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10016 EDMONDS WAY STE D_E_Redacted� y tia CITY OF EDMONDS f BUSINESS LICENSE APPLICATION - COMMERCIAL FEE: $125.00 5 TH CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION 121 5 AVENUE NORTH, EDMONDS, WA 98020 PHONE 425.775.2525 ❑ Building ❑ Engineering ❑ Fire ❑ Planning ❑ Police OFFICE USE ONLY BL# Customer # i 0 334 V) SIC PWWNt I Year Class Sector Date Paid t TR# Fee � 24A I 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 3161 each year. Renewal must be submitted prior to January y3V to avoid late fees. /�,, BUSINESS NAME 0/UV ! I �%��"1�iN7�L i/�f/V i/ Lk lIJKr �,n�Iy� BUSINESS ADDRESS l D0 / 9 -J9, A4aaJQ-5 IfV/ / l � 6VA& V ' " " q00 7,0 Street Suite # City, State, Zip Code MAILING ADDRESS �f 1 Cb C ouv ffw !/y -I , btll�- %O '2�0 7 � 2� Street or PO Box # Suite # City, State. Zip Code BUSINESS PHONE( Ilz' 1 347 I -70(,4- WA STATE TAX ID # (UBI) 14916 q L� `3 BUSINESS E-MAIL �' "i O l (t �C��D I��/`t (e. �I j BUSINESS WESSITE VVV04J • '15 UpIU BUSINESS OWNER/MAIN CONTACT Name Phone Number EMERGENCY NOTIFICATION (For Premise Access in Emergency): a48am+ M G M o L--r�l I<+=r/l / Last Name 'First Name MI Phone Number Pd LoW- ( 2061 (01042 3 9 ( � Last Name First Name MI Phone N umber NATURE OF BUSINESS (Provide a Detailed Description of Business Activities, Products & Services): ix U (aL ``7t'?2U (N7a �f', S�5 ?�Y//11i L G�vih✓lG /�//i/ ST `r✓Gc SPACE ALTERATIONS TO BE MADE: r%i PREVIOUS BUSINESS AT THIS NUMBER OF EMPLOYEES �C ' ( SQUARE FOOTAGE OF BUSINESS SPACE /3,57-�1 TYPE OF BUSINESS - PLEASE CHECK APPROPRIATE CATEGORY: O CONSTRUCTION ❑ FINANCE, INSURANCE, REAL ESTATE ❑ LANDSCAPE, HORTICULTURAL ❑ MANUFACTURING ❑ NON-PROFIT ❑ RETAIL ❑ SECONDHAND DEALER ❑ SERVICES ❑ WHOLESALE ?4 OTHER PROPOSED OPENING DATE: �Aon� / 1 %Jt/ BUSINESS HOURS: 1///,v, ie�i DAYS OPEN: KSUNDAY gWEDNESDAY geMONDAY KTHURSDAY JI TUESDAY 0 FRIDAY �k,SATURDAY AMUSEMENT DEVICES ON PREMISES? YES NO-�(—IF YES, TOTAL NUMBER LIQUOR SOLD ON PREMISES? YES NO-2< GAMBLING? YES_ NO-X— CIGARETTES SOLD ON PREMISES? YES NO- FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED? YES NO.19_ IF YES, PLEASE PROVIDE A LIST OF MATERIALS AND QUANTITIES: PARKING SPACES ON SITE: TOTAL SPACES $L> ACCESSIBLE SPACES FOR HANDICAP P RKING I DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES? YES NO 51rve-�d dN 0 Applications may be mailed in with a check, brought in person, faxed to 425-771-0266 or emailed to business.license edmondswa. v with a valid phone number. We will call you for a Visa or MasterCard payment. ADDRESS '�U 'bI �( RL'S P✓ eymo p W //ww A ^SMEET SUMAPTAINRA CITYSTATMP CODE HOME PHONE( IN(a I%Ali307"7pRNERSUOERMORIDA§STATE PARTNERSHIP - PARTNER 1 NAME LAST FIRST MIDDLE INFOAL ADORE§§ STREET SUITEIAPTNNITA CITYISTATE/ZIPCOOE HOMEPMONE( I DRIVERS LICENSE OR N A S STATE DATE OF BIRTH CITYISTATE OF BIRTH COUNTRY OF BIRTH PARTNERSHIP - PARTNER Y NAME LAST FIRST MIDDLE INITIAL ADDRESS STREET SUITE/gPTNNRA CITYISTATFJZP CODE HOME PHONE( 1 DRIVER'S LICENSE OR D A S STATE DATE OF BIRTH CITVATATE OF BIRTH COUNTRY OF MRTM T /yam CORPORATIONI LLC or PLLC /J /�y J� NAME OFCORPORATa OND PoKr Ii L'" FEDEwuTm D#qt:: 3 OD&O wRP.AooREss ah�lU 1D1 S'( /�1Vry mIt/dr i x 4imp 42"74 07 EIreM SUNB.APL UnLA City. SMNnkilpC a Phwo III~ CITY USE ONLY: BUILDING DEFT 0 APPROVE DISAPPROVE DATE SIGNATURE OCCUPANT LCAO BUILDING PERMIT OCCUPANCY GROUP COMMENTS ENGINEERING Q APPROVE Q DNMFPROVE DATE SIGNATURE HIRE DEPT. APPROVE MSAPPROVE DATE SIGNATURE PLMMNG DEFT. 0 APPROVE Q DMPPROVE MTE BIGNATIRE ZONING CODE CONORIONAL USE MRNHT wMMFNTS POLICE DEFT. LJ APPROVE = DISAPPROVE MTE SIGNATURE 591" 1 12 32' i Benches 42"h x WD )Ois 85.375" 6„ r • � © it • 48x30"Table and chairs 0 I■ 30x30°Table 121 " and chairs sa 9 Gu; 13 ` 3 Fel U � I 28" 66.25" 57' 0 Customer Bathroom 0 with 61 Staff Only 135.5" IN Kind of Equipment ■ 1 2-Door Reach in Refrigerator, SUM Atosa MBF8507 2 2-Door Work top Refrigerator; 48x33 Atosa MGF8402 3 2-Door Glass Refrigerator, 55x34 Atosa MCF8703 ® 4 Refrigerated Display Case; 79L Tor Rey VTA200 5 3 Comp Sink; 18x18x18, HD FauceVSprayer BK Resources BKS3; BKF-SMPR-WB-AF-14 296" 6 1 Comp Fish Sink; Faucet; Cutting Board BK Resources BKS-1-128, BKF-8-8G 7 1 Comp Veg Sink; Faucet BK Resources BKS-1-18; 8KF-8-8G 8 Hand Washing Station w/ Splash Guards BK Resources BKHS-1410-SS-W-P-G 9 23 Cup Commercial Rice Cookers (2) Panasonic SR-42HZP-W ' 10 Digital Scale and Printer Tor Rey 166PC40LTKrr i 1 ShopKeep Register 12 Dry Goods Storage Shelves (2) Placetech 925395 ' 13 Employee Lockers Tennsco I DTS121836CMG i Seating Occupancy: 30 srroz oimsA Co. Seri rrrg Brier, Edirronds, arid 12425 425 Meridian Ave-S Mowitlake Terrace Everett, WA98208 FIRE Phone (425) 551-1200 DISTR IT wwwFireDistrictl.org Fax (425) 551,67272 LOCATION: 10016 Edmonds Way Suite D 98020 BUSINESS NAME: Subway 22801 PHONE: 4254781855 MAILING ADDRESS: 10016 Edmonds Way, Suite D, Edmonds, WA 98020 BUSINESS OWNER: HOME PHONE: EMERGENCY-1: H011ek, Mathew CS 5';O) ` Lt$ ' 2S4'_Z';� HOME PHONE: 4254781855 KEY ACCESS-2: HOME PHONE: EMAIL: PERSON CONTACTED: ' L NAME OF INSPECTOR: "tom FIRE PREVENTION INSPECTION REPORT ❑ EDMONDS ❑ BRIER ❑ MOUNTLAKE TERRACE ❑ UNINCORPORATED FREQUENCY I STATION & SHIFT 2015 20-C SCHEDULECFeb 2015 DATE DUE 513 UFIR / __j CURRENT CITY YES NO BUSINESS LICENSE INITIAL INSPECTION DATE drMtemn HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 2 2 r 3 3 4 4 5 1 5 6 6 ' 1 / 7 ( 7 1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X 1st RE-INSP TION 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 $ 4 $ DATE: DISPOSITION: 7 LETTER NEEDED ❑ YES ❑ NO LETTER NEEDED ❑ YES ❑ NO 8 FIRE DEPARTMENT COPY SNOHOMISH CC FIRE DIST Serving Brier; Edmonds, and Mountlake Terrace 12425 Meridian Ave S Everett, WA 98208 Phone (425) 551-1200 FIRE PREVENTION INSPECTION REPORT ❑ EDMONDS ❑ BRIER ❑ MOUNTLAKE TERRACE ❑ UNINCORPORATED ,i JL%.# Z www FireDistrictL org Fax (425) 551-1272 FREQUENCY STATION & SHIFT LOCATION: V'11001$ Edmonds Wav Suite D 98020 Annual 20-B BUSINESS NAME: v Subway 22801 PHONE: 4 b4781855 SCHEDULED Feb 2014 DATE DUE MAILING UFIR513 ADDRESS: 10016 Edmonds Way, Suite D, Edmonds, WA 98020 BUSINESS OWNER: HOME PHONE: v ✓4254701855 EMERGENCY-1: Hollek, Mathew HOME PHONE: CURRENT KEY ACCESS-2: HOME PHONE: CITY YES NO BUSINESS EMAIL: LICENSE PERSON CONTACTED: INITIAL INSPECTION DATE NAME OF INSPECTOR: CA FIRE SYSTEMS: /FE 5! j„ I HAZARDS FOUN ANDLOCATIONS /COMMUNICATIONS 1 YIG(tA VQ11 2 2 3 /i 3 4 i % 4 / 5 5 6 6 7 7 1 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 or the Town of Woodway, call (425) 775-7720; for Mountlake Terrace or Brier, call (425) 754-0434. BUSINESS COPY SNOHOMISH CO. Sejv�sig Brier,' Edmonds Mountlake Terrace, and the Town of Woodway www.FireDistrictl.org LOCATION: 10016 Edmonds Way BUSINESS NAME: Subway 22801 MAILING 10016 Edmonds Wy #1) ADDRESS: Edmonds BUSINESS OWNER: I- ollek, Mathew EMERGENCY-1: MorgaCher, YUry KEY ACCESS-2: ' PERSON CONTACTED: NAME OF INSPECTOR: SYSTEMS: 01 F1IRE PREVENTION .. area. 12425 Meridian Ave S INSPECTION REPORT &DMONDS Everett, WA 98208 ❑ BRIER Phone (425) 551-1200 ❑ WOODWAY ❑ MOUNTLAKE TERRACE Fax (425) 551-1272 ❑ UNINCORPORATED FREQUENCY STATION & SHIFT 365 20 A PHONE: 4254781855 SCHEDULED DATE DUE ► 02.101113 UFIR ► 513 253 &TI "n HOME PHONE: 425478 1855 HOME PHONE: 4254783317 HOME PHONE: a' ACTIVE CURRENT CITY YES NO BUSINESS LICENSE INITIAL INSPECTION DATE EE _L /_Ll ANNUAL HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS � � qs 1 S x 1 r•• r CG' 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 a DATE: ��D/l,. DATE: DATE: 3 VIOLAT NS 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 5 4 S 6 DATE: DISPOSITION: 7 LETTERNEEDED ❑ YES ElNO LLETTERNEEDED ❑ YES ❑ NO g FIRE DEPARTMENTCOPY FIRE PREVENTION Serving Brier; Edrnonds 12425 Meridian Ave S INSPECTION REPORT j SNOHOMISH CO. FIRE Mountlake Terrace, and Everett, WA 98208 ❑ EDMONDS ❑BRIER 14 DIST-R., the Town of Woodway T Phone (425) 551-1200 ❑ WOODWAY ❑ MOUNTLAKE TERRACE wwwFireDistrictl.org Fax (425) 551-1272 ❑UNINCORPORATED FRE ENCY �yy STAJQN &dHIFT �IJJ LOCATION: 10016 Edmonds Way E BUSINESS NAME: Subway 22801 PHONE: 4254781855 SCHEDULED 02101112 DATE DUE MAILING 10016 Edmonds Wy #D UFIR ► 513 253 ADDRESS: Edmonds 98020 BUSINESS OWNER: HoliBi{, Ma#j'I,Bw HOME PHONE: 4254781855 ACTIVE ' EMERGENCY-1: Mor, Scher Yu g r fY 4254783317 HOME PHONE: CURRENT KEY ACCESS-2: HOME PHONE: CITY YES NO BUSINESS LICENSE nn PERSON CONTACTED: 1L CM �I NAME OF INSPECTOR: ��� o72Z INITIAL INSPECTION DATE l FIRE FE I I ! I I SYSTEMS: ANNUAL HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 1A r4 1 2 2 3 3 4 4 5 5 6 r 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: 1 INSPECTOR: INSPECTOR: INSPECTOR: 2 DATE: DATE: DATE: 3 VIOLATIONS 1 5 VIOLATIONS 1 5 PRE -CITATION LETTER SENT CITATION ISSUED NUMBER: a 2 6 2 6 DATE: CODE SECTION: 5 3 7 3 7 RETURN RECEIPT RECEIVED e 4 8 4 6 DATE: DISPOSITION: 7 LETTER NEEDED ❑ YES ❑ NO LETTER NEEDED ❑ YES ❑ NO g FIRE DEPARTMENT COPY CITY OF EDMONDSw *° BUSINESS LICENSE APPLICATION- COMMERCIAL FEE: $125.00 �'� ;y CITY CLERKS OFFICE, BUSINESS'LICENSE DIVISION 14.. isg° ZW121 57H AVENUE NORTH, EDMONDS, WA 98020 PHONE: 425.775.2525 OFFICE USE ONLY BL# Cust I SIC I Year Class SHD Yate Paid TR# Fee Paid I 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 if'business bloses. BUSINESS NAME BUSINESS ADORE tf MAILING ADDRESS G ` �/ 7o Il J � J Y A(*" 41.11r. W ,4 �&b --)Ll 49 Street or PO Box �y Suite No. City. and Zip Code BUSINESS PHONE NO_ (C/Z �l L 7a — (O 5� WA STATE TAX ID NO. (UBI NO.) �� �J nri .Zc� 9 j _ .• BUSINESS E-MAILM CL 4P 1/ eo M v1 BUSINESS_ WEBSITE PROPERTYOWNER 1/rqn.. Z156 Name Phone Number EMERGENCY NOTIFICATION (For Premise Access In Emergency): NATURE OF BUSINESS vt NUMBER OPEMPLOYEES b SQUARE FOOTAGE OF BUSINESS SPACE D 0 TYPE OF BUSINESS - PLEASE CHECI<.THE-APPRpPRIATE CATEGORIC: D CONSTIfUCTION Q FINANCE. INSURANCE, REAL ESTATE. • D LANDSCAPE, HORTICULTURAL O MANUFACTURING O NON-PROFIT RETAIL- O' SECONDHAND DEALER O SERVICES D WHOLESALE, D.OTHER AMUSEMENT DEVICES'ON•PREMISES? .EI YES 10 . IF YES, TOTAL NUMBER LIQUOR SOLD ON PREMISES . OYES NO,' GAMBLING? OYES )<NO . CIGARETTES SOLD•ON PREMISES? D YES NO FLAMMABLE OR HAZARDOUS MATERiAL.S USED OR STORED?. DYES* IFYES; PLEASE PROVIDE UST OF MATERIALS AND QUANTITIES: ' °t PROPOSED OPENING DAICOF`BUUSINESS XT lBUSINE�,S�S HOURSDAYS OPEN NDAY Q'MONDAYUESDAY WEDNESDAY /�THURSDAY 'F�iIDAY A RDAY PARIONG SPACES ON SITE: TOTAL ACCESSIBLE FOR PERSONS WITH `DIISABIUTIE% ' DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH ISABIUTIES? , MYES PREVIOUS BUSINESS USE AT THIS ADDRESS 90LE PPOPPoETORBxR M1E ieR Fptl w MD s SNM AptN,W 0. DTy,B "744p O OeIE MN EW.( 1 D NO.RRNEfS UCBIBE NO.) MOTIB"R R N0. Are OFBRRI CRYMObTAre OF BRTx CWNINYOFBRTX Pq ER P-PMreMl NPME UM w AOD!✓E56 sem ---i - xP..uwxv an.sd..maP c,w - HOMEPHON W- 1 MND.IDRx Uf.ExSB )O WiflMWx wTE OF BiROI dIYANDSfgIEOFBIRTx CpBRRYOFBRTH . NM1E PMTNERBRP-PMT k .. Tau Pllet . w. noDREss BlMI APLNo..MpBN0. Di).BNT Mp H06¢PfIQNEN0.( '1. DDLN0. �R11rFRti LTOENBENp.I'aM1OlfER111Nh _ MMT BRTP CNYN WAWOFBWTX WfITRYOFBRDI COTBNMWT£DFRCER$ TaYNeinv RrN Nme M TNe ..' �imu - nelNmx M. TNB PINnFNn ODLN0. BNEasIl0. H0.1'mWiRB1.N0. I- _: INmro--PM� ewe . 'fUNNM011EhT aAP RME ODRMRbVP Yq/E COwi911S" BwwR+B:o,®r. OOPPROYE ODISPPPggIE MTE, *Gi4A.T E,. .. OCCDP LQAD" ' •..' ... GUWM PERRR ...:. :: ... ' .. axuPgNc cROCP"^' ..' _-;• 'RRED@T. OAPPRq DDISAPP Dare - GN TUpe. 7- , 1'DUFLOYT. OMPROVE.OgBAPPROVE DpTE� BKdNTUE' . W�®Yf8 m i a Orr" P 'L L; L! OF L, FL-LS-Tj RT -1 31 �T _gWeUGE2 F i NEW LOCATION] CA .1 eox NEWOSTAT fD - F-a r—. I REVISION j#4 MAMiOULW % M, � I, A —C,- MMONDS, WA colmm �22=q I JULY22,2011 D Ptfu1)-qGmc1 ALL DucKSONS MUST BE Y-Jtl V. 1.14H ro tcNEs,.,. A 9-11T 0; FLI" rl�,AJSE —M 00 NOT T.ALI TIII: RODS1, 10 TIC I . I 1.= 9 rFNERAL YOrES ELEC �-;l 1Yl LLI lf—fSi 1EAV-R!' "-' t- I W'�*� a ljt:CnOH DI TO BE LIC170 -1 10A :1; pi- AS SNCL�s No- G�— IJNO uaJLl 0 —qES 1I0 x—E. 1T1S--ETl-5AZILtM 'wM--M Z1KC0—N ALL Ell SW1,LV�—tT3!— 2, FE29W0 IE� ILWud' rol 11-`,k, `:3 Tus 7.1LCT CI1JV1D C1 71 CAE�Ll --C,V--IC V-- ' ' tj'FI1IC—s:TfR I--'S — -/!WIID MILT. -C F=6'IT- —t — I 1F P. IT —t;-K— CC SL-111 C Ilk' TIATEP. JXSTU ZN'- ". -'CC'C�T�C "M-') 17:i 11 st 71 13 t/1- 91�!; , W cnu) It, C., !S,u.jU t0*&.j A., O.W9 I j--tc O4 jloS 1- -E 11 rT ImT .rcr; -1.7.1-K31 Nl%.= -I - ,` —, , , P FAx I PaTILIC C — -:11 EI,C? Ll: -S NUILLED Ty f C. r L;! L`-L. ZP. L-1 --11 S- c A- rFt ,. 1, 1:., AIL '. 61 0r GE? LCZA- CUE LtU& SU3.LqLU W —E'a:,+11, 1.1: ll-J. ALL .1-i V.1r. :4 C cr.flll 51?Z1 U �iE � 4 , : is: 4u, "I:L- ,-.-Ep TO I T-5 jr4c,TE:—�, E . E I - �LANS 4. - Fo' Rt v (Al y ANC IR--- tips TO CZE CONSTijED AS rNAI. APPROVAL " d FIRE PREVENTION CI • � Of EDMON DS � � ' `f ' SAFETY�SURVEY 121 5- AVENUE N. • EDMONDS, WASHINGTON 98020 • (425) 771-0215 FIRE DEPARTMENT 4�'St. 1S90 10016 Edmonds Ws E LOCATION: Y BUSINESS NAME: Sub Shop ##149/006 -I `a.... P, c P Nv- PHONE: 4256700710 MAILING 10016 Edmonds Wy #E ADDRESS: Edmonds 93020 BUSINESS OWNER: "Clark, Yearout & Ors-° HOME PHONE: 4257749$00 EMERGENCY-1: "Clark, Theodore N-" HOME PHONE: 2065421624 KEY ACCESS-2: Yearout, Petrick HOME PHONE: 2065336220 FR E6UENCY STATIOON & SIFT 1 SCHEDULED DATE DUE 02101111 ► UFIR ► 513 253 ACTIVE PERSON CONTACTED: Gpr{�T INITIAL INSPECTION DATE NAME OF INSPECTOR: e GIGS FE f SYSTEMS: ANNUAL HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 1 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 7 4 8 �. 4 8 DATE: DISPOSITION: - 8 LETTER NEEDED ❑ YES NO LETTER NEEDED ❑ YES NO FIRE DEPARTMENT COPY MONDE a,-WASHINGTON 98020 • (425) 771-0215 FIRE PREVENTION SAFETY SURVEY d _ Edmonds Way -5 NAME: Sub Shop #149/006 MAILING 10016 Edmonds 1Vy #E ADDRESS: Edmonds BUSINESS OWNER: "Clark, Yearout & Co." EMERGENCY-1: "Clark, Theodore N." KEY ACCESS-2: Yearout, Patrick E PHONE: 42567007/0 98020 l 4 HOME PHONE: 257749800 HOME PHONE: 2065421624 HOME PHONE: 2065336220 FREQUENCY STATION & SHIFT 365 20 6 SCHEDULED 0, 02�0 1110 DATE DUE UFIR ► 513 253 ACTIVE PERSON CONTACTED: i - J t-,4 1 F. ;— INITIAL INSPECTION DATE NAME OF INSPECTOR: FIRE - FE ,J,1 SYSTEMS: ® ANNUAL ' ' HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 1 ENTER CODE ONLY ONCE ► VIOLATION CODE 1 U 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: t 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 7 4 18 4 18 DATE: DISPOSITION: 8 LETTER NEEDED 0 YES I] NO LETTER NEEDED 0 YES ® NO FIRE DEPARTMENT COPY