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7500 212TH ST SW STE 210 (2)-6pgs_RedactedZ12-+h ST Sty �� tUC I FIRE,PREVENTION :. , , INSPECTION REPORT -- Serving Brier, Eamonasand 12425 Meridian Ave S SNOF10N11SF1 Co. ❑ EDMONDS FIREMountlake Terrace Everett, WA 98208 ❑ BRIER DIET T wwwPhone (425) ssI -1200 ❑ MOUNTLAKE TERRACE .FireDistrictl.org Fax (425) 551-1272 ❑ UNINCORPORATED LOCATION: 7500 212 th Street SW Suite 210 98026 BUSINESS NAME: Radiant Rejuvenation & C S PHONE: 4257127546 MAILING ADDRESS: 7500 212th Street SW, Suite 210, Edmonds, WA 98026 FREQUENCY STTey SHIFT SCHEDULED Dec 2016 DATE DUE / 593 UFIR / BUSINESS OWNER: HOME PHONE: EMERGENCY-1: Lau, Michael HOME PHONE: 4257732673 CURRENT KEY ACCESS-2: HOME PHONE: CITY YES NO EMAIL: BUSINESS LICENSE PERSON CONTACTED: INITIAL INSPECTION DATE � C /�) '�s ; jl NAME OF INSPECTOR: n i r, J O Date Last Serviced: FIRE, PREVENTION SNOHC3ivlISH CO. Serving Brier, Edrnonds, and 12425 Meridian Ave S INSPECTION REPORT EDMO Mountlake Terrace Everett, WA 98208 ❑ BRIER S FIRE ❑RIER Phone (425) 551-1200 ❑ UNINCO AKE TERRACE DISTR T www.FireDistrict].org Fax (425) 551-1272 ❑NINCORPORATED FREQUENCY STATION & SHIFT LOCATION: 7500 212 th Street SW Suites 208-210 98026 2016 16-B BUSINESS NAME: Therapy Solutions&Healthcare PHONE: 4257756547 SCHEDULED Dec 2016 DATE DUE ► MAILING UFIR ► 593 ADDRESS:7500 212th Street SW, Suites 208-210, Edmonds, WA 98026 BUSINESS OWNER: Jackson, Gail HOME PHONE: EMERGENCY- 1:Premere Rehab LLC HOME PHONE: 5035703405 CURRENT KEY ACCESS-2: HOME PHONE: CITY YES NO EMAIL: BUSINESS ❑ ❑ LICENSE ' ' INITIAL INSPECTION DATE PERSON CONTACTED e I NAME OF INSPECTOR: �� FIRE SYSTEMS: . FE 5 I ZI Date Last Serviced: ,b 'f FIRE PREVENTION � SNOHOMISH CO. Sel'1 lllg BI"lel; Edmonds 12425 4_ 5 Mel•Idlatt Ave S INSPECTION REPORT ' I Mountlake Terl•ace,and FIRE Everett, WA 98208 ❑ EDMONDS El BRIER - the Town of Woodway STR T Phone (425) 551-1200 ❑WOODWAY ❑ AKE TERRACE WWW.Fl1•eDlStl'ICt1.Ol'g Fax (425) 551-1272 UNINCORPORATED ❑UNINCORPORATED FREQUENCY STATION & SHIFT LOCATION: 7500 212th S$ SW 210 730 16 O I BUSINESS NAME: Radiant Rejuvenation & C S PHONE: 4257127546 SCHEDULED t DATE DUE ► 12,01/11 MAILING ''7500 212th St SW #210 UFIR ► 593 1�157 ADDRESS: Edmonds 98026 BUSINESS OWNER: Lau, Michael HOME PHONE: 4257732673 EMERGENCY-1: Clay Enterprises HOME PHONE: 4257761234 CURRENT KEY ACCESS-2: (lPpmir�r SUSan HOME PHONE: 2062276353 CITY YES NO BUSINESS ❑ LICENSE PERSON CONTACTED: INITIAL INSPECTIOP DA E I NAME OF INSPECTOR: / 1 FIRE F SYSTEMS: ANNUAL HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 1 ^ 1 2 2 3 �t 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: d., EXTENSION GRANTED TO: FINAL RE -INSPECTION DATE DUE:CITED:i=-. VIOLATIONS ' PERSON CONTACTED: PERSON CONTACTED: PERSONii`•.. CONTACTED: " 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 4 8 4 $'; DATE: DISPOSITION: LETTER NEEDED ❑ YES ❑ NO LETTER NEEDED Q YES ❑ NO g FIRE DEPARTMENT COPY CITY OF EDMONDS BUSINESS LICENSE APPLICATION- COMMERCIAL FEE: $125.00 CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION /*C. 1%9' 121 5T" AVENUE NORTH, EDMONDS, WA 98020 PHONE: 425.775.2525 OFFICE USE ONLY BLit Customer# 3 I sic Year 0 / Class SHD Date Paid �6- TR# oa/ G- Fee Paid S Mailed Delete k 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 a �- BUSINESS ADDRESS '745 OO -SA '��`� -S\.� to © a Q, Street Suite No. Zip Code MAILING ADDRESS 5 Od `�� �� S'Ls`v �J�"'`' �1 � vo r--A V`-%A ��® L Street or PO Box Suite No. City, State and Zip Code q BUSINESS PHONE NO. N�� , ���� "AYJIK.. WA STATE TAX ID NO. (UBI NO.) Q-0 I � �J 5 L \ r BUSINESS E-MAIL t Q � r BUSINESS WEBSITE \r t);' ) rA& rye t 1,14a-A QAn I;! PROPERTY OWNER C'_A.W A Name EMERGENCY NOTIFICATION (For Premise Access in Emergency): First Name MI Last Name NATURE OF BUSINESS NUMBER OF EMPLOYEES I SQUARE FOOTAGE OF BUSINESS SPACE TYPE OF BUSINESS - PLEASE CHECK THE APPROPRIATE CATEGORY: yI� 5 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 OCNO IF YES, TOTAL NUMBER LIQUOR SOLD ON PREMISES?: O YES O NO GAMBLING? O YES W NO CIGARETTES SOLD ON PREMISES? O YES �V' NO FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED?: O YES IQ NO IF YES, PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES: PROPOSED OPENING DAY OF BUSINESS --'309N 'j t1 1 SI BUSINESS HOURS V . rj g 1 DAYS OPEN O SUNDAY IXMONDAY V TUESDAY V WEDNESDAY 72THURSDAY kPFRIDAY O SATURDAY t PARKING SPACES ON SITE: TOTAL rliq Aj __-ACCESSIBLE FOR PERSONS WITH DISABILITIES DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES? `YES O NO PREVIOUS BUSINESS USE AT THIS ADDRESS v\ V- A HOME PHONE N0.A2i5)2Va-a2a DOL NO. DRIVERS LICENSE NO.) OR OTHER ID NO. WTEOP BIRTN]a a� CIttANDSTRTE Of BIRTH A1a�o_. SAP IA IXUNTRY OF GIRTH U.� ERROR Apt. NO„Und NO. City, Sole and ZP Code HOME PHONE NO(_J OOL ND.(DRIVERS LICENSE NO.) GR OTHER ID NO. WTEUPBUTH GTYAND STATE OF BIRTH COUNTRY OFBIRTH PARTNERSNI®-PANTPoERZ ADDRESS SM1eN API.NO.. UpNo. CDy,SbM eMDDCode HOVEPHONENO.0 OCL NO (DRIVERS LICENSE Ni OTHER ONO. DATEOFBUTH CITYANDSTATEOFBMTX COUfTRYOFSIRTX _.. CORPDRAYION - - - NAMEOFCORPORATIOV FEDERALTAXIDNO. CORP.AODRESS PHONE SuaN Style. Apl. Unit NO. 6ry. GlNe elq Lp Cade CORPORATEOFFCERS: LeMNemP RNNam MI TNe Dated BlM DOL NO. tDdegR Clue Nut or Offer 10 No. LOLRICONTACT bfl Nang F'rrSl Name MI TiW PM NO. DOLfb.tDrNeR LiG NO.IrcO1Mr Np CITY USE ONLY: P HNGDEPT. OAPPRDVE ODISAPPROVE DATE SIGNATURE ZONING CODE COEDRIomvl WE PERMD COMMENTS SUILDNGUEPT. OAPPROVE OOISAPPRONE DATE SIGNATURE OCCUPANT LORD BUILONG PERMR OCCUPANCY GROUP COMMENTS ME DEPT. G APPROVE O DISAPPROVE DATE SIGNATURE LLP.LR EOW! T3 POLICEDEPT. ORPPROVE C OSAPPROVE DATE SIGNATURE_ COMMEN S . . . a