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109 4TH AVE N_RedactedIf- -� "..' r., '!!"- 17, I 10 '(4 h �j 4 /q FIRE PREVENTION Serving Brier, Edinonai, and 12425� Meridian Ave.S INSPECTION REPORT SNOHONAsli Co OEDMONDS Mountlake Terrace Everett, WA 98208 0 BRIER FIREPhone (425) 551-1200 0 MOUNTLAKE TERRACE [I UNINCORPORATED �I�R T www.FireDistrictl.org org Fax (425) 551-1272 -F-RF55PNry I 737mix -qw-w-T*\ 109 4 th Avenue N 98020 LOCATION: The Churchkey Pub BUSINESS NAME: PHONE: MAILING 109 4th Avenue N, Edmonds, WA 98020 ADDRESS: Miller, Trevor BUSINESS OWNER: HOME PHONE: EMERGENCY-1: Miller, Amy HOME PHONE: 0 KEY ACCESS-2: HOME PHONE: PERSON CONTACTED: NAME OF INSPECTOR: Date Last Serviced: 3602028335 CURRENT CITY YES NO BUSINESS F--j LICENSE L—j INITAINPE10(J DATE John J. Westfall From: John J. Westfall Sent: Monday, November 09, 2015 10:18 AM To: 'Ibjorback@edmondswa.gov' Cc: 'cmiller@edmondswa.gov'; Kevin Zweber Subject: Churchkey Pub 109 4th Ave N Leif: I spoke with Trevor Miller about the rooftop assembly area less than 50 with single exit, we had good discussion. We spoke to covered assembly above, independent heating appliance (natural gas preferred), dumbwaiter shafts and you apparently had covered passenger elevators. I told him FD would like him create separate (horizontal) fire area so we could be assured that the two occupant loads, above and below could remain independent of each other. He had anticipated increasing the 52 below to 70. He did not balk at the separation, due to the structural work already anticipated for the rooftop occupancy. John J. Westfall Deputy Chief -Fire Marshal Fire Prevention Services 425-771-0213 Desk 425-775-7721 Fax 425-231-3644 Mobile 000 4 CITY OF EDMONDS BUSINESS LICENSE APPLICATION-- COMMERCIAL FEE: $125.00 CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION In, 116011 121 5TFI AVENUE NORTH, EDMONDS, WA 98020 PHONE: 425.775.2525 OFFICE USE ONLY `BLit "'" Customer# SIC _ . Y{{e��ar .. dZ4." e'3 COss '£ SHD" Date Paid {5 - iw./ i T,,nnR# .fd,. / . T� ds Fee Pald y:� d :\•nk Mailed Delete INSTRUCTIONS: Please complete the application in full and attach the required floorplan. Middle initial or name required of all parties: concerned.: if:no:middle -name, please indicate bywriting NMN: °Sign and return' applicationwith fbe.''Please:advise of any change in,:status, :New;.11cense:required: f:business:changes: ocation orownershipNotification to City'of Edmondsrequlred if business closes. BUSINESS NAME BUSINESS ADDRESS /0y '7 bi I u / MAILING ADDRESS _ 1 ?`6 yf Alc, Street or PO Box Suite No. City, Stal - (360 ) 2--?33.Sr ..BUSINESS NO. ' WA STATE TAX ID NO: (OBI NO.) A BUSINESS E-MAIL G GKG� (`. GL/M Bt. �-- PROPERTY OWNER ✓ or ��fWl1C+�' �S hro i Name OWl1tti'i nrry AJG SUJ ft1 EMERGENCY NOTIFICATION (For Premise Access in Emergency) - last Name NATURE OF BUSINESS First Name A - Name MI L Mi Suite No. Zip wl+ 12-0 3 and Zip Code r.. "Ia3 33 t/w,C1n-v�G �Ce= , u2r. 4rN_ Phone Number 3d()ai9 Phone No. -74,1 : _4�-JItir -J?73 - r NUMBER OF EMPLOYEES —SQUARE FOOTAGE OF BUSINESS SPACE_131(/ �q TYPE OF BUSINESS - PLEASE CHECK THE APPROPRIATE CATEGORY: O CONSTRUCTION O: FINANCE; INSURANCE, REAL ESTATE O LANDSCAPE, HORTICULTURAL O'MANUFACTURING O`NON-PROFI T O RETAIL O SECONDHAND DEALER SERVICES O WHOLESALE O OTHER n: AMUSEMENT DEVICES ON.PREMISES? .:>Q.YES.......ONO _.: IF YES; TOTAL NUMBER LIQUOR -SOLD ON PREMISES?: YES' ONO "` GAMBLING? OYES` °,KNO CIGARETTES SOLD ON PREMISES' FLAMMABLE:OR:HAZARDOUS MATERIALS USED OR -STORED?: O YES A NO IF-YES;'PLEASE'PROVIDE ' LIST` OF-MATEF IALS PROPOSED'OPENING'DAY OF BU51NES5_� BUSINESS HOURS DAYS OPEN 91 SUNDAY ;k MONDAY �U TUESDAY P11 WEDNESDAY THURSDAY FRIDAY PARKING SPACES ON SITE: TOTAL _ _ACCESSIBLE FOR PERSONS WITH DISABILITIES g SATURDAY DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES? ,YES ONO `.:PREVIOUS BUSINESS USE AT THIS ADDRESS-- ADDRESS Strad AM No.. Um No CRY, SW am ZptoNa HOME PHONE NO. L_) DOLNO.(DRIVERS LICENSE NO.I OR OTNER ENO DATE OFDBITH CITYOND STATE OF BNTDI COUNTWOFBERH PARTNERSHIP-PARTNEAI NAME Losl Fil MI ADDRESS SMN AN. No -UN No. City, Sap and DO Code HOME PHONE NO COL NO. IORIVERS LICENSE NO) OR OTHER IO NO _ DATE OF BIRTH CRY AND STATE OF BIRTH COUNTRY OF BIRTH PARTNERSHIP -PARKER! NAME will Find MI ADDRESS SweI Apt. No.. Wt W. CNY'Sbbandap Cock — NOW PHONENO.( I VOL NO.(DRIVERS LCENSE NO) OR OTHER ID NO. DATECFSIRTH CITYAND STATE OF BIRTH COLNTRYOFBlWH NAME OF CORPORATION MAI LLB. fvv REDERAL TA% IO NO.' tic HGI.St°aY '•,001 awe. Ali Don No. uV. Time and rip Cana LaLel NamKEe.neecr Name Find Name NI Tole DHad BIM DOL Na IDIrvaM U¢nsa Nalp Over No. M;llrrr T✓xuor � Vn l�P✓' l%i v'i% Hrwher Nybau p "�I Auk T/ gamMP LDGIL I:DNTPCT MIIIg- �Y (I//Are la u�•--•��- (� I"�1-%7�� lalNmm irsl Name MI Titl¢��L PM1pne No. er o APPLICPNT--i rcI/(/r /"1111�y __ u 1 /� Nema-Prttlad Tnle (NOW CRY USE ONLY: PIANNINGOEPT. DAPPRWE ODISIPPRWE DATE SIGNATURE ZONING CODE CONDITIONAIL USE PERNOT COMMEN S WILDING DEPT. 0APPIRME 0DI:APpNWE DATE SIGNATURE OCCIAANT LOAD BALDING PERMIT OCCUPANCY DROOP CCMLffNTS ME DEPT. 0APPRWE 0DdSAPPRWE DATE SIGNATURE UFLR COMMEN S PoLICE DEPT. 0AFPROVE 0OdS PpOVE OATS SIGNATURE COMMEMS I' i tj a. is : 1� 'i' i : i i I •� I i L.... cc S SHEET NO m ... MEN Aft . _ .._—.. ..._- REVISED' DATF id es a ` N s C ®®®®®® DRAWN: L , W A R R E N 1. A E Cl n _ _� CE+E Cn CP �{ OF A R C H I T E C T JOB NO PLOT DATE' :.. - 1 I ®oo 0'3�3 "2_02— CITY OF EDMONDS c— 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# Custome SlC Year CI ss SHO Date Paid TR# Fee Paid Mailed Delete D S - 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 �al� c� r� Street MAILING ADDRESS] Street or BUSINESS PHONE NO. BUSINESS E-MAllt PROPERTY OWNER Name CY NOTIFICATION (For Prf Last Name Last Name Access in Emergency): First Name No. Suite No. City, State and Zip Code NUMBER OF EMPLOYEES SQUARE FOOTAGE OF BUSINESS SPACE bO TYPE OF BUSINESS - PLEASE CHECK THE APPROPRIATE CATEGORY: Number Zip Code O CONSTRUCTION O FINANCE, INSURANCE, REAL ESTATE O LANDSCAPE, HORTICULTURAL O MANUFACTURING O NON-PROFIT O RETAIL O SECONDHAND DEALER "; SERVICES O WHOLESALE O OTHER AMUSEMENT DEVICES ON PREMISES? O YES )kNO IF YES, TOTAL NUMBER LIQUOR SOLD ON PREMISES?: AzS ONO GAMBLING? O YES *,0 CIGARETTES SOLD ON PREMISES? O YES '* O FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED?: O YES XNO IF YES, PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES: I PROPOSED OPENING DAY OF BUSINESSVESDAY Z�_ � BUSINESS HOURSp DAYS OPEN �SUNDAY ID 40NDAY &WEDNESDAY %HURSDAY p1.ERIDAY %ATURDAY 1 PARKING SPACES ON SITE: TOTAL ACCESSIBLE FOR PERSONS WITH DISABILITIES DOES THE BUSINESS CONTAIN AN ENTRANCE ACCE MSIBLETO PERSONS WITH DISABILITIES? �ES O NO PREVIOUS BUSINESS USE AT THIS ADDRESS ADDRESS SNeY AM No., Unit No. City, Slap am Lp Cade HOME PHONE NO. (_I DOLNO. IORIVERSLICENSENO.)ORTMERIDNO. DATE OF 81RTH CITY AND STATE OF BIRTH COUwRYOFBIRTH PARTNERSHIp.ppRYPoERI NAME Leal First NI ADDRESS G4en1 Apt No., Unit No. city. Sam am ZIp Coca HOME PHONE NOf I OOL NO.(DRIVERS LICENSE W..) OR OTHER ID NO. MTE OF BIRTH CRY AND STATE OF BIRFX COIMTRY OF BIRTH NAME PARTNBABHP•PMR ER2 Last FiN M ADDRESS 84eY AM. No.. Unit No. City, Slaty am ZIP Coda NONE PHONE Ni COL NO. LORNERS LICENSE NO.) OR OTHER ID NO. DATE OF BIRTH CRY AND STATE OF OWN COUNTRY OF BIRTH CORPOMTEOFFICERS: Nam MI (T�lb Date of Birth DOL .(D wars Licame No.) or Omr ID No. >S"aa, �, \ ca& LOCAL CONTACT�CSaI OC Last Name Fiat Nana No We r CRY USE ONLY: PLANNING DEPT, OAPPROVE ODISAPPROVE DATE SIGNATURE ZONINGCOOE CONDITIONAL USE PERMR COMMENTS BUILDING DEPT. OAFli ODISAPPROVE DATE SIGNATURE OCCUPANT LOAD BUILDING PERMR OCCLPANCY GRDUP COMMENTS FIRE DEPT. 0AFPROVE 0DISAPPROVE MTE SIGNATURE U.F.I.R. COMMENTS POLP EDEPT. COM.ENTB OAPPROVE 130ISAPPROVE DATE SIGNATURE • TOILET PLAN -1 N .YC • FIRST FLOOR PLAN • HORN • TOILET ELEV. • • TOILET ELEv. - (, I ..0 •. N• . Y.0 S1LG. N' . Y•O � � A-3 i OF U% L/tS t . SNOHOMISH CO. Serving Brier, Edmonds, and Mountlake Terrace www.FireDistrict].org LOCATION: 109 4 th Avenue N 98020 BUSINESS NAME: The Churchkey Pub MAILING ADDRESS: 109 4th Avenue N, Edmonds, WA 98020 BUSINESS OWNER: Miller, Trevor EMERGENCY 1 �y-v l`e� KEY ACCESS-2:P��l EMAIL:Co✓-�- PERSON CONTACTED: 40e— p0•G�_ NAME OF INSPECTOR: `t,:X w� 1 , 6 FIRE SYSTEMS: FE/ rlato I act Coniirorl- 12425 Meridian Ave S Everett, WA 98208 Phone (425) 551-1200 Fax (425) 551-1272 PHONE: 3602028335 FI PREVENTION IN ECTION REPORT EDMONDS ❑ BRIER ❑ MOUNTLAKE TERRACE ❑ UNINCORPORATED FREQUENCY STATION & SHIFT Annual 17-D SCHEDULED DATE DUE 0 Mar 2016 UFIR 0 514 202 HOME PHONE: ]�_ao.� ?33T HOME PHONE: "' CURRENT HOME PHONE: �j(o7<fs �(jgr CITY YES BUSINESS LICENSE INITIAL INSPECTION DATE I HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 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 In our continuing effort to promote fire safety and prevention within the community, your fire department conducts regularly scheduled "Fire Safety Survey Inspections" of all.businesses and multi -family occupancies in the Cities covered by Snohomish County Fire District 1. You are to be congratulated on the relative good condition of your occupancy in regards to fire safety. Above you will find the item(s) that were noted during. our inspection which require attention to bring them into compliance with the minimum standards adopted by the above jurisdictions. Any overlooked hazards or violations of the fire regulations does not imply approval of such conditions or violation. If you require additional information or to schedule a re -inspection for Edmonds, call (425) 775-7720; for Mountlake Terrace or Brier, call (425) 744-6231. FIRE PREVENTION INSPECTION REPORT SrzoxOMISx CO. Serving Brier, Edmonds 12425 Meridian Ave S ❑ EDMONDS Mountlake Terrace,and Everett, WA 98208 ❑BRIER writ Tthe Town of Woodway Phone (425) 551-1200 ❑ WOODWAY ❑ MOUNTLAKE TERRACE www FireDistrictl.org Fax (425) 551-1272 ❑ UNINCORPORATED FREQUENCY STATION & SHIFT LOCATION: 109 4th Ave N 365 7 D BUSINESS NAME: Jack Murphy131 PHONE: 7139387711 7 11 SCHEDULED DATE DUE ► Q&Y/ 01'12 MAILING 109 4th Ave, N UFIR / 514 3202 ADDRESS: Edmonds 98020 BUSINESS OWNER: Taylor, BrianHOME PHONE: 118938771/ EMERGENCY-1: F9'EfEL'f, Louise HOME PHONE: 7/89866750CURRENT KEY ACCESS-2: HOME PHONE: CITY YES NO BUSINESS LICENSE A PERSON CONTACTED: INITIAL INSPECTION DATE � � ('"-' ,A NAME OF INSPECTOR:AF y: FIRE SYSTEMS: ANNUAL HAZARDS �IFOUND AND LOCATIONS / COMMUNICATIONS 2 3 4 5 -_6 . _ _ _ 7 7 I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X 7Y 1st RE -INSPECTION 2nd RE -INSPECTION EXTENSION FINAL RE -INSPECTION VIOLATIONS DATE DUE: DATE DUE: GRANTED TO: DATE DUE: I CITED: PERSON PERSON' CONTACTED: CONTACTED: PERSON CONTACTED: INSPECTOR: INSPECTOR: INSPECTOR: 2 DATE: DATE: DATE: 9 e VIOLATIONS VIOLATIONS PRE -CITATION CITATION ISSUED 5 1 5 LETTER SENT NUMBER: 4 CODE 2 8 2 8 DATE: SECTION: RETURN RECEIPT 3 7 3 7 RECEIVED 6 DISPOSITION:�� 4 8 4 8 DATE: _�® 7 LETTER NEDE ED ❑ YES ❑ NO LETTER NEEDED ❑ YES ❑ NO 8 FIRE DEPARTMENT COPY