110 JAMES ST STE 108_Redacted- -- IIII�lIII Jw TAtPiTsTp
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CITY OF EDMONDS
BUSINESS LICENSE APPLICATION— COMMERCIAL
FEE: $125.00
CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION JUN 2 2 2012
41C.gs 1 5T" AVENUE NORTH, EDMONDS, WA 98020 PHONE: 425.775.2525
EDMONDS CITY CLERk
OFFICE`USE ONLY
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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.
BUSINESS NAME Sl NfGt(1 L '4 fZ j 7—X
BUSINESS ADDRESS I / O .T/+t44 P S S7- S 7'-
.�_ /O ,fib 14A b rV L S Q Cg O ZO
Street Suite No. Zip Code
MAILING ADDRESS 5-41440
Street or PO Box Suite No. City, State and Zip Code
BUSINESS PHONE NO. c yz.�� ` RHO L`i WA STATE TAX ID NO. (UBI NO.) 6'0/ 14'/ /0(0
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BUSINESS E-MAIL St !ji�rVJa., tt* cor�o� earth 4*k. t7 J BUSINESS WEBSITE 104- / tJ
PROPERTY OWNER ,E'F� �9 - G-G-�- (y Z� > T O - R�e 6 O
Name Phone Number
EMERGENCY NOTIFICATION (For Premise Access in Emergency):
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Last Name First Name MI Phone No.
Last Name First Name Mi Phone No.
NATURE rOF BUSINESS R4 I t111-rl� .0V V45 7/0"t 4W7_5 ZJZI N7V /Z ! G iW /TA (-no A,; f>asaytess'4
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NUMBER OF EMPLOYEES SQUARE FOOTAGE OF BUSINESS SPACE S o
TYPE OF BUSINESS - PLEASE CHECK THE APPROPRIATE CATEGORY:
O CONSTRUCTION O FINANCE, INSURANCE, REAL ESTATE O LANDSCAPE, HORTICULTURAL O MANUFACTURING O NON-PROFIT
❑ RETAIL O SECONDHAND DEALER O SERVICES O WHOLESALE O OTHER P I kt4-17 . L nl � O t !tir E AJ �
AMUSEMENT DEVICES ON PREMISES? O YES e'NO IF YES, TOTAL NUMBER
LIQUOR SOLD ON PREMISES?: O YES A 140 GAMBLING? O YES 0'I 1�0 ko CIGARETTES SOLD ON PREMISES? ❑ YES Er
FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED?: O YES 0<IF YES, PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES:
PROPOSED OPENING DAY OF BUSINESS Al - BUSINESS HOURS ✓9 r/ 1z& t°
DAYS OPEN O SUNDAY �1AONDAY IITUESDAY -EI WEDNESDAY-fITHURSDAY 9'9RIDAY O SATURDAY
PARKING SPACES ON SITE: TOTAL / ACCESSIBLE FOR PERSONS WITHDISABILITIESSr fl4--CcT
DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES? O'YES O NO
PREVIOUS BUSINESS USE AT THIS ADDRESS _ rllJ4/G/ AL " O /S Or-S
ADDRESS
Street Apt No.. UM No. CRY.SMNand4Cod9
HOME PHONE NO.(_) OOL NO.(ORIVERS LICENSE NO.) OR OTHER ID M.
DATE OF SIRTH CNY AND STATE OF BIRTH COIMTRYOf BIRTH
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CITY USE ONLY:
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' = CITY F EDMONDS
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�121'5- AVENUE N. • EDMONDS, WASHINGTON 98020 • (425) 771-0215
-FIRE DEPARTMENT
�'St 18g�
LOCATION:
110 James Street
BUSINESS NAME: Singulariti Corp
MAILING 110 James St #104
FIRE PREVENTION
SAFETY SURVEY
108
PHONE: 42564086"
FR EJEENCY
STAT11 & SHIFT
7N
SCHEDULED
12/01;10
DATE DUE ►
UFIR ► 591
1:202
ADDRESS: Edmonds 98020 �
BUSINESS OWNER: Neely, ScoffHOME PHONE: 2065420894 ACTIVE
itlleeks Michael 4256408660
EMERGENCY-1: t HOME PHONE:
KEY ACCESS-2: HOME PHONE:
r.
PERSON CONTACTED: �� � .,•` INITIAL INSPECTION DATE
NAME OF INSPECTOR: 1
FIRE FE 10j
SYSTEMS: ANNUAL.
HAZARDS FOUND AND LOCATIONS / COMMUNICA
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ENTER CODE ONLY ONCE ►
VIOLATION CODE
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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
L� l
DATE: % � / � % A
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
8
7
4
8
4
8
DATE:
DISPOSITION:
8
LETTER NEEDED [ YES ❑ NO
LETTER NEEDED ❑ YES NO
FIRE DEPARTMENT COPY