7500 212TH ST SW STE 215-5pgs_Redactedz�
7soo ziz f� Jw fr
�. ;t\ Serving Brier, Cm aonds, and 12425 Meridian Ave S
sN011OntIS11 CO. 0" . g
� Mountlake Terrace Everett, WA 98208
FIRE Phone (425) 551-1200
DIS."311"'Ria www.FireDistrict].org Fax (425) 551-1272
LOCATION: 7500 212 th Street SW Suite 215 98026
BUSINESS NAME:
The Conom PHONE:
Law Firm 4257746747
MAILING 7500 212th Street SW, Suite 215, Edmonds, WA 98026
ADDRESS:
BUSINESS OWNER: COnOm, Tom HOME PHONE:
Conam, Derek 4254123212
EMERGENCY-1: HOME PHONE:
KEY ACCESS-2: HOME PHONE:
EMAIL:
PERSON CONTACTED: �%7 /
NAME OF INSPECTOR: `" AX L iM
FE 3 /L
Date Last Serviced: ._...--'
FIRE'PREVENTION
INSPECTION REPORT.
❑ EDMONDS
❑ BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FROE1 UUENCY STATIONS& SHIFT
SCHEDULED Dec 2016
DATE DUE �
591
UFIR /
__j
CURRENT
CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECT N DATE
t�rl
Serving Brier, Edrnonds 12425 Meridian Ave S
SNOHOCO.
FIREMountlake Terrace,and Everett, WA 98208
S
�the Town of Woodway Phone (4 25) 551-1200w wwFireDistrictl. org Fax (425) 551-1272
LOCATION: 7500 212th St SW 215
BUSINESS NAME: l3ae Muscular Therapy & Rehab , PHONE: 4257713164
MAILING 7500 212th St SAY 4215
ADDRESS: Edmonds 98026
} BUSINESS OWNER: Oliveto, Carl HOME PHONE: 2535682436
EMERGENCY-1: Clay, Diana HOME PHONE: 4257761234
KEY ACCESS-2: HOME PHONE:
11 PERSON CONTACTED
NAME OF INSPECTOR
FIRE
gYSTEMS:
FIRE PREVENTION
INSPECTION REPORT
❑ EDMONDS
❑ BRIER
❑ WOODWAY
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQU NCY STATION &SHIFT
SCHEDULED 121ovi 1
DATE DUE ►
UFIR ► 593 1:157
CURRENT CITY YES No
BUSINESS
LICENSE 1:1 El
INITIAL INSPE TIO(N DATE
TI
FE _!_
ANPdUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1
1
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:
I
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
8
4
18
4
$
DATE:
DISPOSITION:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
g
FIRE DEPARTMENT COPY
S� DO Ol C� -�
CITY OF EDMONDS
BUSINESS LICENSE APPLICATION- COMMERCIALRECEIVED
FEE: $125.00
CITY CLERK'S OFFICE, BUSINESS -LICENSE DIVISION JAN 2 3 2014
44c.11190 121 5' AVENUE NORTH, EDMONDS, WA 98020 PHONE: 425.775.2525
®f�K �7l... r � �r'\'�Il si � , 11 1 =1' �' � � ✓ �. ...t'. ._ 1, ®®
INSTRUCTIONS: Please complete the application in fill and attach the required floor plan. Middle initial or name required of all
parties concerned. if no middle name, please Indicate by writing NMN. Sign and return application with fee. Please advise of
any change in status. New license required If business changes location or ownership. Notification to City of Edmonds requlrad
Wbustness hoses.
BUSINESS NAME
BUSINESS ADDRE
MAILING ADDRESSe—
' L .Street or PO B'oxx u Suite No. City. State and Zip Code
BUSINESS PHONE NO. (`7 �•� f 77�f . (o'7T-)WA STATE TAX ID NO. (UBI NO.) 600 256* 989 2..
BUSINESS E4ML •(/hT ? ^ , BUSINESS WEBSITE LL �7r !,
PROPERtTY OWNER 1-0 "' ')4-1 GR.�/ t *2..51 1 14 -123`i- •
U/ v/W
EMERGENCY NOTIFICATION (For Premise Aoc ess in
6/gW2
NATURE OF BUSINESS
C
NUMBER OF EMPLOYEES O SQUARE FOOTAGE OF BUSINESS SPACE
TYPE OF BU$INES$ - PLEASE CHECK.THEAPPROPRIATE CATEGORY:
O CONSTRUCTION Q FINANCE. INSURANNCCE.REAL ESTATE. ' O LANDSCAPE. HORTICULTURAL -D MANUFACTURING O NON-PROFIT
D RETAIL D SECONDHAND DEALER SERVICES O WHOLESALE O OTHER / -
AMUSEMENT DEVKE3�014fRE1011SES? Cl YES I(W . 10 YES, TOTAL NUMBER
LIQUOR SOLD ON PREMISES?: D *Es. se NO. GAMBLING? DYES SN/O CIGARETTES SOLD•ON PREMISES? DYES sa 1�0
FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED?: O YES IXf4O IFYES. PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES:
PROPOSED OPENING 6A1[OF BUSINESS Z " 2 ZO I Af BUSINESS HOURS 7 4, s A" iQ
DAYS OPEN D SUNDAY MQONDl Y Gi'fUESDAY IIEDNESDAY WI�URSDAY OrfMDAY D SATURDAY
PARKING SPACES ON SITE: TOTAL tf"" ACCESSIBLE FOR PERSONS WITH DISABILITIES
DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES? IVIES D NO
PREVIOUS BUSINESS USE AT THIS ADDRESS a4 &0 0L A
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