110 MAIN ST STE 102 (2)_Redacted'
o ✓��-'v �r
SrrOxOMisx co.
Serving Brier, .Edmonds, and 12425 Meridian Ave
Mountlake Terrace Everett, WA 98208
��� � Phone (425) 551-121
wwwFirebistrictl.org Fax (425) 551-1272
LOCATION: 110 Main Street Suite 102 98020
BUSINESS NAME: Vacant
MAILING
ADDRESS:
BUSINESS OWNER:
PHONE: 2d,-5` l{ siip
HOME PHONE:
02
FIRE PREVENTION ::' '
INSPECTION REPORT'
EDMONDS
❑ BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY STATION & SHIFT
2015 17-D
SCHEDULED NOV 2015
DATE DUE
UFIR 0 202
'EMERGENCY-1: L W,A N 0 A K (^ 0 HOME PHONE: 2040 .12 8' 749k CURRENT
HOME PHONE:
KEY ACCESSCITY YES NO
: BUSINESS
EMAIL _ �e�+`+� Spa I-e c:VI%\ i�rNSCVvr�s, f- LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR: 9 7QZZ C Fe Fig/ IZ 114 — 1
FIRE SYSTEMS:
Date Last Serviced:
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1
2
2T..._........ _
3 _. _ ._.. _...._.
3
4
4
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE -INSPECTION
FINAL RE
EXTENSION
-INSPECTION
VIOLATIONS
DATE DUE: —
DATE DUE:
GRANTED T0:
DATE DUE:
CITED:
PERSON,
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
9
DATE:
-
VIOLATIONS
VIOLATIONS",
PRE -CITATION
CITATION ISSUED
_
1 5
1 5
LETTER SENT
NUMBER:
4
CODE
5
2
6
2
6
DATE:
SECTION:
RETURN RECEIPT
3
7
3
7
RECEIVED
5
DISPOSITION:
4
8
4
8
DATE:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES '• ❑ NO
8
SNOHOMISH CO. 1
FIRE .�,.
DISTR T
Serving Brier, Edmonds, and
Mountlake Terrace
www.FireDistrictl.org
' FIRE PREVENTION
12425 Meridian Ave S INSPECTION REPORT
NDS
Everett, WA 98208 EDMO
�] ►ER
Phone (425) 551-1200 ❑ UNTLAKE TERRACE
Fax (425) 551-1
�'272 ❑UNINCORPORATED
FREQUENCY STATION & SHIFT
6 LOCATION: 110 Maill Street Suite 102 98020 2 Year 13 17-B
BUSINESS NAME: i�al Estalc InvusLar5, Inc: PHONE: 42�,� j$�j$7$ SCHEDULED �V 2013
DATE DUE
MAILING UFIR a"I
ADDRESS: 110 Main 51.rccL Suilc 102, bdr n&-, VVA 08020
BUSINESS OWNER: t-A6-r, t',rmnir. HOME PHONE:
EMERGENCY-1: Frii yrR, Fain HOME PHONE: )j)b j4t)7405
KEY ACCESS-2: HOME PHONE:
EMAIL:
PERSON CONTACTED:
I ' NAME OF INSPECTOR:
FIRE SYSTEMS. FE t_
CURRENT
CITY YES NO
BUSINESS
LICENSE El El
INITIAL INSPECTION DATE
! HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1 �
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:
'
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE'
DATE' - "`r-
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
12
6
2
6
DATE:
CODE
SECTION:
5
j,
,. 3
7
3
7
RETURN RECEIPT
RECEIVED
5
4
8
4
18
DATE:
DISPOSITION:
},
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
g
J . FIRE DEPARTMENT COPY
V� CITY OF EDMONDS
121 5TM AVENUE N. • EDMONDS, WASHINGTON 98020 • (425) 771-0215
FIRE DEPARTMENT
�'Sc lago
LOCATION: 110 Main Street
BUSINESS NAME: Real Estate Investors, Inc
MAILING 110 Main ;t #102
FIRE PREVENTION
SAFETY SURVEY
102
PHONE: 4255827878
ADDRESS: Edmonds 98020
Yr BUSINESS OWNER: Erhardt, Fran HOME PHONE: 2062407405
EMERGENCY-1: Galer, Connie HOME PHONE: 4257505647
KEY ACCESS-2: HOME PHONE:
I✓
FREQUENCY
STATION & SHIFT
730
17 C
SCHDATEEDUEE ►
11/01110
UFIR ► 591
it
1202
ACTIVE
INITIAL INSPECTION DATE
PERSON CONTACTED:rtJit/ / � � j
NAME OF INSPECTOR: (4—V,nJ '7t=,' C1
FIRE FE jLIZZ
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUPICATIONS /p /
1 f1CyyltJ�/� F�l�/gf%�BlJ� �x�• Co�.rJ;-�.S ��'s/�
ENTER CODE ONLY ONCE ►
VIOLATION CODE
1
s
2
2
3
3
4
4
5
5
6
6
7
7
8 0 t"(ea"
6
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
(,
r
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED: A
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
jG1OLATIONS
1 5
1
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
i CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7+
RETURN RECEIPT
RECEIVED
6
4
8
4
8
DATE:
DISPOSITION:
-
7
8
LETTER NEEDED I] YES NO
LETTER NEEDED C? YES NO
FIRE DEPARTMENT COPY
S� 08 d
CITY OF EDMONDS
BUSINESS LICENSE APPLICATION— COMMERCIAL
FEE: $125.00
CITY CLERK'S OFFICE, BUSINESS'LICENSE DIVISION
121 5TM AVENUE NORTH, EDMONDS, WA 98020 PHONE: 425.775.2525
OFFICE USE ONLY
BL#
stp(rl 66 ` 9.
`at t bRot
IC
Year
Class
SHD
ate Paid
T�# 3
F e Pai
Mailed Delete
INSTRUCTIONS: Please complete the application in full and attach the required floor plan. Middle initial or name required of all
parties concerned. if no middle name, please Indicate by writing NMN. Sign and return application with fee. Please advise of
any change In status. New license required if business changes location or ownership. Notification to City of Edmonds required
if'business closes.
BUSINESS NAME ' S5`e-A l Es i a� � j -Q 5 At S
v BUSINESS ADDRESS _ 1 1 1 I\ A i/N ) 07— 1910 2,U
Street 1 ' ' Suite No.
lZip Code
�• MAILING ADDRESS 0• 18DY � � bC, � Uyyxoyi l � W � l op O l
Street or PO Box Suite
�7 j7 Suite No. City, State and Zip Code CIS R
BUSINESS PHONE NO. 21^ S D d — • 00 VA STATE TAX ID NO. (UBI NO.) `'�'
BUSINESS E-MAIL CahY%I eCu,LJkowSl-1! ( Me f BUSINESS' E'BSITE ' `UU-SI'� YID -
PROPERTY OWNER � Gt � C e S l—�i k t d A + ( 1p ) o� qO 1 L4 O
Name Phone Number
EMERGENCY NOTIFICATION (For Premise A in Emergency): 2S) , �;_u — S to q
(-nGi. le 1(_ r1 N n1 li� ZS.- -1 �{2� !o I1l3Cha'ti'Q�
Lastpame FlrI Name Ml Phone No.
Last Name First Name MI Phone No.
NATURE OF BUSINESS CW VN 9k /V C1 D l ✓L+r' -e ram.
✓`�%�. CGL fr
CA_CC_0q--L+jj . /V C� SOU e✓S
l -U i�1� -Also, do t�ersal
NUMBER OF -EMPLOYEES , t ^ � U E FOOTAGE OF BUSINESS SPACE - IL 1000
TYPE OF BU$INES,S - PLEASE CHECK.THEAPPRQPRIATE CATEGORY:
O CONStAUCTION ' Q FINANCE; INSURANCE, REAL ESTATE. ' O LANDSCAPE. HORTICULTURAL O MANUFACTURING O NON-PROFIT
• .O RETAIL OSECONDHAND REALER QSERVICES O WHOLESALE. �THER rP:✓�..'i-ct. L-S
t
AMUSEMENT DEVICES-ON'PREMISES?, '.Cl YI%S NO . 1F YES. TQTAL NUMBER
.LIQUOR SOLD ON PREMISES'?:- OYES NO,' GAIMBLING? O YES t NO CIGARETTES SOLDON PREMISES? O YES I�NO
P • ' . X.
'`
Ft_AMMABLE OR HAZARDOUS MATERIALS USED OR STORED?: O YES 1p. NO IF'YES; PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES:
PROPOSED OPENING DAY -OF BUSINESS 1 [it O BUSINESS HOURS N
DAYS OPEN O SUNDAY O MONDAY O TUESDAY O WEDNESDAY O THUR�DAY O FRIDAY -O SATURDAY
PARKING SPACES ON SITE: TQTAL ACCESSIBLE FOR PERSONS WITH DISABILITIES
DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS�WITH 1SABB^ILIITIES? . S O NO
PREVIOUS BUSINESS 'USE AT THIS ADDRESS L��- J7 S j
AWlE83
6eeN Mt Nw,UM NN Ciy.� entl Lp CdOe
HOWFHONENO.t ( m NO.OnwvEA6 L(CEN6E Np.)OR OTHFRON0. .
oar6avfiw(x attnxo 6rATEOFawm - wunmvavewm
PAlRl6l61Bp • PMINER n
N E
sd9
FlRI
M
wNE65
' 64cet
AFG Nw UINNe
w6W mOlV OOM
HOMEPHONENO(
1 pOLNp, (pPrypG51ACg1$Etp,(Op 0i1BiCN0.
BATE OF BIFIN
C AND UATE OFMCPH
CIXPoI!'l OF GIANH .
. PAR111ER6HW-PANTHER!
NAME
usl
.Flit
M.
ABORE66
steal
APL w. ylnxa
clAslmaneapcoae
HCMEPHONENV.( I
DOLNO. (pyyEBglMEN9ENOJ'ORMfENb NC!
VATEOFBIRTH
NQ)BfATE OFBBNII
COUNRrypFBIRiN
COXPORAIgII
..pp
NAME OFcoRagsATR�ONCG�^.JC ZnJ-f �LS
S1/��!•,,//ss Ew+.T�A%xlo no.
CORP. MORM C.O. X. I�f R'3 rLL WINI
-A nM
����s,�
dS WA �Qa� PHONE NO.�1Ya-14o5
6tlN1 $ub. A
CPy: dM
OOPPOMIEOFFlCEIt6:
_
ml
IAI.ALCWO'ACT Evhdclf Fn
WIMm. HIMNure
.lMs. PM1md No- - OOLNo, (OMgPIN. N0.1 a,OtlnlONn
EXHIBIT "A-1"
FLOOR PLAN
e
Synset ar►d Male - First Floor