110 3RD AVE N STE 102_RedactedIIII��I�I `Q 300 AOF N 'Tic l OZ FIRE PREVENTION
1 >" g Serving Brier, Eatnonu6; and 12425 Meridian Ave S INSPECTION REPORT
SNOEDMONDS
Mountlake Terrace Everett WA 98208 4BRIER
FIRS = ,
DISTR
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Phone (425) 551-1200 ❑ MOUNTLAKE TERRACE
www.FireDistrictl.org Fax (425) SSI -1272 ❑ UNINCORPORATED
126 3 rd Avenue N Suite 102 98020
LOCATION:
BUSINESS NAME: j'Qv„,o NyteIrf Ca-.05ZlNa /-L'.r— PHONE:
MAILING
ADDRESS: 126 3rd Avenue N, Suite 102, Edmonds, WA 98020
F1ffg1 �NCY STATfy SHIFT
SCHEDULED Ct
2016
DATE DUE /
UFIR /
BUSINESS OWNERM4(,,4A/ 012M5,1-1 R 1% J;ko0f ..HOME PHONE d/-, 704'2 6,96
EMERGENCY-1: HOME PHONE: CURRENT
KEY ACCESS-2: HOME PHONE: CITY YES NO
EMAIL: BUSINESS ❑ 1-1LICENSE
PERSON CONTACTED: 0/tJC• } p INITIAL INSPECTION DATE
_ NAME OF INSPECTOR: 'Jl G}� ✓ �i I/ O� / I �/� 0 //b
Date Last Serviced:
SWOHOM18ii CO.
Serving Brier, Edmonds, and 12425 Meridian Ave S
Mountlake Terrace Everett, WA 98208
Phone (425) 551-1200
1JZr-.7 A JM LV 1 www.FireDistrictl.org Fax (425) 551-1272
LOCATION: 110 3 rd Avenue N Suite 102 98020
BUSINESS NAME:
Invite Change, LLC PHONE: 4257783505
MAILING 110 3rd Avenue N, Suite 102, Edmonds, WA 98020
ADDRESS:
FIRE PREVENTION
RSPECTION REPORT
EDMONDS
BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FE69VNCY
STATIIQV SHIFT
SCHEDULED
DATE DUE
Oct 2016
UFIR /
BUSINESS OWNER: HOME PHONE:
Harvey, Janet 3606329092
EMERGENCY-1: HOME PHONE: CURRENT
KEY ACCESS-2: HOME PHONE: CITY YES NO
1:1 El
BUSINESS
EMAIL: / LICENSE
r INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR: /,y�✓ L.��% �� / 1� /,�
Date Last Serviced:
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
, V15vA.,L_ !,�}� °1,A1-7 Civo ova Atr
2
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
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3
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7
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.
I A
jj
Serving Brier, Edmons` 12425 Meridian Ave S
Mountlake Terrace,and Everett, WA 98208
the Town of Woodway Phone (425) 551-1200
www.FireDistrictl.org Fax (425) 551-1272
FREQUENCY I STATION & SHIFT
t LOCATION: 110 3rd Ave N 102 731 17 B
BUSINESS NAME: Invite Change, LLC PHONE: 4257783505 DATE DUE SCHEDULED► 10I01/12
MAILING 110 3rd Ave N #102 UFIR ► 591 1[252
ADDRESS: Edmonds 918020 '
BUSINESS OWNER:
Harvey, Janet I
HOME PHONE:
3606329092
EMERGENCY-1:
RvadruCk, Debbie.
HOME PHONE:
4252994768
KEY ACCESS-2:
HOME PHONE:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIFE
SYSTEMS:
FIRE PREVENTION
INSPECTION REPORT
❑ EDMONDS
❑ BRIER
❑ WOODWAY
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
CURRENT
CITY YES NO
BUSINESS
LICENSE El n
INITIAL INSPECTION DATE
11 /5/ )z
FE, .L/_U
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1 U I't� J
1
2
J
2
3
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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
4
2
6
2
6
DATE:
CODE
SECTION:
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3
7
3
7
RETURN RECEIPT
RECEIVED
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4
8
4
6
DATE:
DISPOSITION:
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
g
FIRE DEPARTMENT COPY
CITY OF EDMONDS
BUSINESS LICENSE APPLICATION— COMMER R
FEE: $125.00
CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION�12
121 5' AVENUE NORTH, EDMONDS, WA 98020 PHONE: 425.775.252 '
,,� /_( l a 0 d 1118 2�t3 Z NaWWj jn
OFFICE USE ONLY
BL#
Custom gr ,
Me
SIC
Year
Class
SHD
Date Pad
3;#t
®(
Fee Palc V
'
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 I nV Jv-dAANa E' LLr
BUSINESS ADDRESS 110 3rO AVe /�,c u,, i02 980st0
Street Suite No. Zip Code
MAILING ADDRESS
Street or PO
Suite No.
and Zip Code
BUSINESS PHONE NO. ( N� ) 7-19'3�50JT WA STATE TAX ID NO. (UBI NO.) -069 - -7
BUSINESS E-MAIL DIriM,e%E?-,r.NV.-4rotlAMar-. (iC lln BUSINESSWEBSITE L, in0i'te"AAJAC I^Qrbn
PROPERTY OWNER _Jo rnt.S 40Z-:)
Name Phone Number
NOTIFICATION (For Premise Access In Emergency):
14&r Vey 7auilr-4 (,7)&)> CQ - 9092
Last Name First Name n MI Phone No.
NATURE OF BUSINESS a._L L �`Y�C +L �� , �; C�iO n
NUMBER OF EMPLOYEES I SQUARE FOOTAGE OF BUSINESS SPACE ts-on
TYPE OF BUSINESS - PLEASE CHECK THE APPROPRIATE CATEGORY:
O CONSTRUCTION O FINANCE, INSURANCE, REAL ESTATE O LANDSCAPE, HORTICULTURAL O MANUFACTURING O NON-PROFIT
O RETAIL O SECONDHAND DEALER O SERVICES O WHOLESALE 916THER
AMUSEMENT DEVICES ON PREMISES? O YES M<O IF YES, TOTAL NUMBER
LIQUOR SOLD ON PREMISES?: O YES C9'NO GAMBLING? O YES (PIZ CIGARETTES SOLD ON PREMISES? O YES V4e
FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED?: O YES O IF YES, PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES:
PROPOSED OPENING DAY OF BUSINESS 150' BUSINESS HOURS / `
DAYS OPEN O SUNDAY 17 MONDAY Qr UESDAY UVGEDNESDAY -er�URSDAY 49-FRIDAY O SATURDAY
PARKING SPACES ON SITE: TOTAL �, ACCESSIBLE FOR PERSONS WITH DISABILITIES
DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS
`WITH DISABILITIES? l�S O NO
PREVIOUS BUSINESS USE AT THIS ADDRESS T �n - ' 4 cy'3
S�
i
SOLE PROPRIETORSHIP
NAME
Last First MI
ADDRESS
Street Apt. No., Unit No. City, State and Zip Code
HOME PHONE NO. OL NO. (DRIVERS LICENSE NO.) OR OTHER ID NO.
DATE OF BIRTH CITY AND STATE OF BIRTH COUNTRY OF BIRTH
PARTNERSHIP- PARTNER I
NAME VAor\)L'� _ZZ-41F± IA,
Last (� -�� First �^ MI
Anna
T C) . ,1 y 1.Qq / t2d / i fi % �►Q!
HOME PHONE NO (D LQ - 9 q DOL NO. (DRIVERS LICENSE NO.) OR OTHER ID NO,
DATE OF BI CITY AND STATE OF BIRTH COUNTRY OF BIRTH
- PARTNER 2
HOME PHONE'NO.f - 9 7 7 DOL NO. (DRIVERS LICENSF NO) OR OTHER ID NO
DATE OF BIRT CITY AND STATE OF BIRTH COUNTRY OF BIRTH
CORPORATION
NAME OF CORPORATION FEDERAL TAX ID NO
CORP. ADDRESS PHONE NO.(__j
Street Suite, Apt., Unit No. City, State and Zip Code
CORPORATE OFFICERS:
Last Name First Name MI Title Date of Birth DOL No. (Drivers License No.) or Other ID No.
LOCAL CONTACT
Last Name First Name MI Title Phone No DOL No. (Drivers Lic. No ) or Other 10 No.
APPLICANT & A 4,
Name- Printed
PLANNING DEPT. O APPROVE O DISAPPROVE DATE SIGNATURE
ZONING CODE CONDITIONAL USE PERMIT
COMMENTS
OoAer- I -10 1.%
Title Date
BUILDING DEPT. 0 APPROVE O DISAPPROVE DATE SIGNATURE
OCCUPANT LOAD BUILDING PERMIT OCCUPANCY GROUP
COMMENTS
FIRE DEPT. O APPROVE 0 DISAPPROVE DATE SIGNATURE
U.F.I.R.
COMMENTS
POLICE DEPT. O APPROVE 0 DISAPPROVE DATE SIGNATURE
COMMENTS
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