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22618 HWY 99 STE 108 (3)_RedactedIIIi��lll Zzc���-�wy g g fir— -1a$ '` `'• FIRE PREVENTION ServingBrier, Edmonds, and 12425 Meridian Ave S 0EDIVIONDS., CTION REPORT SNOHOMISH CO. FIREMountlake Terrace Everett, WA 98208 ❑ BRIER ����� `.• ` � T � Phone (425) 551-1200 ❑ MOUNTLAKE TERRACE wwwFireDistrictl.org ./,-Fax (425) 551-1272 ❑UNINCORPORATED FREQUENCY STATION & SHIFT LOCATION: 22618 Highway 99 Suite 108 9880026 ' `� �2016* 20-B BUSINESS NAME: 1L�:: ��iriag� ��t/ PHONE: 4255 SCHEDULED DATE DUE ► Mar 2016 MAILING �V / UFIR / 549 ADDRESS: 22618 Highway 99, Suite 108, Edmonds, WA 98026 ✓ BUSINESS OWNER: � � � � � � HOME PHONE: EMERGENCY-1 : Ho 6 t `e t.i� �C- t Y� HOME PHONE: KEY ACCESS-2: \j ZAa CURRENT YES NO HOME PHONE: CITY BUSINESS EMAIL: LICENSE PERSON CONTACTED: INITIAL INSPECTION DATE vF NAME OF INSPECTOR: FIRE SYSTEM FE Date Last S iced:. HAZARDS FOUNP AND LOCATIONS ICOMMUNICATIONS 1 1 4 V --f ---n, 3 - 5 f 5 /Z% �� S C (r ,J S r� i� 5�/; C T 1 dam% 5 • —6 7 I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X 1st RE -INSPECTION 2nd RE -INSPECTION EXTENSION FINAL RE -INSPECTION I VIOLATIONS' . DATE DUE' DATE DUE: "_. — GRANTED TO: I DATE DUE CITED: PERSON PERSON PERSON CONTACTED: CONTACTED: CONTACTED' INSPECTOR, INSPECTOR: 4INSPECTOR- RATE:i 2` ' . DATE:.__ _____. _._..._.._... ..... __ .. ._._ .. .� ... 3 DATE:. ._ —_ __ .. _ _ .. _ ..._ . •1 VIOLATIONS— -•• —VIOLATIONS-; ----• _ _ . _.. __._ —__ _.QTATl6N ISSUED PRE -CITATION _ — LETTER SENT NUMBER: a ! CODE 2 16 — 2 16 DATE: I SECTION• 5 ' -.. _.—... _ i f1 RETURN RECEIPT i". •--_..__ ... 3 j 7 3 17 RECEIVED 6 DISPOSITION: �......4 18 DATE_.__...._ I LETTER NEEDED ❑ YES 0 NO. LETTER NEEDED - •-- • .--.___ _.. ... _ 0 YES ❑ NO e r CITY OF EDMONDS BUSINESS LICENSE APPLICATION — COikI MERCIAL Englinng I. Engineercng FIDE: $125.00 " Fire „ CITY CLERK'S OFFICE BUSINESS LICENSE DIVISION Planning Police 121 5TH AVENUE NORTH, EDMONDS, WA 98020 PHONE 425.775.2525 — , "FFIGE USE ONLY BL# Customer # SIG I ?Year Class Sector Ma Date Paid TR# Fee iled Deleted INSTRUCTIONS. Pieaso complete the application In full anti 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 too. 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. L(censeexpires December 31" oach year. Renewal must be submitted prior to January 31" to avoid late fees. BUSINESS NAME !C7! "e-7 "p4 Ag�l ®B-� , BUSINESS ADDRESS, _ d da- _. _ c144 �� ���� Street Su to # City, State, Zip Cede MAILINGADDRESS I'lf.t T. _ _ 4bo Y&; j ! L hj Steel or PO Box # Suite # CHYdY,�Stale, �Zip Cade =—a BUSINESS PHONE( j 1 / 1" 24 WA STATE TAX iD B (UBI) ( 1 it I k� 1 P I A l l BUSINESS E-MAIL_ _ - BUSINESS WESSITE BUSINESS OWNER i MAIN EMERGENCY NOTIFICATION (For Preamiso Access in Emarq Last Name Firw Name F(rel MI MI NATURE OF BUSINESS (Provide a Detmled Dewripilon of Business Activities, Products & Services) SPACE ALTERATIONS TO BE MADE: YES—NOA DESCRIPTION _ Y PREVIOUS BUSINESS AT THIS ADDRESS � & NUMBER OF EMPLOYEES SQUARE FOOTAGE OF BUSINESS SPACE 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 DATE. — BUSINESS HOURS., _/. q— - / .( M DAYS OPEN: d P—Q - r-p o" 1/SUNDAY 40WEDNESDAY 15rMONDAY 0-1HURSDAY VIUESDAY IIRIDAY V'%ATURDAY AMUSEMENT DEVICES ON PREMISES? YES NOIA ,IF YES, TOTAL NUMBER IIOUCIR SOLD ON PREMISES? YES NO GAMBLING? YES_ NOX--- CIGARETTES SOLD ON PREMISES? YES, . NO_ FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED? YES NO_,g_ IF YES, PLEASE PROVIDE A LIST OF 104TERIALS AND QUANTITIES. PARKING SPACES ON SITE: TOTAL SPACES !�., — ACCESSIBLE SPACES FOR HANDICAP PARKING. — DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WrTH DISABILITIES? YES NO APPLICANT -- -- _ NAME C7 (5— 4�Fli wd- its/) — TITLE Pnntod Name ls'Rfi -- Y DATE Signature �f �s Applications may be mailed in wkh a check, brought in person, faxed to 425-771-0266 or emalled to buNiinqn.licerllRpqdmortdsai. with a valid phone number. We will call you for a Visa or MasterCard payment. 4W SOLE PROPRIETORSHIP NAME i4 ' " r ge: 6WAACT L2T AS,toTL rL �f FIRST MIDDLE INITIAL ADDRESS 2--� � c?qA PL dot% (5--d&A10040(,5r , wfi gpozo STREET SUITE/APTIUNIT# CITYISTATFJZiPCODE RCW 42.56.230(7)(a) Personal information for DL c DATE OF BERTH CITYISTATE OF 61RTH 7Gy KG- L D X47A- COUNTRY OF HIP - PARTNER t NAME LAST FIRST MIDDLE INITIAL ADDRESS STREET SUITSIAPTIUNIT N CITYISTATEIZIP CODE HOME PHONE( 3 DRIVERS LICENSE OR ID N & STATE DATE OF BIRTH— CITY(STATE OF BIRTH ---COUNTRY OF BIRTH PARTNERSHIP — PARTNER 2 NAMIF LAST FIRST MIDDLE INITIAL ADDRESS STREET SUITEIAPTIUNIT. N CITYISTATEtZIP CODE HOME PHONE( 1 DRIVER'S LICENSE OR 10 # & STATE OF BIRTH COUNTRY OF or NAME OFCORPORATION FEDERALTAX ID CORP.ADDRESS..- _ Street Su'de,APL Unit# City, State and Zip Code Phone Number CORPORATE OFFICERS: Last Name FirstNamo MI Title Dateof Binh Drivers License or Other [DOISlate LOCAL CONTACTt�--- Last Name Firm Name Nil Title Dataof&rth Drivers License or Other IDOISlate . _ __- _. _ .__ Phone Number CITY USE ONLY. BUILDING DEPT 0 APPROVE =1 DISAPPROVE PATE SIGNATURE OCCUPANT LOAD BUILDING PERMIT OCCUPANCY GROUP COMMENTS, ENGINEERING APPROVE O DISAPPROVE OATS SIGNATURE FIRE DEPT APPROVE 0 DISAPPROVE DATE SIGNATURE COMMENTS PLANNING DEPT Q APPROVE Q DISAPPROVE DATE SIGNATURE ZONING CODE ___ CONDITIONAL USE PERMIT _ COMMENTS, _ POLICE DEPT 0 APPROVE ® DISAPPROVE DATE SIGNATURE COMMENTS--- I 1,oc7 I-Alv b c)�s i �s..;r .......,.. _... t �.�...�.�........w...s�.�..w.,,.-...�--+`e �.r.---n..c..s.�., .d-,.. ...�.0 .-nr M.=:z-.a ...wn•• - � - i. FIRE PREVENTION INSPECTION REPORT Serving Brier: Edmonds, and '"SNOHOMISH 12425 Meridian Ave S CO. FIRS Mountlake Terrace DPhone Everett, WA 98208 EDMONDS BRIER DISTR T„ !, (425) 551-1200"MOUNTLAKE TERRACE 0 UNINCORPORATED tivwwFir-eDistrictl.org Fax (425) 551-1272 FREQUENCY STATION & SHIFT LOCATION: 22618 High%Aay 96 Suite IDS 08026 '9�ea1- d4 20-13 /SCHEDULED BUSINESS NAME: I tart Kul, Vi&a nrr PHONE: 42LLS2034 DATE DUE II' Wr 2014 MAILING UFIR448 ADDRESS: 2261E I Ilghway 00, Suk 10°, Edrmrict., WA OBL12C BUSINESS OWNER: HOME PHONE: EMERGENCY-1: I fang, 1 lama HOME PHONE: 2067432M) eCURRENT KEY ACCESS-2: HOME PHONE: CITY YES NO EMAIL: BUSINESS LICENSE PERSON CONTACTED: INITIAL INSPECTION DATE NAME OF INSPECTOR: 1-1RL EWE, ILMS: FE I G I i � HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 1I I I f Ali) A 2 2 3 I 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: 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 5 Q 6 — 4 8 DATE: DISPOSITION: LETTER NEEDED ❑ YES [__]'NO LETTER NEEDED ❑ YES ❑ NO g FIRE DEPARTMENT COPY CITY OF EDMONDS BUSINESS LICENSE APPLICATION— COMMERCIAL FEE: $125.00 CITY CLERK'S OF = CE. BUSINESS -LICENSE DIVISION 121 5' AVENUE NORTH, EDMONDS, WA 88020 PHONE: 425.775.2525 OFFICE USE ONLY BL# Customer# .6 5 SIC Year c Class SHD Date Paid -.S /-3 TR# - LLb 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 mimed. 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 N business closes. 8MINESS NAME HMI KO K V t Op�U ) BUSINESS ADDRESS _!.; /(f H4V# 9/ -51e le,? w4 Street Suite No. Tip Code eW MAILING ADDRESS Street or PO Box Suite No. City, State and Zip Code BUSINESS PHONE NO. ) 7 034/ . WA STATE TAX ID NO. (UBI NO.)60'' BUSINESS E-MAIL item 9a K e1 j , Gevil BUSINESS WEBSITE PROPERTY OWNER D-146 �� N t •44 ) -Z)g Name Phone Number EMERGENCY NOTIFICATION (For Premise Access in Emergency): �ftNGT Se'PK P,4V C 5u&) 916 2- Last Name First Name MI Phone No. - U Last Name Fast Name ry Mi Phone No. NATURE OF BUSINESS IIAI �)7 t1 � e"' FW NUMBER OF EMPLOYEES / SQUARE FOOTAGE OF BUSINESS SPACE /, B op S f TYPE OF BUSINESS - PLEASE CHECK.THE APPROPRIATE CATEGORY: O CONSTRUCTION - 6 FINANCE; INSURANCE, REAL. ESTATE. ' O LANDSCAPE, HORTICULTURAL O MANUFACTURING - O NON-PROFIT D RETAIL O SECONDHAND DEALER SERVICES O WHOLESALE O.OTHER AMUSEMENT DEVICES'ON PREMISES? .17 YES K,1 NO _ 7F YES, TOTAL NUMBER LIQUOR SOLO ON PREMISES?: OYES #I NO . GAMBLING? O. YES ,Q NO . CIGARETTES SOL90N PREMISES? DYES �NO FLAMMABLE OR HAZARDOUS MATERIALS USED'OR STORED?: Cl YES O NO IF YES; PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES: PROPOSED OPENING DAY -OF BUSINESS BUSINESS HOURS DAYS OPEN Q[SUNDAY 01 MONDAY toTUESDAY MWEDNESDAY P(THURSDAY d FRIDAY • I SATURDAY PARING SPACES ON SITE: TOTAL �fy� �n . LrsT ACCESSIBLE FOR PERSONS WITH DISABILITIES _ XV -3 DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH. DISABILITIES? CIYES © NO PREVIOUS BUSINESS USE AT THIS ADDRESS SOLE PROPRIETORSHIP NAME �h 0. nesuFc¢lj 1� T 1 F YJIrf t1 f L(,►,� �� �� MI n Apt. No., Unit No. .CCd'y�State and: HOME PHONE O. �Oto -% - Z� oa OOl NO. (DRIVERS LICENSE NO.) t)RM - M Ntl� O. —_` DATE OF B ITY AND STATE OF BIRTH C A �/_ COUNTRY OF PARTNERSHIP - PARTNER I NAME Last Firsi M! ADDRESS ' Strael Apt. No., Un0 No. City, Slate and � 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 2' NAME • Last -Fast MI. ADDRESS Street Apt. No.. Unit No. City, Stata and Zip Codo HOME PHONE NO ( OOL NO. (DRIVERS UCENSE NO.) OR OTFIEiY ID NO. DATE OF BIRTH CITY AND STATE OF BIRTH COUNTRY OF BIRTH CORPORATION NAME OF CORPORATION FEDERAL TAX ID CORP. ADDRESS . PHONE NO.( Street Suite. Apt.. Unit No. City: State and Zip Code CORPORATE OFFICERS: Last Naive First Name MI Title Date of Birth DOL W. (Drivers License No.) or Offw ID No. LOCAL CONTACT Last Name Fast Name MI Title Ptwne No. OOl No. (Driverstic No.) or Otlrer ID. No. Name —Punted "SIgnatuldTide Date Y'Z. .CITYUSEONLY:.• . :' ,.. PUWNINGIDEPT. 1rAPPROVE `.00ISAPPROVL' DATEGNAfiURfi` .' t •. ZONt0 COE: ...' • • .. PERMIT •.CON E C0ICIMENTS` a.U"ING.PEPT- O APPROVE O DISAPPROVE DATE SIGNATURE. OCCUPANT LOBO' BUILDMG PERMIT OCCUPANCY GROUP ­ COMMENTS OMMENTS FIRE DEPT. 'O APPROVE O DISAPPROVE DATE SIGNATURE U:F.LR...: COMMENTS POLICE DEPT. O APPROVE O DISAPPROVE DATE SIGNATURE COMMENTS v CA pVD Rze-ord.n-16- w V I I y Tie. DVD pis P� S6 - I — ( Cvv �.� b U.D Dry I I i GmTC., Icth(es Tcpe DVD 0 c C P`Grw'G +4tbf�� SIE �,l.�w w�.�w p►4 poor <-4 kAk �J�- V'-k-4eC Sal 660 o 33 / �(,-- CITY OF EDMONDS BUSINESS LICENSE APPLICATION- COMMERCIAL FEE: $125.00 CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION 121 5' AVENUE NORTH, EDMONDS, WA 98020 PHONE: 425.775.2525 OFFICE USE ONLY BL# j Customer# SIC Year CI ss SHD Date Paid s Z TR# Fee Paid .., o Mailed Delete INSTRUCTIONS: Please complete the application In full and attach the required floor plan. Middle Initial or name required of all parties concerned. If no middle name, please Indicate by writing NMN. Sign and return application with fee. Please advise of any change in status. New license required If business changes location or ownership. Notification to City of Edmonds required If business closes. BUSINESS NAME BUSINESS ADDRESS 1 i 6 t/O b�N Pvoe;� a MAILING ADDRESS Sb1R) or PO Box v0 LA (_CC.:,Z 9, Ofi, 9 C BUSINESS PHONE NO. (2-0 6 ) R"l�% WA STATE TAX ID NO. (UBI NO.) 663 — L'r-1 BUSINESS E-MAIL ``!`A 1E++ L ,,(�►!�p CC1 BUSINESS WEBSITE � �\' " PROPERTYOWNER &Cb tPrh� Q L( 06) Name Phone Number EMERGENCY NOTIFICATION (For Premise Access in Emergency): I\Af� SAC_` Y (Wt ) "1 r�A--h 4G6 Last Name First Name MI Phone No. Last Name First Ngme MI Phone No. NATURE OF BUSINESS NUMBER OF EMPLOYEES SQUARE FOOTAGE OF BUSINESS SPACE I VI.t.J TYPE OF BUSINESS - PLEASE CHECK THE APPROPRIATE CATEGORY: O CONSTRUCTION O FINANCE, INSURANCE, REAL ESTATE O LANDSCAPE, HORTICULTURAL O MANUFACTURING O NON-PROFIT RETAIL O SECONDHAND DEALER O SERVICES O WHOLESALE O OTHER AMUSEMENT DEVICES ON PREMISES? O YES (XINO LIQUOR SOLD ON PREMISES?: O YES 0 GAMBLIP FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED?: IF YES, TOTAL NUMBER G? O YES '1'0 CIGARETTES SOLD ON PREMISES? O YES �NO O YES(YN IF `YES. PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES: PROPOSED OPENING DAY OF BUSINESS O�I 'LO BUSINESS HOURS ' / cOb IAm DAYS OPEN %V$UNDAY 10 MONDAY �LTUESDAY WEDNESDAY HURSDAY �RIDAY � SATTURDAY 14 PARKING SPAC//ES ON SITE: TOTAL I ZA ACCESSIBLE FOR PERSONS WITH DISABILITIES DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO NS WITH DISABILITIES? O YES iKNO Y PREVIOUS BUSINESS USE AT THIS ADDRESS to&q I �PERS i 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. i DATE OF BIRTH CITY AND STATE OF BIRTH COUNTRY OF BIRTH I 3 PARTNERSHIP -PARTNER 1 i NAME Last First MI ADDRESS Street ApL 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 2 NAME i 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. I DATE OF BIRTH CITY AND STATE OF BIRTH COUNTRY OF BIRTH CORPORATION NAME OF CORPORATION 17 T� V <— `'\, _ FEDERAL TAX ID NO. CORP. AODRESS...0b.P 3 PHONE NO. Street Suite, Apt, Unit No. City, State and Zip Code CORPORATE OFFICERS: Last Name First Name MI Title - xi;) y M�1r/�j1 bEj LOCAL CONTACT_ Last Name First Name MI Title Phone No DOL No. (Drivers Uc. No.) or Other ID No APPLICANT ~ T �c Namrinted S nature Ti Date CITY USE ONLY: PLANNING DEPT. O APPROVE O DISAPPROVE DATE SIGNATURE ZONING CODE CONDITIONAL USE PERMIT COMMENTS BUILDING DEPT. O APPROVE O DISAPPROVE DATE SIGNATURE OCCUPANT LOAD BUILDING PERMIT OCCUPANCY GROUP COMMENTS FIRE DEPT. O APPROVE O DISAPPROVE DATE SIGNATURE U.F.hR. COMMENTS POLICE DEPT. O APPROVE O DISAPPROVE DATE SIGNATURE COMMENTS �o Z 26 iz Ow V Ia46 Le--Ov 66pV-t, Serving Brief; Edmonds 12425 Meridian Ave S SNOHOMISH CO. Mountlake Terrace,and FIREMWW Everett, WA 98208 DIST T the Town of Woodway FireDistrict1. Phone (425) 551-1200 www org Fax-(425) 551-1272 LOCATION: 22618 Hwy 99 108 BUSINESS NAME: Pearlmond Jewelry PHONE: 4257752022 MAILING 22618 Hwy 99 ##108 ADDRESS: Edmonds 98026 ' BUSINESS OWNER: i i, YdA$3g HOME PHONE: 2537325559 EMERGENCY-1: Han, J HOME PHONE: 4257787400 KEY ACCESS-2: YI, Sung HOME PHONE: 2536818732 ' PERSON CONTACTED NAME OF INSPECTOR I "\ FIRE SYSTEMS: FIRE PREVENTION INSPECTION REPORT ❑ EDMONDS ❑ BRIER ❑ WOODWAY ❑ MOUNTLAKE TERRACE 0 UNINCORPORATED FREQUENCY I STATION & SHIFT 730 20 B DATE DUED► 03/01t12 r UFIR ► 544 3 156 CURRENT CITY YES NO BUSINESS LICENSE INITIAL INSPECTION DATE J 2-i(J /// FE _!_ ANNUAL HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 1 1 2 2 3 3 4 5 5 6 6 \ y 7 7 1 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: I INSPECTOR: INSPECTOR: 2 INSPECTOR: DATE: DATE: 3 - _ VIOLATIONS VIOLATIONS PRE -CITATION CITATION ISSUED 5 1 5 LETTER SENT NUMBER: a CODE 5 .G 2 6 DATE: SECTION: RETURN RECEIPT - 3 7 RECEIVED e DISPOSITION: 7 4 8 DATE: LETTER NEEDED ❑ YES ❑ NO 8 FIRE DEPARTMENT COPY