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115 5th Ave S_6pgs__Redacted (8). �7.11 r �1-41- 4 Tr �� � • � > :� � 7IIII III FIRE PREVENTION INSPECTION REPORT ONIISH CO Serving Brier, Edmurw.5, and 12425 Meridian Ave S SNOR----6EDMONDS Mountlake Terrace Everett, 'WA 98208 0 BRIER FIRE 0 MOUNTLAKE TERRACE Phone (425) 551-1200 ❑ [1 UNINCORPORATED DISTRIUT www.FireDistrictl.org Fax (425) 551-1272 1155th Avenue S 98020 LOCATION: Legendary Properties BUSINESS NAME: MAILING 115 5th Avenue S, Edmonds, WA 98020 ADDRESS: BUSINESS OWNER: Blevins, Kirk EMERGENCY -I: KEY ACCESS-2- e 'EMAIL: , VZ4 D PERSON CONTACTED: r r V, -,j� c It j i --s ) NAME OF INSPECTOR: SYSTEM& FE ll� 4257715180 PHONE: HOME PHONE: V, 4258766944 HOME PHONE: 17 HOME PHONE: F�ffff NCY STA�ft SHIFT"� SCHEDULED May 2017 DATE DUE 59 1 203 LIFIR CURRENT NO CITY BUSINESS LICENSE INITIAL INSPECTION DATE Lt _ --Z 1.( .- 1 -1 1 I Serving Brier, -Edmonds, and Mountlake Terrace www.FireDistrictl.org LOCATION: 115 5 th Avenue S 98020 BUSINESS NAME: Legendary Properties MAILING ADDRESS: 115 5th Avenue S, Edmonds, WA` 98020 BUSINESS OWNER: FIRE PREVENTION 12425 Meridian Ave S INSPECTION REPORT ` EOMONDS Everett, WA 98208 ❑ BRIER Phone (425) 551-1200 ❑ MOUNTLAKE TERRACE Fax (425) 551-1272 [I UNINCORPORATED _ FREQUENCY STATION & SHIFTr,;•, . PHONE: SCHEDULED 4257715180 DATE DUE ► UFIR / 591 203 HOME PHONE: EMERGENCY-1: HOME PHONE: CURRENT KEY ACCESS-2: Blevins, Kirk HOME PHONE: 4258766944 CITY YES NO EMAIL: __ k i r K b 1 ev A52 �`c o �-D A-1. LB S CEINSE ❑ INITIAL INSPECTION DATE PERSON CONTACTED: NAME OF INSPECTOR:45-1 FIRE SYSTEMS:. FE 9/13 DstakautcSwAaedowiONS / COMMUNICATIONS 2 11-7-& 1030 AYLI Gs OS&A 2 Sir- 4 4 .... w_ 6 6 7 7 I AGREE TO.CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS 1st RE -INSPECTION 2nd RE -INSPECTION ENSION FINAL RE -INSPECTION VIOLATIONS DATE DUE: DATE DUE: GRANTED TO: DATE DUE: CITED: �� PERSON r CONTACTED: PERSON CONTACTED: PERSON CONTACTED: 1 INSPECTOR: INSPECTOR: -+' INSPECTOR: 2 DATE: DATE: DATE: 3 VIOLATIONS VIOLATIONS` ^ t PRE CITATION CITATION ISSUED 1 5 1 5 LETTER SENT NUMBER: 4 2 6 2 6 DATE: CODE �^ SECTION: L'• ` �J ,• R 'RETORN ! 6 is 3 7 3 7 ECEIVEDRECEIPT DISPOSITION: 4 8 4 18 DATE: LETTER NEEDED ❑ YES ❑ NO LETTER NEEDED ❑ YES ❑ NO 6 20� 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 BL# Customer# 9 SIC Year ao a CI S SHD Date Paid TR# Fee I 1 W Mailed Delete INSTRUCTIONS: Please complete the application in full and attach the requirod 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 4.�G I� �f 0 P BUSINESS ADDRESS _ FS A v E O: -1 _� _Q - Street Suite No. Zip Code MAILING ADDRESS Z? Z sr� Su_:) 6r0M o N 0-s i w A, D?-. Street or PO Box Suite No. City, State and Zip Code BUSINESS PHONE NO. t y �S, -77 I S 1 g0 WA STATE TAX ID NO. (UBI NO.) 6 U BUSINESS E-MAIL QFCkC lC"_ryerse • 1af�BUSINESSWEBSITE PROPERTY OWNER Name EMERGENCY NOTIFICATION (For Premise Access in Emergency): Phone Number AULA— ZCUL" _(20 :..5S -3520 Lwt Name First Name MI Phone No. � v/fps $'7G -04ti Last Name First Name Mi Phone No. NATURE OF BUSINESS lZ1r=;A L 5i $TAT" S 6 -V ( CAF-=7S NUMBER OF EMPLOYEES SQUARE FOOTAGE OF BUSINESS SPACE TYPE OF BUSINESS - PLEAS8 CHECK THE APPROPRIATI.� CATEGORY: 17 CONStAUCTION CI FINANCE; INSURANCE, REAL ESTATE- ' L7 LANDSCAPE, HORTICULTURAL O MANUFACTURING O NON-PROFIT _17 RETAIL O• SECONDHAND DEALER YWRVIQES Cl WHOLESALE ©.OTHER AMUSEMENT DEVICES"ON-PREMISES? .CI YES it) _ 1F YES. TOTAL NUMBER LIQUOR SOLD ON PREMISES?: O YES, �Kb , GAMBLING? O YES iQ(NO CIGARETTES SOLD -ON PREMISES? CI YES *,NO FLAMMABLE OR KAZARDOUS MATERIALS USED bR STORED.: 0 YES V440 IF YES, PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES: i PROPOSED OPENING DAICOF BUSINESS BUSINESS HOURS O DAYS OPEN 0 SUNDAY MONDA�Y QLTUESDAY SLWEDNESDAY Q.THURSDAY MYRIDAY • 0 SATURDAY PARKING SPACES ON SITE: TOTALt2c ACCESSIBLE FOR PERSONS WITH DISABILITIES yS DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES? . *ES O NO PREVIOUS BUSINESS'USE AT THIS ADDRESS D 15 0 SOLE PROPRIETORSHIP NAME Last First MI ADDRESS Street Apt. No., Unit No. City, State and Zip Code HOME PHONE NO. ( DOL NO. (DRIVERS LICENSE NO.) OR OTHER ID NO. DATE OF BIRTH CITY AND STATE OF BIRTH COUNTRY OF BIRTH PARTNERSHIP • PARTNER 1 NAME Last First MI ADDRESS Street Apt. No., Unit No. City, State and Zip Code HOME PHONE NO.(�DOL NO. (DRIVERS LICENSE NO.) OR OTHER 10 NO. DATE OF BIRTH CITY AND STATE OF BIRTH � COUNTRY OF BIRTH PARTNERSHIP - PARTNER 2- NAME Last -First MI ADDRESS Street Apt. No., Unit No. City, State and 7Jp Code HOME PHONE NO.( j DOL NO. (DRIVERS LICENSE NO.) OR OTHER10 NO: DATE: OF BIRTH CITY AND STATE OF BIRTH COUNTRY OF BIRTH CORPORATION f NAME OF CORPORATION t.. CAN D AQ�_ �� RTC �C _.. FEDERAL TAX ID NO. y 4 — S14 I� CORP. ADDRESS I I .r A U �rr) w DS Q $ OZC�_ _ - PHONE NO.( L Street Suite, Apt.. Unit No. City; St6teland Z p Code CORPORATE OFFICERS: Last Wine First Name MI Title 0 No. lEyI&,s LOCAL CONTACT SL�V I K1 �� G�hL jT Q�L ''SID�yC (� S7�O�Co Last Name First Name MI Tille Phone No. DOL No. (Drivers Lic. No.) or o. Name —Printed I n to Tille Date CRY, USE- ONLY: ., - OLANNING-DEPT. 'd-APPROVE:= . b'DISAPPROVI; DATE - SIGNATURE` ZONING C0DE­ - ' CONDITIONAL USE' PERMIT •COMMENTS ` ' .. � . '. • -' - . 8UILDING:OEPT. 0-APPROVE O DISAPPROVE DATE OCCUPANT LOAD' BUILDING PERMIT_ .:SIGNATURE: _ OCCUPANCY GROUP COMMENTS FIRE DEPT. O APPRQVE O DISAPPROVE DATE SIGNATURE— • __ COMMENTS POLICE DEPT. O•APPROVE O DISAPPROVE DATE SIGNATURE COMMENTS II Air - CITY I ' E1♦ ` OF ,.EDMONDS 121 5T" AVENUE N. • EDMONDS, WASHINGTON 98020 (425) 771-0215 FIRE DEPARTMENT �S.t. LOCATION: 115 5th Avenue i I BUSINESS NAME: Edrno ds Homestead Coffee r y MAILING ` rr$h 11w C�- FIRE PREVENTION SAFETY SURVEY PHONE: 42 786823 I ADDRESS: � Edmonds �� 9�aD2O BUSINESS OWNER: Harris, Mike HOME PHONE: 2063633640 f . EMERGENCY-1:' HOME PHONE: I KEY•ACCESS-2: , HOME PHONE: i FREQUENCY STATION & SHIFT 731 17 A t SCHEDULED �a,,� DATE DUE ► UFIR ► 5-15 169 5 203 ACMVE -1 =�;" . INITIAL INSPECTION DATE PERSON CONTACTED: NAME OF INSPECTOR: FIRE F f SYSTEMS: " _ANNUAL HAZARDS FOUND AND LOCATIONS ! COMMUNICATIONS ENTER CODE ONLY ONCE. ► - . '' VIOLATION CODE 1 • 1 2 _ 2 tw__ _t ;r 3 �` ( 3. 4 4 5 5 6 6 7 7 8 8 1st RE -INSPECTION 2nd RE -INSPECTION EXTENSION FINAL RE -INSPECTION VIOLATIONS GRANTED TO: CITED: DATE DUE: DATE DUE: PERSON DATE DUE: PERSON PERSON CONTACTED: CONTACTED: INSPECTOR: DATE: VIOLATIONS CONTACTED: 1 INSPECTOR: INSPECTOR: DATE: 2 DATE: 3 VIOLATIONS PRE -CITATION CITATION ISSUED 1 5 1 5 LETTER SENT NUMBER: 'CODE 4 2 6 2 6R DATE: SECTION: _ 5 6 RETURN RECEIPT 3 7 3 7 RECEIVED � 7 �� DISPOSfTION: 4 8 4 .8 ` DATE: ` LETTER NEEDED E] YES NO LETTER NEEDED YES NO z� 8 FIRE DEPARTMENT COPY