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7500 212TH ST SW STE 116 (2) - 14pgs_RedactedCITY OF EDMONDS BUSINESS LICENSE APPLICATION — COMAK&° ❑ Building ❑ Engineering FEE: $125.00 Fire u CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION FEB 2Z% ❑ Planning ❑ Police 121 e' AVENUE NORTH. EDMONDS, WA 98020 PHONE 425.775.2525 OFFICE USE ONLY , 80 Customer # do 33e)94' SIC ` r Year o"U1! Clss Z SHO /�z Date Paid liz-071-1;7 T Fee Fos; 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 310 each year. Renewal must be Q„ti.,,teea .,A-, s., _,s.,,,s... 24st 4- -IA rsb f Q BUSINES BUSINES MAILING BUSINESSPHONEI rtO.0 tti Y %, '� UiV BUSINESS E-MAIL-f"HIV 9f C�/0aaL;V BUSINESS OWNER / MAIN CONT PROPERTY Name (Far Premise Access in Last Name WA STATE (TAAX 10 # (UBI) ,r�`ff), W m RiiRINFSS WFRSITF IMAAAI• MX-CP;V t a<.1)/11 Last Name First Name MI Phbne Number NATURE OF BUSINESS (Provide a Detalled Description of Business Activities, Product.l~ Servicoo): gowcnc V k-`"(1s-nimmS --- -Alai - ny-! �64 L- 1Y1 (01) k-' /V'tw(w," i-f SPACE ALTERATIONS TO BE MADE: YES_NO_r_ DESCRIPTION PREVIOUS BUSINESS AT THIS ADDRESS 1� ftlIUUbJ N NUMBER OF EMPLOYEES SQUARE FOOTAGE OF BUSINESS TYPE OF BUSINESS - PLEASE CHECK APPROPRIATE CATEGORY: ❑ CONSTRUCTION ❑ FINANCE, INSURANCE, REAL ESTATE ❑ LANDSCAPE, HORTICULTURAL ❑ MANUFACTURING ❑ NON-PROFIT ❑ RETAIL ❑ SECONDHAND DEALER SERVICES ❑ WHOLESALE ❑ OTHER PROPOSED OPENING DATI BUSINESS HOURS: I DV a IBM 0 DAYS OPEN: ❑ SUNDAY GMEDNESDAY IrMONDAY Jff THURSDAY AJ/TUESDAY 4!rPRIDAY ❑ SATURDAY AMUSEMENT DEVICES ON P� REWES? YES NO IF YES. TOTAL NUMBER -�-LIQUOR SOLD ON PREMISES? YES NO GAMBLING? YES_ NO Z CIGARETTES SOLD ON PREMISES? YES � ENO V FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED? YES NOS Ir YES, PLEASE PROVIDE A LIST OF MATERIALS AND QUANTITIES: PARKING SPACES ON SITE TOTAL SPACES L45 ACCESSIBLE SPACES FOR HANDICAP nnec. rue e„c ueao n�urw ui w., eurr�•un� •n..�e.n,.,..- �.. ...-.......,.. ..,.�, , ........., ..,�.... ..�.. NCl ( APPLICANT NAME ame L ( ignatu TITLE ./ �'' `� DATE RECOVER FEB 21 201' N l Tml MIWLtryIIIPL Ea)M(1MD5 CtfV (9kRK ooREss STREET SUITE/APTNNRp LRYISTATE2IPCODE HOME PHONE( I DRIVERS LICENSE OR ID M S STATE DATE PARTNERSHIP— PARTNER T NAME IABT FIRST MIDDLE WITML ADDRESS STREET SIATEIAPTNNRM CIT'STATERIP CODE HOME PHON 1 ORNERS LICENSE OR O p68TATE DATE OF BIRTH CR ATATEOFBWTH COLWTRYOFSIRTN PARTNERSHIP —PARTNER 2 NAME LAST FIRST MIDDLE INRML ADDRESS STREET SUR APTNNRI CTYSTATFRp CODE HOME P 'S LICENGE OR DO S STATE DATE OF BATH CRYBTATE OF BIRTH COUNTRY OF FIRM NAME OFCORPORAIT.�IOI II'11r1AI-i.��..A1.�� VC��/`�,f`-.f()FIC('�-F�_FEDERI I%��5� Alt- 5 IAIALITµN�('QON�F�J ��Y•L/D�C�� CORP.ADORESS d'1 C1 9L(cw l 00( SYMI SMM.w ON# CIb. SMMen03yCOEe PMre NurrLar CORP OPoATE OFFIL�E(R�G(: LeM Wm.p °�"/y��j1.a. d\�YMI c f�/y' L///�Lyy/Lp� /� .�( a LOCALCONTAOT OOWNVS U�y 1!J 'IN-^s�YYNI LNi NeeM FLAP Nerve MI Me DMBMPB 966 7 , S;qq 06wesUTrsear ONN DNISMM FMnB NIMBI CRY WEONLY: BUILDING DEFT. ED APPROVE Cl DISAPPROVE DATE SIGNATURE OCCUPANT LOAD SULDNG PERMT OCCUPANCY GRO COMMEN G EMOMEERM O APPROVE DISAPPROVE DATE SIGNATURE NRE WT. 0 APPROVE 0 DISAPPROVE OATE SIGNATURE LLF.I.R. COMMENR PLANNING DEPT, Q APPROVE Q DISAPPROVE MTE SDNATURE ZONING CODE _CONDITIONALUSEPERMT COANNIT6 "We DEFT. APPROVE [] DISAPPROVE DATE SIGNATURE COMMENTS iW EWED FEB 21 20 rr U, Dmons, offy CLERK :3uu tjUildiong I VKIKIIAlr%^n 1AIAQUlKjt�-%jr^kj Ale Partners 16.E :+E SiR FiSUIfE IDIpfamMW D1WA AWt N�, Uid.ifrdOflf FA): Ai SfCf PROJECT: ISM BUILDIWx LOCATION EDMONDS, WABNINGTON 1✓M I M. LA- I LA=K l�7, Aff/1C I h 5�^ Serving Brier, Edm6n&, 12425 Meridian Ave S SN0110b.11sli Co ' :� i I. -I T -J Moqntlake� -Terrace-1 Everett, WA 98208 FIRE Phone (425) 551-1200 DIAL 1,RU!" T www.FireDistrictl.,org Fax (425) 551-1272 LOCATION: 7500 212 th Street SW Suite 116 98026 BUSINESS NAME: NW Orthopedic Massage PHONE: 4257766966 M'AILING ADDRESS: 7500 212th Street SW, Suite 116, Edmonds, WA 98026 BUSINESS OWNER: Parker, Maureen HOME PHONE: EMERGENCY-1: HOME PHONE: KEY ACCESS-2: HOME PHONE: EMAIL: PERSON CONTACTED: NAME OF INSPECTOR: "FIRE PREVENTION INSPECTION REPORT OEDMONDS 0 BRIER [3 MOUNTLAKE TERRACE [I UNINCORPORATED FREQUENCY STATION & SHIFT*� 2016 1 16-B SCHEDULED Dec 2016 DATE DUE 0 591 UFIR CURRENT CITY YES NO BUSINESS F--j LICENSE INITIAL 1. SPEC 0 1137/ 7- ' FIRE PREVENTION Serving Brier, Edmonds 1 12425 Meridian Ave S INSPECTION REPORT SNOHOMISH CO. Mountlake Terrace,and YIRE Everett, WA 98208 ❑ BRIER NDS the Town of Woodway DISTR T Phone (425) 551-1200 ❑WOODWAY ❑ AKE TERRACE wwwFireDistrictl.org Fax (425) 551-1272 UNINCORPORATED ❑UNINCORPORATED III LOCATION: 7500 212th Street SW 116 FREQUENCY I STATION &SHIFT BUSINESS NAME: Miller Business Solutions PHONE: 4257706049 SCHEDULED 12101i11 DATE DUE ► MAILING 7500 212th St SW #116 UFIR ► 591 1 t157 ADDRESS: Edmonds 98026 } BUSINESS OWNER: Miller, Bob HOME PHONE: 4257706050 ACTIVE EMERGENCY-1: HOME PHONE: CURRENT - KEY ACCESS-2: HOME PHONE: CITY YES NO BUSINESS LICENSE PERSON CONTACTED: INITIAL INSPECTION DATE 1 NAME OF INSPECTOR: ' FIRE FE i ANNUAL SYSTEMo: HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 1 � 1 2 2 k 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: � INSPECTOR: INSPECTOR: INSPECTOR: 2 3 4 5 6 7 DATE: DATE: DATE: VIOLATIONS 1 5 VIOLATIONS 1 5 PRE -CITATION LETTER SENT CITATION ISSUED NUMBER: 2 6 2 6 DATE: CODE SECTION: 3 7 3 7 RETURN RECEIPT RECEIVED 4 18 4 8 DATE: DISPOSITION: LETTER NEEDED ❑ YES ❑ NO LETTER NEEDED ❑ YES ❑ NO FIRE DEPARTMENT COPY Building L BUSINESS LICENSE APPLICATION - COMMERCIAL ❑ ❑ Engineering ering ` FEE: $125.00 ❑ Pl� ❑ Planning CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION ❑ Police 14. 56;10 121 5TH AVENUE NORTH, EDMONDS, WA 98020 PHONE 425.775.2525 OFFICE USE ONLY BL# Customer # SIC Year Class Date Paid TR# Fee Mailed Deleted 003 2015 �b3�3r-1- Z�� iSTRUCTIONS: Please complete the application in full and attach the required floor plan. Middle initial or name required of all parties concerned. If rn fiddle name, please indicate by writing NMN. Sign and return application with fee. Please advise of any change In status. New license required i usiness changes location or ownership. Notification to City of Edmonds required if business closes. License expires December 31" each year. Renewa: tust be submitted prior to January 31'a to avoid late fees. USINESS NAME Sir e n e 1v a+Lt raVLI USINESS ADDRESS S o o IAILING ADDRESS 13 S1 St 5k-) S}e 2-11 Street - +o& 4ve LJ Street or PO Box e rrloni�'d , W 11 IS o W6 1$6 , State, Zip Code City, State, Zip Code 6 1 11 1 - 4 2- 1 2— WA STATE TAX ID X (UBI) 6 b 3 — 5 0 6 IUSINESS PHONE- r0 r Sere 11 -C- 110. lu�rcJ _ L3. ' BUSINESS wEBSITE W ww • S e.6 P 'WSW hea IUSINESS E-MAIL he& ALt i C I A GO fJ A If- Z1 N� r �ia� 9lR 4-L4; IUSINESS OWNER / MAIN CONTACT Name PhoneNumber r p ^ �NY l� 1 i 1f✓ f 1 �J e S /' D i 0. 9/l '{ [ a 1 1 1 2✓ 'ROPERTY OWNER ` it Phone Number :MERs� CY NOTIFICATION (For Premise Access in Em ency): .ast Name First Name MI Phone Number I I ast Name First Name MI �pPhone N ber 4ATURE OF BUSINESS (Provide a Detailed Description of Business Activities, Products & Services): I"' i-j.W0 -P nnQ�c t � , &c"4 �` Tu Ire , 1 t SPACE ALTERATIONS TO BE MADE: 3REVIOUS BUSINESS AT THIS ADDRESS a'u 1yl r VUMBER OF EMPLOYEES_ SQUARE FOOTAGE OF BUSINESS SPACE -. PROPOSE PENING DAT k 12d31 5'J TYPE OF BUSINESS - PLEASE CHECK APPROPRIATE CATEGORY: t� A m ❑ CONSTRUCTION BUSINESS HOURS: 1O Q ❑ FINANCE, INSURANCE, REAL ESTATE XI ❑ LANDSCAPE, HORTICULTURAL DAYS OPEN: ❑ MANUFACTURING ❑ NON-PROFIT ❑ SUNDAY KWEDNESDAY ❑ RETAIL X MONDAY ,(THURSDAY ❑ SECONDHAND DEALER p(TUESDAY )<FRIDAY )< SERVICES ❑ WHOLESALE ❑ SATURDAY ❑ OTHER AMUSEMENT DEVICES ON PREMISES? YES NO-,>—e IF YES, TOTAL NUMBER LIQUOR SOLD ON PREMISES? YES NO GAMBLING? YES_ NO->;— CIGARETTES SOLD ON PREMISES? YES NO 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 DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES? YES NO APPLICANT NAME I-t L,%e- i l9 C o n,) P Print lilamg �\ p c� A ATE TITLE , SOLE PROPRIETORSHIP NAME IABT FNBi MIDDLE INRIAL ADOREeB S1RE:T SURF/APTNNR� CT'BTATFJLP CODE NOMERIOLE! ORNpt9 LICENSE OR I008 RTATE DATEOFERR CITY/STATE OF BIRTH COVNTRV OFBMTH PARTNERSHIP —PARTNER T NAME TART FSiBT MIDDLE NRUL ADpREBB S1RffT SUITFIAPTANNDi CRYAiTATELPCODE NONE PHONEl 1 ORNERS LIGEHBE OR ® PS SPATE DATE OFGW" CRYISTATE OF BwrR COUNTLY OF BIRTH PARTNERSHIP —PARTNER 2 IAST FIRST MIDDLE HIIIPL ADDRIPB BTLiffT EIIIEIAPTNNRf CIIY/STAl1�PC00E NONE PHONEL T DRNET8 LICENSE ORIDB88TATE MTEOFBMIN CMISTATEOFSIRTN COUNTRY OF BIRTH e , I , CORPORATIOW LLC DF PLLC CORPORATE OFFICERS Sliwt HINNAPt. LAAP DIM. SLAM I A / . ROW 42 56.230(7Ha) Personal infaonation far OL or SSN OW USE ONLY BUILMNA DEPT. O APPROVE DISUIPgpyE OATS SIGNATURE OCCUPANTLOPD BUADING PERMR OCCUPANCY GROUP COMMENTS EMGINEERMG Q APPROVE OIBRPPRGVE DALE SIGNATURE HIRE DEFT. APPROVE DISAPPROVE MTE SIGNATURE PLANING DEPT. Q APPROVE O DISIPPROVE DATE _SIGATURE ZONING CODE COWRNINPL USE PERMR COAMBITS POLICE DEPT, 0 APPROVE O DIBAPPRovE MTE SIGNATU S 3 33 N 11 LEASEHOLD IMPROVEIVMNTS This attachment is a continuation of that certain Lease Agreement by and between 7500 BLDG, LLC (Lessor) and Serene Natural Health, LLC (I.essee� dated May 27th, 2015 on real property in Snohomish County, Washington and by this reference shall become a part of that agreement. PROJECT: 7500 Bldg. TENANT: Serene Natural Health, LLC BUILDING / SUITE: Suites 211, 212 & 213 PARTITIONS: Remove existing wall and add new walls per attached space plan. CEILINGS: Existing, and replace stained and damaged tiles. DOORS: Existing, and add 3 doors per attached floor plan. Remove cafd door and install new 'h height door with a top. FLOOR COVERING: Existing, Steam clean carpets. PLUMBING: Relocate sink in reception area to unit 211 per attached floor plan. Add new sink in east private office. LIGHTS: Existing, Lesser to repair and/or replace any fixhues not working and add new lights as needed to new walls. SWITCHES: Existing WALL ELECTRICAL OUTLETS: Existing, and to add new outlets to new walls. PHONE OUTLETS: Existing, by lessee A/C HOOK-UP: Existing VENT FAN: Existing WATER HEATER: Existing PAINTING: Repaint walls OTHER: Relocate cabinets from now reception area to Unit 211 and make 6' opening in the existing wall. Install a new counter top plus a new work surface below to create a reception area and work area UNLESS OTHERWISE STATED, THE IMPROVEMENTS LISTED ABOVE WILL BE FINAL, ANY ADDITIONS WILL BE PAID BY TENANT. LESSOR RESERVES THE RIGHT TO MODIFY ANY AND ALL IMPROVEMENTS. s CITY OF EDMONDS BUSINESS LICENSE APPLICATION— COMMERCIAL FEE' CITY CLERK'S OFFICE, SUSINESS-LICENSE DIVISION �pc. tth9� 121 5'" AVENUE NORTH, EDMONDS, WA 98020 PHONE: 425.7752525 OFFICE USE ONLY t Customers bU L SIC Year _s 0 1`5 SI D Oa Paid 1 1 TR(1, -coo Fee PMd z S Mailed Deletle INSTRUCTIONS: Please complete the application In full and attach the re*dmd floor plan. Middle Initial or name required of all parties concwned. If no middle name. please indicate by whiting NMN. Sign and return application with tee. Please advise of - any change in status. New license required If business changes location or ownership. NoNcation to City of Edmonds required If business closes. 1:11 ;:, I,,! _. BUSINESS ADDRE MAILING ADDRESS 5I 4 Sheet or PO Box / t _ Suite Nm City, State and Zip Code i ' BUSINESS PHONE NO. 425) 1 t (Q l//��-7 �O l!J WA STATE TAX ID NO. (UBI NO.) ��A y 1' BUSINESS E-MAIL t 1; 6ktkA«AL-tF �W &neA t t j U n BUSINESS WEBSrrE j �,,11�1 a7 b( \c iytYlC.rj GP• Lcx� PROPERTY OWNER � . Name ( Phone Number EMERGENCY NOTIFICATION (For Premise Access in EmwWn y): Last Name Fh* Name MI Phone No. Phone No. NATURE OF BUSINESS NUMBER OF EMPLOYEES SQUARE FOOTAGE OF BUSINESS SPACE TYPE OF BUSINESS - PLEASE CK-CK.THE APPROPRIATE; CATEGORY. O CONSTRUCTION a FINANCE; 4SUR- Mi CE,REAL ESTATE ' O UWDWAPE. HORTICULTURAL O MANUFACTURING O NON-PROFIT .O RETAIL O SECONDHAND QEALER 4AERVIC,ES O WHOLESALE O.OTHER AMUSEMENT DEVICES'ONPREMISES? .d YES tkNO - IF YES. TOTAL NUMBER LIQUOR SOLD ON PREMISES?: O YES - `�" 0 GAMBLING? O YES ONO CIGARETTES SOLD -ON PREMISES? (3 YES O NO FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED?. O YES)Q. NO IF YES; PLEASE PROVIDE UST OF MATERIALS AND QUANTITIES: � PROPOSED OPENING DAXOF BUSINESS x�c �� BUSINESS HOURS MA'13 DAYS OPEN O SUNDAY IXMOND,,Y &TTU]ESDAY *%VEDNESDAY 00HUR§DAY &FRIDAY •�I!SATURDAY PARMNG SPACES ON SITE: TOTAL O I ACCESSIBLE FOR PERSONS WITH DISABILITIES DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DLSABILITIES? {YES O NO _ PREVIOUSOLWIESSUSEATTHISADDRESS !&4*nAt— n Y 90LE P110PNEFOR81! PME Fm FBa w ooREss Soea Ip Na.BMNo CIY.SebatlTip Calla ON ONENO.( 1 OOFNO, p1pRENSNCENSENO)p201 MNO ATEOFSIRTN G MOVATEOFB2iTR CgWFRYOFBBIM ME PMTNFA9NIP-PLRTNFA t � RNA M PDDFE$S ' Shed qG No..V YNa CMy. Slab aq TipCWa Ntt.EPNCNENO.U_ pCL NO.(DRNER5 110EN9 )ORONEN ONO. MYE OF BWFN C" AND STAM OF BIRi _ WMRRY OFBIRTN NN.¢ P/RMER&YP-PMINFR2' W 4ppPFSS i1rt . W Sbaet pp, Ne..MNNa CN.SM_ WSb COM1 FAME PNORE NOA ENO)ORON19iDNO:_' GATE OF SIRFN CRYPND MF OF MTR COIMIRYOFMM CORNRATNM NICE OF-CDFPORATNM Al 1� 1'Yhtrr,r� l ,t 1 ��1 /',� � I C /J. mot, µTMIDNO.'31' 1X�1� cpr,o_AWREs2:1-L'D :1\1 ci-.. G :: �! I/1 fi sNeN aNMAµ,wnna F✓I.,�rF CK wrWwNn� L)(� trADJU PnaNE wrapwniEOFFrcERs . fYns FlMNa�y TNa .!]rtv. 4F Lo?pL �FyA WIi' FMW� M. TI,M. - R�NieN¢' OOLNa(Ortsella WF)« RPAI--GN:R_ 1 L1�.� Otls _.Washington State Department of Health - = --- By the authority of RCW 18.t08 this person - - Maureen R Parker is granted a Massage Practitioner License Status M Credential Number ACTIVE MA 00022740 Effective Date Initial Issuance Expiratlon Date Secretary 10/0612014 06/26/2006 10/08/2015 .J 0 iii iiii iiiiiiii i iiiiiiiiiiiiiii I a EI! 744111tlt�g�� 61QiIQEEEaQQIItlBaG jj t