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7500 212TH ST SW STE 110 (2) - 15pgs_Redacted`~:.T--x.►t ~ f IIII�`III 17J��U . z'%Z f� .!'i[.,,J .Si t 11 U FIRE PREVENTION -� , Serving Brier, aarnunds, and 12425 Meridian Ave IS INSPECTION REPORT SiOHOMJSH CO. ❑ EDMONDS �� o Mountlake Terrace Everett, WA 98208 ❑BRIER 'L1 ii'' 1 =� Phone (425) 551-1200 ❑ MOUNTLAKE TERRACE i7►ISTR► Twww.FireDistrictl.org Fax (425) 551-1272 [I UNINCORPORATED LOCATION: 7500 212 th Street SW Suite 110 98026 BUSINESS NAME: Progressive Chiropractic PHONE: 4256732190 MAILING 7500 212th Street SW, Suite 110, Edmonds, WA 98026 ADDRESS: BUSINESS OWNER: Leach, Kevin HOME PHONE: � oEQUUENCY STA,lTION SHIFT SCHEDULED Dec 2016 DATE DUE / 591 157 UFIR / EMERGENCY-1: Ball, Andrew HOME PHONE: 4258353077 CURRENT KEY ACCESS-2: HOME PHONE: CITY YES NO EMAIL: BUSINESS ❑ El PERSON CONTACTED: INITIAL INSPECTION DATE NAME OF INSPECTOR: Date Last Serviced: HAZARDS FOUND AND LOCATIONS / COMMUNICATION TZ`"/' 2 �??,c �C T'� lv�i tom! ...5 %C�.L: yi c� L - --" 2 � z� F_5 f� 3 3 4 4 5 1 5 6 1 6 I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X 1st RE -INSPECTION 2nd RE -INSPECTION FINAL RE -INSPECTION EXTENSION VIOLATIONS DATE DUE, DATE DUE GRANTED TO: ' DATE DUE: CITED: PERSON PERSON PERSON CONTACTED CONTACTED CONTACTED: INSPECTOR: INSPECTOR: 2 `• INSPECTOR' _ DATE: DATE: `DATE: 3 J VIOLATIONS VIOLATIONS PRE -CITATION CITATION ISSUED 1 5 .... ... 1 5 LETTER SENT NUMBER 4 CODE 5 2 6 2 6 DATE- SECTION. RETURN RECEIPT 3 7 3 7 RECEIVED 6 DISPOSITIONS 7 4 8 4 8 DATE ❑ ❑ LETTER NEEDED ❑ YES ❑ NO LETTER NEEDED YES NO 8 . .. _.-- . _ '.r•... ... .i .. �. - .t:. �.:r :.v; •.x•c.-s:; 7`^'-, w-, n.yron -;"�•: •'.T +'-:.1,i; C ,:.t';t �\ V FIRE PREVENTION A INSPECTION REPORT Serving Brier Edmonds and Meridian Ave r 12425 Me ad S SNOHONIISH CO. : ' ,. g �, • ❑ EDMONDS FIREMountlake Terrace Everett, WA 98208 ❑ BRIER j DISTR T. Phone (425) 551-1200 ❑ MOUNTLAKE TERRACE www.FireDistrictl. org Fax (425) 551-1272 ❑ UNINCORPORATED LOCATION: 7500 212 th Street SW Suite 112 98026 BUSINESS NAME: North Seattle Holistic LLC PHONE: 8883156610 MAILING 7500 212th Street SW, Suite 112, Edmonds, WA 98026 ADDRESS: BUSINESS OWNER: Mendoza, Richard HOME PHONE: FROE1 UUENCY STATION 1, SHIFT SCHEDULED Dec 2016 DATE DUE / UFIR / EMERGENCY-1: Rasti, David HOME PHONE: 2063546903 CURRENT KEY ACCESS-2: HOME PHONE: CITY YES, NO BUSINESS EMAIL: LICENSE PERSON CONTACTED: 7, lv INITIAL INSPECTION DATE NAME OF INSPECTOR: %,d I4 v�,.,� eoo 7 13ZI& FE ' / /4, i Date Last Serviced: HAZARDSFOUND AND LOCATIONS / COMMUNICATIONS 1 / Y U %% _7 `yfv' y' ✓G'r��f t7�.'yl� / 2 2 3 3 / 4 4 5 `� 5 6 6 a 7 7 I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X 1st RE -INSPECTION 2nd RE -INSPECTION ' FINAL RE -INSPECTION EXTENSION f VIOLATIONS DATE DUE' DATE DUE - GRANTED TO, ,< DATE DUE: CITED: PERSON PERSON I PERSON CONTACTED. CONTACTED. ;CONTACTED - 2 INSPECTOR: INSPECTOR: i INSPECTOR, DATE* DATE: 3 - DATE: VIOLATIONS VIOLATIONS CITATION ISSUED ; PRE -CITATION. 1 4 1 5 1 5 LETTER SENT NUMBER: CODE 5 Z 8 2 5 DATE: SECTION* RETURN RECEIPT 3 7 3 7 RECEIVED 6 DISPOSITION. 4 8 4 8 DATE LETTER NEEDED ❑ YES ❑ NO LETTER NEEDED ❑ YES ❑ NO se j FIRE PREVENTION ' } Serving Brief, Ednionds 1.,425 Meridian Ave S INSPECTION REPORT sNOHOMISH CO. 'FIRE Mountlake Terrace,and Everett, WA 98208 ❑ EDMOBRIER S ❑BRIER ' the Town of Woodway DISTR Phone (425) 551-1200 ❑ WOODWAY ❑ MOUNTLAKE TERRACE wwwFireDistrictl.org Fax (425) 551-1272 ❑UNINCORPORATED LOCATION: 7500 212th St SW .I / 11U/J1/ )1217762936 FREQUENCY 730 STATION & SHIFT 16 D ,J BUSINESS NAME: Heald to Toe Chiropra ctic PHONE: DATE DUE SCHEDULED► 12I01111 MAILING 7500 212th St SW UFIR ► 593 1 e157 ADDRESS: Edmonds 98026 iBUSINESS OWNER: Armstrong, Angelina HOME PHONE: 4256092536 EMERGENCY-1: HOME PHONE: CURRENT KEY ACCESS-2: HOME PHONE: CITY YES NO BUSINESS LICENSE PERSON CONTACTED: INITIAL INSPECTION DATE I NAME OF INSPECTOR: wdJ -7Uov �� /� S / 1211 f/ FIRE F I I SYSTEMS: ANNUAL / HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 2 2 a 3 3 4 4 5 5 6 6 r 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: r. 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 FIRE DEPARTMENT COPY CITY OF EDMONDS BUSINESS LICENSE APPLICATION - COMMERCIAL FEE: $126.00 CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION 121 5T" AVENUE NORTH, EDMONDS. WA 98026 PHONE 425.775.2526 a Building Engineering Fire Planning o Police OFFICE USE ONLY BL# Customer Ai SIC I Year Class SHD Date Paid Sit kt, TRO Day2�t 1. Fee IZs 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 wrlttng 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 Docombor 31'r each year. Renewal must be submitted prior to January 31 i1 to ovoid late foes. BUSINESS NAME NOrth Seod& /��/rS�L' BUSINESS ADDRESS Ire c air ih & IL W iCGV �r - t G jW/+ '9'6WA� Street Suite p City, Stale, Zip COCW MAILINGADDRESS cis' o6 ref BUSINESS PHONE!' ly ) ~� � WA STATE TAX ID # (UBI) 1 (0 BUSINESS E-MAIL �r1� �+ iS�'C'I'�• 10/r'sE��I�t' C;C•111 BUSINESSWEBS7 r ` BUSINESS OWNER I MAIN,CONTACT�.R�"FA�A' A/V ,,R Cr frtdEA'0 2Vf: _I Name PROPERTY OWNER L) / ern cr Name l EMERGENCY NOTIFICATION (For Premise Access in Eme om): Last omo �1Firsi Name tAl /�pS'tr �• //Gtiti t� '_set amo Frost Name MI NATURE OF BUSINESS (Provide a Detailed. Description of'RuOpm AciAties, Produrxs ."I.90 rtces): SPACE ALTERATIONS TO BE MADE: PREVIOUS BUSINESS AT THIS ADDRESS — NUMBER OF EMPLOYEES a -I T YPE OF BUSINESS - PLEASE CHECK APPROPRIATE CATe,90RY: 0 CONSTRUCTION r, FINANCE, INSURANCE, REAL ESTATE o LANDSCAPE. HORTICULTURAL v MANUFACTURING r ' NON-PROFIT n RETAIL r SECONDHAND'DEALER SERVICES WHOLESALE ❑ OTHER U ®© r•,S3I &2--'9y4-T- Phone Number Phone Number r .26G, �eo _ lea Phone Number Phone Number PROPOSED OPENING DATE: —V -- EUISINESS HOURS: % /F" — 7!j_ DAYS OPEN: o SUNDAY VWEDNESDAY rV*ONDAY y0"rMIURSOAY wTUESDAY wf�RIDAY n SATURDAY AMUSEMENT DEVICES ON PR SES7^8 NO�IF YES,.TOTALNUMBER LIQUOR SOLD ON PREMISES? YES____ NO_ y . GAMBLING? YES N0Z 0*ETTES SOLD ON PREMISES? YES — FLAMMABLE OR HAZARDOUS MAT_RfiIALS USED OR STORED? YES NO IF YES, PLEASE PROVIDE A LIST OF MATERIALS AND QUANTITIES: PARKING SPACES ON SITE: TOTAL SPACES ACCESSIBLE SPACES FOR HANDICAP PARKING DES THE BUSINESS CO AIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES? YES &Z N APPLICANT NAME:k_7V/�Ni� hrQl/iJ�-7VL7O:�/4 /t7� rO�' g TmF.,_0 Na & ellt A;:4 � LigC PATE OBI /'�t� ' Q!' (SIZ-- 6- 1Z-�)- ADDRESS 57REU SLITEAPTNWT* CRY5TATMP CODE ROME RIONEI I _DRIVERS LICENSE M10 N 8 STATE DATED BIRTH CITYtSTATE HOME PHOIEI 1 OaNER'S CORPAODRESB /SbO ���H1 IS�. SEeH HMI RNBs LICENSE OR I049 STATE PARTNERSHP—PARTNER¢ RRST l MIDOIEINRUL U tE CI¢. State am ZpCatle MI TNe Doom" MI ¶II¢. / O�I¢plgli!II CITYIIEEONLY'. BUILDMIEPT. O A VE O DISAPWME MlE SIGVFTURE OCCUPANT LOAD BUILDING PERMR OCCUPANCY GROUP COMMENTS ENGINEERING APRR INE LJ OISAPIROVE W SN;RoTURE NEEDS", APPROVE 0 OISAPPROVE WTE SN TURE O ar llcene or GheT DO ISe2 COMMEME PMIINING DEPT. Q APRWYE Q DISAPPROVE DATE SIGNATUR ZONGMICODE CONDRpNAL USE PERMIT CCIMWENT6 INDUCE DEFT. 0 APPROVE 0 OISAINRWE DATE SIGNATURE COMMENTS n f7 '-�� ►� ARtrA FX Cr COA r .r r MAW T(,Z,4/ A/ / N q 4VR e-,A- J (' opE'n/ x ,S;H Zl-r— g'' x 8., sf,, Agl* cnga li /409r" g5A4rn4c Mocf Cn c. i t iJa/ ! r 4 SD C-"w r l ,O#yctc*t- r •:VVV-y AA45 O2%4A+L@rS, "o n/1 �lt+r.r` t} i i� G►n q E �8m� f' I C> r'T =e='v' 4i` 0"'CITY OF EDMONDS BUSINESS LICENSE APPLICATION - COMMERCIAL FEE: $125.00 CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION 121 5T" AVENUE NORTH, EDMONDS, WA 98020 PHONE 425.775.2525 G Building i : Engineering c Fire ❑ Planning G Popes OFFICE USE ONLY BL# ustomer # SIC Year Class Date Paid TR# Fee Mailed Deleted �161C 2,o1i 15i 'Aw 131w-cro�g 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 31" each year. Renewal must be submitted prior to January 3191 to avoid late fees. BUSINESS NAME Wrt-� Kt` i—A I d ✓ BUSINESS ADDRESS ��� �12� !;&ar•l�iQozc- Street 1c.[ 1 Suite # `City, State, Zip Code MAILING ADDRESS t✓��y 1t��! � N W #i_J3 Su l�t-r.-- . 'k- 1 b 1 VIX- ✓ Street or PO Box # Suite # City. State. Zip Code BUSINESS PHONE( IA2,< ) gSf - "&0_*+ WA STATE TAX ID # (UBI) AA __ �t (o BUSINESS E-MAIL /dam f7aBUSINESS WEBSiT.E+J�J. hlstYhu��� " L..d►e-• a o`er '� BUSINESS OWNER I MAIN CONTACT Awks + Name Phone Number PROPERTY OWNER Di t..a CAO"u I .12 I I?&' I2.Sq Namel Phone Number EMERGENCY NOTIFICATION (For Premise Access in Emergency): Last Name First Name MI Phone Number First Name NATURE OF BUSINESS (Provide a Detailed Description of Business Activities, Products & SPACE ALTERATIONS TO BE MADE: YES_NO_,.%_4 PjM9t1S BUSINESS AT THIS ADDRESS_ NUMBER OF EMPLOYEES i Log- IL SQUARE FOOTAGE OF BUSINESS SPACE 13 -*"5— TYPE OF BUSINESS - PLEASE CHECK APPROPRIATE CATEGORY: ri CONSTRUCTION * FINANCE, INSURANCE, REAL ESTATE ❑ LANDSCAPE, HORTICULTURAL u MANUFACTURING ❑ NON-PROFIT ❑ RETAIL ❑ SECONDHAND DEALER A6 SERVICES ❑ WHOLESALE ❑ OTHER Number 40 - PROPOSED OPENING DATE: ClT j1XW(— BUSINESS HOURS: DAYS OPEN: i i SUNDAY ) WEDNESDAY ❑ MONDAY )PTHURSDAY ❑ TUESDAY >,FRIDAY n SATURDAY AMUSEMENT DEVICES ON PREMISES? YES NO_ IF YES, TOTAL NUMBER LIQUOR SOLD ON PREMISES? YES NO ! GAMBLING? YES_ NO_C CIGARETTES SOLD ON PREMISES? YES NO K FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED? YES NO - IF YES, PLEASE PROVIDE A LIST OF MATERIALS AND QUANTITIES: PARKING SPACES ON SITE: TOTAL SPACES ACCESSIBLE SPACES FOR HANDICAP PARKING nncc TU= DI IODICQO nnKMAWI AN cA1T0AAlnc A!•PCQQ1O1 c TO ocQOnA1O \A"T" n1QAGII M=Q9 vco Nf% 11 APPLICANT NAME �O�n, �� "G- TITLE A`rPrintedName DATEyi �4'q Signature NAME LI SOLE PROPRIETORSHIP llilc..kfi r1. LAST FIRST MIDDLE INITIAL ADDRESS ft u a T, STREET SUITE/APTANITR NOMEP1101i Nl�� I DRIVERS LICENSE OR ID tl b SEA DATE OF NRTH 0j 11i CITYSTATEOF BIRTH 6"1 COUNTRY OF BIRTN PARTNERSHIP —PARTNER I NAME IABi FIRST MIDDLE INITNL ADDRESS STREET SUITEIAPTILNITIf CSIYISTATEDSP CODE HOME Filli I ORIVERS LICENSE OR 1D N 88TATE NOECIPS H CITY/STpTE OF NRTH CgINTRY OF BWTH PARTNERSHIP —PARTNER 2 NAME LABi FIRST MIDDLE INRVL ADORESS STREET BVITEIAPTNNRtl CRYISTATErDP CODE HONE PHONE( 1 NNVER'8 LICENSE OR ID F B STATE DATE OF BIRTH CRYSTATE OF BIRTH CCUNTRYOFBRTN NAMEOFCDR MT gM CORPADORESB CORPORATIONI LLC or PLLC FEDERALrAx Rtl f 1 S" CORPORATE OFFICERS: 4M Nam FIrF1N&m SUN, Apt. UM/ City. Stand and Lp Codo Phone NumEm MI TWO Delefalm Odi License or Other Dp/STIR! LOCALCONTACT LeAN FIIN Name MI TIOe Dneemm f 1 Omni Uwnm or011ner IDp/SIRS Plane NPmhN CITY USE ONLY: BUILDING DEPT. APPROVE DISAPPROVE DATE SIGNATURE GGCOPANT LOAD BUILDING PERMIT OCCUPANCYG ENGINEERING Q APPROVE Q DISMPROVE DATE 81GNATURE FIRE Do". O APPROVE O DISAPPROVE DATE_._. _.. SIGWITME PLANNNG DEPT. Q APPROVE Q DISAPPROVE ZONWGCOOE CONOIfEWAL USE PER POLICE BE". L—J APPROVE ED DISAPPROVE OATE SIGNATURE 91 !3'-4' VIENA 1,315 S.F. 645 S.F. !BLJ;TES 110-ill S'JIT=— i12 Suite 110- 111- 112 75uki nuiddina 'b LYNNWOOD, WASHINGTON bf PartnvmlaS vml� Architectural Design Group, Inc. PROJECT: 1500 BUILDING LOCATION, EDMOND5, WA!5HlNGTCN :ATE, C--TO5EP 3. 201-" CITY OF EDMONDS BUSINESS LICENSE APPLICATION— COMMERCIAL FEE: $125.00 CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION 121 5' AVENUE NORTH, EDMONDS, WA 98020 PHONE: 425.775.2525 OFFICE USE ONLY Ir 1 CI ss SHD I Date Paid R#. Fee P" id 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 closes. BUSINESS NAME 1�iZb tLp S S s^v� tf2>ed P� AL'ir- BUSINESSADDRESS 7,5005 2 /2 rK ST; Street Suite No. Zip Code MAILING ADDRESS Street or PO Box Suite No. City, State and Code BUSINESS PHONE NO. (�>' Z �) 673 - � I b WA STATE TAX ID NO. (UBI NO.) yoV >'A `Zip' - I BUSINESS E-MAIL /ri For P/. o "tr-s r—v = s awk*Y',t,F_`. ep o,k _BUSINESS WEBSITE W IV. )eG R s 1 v� s P it7't^1 � . c ►�✓ _ PROPERTY OWNER ["�,FIAAr* G/_AcJt �y ) 776 - I23`-r Name Phone Number EMERGENCY NOTIFICATION (For Premise Access in Emergency): �zAr ►SzAAfX ( , -776 - 123�r Last Name First Name MI Phone No. Last Name First Name Mi Phone No. NATURE OF BUSINESS i F (yZo PRNC-t-rc r.> r r—= G. f^ NUMBER OF EMPLOYEES I SQUARE FOOTAGE OF BUSINESS SPACE TYPE OF BUSINESS - PLEASE CHECK THE APPROPRIATE CATEGORY- O CONSTRUCTION Cl FINANCE, INSURANCE, REAL ESTATE O LANDSCAPE, HORTICULTURAL O MANUFACTURING O NON-PROFIT 0 RETAIL O SECONDHAND DEALER I'SERVICES O WHOLESALE O OTHER AMUSEMENT DEVICES ON PREMISES? O YES O NO IF YES, TOTAL NUMBER LIQUOR SOLD ON PREMISES?: O YES P1'NO GAMBLING? O YES O NO CIGARETTES SOLD ON PREMISES? O YES (3rN'O FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED?: O YES O NO IF YES, PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES: PROPOSED OPENING DAY OF BUSINESS ✓ n/ I ST/2 / 5- BUSINESS HOURS 14, T - , rW .0 r— el- h a - 4 DAYS OPEN O SUNDAY a t� MONDAY D TUESDAY WEDNESDAY ITJ THURSDAY O FRIDAY O SATURDAY PARKING SPACES ON SITE: TOTAL ACCESSIBLE FOR PERSONS WITH DISABILITIES DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES? D YES O NO PREVIOUS BUSINESS USE AT THIS ADDRESS . c--d j:::-I%e PAA-t ti- s G 5�3 0� osc ls� AWRESS slRr Apt W.. unnW. cay.swbeWaPcom HOMEPHONE NO.1 1 OOL NO. (DRIVERS LICENSE NO )pa OTHER ONO. DATE OF BIRTH CITY AND STATE OF BIRTH COUNTRY OF BIRTH PMINFASNIP-PMINER 1 NAME teal FlW MI ADDRESS SAWN AM. W.. UM No. CRY. Saw And ZP Cole HOMEPHONENO(J DOL NO. (DRIVERS UCENSE NO) OR OTHER ID NO, DATE OFBIRTX GTY AND STALE OF BIRTH COUNTRY OF BIRTH PMTNERBHIP-PARTNER: NAME Lad Feat MI moms Served Apt W.Unil W. Cny.Swwamd;mo We HOMEPHONENO.1 ) DOL NO. D]RNERS LICENSE NO.) OR OTHER ID N0. DATE OF BIRTH CRY AND STATE OF BIRTH COLNTRYOFaIRTH CORPORATION pp NPMEOFCORPORATION LIZ IC BVPW LPAc// PLLG FEDERALTA%IO NO. CORP ADDRESS 7LO ' li fN sr St Ss! /1 i�a f ,f/� ga�a26 PHONE NO.LJ SINeI SWIG AX., UnI1N0. ply, SwMAW LpC a CORPORATEOFFICERS: Lasl Name FW Name MI Me DaNdBIM OQL N . OmAm Liocneo No.) ai Olbei LOCAL CONTACT 1 ) teal Nang FAR MOMM Titla PMIMNR DOL W.(DI'veO Ua NP)OrpnarA NP APPLICIWT K�� & /_edpw Z Wlre-PAMeO ndw TBe Deb CRY USE ONLY: PUINNINGDEPT. OAPPRGVE ODISAPPROVE DATE $*NA%RE ZONING CODE CONDRICNAL USE PERMIT OOMMEN S BURENNGDEPT. OARPROVE ODISAPPROVE CATS SIGNATURE CCCUPANTLGRI BUILDINGPERMIT OCCUPANCYGRGW COMW WE DEPT. OAPPROVE OOIEAPPROVE DATE SIGNATURE UF.LR COMMENTS POUCE DEPT. OMPROVE OOISAPPROVE DATE SIGNATURE COMMPN 6 4' - 913' - 4' `4'-9' 4'-10' 5'-4 1/2 N � � .i i r `, `` \\, 1,315 S.F. 645 S.F. SUITES 110-111 SUITE 112 Suite 110-111-112 7500 Building LYNNWOOD, WASHINGTON . �� Partners Architectural Design Group, Inc. 16198NEBSiHSTgFETStfliE IQt RFDd1aVD WA 9805fP7PotlYE: f2S696B00EiAX 475.28?Sbp1 PROJECT: 1500 BUILDING LOCATION: EDMOND5, WA5NINGTON DATE: OCTOBER 3, 2012 r -T3 CITY OF EDMONDS BUSINESS LICENSE APPLICATION- COMMERCIAL FEE: $125.00 CITY CLERK'S OFFICE, BUSINESSLICENSE DIVISION 121 5' AVENUE NORTH, EDMONDS, WA 98020 PHONE: 425.775Z4k / OFFICE USE ONLY Bl.# Customed SIC year pass I SHD I Date Pall TR# Fee Paid Mailed Delete INSTRUCTIONS: Please complete the application in full and attach the required floor plan. Middle Initial or name required of all parties cdncerned. If no middle name, please Indicate by writing NMN. Sign and return application with fee. Please advise of any change in status. New license required If business changes location or ownership. Notification to City of Edmonds requUsd If 'business doses. BUSINESS ADM MAILING ADDRESS Street or PO Box Suite No. City. State and Zip Code BUSINESS PHONE NO. � 6 WA STATE TAX Iq NO. (UBI NO.) (O O t4 -7 7 V BUSINESS E-MAIL BUSINESS WEBSITE PROPERTY OWNER EMERGENCY NOTIFICATION (For Premise Aa/ooees�s in Emergency): NUMBER dPEMPLOYEES XJ SQUARE FOOTAGE OF BUSINESS SPACE N TYPE OF BUSINESS - PLEASE CHECK -THE APPROPRIATE CATEGORY: O CONS RUCTION • O FINANCE,' INSURANCE.RM ESTATE• • O LANDSCAPE, HORTICULTURAL O MANUFACTURING - O NON-PROFIT ,RETAIL O SECONDHAND DEALER )SERVICES O WHOLESALE. O.OTHER - AMUSEMENT DEVICEVOUPREMISES? .d YES )-!.(No. IF YES, TOTAL NUMBER LIQUOR SOLD ON PREMISES?:• OYES NO.: GAMBUNG? O YES �NO , CIGARETTES SOLDON PREMISES? OYES / Z - RAM MABLE OR HAZARDOUS MATERIX S USED OR STORED?: O YESANO IF YES, PLEASE PROVIDE UST OF MATERIALS AND QUANTITIES: PROPOSED OPENING DAI OF BUSINESS - r 1 BUSINESS HOURS DAYS OPEN O SUNDAY MONO/,Y 11ESDAY [�*MNESDAY THUR$DAY FltIDAY O SAIIJRDAY PARKING SPACES ON SITE: TOTAL - 4- ACCESSIBLE FOR PERSONS WITH DISABILITIES J t DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSO�NS� WITH DISABI �� ?. �S ONO PREVIOUS BUSINESS 'USE AT THIS ADDRESS �1` b' 1071rt/� •' SOLE ROPRIETORSHIP NA D CAplG l- aLed ADDRESS —1JUD _ 1� ( 'V�/ .J 1 f� I111 fili`�2���OC-��-yV J! C go�� Street ..�� n Apt No.. Unit No. City, State and Zip Code HOME PHONE NO. t ,,%; � _(6 :5 .54�'�Z f DOL NO. (DRIVERS UCENSE NO.I OR OTHER IDNO. �� SC �I J 919 �� g GATE OF a IRTH- 7— 6 - 7 TCITY AND STATE OF BIRTH �QD`> C� /T T li COUNTRY OF BIRTH �� 7 PARTNERSHIP -PARTNER 1 Lass First M ADDRESS Street Apt. No.. Unit No. City, Stele and Zip Code HOME PHONE NO.( l - DOL NO. (DRIVERS LICENSE NO.) OR OTHER ID NO. DATE OF BIRTF j CTTY AND STATE OF BIRTH COUNTRY OF 81RTH PARTNERSHIP - PARTNER 2• NAME Last First MI . ADDRESS Street Apt. No.. UnQ No. City, State and Zip Cale HOWE PHONE NOd ) DOL NO. (DRIVERS LICENSE NO:) OR OTHER ID NO. DAVE OF BIRTH Cl TY AND STATE OF BIRTH COUNTRY OF BIRTH CORPORATION NAM OF CORPORATION FERAL fAX ID NO. CORP. ADDRESS PHONE Nat I ' Street C��Hw, nsf ; Ua! N2. �Y: S� as�l Lrp Cods CORPORATE OFFICERS: Last Naive First Name MI Title Date of Beth DOL No. (Drivers Lkow No.) or Ottw[D No.. LOCAL CONTACT Last Name Fust Name lau . TMQ c I Phone No DOL No. (DdVwvUm Nq.) or Other lD.Na apaii _�-C CK i' i?l 4z(`i,Lt/►� (/::: •' ,�'1/J. ;//y( _/L . L` %� ' • - PrlMed ... Signs to �' - _ - me _ 1?�te • - t %1}drtldG'D01 'Efii4P�RDKI�'..:0313APPRbV bAfE. :'SIC tAi13R 4 -'' Zt)lIN(3Ct�E C.OyptTlOtiN.UISEPERINIT'" BUI(AIHt; OEPT. O APPROVE O DISAPPROVE DATE SIGNATURE . OCCLIMANT LOADBUDDING PERK T OCCUPANCY GRdIIJP OOtu�1�SENTS • ' ' .. . FIRE OE'P.T. 'G APPWQVE O DISAPPROVE DATE SIGNATURE COhIMENI'3 - • .. . POLICE OEPT. O-APPROVE : 0 DISAPPROVE DATE SIGNATURE ' t V 1 151 L � [,�3 � "'i lhe/l\/ GZL'•GiQ`1� �.� QJ��, o ry �i J�. 'J'�sc Suite 110-111-112 7500 Building LYNNWOOD, WASHINGTON Pallniare kd tedwW De r Group Ua PROJECT= IBM BUILDING LOCATION: EDMONDS, WA5wmTON DATE: NOyEMBER %, 2MS