT
LOCATION: 110 West Dayton Street Suite 205 08020 A 2 Year 13 1 ?-B
BUSINESS NAME: Max Foundation L PHONE: 4257768660 SCHEDULED Sep
DATE DUE
MAILING UFIR / 591
ADDRESS: 110 West Dayton Street, Suite 205, Edmonds, WA 98020
BUSINESS OWNER: HOME PHONE:
Email:
EMERGENCY-1: d HOME PHONE:(-/?—JZ'j—E S_ CURRENT
KEY ACCESS-2: HOME PHONE: CITY YES NO
BUSINESS � ❑
LICENSE
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR: / �J /� 7 3
FIRE SYSTEMS: FEW-j!. -
HAZARDS FO AND LOCATIONS / COM
TIONS
2
2
'3
3
4
4
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATIONS) IN THE NEXT 30 DAl'
X
1st RE -INSPECTION
DATE DUE:
,
2nd RE -INSPECTION
DATE DUE:
s
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
3
7
RETURN RECEIPT
RECEIVED
6
4
8
4
8
DATE:
DISPOSITION:
LETTER NEEDED ❑AYES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8
FIRE DEPARTMENT COPY
y
" CITY OF EDMONDS
121 5T" AVENUE N. • EDMONDS, WASHINGTON 98020 • (425) 771-0215
FIRE DEPARTMENT
4�'S t. 1 890
1
FIRE PREVENTION
SAFETY SURVEY
LOCATION: 11 a W. Dayton Street 205
BUSINESS NAME: Max Foundation PHONE: 4257788660
MAILING 110 W. Dayton St #205
ADDRESS: Edmonds 98020
.-,- BUSINESS OWNER: Garcia/GonZaieZ, Pat HOME PHONE:
4257784471
EMERGENCY-1: Conner, Jan HOME PHONE. 4257759363
KEY ACCESS-2: CA�-p T ► �A Q"� HOME PHONE: -A 82q 6q 5?j
' FREQUENCY
STATI' &
SHIFT
N
SCHEDULED
09%01/10
DATE DUE ►
UFIR ► 591 9202
ACTIVE
PERSON CONTACTED: QA(v LA( INITIAL INSPECTION DATE
NAME OF INSPECTOR: "mil l0 ! `�
FIRE FE J 0
SYSTEMS:
�I
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
N �A61 f::�a\J00
ENTER CODE ONLY ONCE ►
VIOLATION CODE
1
2
2
3
3
4
-
4
5
5
6
6
7
7
8
8
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 E] YES I] NO
FIRE DEPARTMENT COPY
jr
CITY OF EDMONDS
250 5TH AVENUE NORTH - EDMONDS, WA 98020 - (206) 771-0220 - FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
�St. 1890
Public Works • Planning • Parks and Recreation • Engineering
April 17, 1997
Ms. Jan Conner
Property Manager
Harbor Square Associates
120 West Dayton, Suite Bb
Edmonds, Washington 98020
RE: Nationwide Business Consultants @ 110 W Dayton, Suite 205
BARBARA FAHEY
MAYOR
RECEIVED
APR 1 88 1997
EDMONDS FIRE DEPT.
As a follow-up to our conversation yesterday the purpose of this letter is to establish the
maximum occupant load for Nationwide Business Consultants located in Suite 205. As
the property manager of Harbor Square you are aware of the building code requirement
for two separate exits from tenant spaces when the occupant load exceeds 29. As you
know, the Building Inspector has informed me that the subject tenant space will require
two separate exits into the main building corridor due to the large conference room.
Since the tenant agreement for this space confirms that the occupant load will be 29 or
less and you have determined that providing a second exit may not be feasible at this time;
the maximum occupant load of Nationwide. Business Consultants must be established at 29
persons. Please post an occupant load sign in the main reception area at your earliest
convenience and note, the occupant load is subject to field checks by the City Fire
Marshal.
If in the future, Harbor Square has the ability to provide a second conforming exit from
this space, a building permit would be required and the occupant load could be increased.
If you have any questions please feel free to contact me at 771-0220.
Thank you,
4�kft ;��
Jeannine L. Graf
Building Official
cc: Fire Marshal JJ-;-'K
Nationwide Business Consultants
• Incorporated August 11, 1890 •
Sister Cities International — Hekinan, Japan
4tSt. 189v
CITY OF EDMONDS
250 5TH AVENUE NORTH • EDMONDS, WA 98020 • (206) 771-0220 • FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works • Planning • Parks and Recreation • Engineering
April 3, 1997
Ms. Jan Conner
Property Manager
Harbor Square Associates
120 West Dayton, Suite B6
Edmonds, Washington 98020
RE: Nationwide Business Consultants @ 110 W Dayton, Suite 205
BARBARA FAHEY
MAYOR
The Building Inspector has informed me that the subject tenant space will require two
separate exits into the main building corridor. Pursuant to Uniform Building Code Section
1003, two exits must be provided for every building or useable portion thereof when the
occupant load requires such. For office buildings when the occupant load of the second
floor exceeds 10, two exits are required and when an individual office space occupant load
exceeds 30, two exits from within the individual space into the common building corridor
are required. Since the occupant load of Nationwide exceeds 30, two exits are required.
At your earliest convenience, please provide a floor plan showing how the second exit
from this suite will be provided. Be sure the second exit is properly spaced from the
existing door and note, a permit shall be required for this work. If you have any questions
please feel free to contact me at 771-0220.
Thank you,
60A�*A�7�
Jeannine L. Graf
Building Official
cc: Fire Marshal
• Incorporated August 11, 1890 •
Sister Cities International — Hekinan, Japan