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CITY OF EDMONDS
BUSINESS LICENSE APPLICATION— COMMERCIAL
FEE: $125.00
CITY CLERI{'S OFFICE. SUSINESS'LICENSE 0IVISI0N
Z+�r.l89a 121 5'}' AVENUE NORTH, EDMONDS. WA 98020 PHONE: 425.775.2525
INSTRUCTIONS: Please complete the application in full and attach the required floor plan. Middle initial or name required of all
parties conoomed. If no middle name, please indicate by writing NMN. Sign and roturn 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 ADDRE
if -a t) j4-
as
MAILING ADORESS r
Street or PO Box / r Suite No. City. State and Zip Code
BUSINESS PHONE NO. I- WA STATE TAX ID NO. IUBI NO,)
BUSINESS E-MAIL 6t a &O-L4 C�.Y` C•�m- BUSINESS WEV SITE
PROPERTY OWNER :{ cd't Q �--� �— 0—
EMERGENCY NOTIFICATION [Far Premise Access in Emergency] -
Name
NATURE OF BUSINESS
Phono No.
NUMBER OF EMPLOYEES SQUARE FOOTAGE OF BUSINESS SPACE
TYPE OF BUSINESS • PLEASE CHECK -THE APPROPRIATE CATEGORY:
0 CONSTRUCTION 'FINANCE, INSURANCE, REAL ESTATE 0 LANDSCAPE, HORTICULTURAL 0 MANUFACTURING ❑ NON-PROFIT
D RETAIL ❑ SECONDHAND DEALER KSERVICES 0 WHOLESALE n OTHER
AMUSEMENT DEVICES -ON PREMISES? 0 YES �.NO . IF YES. TOTAL NUMBER
LIQUOR SOLD ON PREMISES?: 0 YES 1StO GAMBLING? 0 YES )aO CIGARETTES SOLD ON PREMISES? 0 YES WN❑
FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED?: ❑ YES 0:740 IF YES, PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES:
PROPOSED OPENING DAY_OF BUSINESS I < < � 1 BUSINESS HOURS r
DAYS OPEN 0 SUNDAY OLMONDAY "ESDAY F' WEMIESDAY P THURSDAY OFRIDAY 0 SATURDAY
PARKING SPACES ON SITE: TOTAL '
ACCESSIBLE FOR PERSONS WITH DIWILITIES r e S
DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSI
BUSINESS USE AT THIS ADDRESS Avajt0e,
WrTH DISABILITIES? IXYES 0 NO
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COUNTRY OF BIRTH
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DATE OF elm
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CORPORATION
NAME OF CORPORATION --.FEDERAL TAX M NO
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CORPORATE OFFICERS:
Lad Name FMU Name 09 Tide Qalg of l3ir"t OOL No, (D&M Lkmmo No-) w Olhm ID No.
LOCAL CONTACT
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CITY OF EDMONDS l
R BUSINESS LICENSE APPLICATION- COMMERCIAL
FEE: $125.00
CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION
l a4e 121 5T" AVENUE NORTH, EDMONDS, WA 98020 PHONE: 425.775.2525
OFFICE USE ONLY
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INSTRUCTIONS: Please complete the application In full and attach the required floor plan. Middle initial or name required of all
parties concemed. If no middle name, please indicate by writing NMN. Sign and rotum application with fee. Please advise of
any change in status. New license required if business changes loeatlon or ownership. Notification to Clty of Edmonds required
If business closes.
BUSINESS NAME --Fyu JQe_ H " , L C_
BUSINESS ADDRESS r - ' 6-rd5 WA D L)20
Street Suite No. Zip Code
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MAILING ADDRESS 4 r ' �L +�' r}i.0 1JLR i c — �� Cti Z' fiV 1
Street orr[P¢O' Box r Suite No. City. State and Zip Code
BUSINESS PHONENO. WA STATE TAX ID NO. (UBf NO.)
allSINESS E-MAIL BUSINESS WEBSITE
PROPERTY OWNER
Name
EMERGENCY NOTIFICATION {For Premise Access in Emergency} -
Last Name I First Nam
Last Nam J First Name
NATURE OF BUSINESS
s
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NUMBER OF EMPLOYEES _ - f SQUARE FOOTAGE OF BUSINESS SPACE
TYPE OF BUSINESS - PLEASE CHECK THE APPROPRIATE CATEGORY:
Phone Number
No Phone No.
Phone No.
O CONSTRUCTION O FINANCE, INSURANCE, REAL ESTATE ❑ LANDSCAPE, HORTICULTURAL O MANUFACTURING 0 NON-PROFIT
❑ RETAIL ❑ SECONDHAND DEALER *-SERVICES ❑ WHOLESALE ❑ OTHER
AMISEMEIHT DEVICES'ON PREMISES? ❑ YES IF YES. TOTAL NUMBER
LIQUOR SOLD ON PREMISES?: ❑ YES GAMBLING? ❑ YES NCO CIGARETTES SOLD•ON PREMISES? ❑ YES >(No
FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED?: ❑ YES�N❑ IF YES, PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES:
PROPOSED OPENING DAY, OF BUSINESS I r✓ I BUSINESS HOURS
DAYS OPEN ❑ SUNDAY 1P(MONDAY )6FEfE/SDDAA.Y_ )dWEONESDAY _Z�URSOAY �6 FRI DAY • Q SAT+UrRDAY
PARIONG SPACES ON SITE: TOTAL ACCESSIBLE FOR PERSONS WITH DDISAGIUTIES _ 7 p 5
DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DiSABILIrTIES? Tm<ss ❑ NO
IX�5BUSINESS USE AT THIS ADDRESS 1k r� � 5 d_
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DATE OF BROH CIIV MO STATE OF BIRTH COUMRY OF BIRTH
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l SNOHOMISH CO.
r Serving Brier, Edmonds
Mountlake Terrace, and
the Town o, f Woodway
�vww FireDistricil. org
LOCATION: 437 5th Ave S 102, Edmonds 08020
r - BUSINESS NAME:__,,, LL(±
MAILING 1 3 V 4�0- ieG �G
ADDRESS:
dal 51h Div„„4 5 t1 02, ,
BUSINESS OWNER:
Email:
EMERGENCY-1:
KEY ACCESS-2: ,^1 _■■
�r7�/r F 11TO•CS
,PERSON CONTACTED:
NAME OF INSPECTOR: t /
FIRE SYSTEMS:
FIRE PREVENTION
12425 Meridian Ave S
INSPECTION REPORT
Ev6 ii, VA"98208-
❑ EDMONDS
❑ BRIER
Phone (425) 551-1200
❑ WOODWAY
[I MOUNTLAKE TERRACE
Fax (425) 551-1272
❑UNINCORPORATED
FREQUENCY ST
PHONE: ��0.
' HOME PHONE:
NUMM rn�lvr-:
HOME PHONE:
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erg Yea Jr
ATION &SHIFT Annual 47-A
SCHEDULED
DATE DUE 0 Aug
UFIR ► 422
CURRENT
CITY
YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
�i - /r_.
- l 7
HAZARDS FOUND AN15 LOCATIONS 1 COMMUNICATIONS
2
2
3
3
4
4
5
g
"6
fi
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:
GATE:
s
VIOLATIONS
1 15
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER
°
2
6
P
6
DATE:
CODE
5SECTION:
3
7
3
7
RETURN RECEIPT
RECEIVED
5
4
8
4
8
DATE:
DISPOSITION:
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
e
FIRE DEPARTMENT COPY
SNOHOMISH CO.
Serving Brier, Edmonds, and 12425 Meridian Ave S
Mountlake Terrace Everett, WA 98208
Phone (425) 551-1200
www.FireDistrictl.org Fax (425) 551-1272
LOCATION:
437 5 th Avenue S 98020
BUSINESS NAME: PHONE:
MacGregor Condos 0
MAILING
ADDRESS:
437 5th Avenue S, Edmonds, WA 98020
BUSINESS OWNER: HOME PHONE:
FIRE PREVENTION
_ INSPECTION REPORT
0d 6DMONDS
❑ BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY STATION & SHIFT
SCHEDULED
DATE DUE 0
Aug 2016
UFIR
422 203
EMERGENCY-1:JLt06�-4 WVES PkS4d PHONE: 5texA'i.r'f"' el CURRENT No
KEY ACCESS 2: a HOME PHONE. 5 23 CITY
MESS
EMAIL: � '�° BUSINESS
eeaC- LICENSE
&P G4f iA INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE SYSTEMS: A5 11tA 2411 E 513 w0y,
2MAQ8 AnONS 1 COMMUNICA S
1 i
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) 744-5231.