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FIRE PREVENTION
Serving Brier; Aamonds, and
12425 Meridian Ave S
INSPECTION REPORT
SNOHONIISH GO.
>r^'
FIRE
Mountlake Terrace
Everett, WA 98208
❑ BRIER OEDMONDS
° .
DISTR
Phone (425) 551-1200
❑ MOUNTLAKE TERRACE
[I UNINCORPORATED
www.FireDistrictl.org
Fax (425) 551-1272
7500 212 th
Street SW Suite 104
FREQUENCY STATIO ySHIFT
LOCATION:
98026
2016 16
slum ea
BUSINESS NAME:
3853130171
PHONE:
SCHEDULED Dec 2016
/
MAILING 7500 212th Street SW, Suite 106, Edmonds, WA 98026
ADDRESS:
eorge
BUSINESS OWNER: Detan HOME PHONE:
EMERGENCY-1: Delaney, -George._ HOME PHONE: 201349
KEY ACCESS-2: HOME PHONE:
EMAIL:
PERSON CONTACTED:
NAME OF INSPECTOR:i
Date Last Serviced:
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
............ 7
/ 0 ��12 /
2
DATE DUE
91
UFIR /
OWL
L
CURRENT CITY YES No
BUSINESS �1777L
LICENSE u
INITIAL INSPECTION DATE
I_VJ17
1
2
3 L4 3
Tf �-
.j.." 1
6
7 1 7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2Dd RE -INSPECTION
FINAL RE -INSPECTION
EXTENSION VIOLATIONS
DATE DUE'
DATE DUE
GRANTED TO: DATE DUE: CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
.' CONTACTED:
INSPECTOR-
INSPECTOR
INSPECTOR: 2
. 5
DATE,
DATE,
DATE: ` 3
VIOLATIONS.
VIOLATIONS
PRE -CITATION CITATION ISSUED
1 ; 5
1 � 5
LETTER SENT NUMBER: 4
a
"
'
CODE 5
2 .6
2 6
DATE. SECTION-
-
RETURN RECEIPT -
3 .7
3 7
6
RECEIVED
DISPOSITION'
T
4 ` 8
4 8
DATE: .
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8
SNo
D
Serving Brier, Edmonds
Mountlake Terrace,and
the Town of Woodway
www FireDistrictl. org
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
❑ EDMONDS
❑ BRIER
❑ WOODWAY
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY
STATION & SHIFT
LOCATION:
7500 212th Street
SW 106
730
16 D
BUSINESS NAME:
Vacant
PHONE:
4257128509
DATE DUE SCHEDULED 1 ®1t11
�A
MAILING
7500 212th St ` W ##106
LIFIR ► 591 1 i157
ADDRESS:
Edmonds
90026
�I BUSINESS OWNER:
Santos, Mark
HOME PHONE:
2064096451
ACTIVE
/ EMERGENCY-1:
Thornburg, Kristen
HOME PHONE:
2066697329
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
LICENSE
PERSON CONTACTED:
IN14TIAL INSPECTION DATE
1
NAME OF INSPECTOR:
FIRE
I �FE �1
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
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:
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
8
4
8
DATE:
DISPOSITION:
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8
FIRE DEPARTMENT COPY
BLDG
ECON V
CITY OF EDMONDS EnEv
; -FIR '
BUSINESS LICENSE APPLICATION —COMMERCIAL MAYOR
FEE: $65 PLAN
CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION POLICE
121 5T" AVENUE NORTIjLEDMONDS, WA 98020 PHONE: 425.7752525 U71L MLA
z�-to�J is7 W �� q ( DDO 12-j6 f 7
BL# Customer# ,SIG��' I Year I CIrs I SHD I Date Paid I TR# I Fee Paid I Mailed I Delete
I
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 F 0 b dX �S's E Cl W1p11 JS. ccj
StreetorPO Sox Suite No. City, State and Zip Code p /
BUSINESS PHONE NO. (�� )_ [Io2' RSC�� WA STATE TAX ID NO. (UBI NO.)
BUSINESS E-MAIL krls P W h1aj S?�nBUSINESS WEBSITE
PROPERTY OWNER C ��V �T �]Yl��� �� Q I a %LC-
N me T Phone Number
EMERGENCY NOTIFICATION (For Premise Access in Emergency):
Last Name First Name MI Phone No.
Name
NATURE OF BUSINESS
Name
MN (dam)
Mi Phone No.
NUMBER OF EMPLOYEES 4 _SQUARE FOOTAGE OF BUSINESS SPACE S C7
TYPE OF BUSINESS - PLEASE CHECK THE APPROPRIATE CATEGORY:
O CONSTRUCTION NFINANCE, INSURANCE, REAL ESTATE O LANDSCAPE, HORTICULTURAL O MANUFACTURING O NON-PROFIT
❑ RETAIL O SECONDHAND DEALER O SERVICES O WHOLESALE O OTHER
AMUSEMENT DEVICES ON PREMISES? ❑ YES )I NO IF YES, TOTAL NUMBER
LIQUOR SOLD ON PREMISES?: O YES P NO GAMBLING? OYES , '� NO CIGARETTES SOLD ON PREMISES? OYES 9NO
FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED?: O YES 'NO IF YES, PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES:
PROPOSED OPENING DAY OF BUSINESS — ��^O $ BUSINESS HOURS
DAYS OPEN O SUNDAY I XMONDAY ;56TUESDAY P WEDNESDAY--PTHURSDAY �14 FRIDAY O SATURDAY
PARKING SPACES ON SITE: TOTAL G% ACCESSIBLE FOR PERSONS WITH DISABILITIES
DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE
T,O PERSONS WITH D/I/SABILITIES?IYES ONO
PRFV101 I.R RI IRINFRR I IRF AT TI-IIR AnnP;=RR 7 ///i it / U V 9'1 �/ h f:7W -J%.—1 i?- i / V ✓ �Y
F'l
ADDRESS
Basin Apt No, Unit No. Cily,Stabend Lp Cade
HOMEPHONE NO.( 1 DOL NO, (DRIVERS LICENSE NO.) OR OTHER ID NO.
DATE OF BIRTH CITY AND STATE OF BIRTH COUNTRY OF BIRTH
NAIVE
PIIRTNERSMIP-PAflTNER1
IaD
Flint
MI
ADDRESS
Street
Apt. No.. Unit No.
City, Sade am Lp Cooler
HOME PHONE NO.L 1
DOL NO. (DRIVERS LICENSE NO) OR OTHER ID NO.
DATE OF BIRTH
CITY AND STATE OF BIRTH
COUNTRY OF BIRTH
PARTNERSHIP - PARTNER 2
NAME
tan
First
MI
ADDRESS
Shalt
Apt. No., Unit No.
City, States am Zip Code
NONE PHONE NO.( I
DOL W.(ORTVERS LICENSE NO.) OR OTHER ID NO.
DATE OF BIRTH
CITY AND STATE OF BIRTH
COUNTRYOFBIRTH
NAMEOFCORPORATON SAMTAS t -M*I6o bWA We - FEDERALTA%IDNO. 30OVAM14
CORP.ADDRESS 7600 dl'ASfSW 100 WS 9jr;-4 PHDNENO.y( -z$) Z/.-Z
Deceit Suite, Apt.,L Na City, Bhb am LIP Code
CORPORATE OFFICERS:
L st Name First Name MI
SMA.TAc A{A2t I-
'rY.e�x {ee„c �Rlt9EV
Tide Deb of BMh DOL No.(Drivers L ccnsa No.( or Other ID No.
PLL
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P�
Ifol
Lail Name
First Name -
MI
Title
PIOne No. DIM No.(Odvers Uc, No.) or Otter ID No.
APPLICANT Igkx SiDnAS
`/Gt[[..-.0 K4SA
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Namer-Primed
- signature
Tide
rDale
CITYDSEONLY:
PLANNINGDEFT.
OAPPROVE
ODISAPPROVE
DATE-
SIGNATURE
ZONINGCODE
CONDYTICNAL USE PERM?
COMMENTS
BUILDINGDEPT.
OAPPROVE
ODISAPPROVE
DATE
SIGNATURE
OCCUPANT LOAD
BUILDING PERMD
OCCUPANCY GROUP
COA4.ENTS
ORE DEPT.
'DAPIi
DDISAPPROVE
DATE
SIGNATURE
U.F.I.R
COMMENTS
POLICE DEPT.
OAPPROVE.
ODISNPPROVE
DATE -
SIGNATURE
COMMENTS
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DATE, APPIL 90, 20D
I I I I I I I I I I I I
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Partners
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LOCATION, EDMONDS, UAABHMGTCN
DATE, APRIL 30, 2009
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COSMETIC SMEW FLLC SERVICES IATES
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EDMONDS, WASHINGTON
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LOCATION. EDMONDS, WABHINGtON
DATE. JAN UARY 31, 20mH