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swot o��isx CO.Serving brier, aurrionds, and 12425 Meridian Ave S
WA 98208 ❑ EDMOBRIER S
FIR
�1 �, ;� Mountlake Terrace Everett, ❑BRIER `� Phone 425 551-1200 ❑ MOUNTLAKE TERRACE
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-UNINCORPORATED
DISTR T www.FireDistrict].org Fax (425) 551-1272
LocarloN: 7500 212 th Street SW Suites 212 & 213 98026
BUSINESS NAME: JObaBau rielst@PHONE: 4257446022
MAILING
ADDRESS: 7500 212th Street SW, Suites 212 & 213, Edmonds, WA 98026
BUSINESS OWNER: .+"'� 0 N L-.. / HOME PHONE:
- Raumel ,. —John- - 42SM3632
EMERGENCY 1 `'�-----^ HOME PHONE:
HOME PHONE: 2 W&
EMAIL: '9Z 7- UZ / e
PERSON CONTACTED:
NAME OF INSPECTOR:
Date Last Serviced:
FREQUENCY STATION & SHIFT
2016 16-B
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SCHEDULED Dec 2016
DATE DUE /
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CURRENT
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INITIAL INSPECTI N DATE
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HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE -INSPECTION .
< FINAL RE -INSPECTION
r EXTENSION VIOLATIONS
DATE DUE
DATE DUE.
GRANTED TO DATE DUE- CITED:
PERSON
PERSON
€ PERSON.
CONTACTED:
CONTACTED:
`'. CONTACTED:
INSPECTOR:
INSPECTOR.
= INSPECTOR- 2
DATE:
DATE:
3
DATE'
VIOLATIONS
VIOLATIONS
_
PRE -CITATION i 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 • 6
---.
- _
DISPOSITIONS
4 i 8
4 8
DATE: 7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
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Serving Brief; Edmonds
Mountlake Terrace,and
the Town of Woodway
www.FireDistrictl.org
LOCATION: 7500 212th St SW
BUSINESS NAME: Jahn Baumeister DO
MAILING 7500 212th St Slid #212
ADDRESS: Edmunds
BUSINESS OWNER: Baumeister, T. Jahn
EMERGENCY-1: Cell #
KEY ACCESS-2:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS:
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
212/213
PHONE: 4257446022
93026
HOME PHONE: 4256703632
HOME PHONE: 4254788939
HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
❑ EDMONDS
❑ BRIER
❑ WOODWAY
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY I STATION & SHIFT
731 16 D
SCHEDULED
DATE DUE ► 12101111
UFIR ► 593 1 s157
CURRENT
CITY
BUSINESS
Yes No
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LICENSE
INITIAL INSPPE TION11DATE
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
l/r "
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:
I
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
8
4
18
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8
FIRE DEPARTMENT COPY
BLDG I
CITY OF EDMONDS ECON DEV FIRE
BUSINESS
BUSINESS LICENSE APPLICATION-COMMERCIALMAYOR
FEE$65 PLAN
CITY CLERK'S OFFICE, BU•SIINESS LICENSE DIVISION POLICE
121 5T" AVENUE NORTH, EDMONDS, WA 98020 PHONE: 425.775.2525UnL BILL.
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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 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 ilS�� 212_7 N S_TIZ V,___i SW 2 /�J2tO
Street Suite No. Zip Code
MAILING ADDRESS S A'ME
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BUSINESS PHONE NO. (_4_25) [rPT / 44— �[/L1e.OZZ WA STATE TAX ID NO. (UBI NO.) O
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PROPERTY OWNER
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Last Name First Name MI Phone No.
Last Name First Name Mi Phone No.
NATURE OF BUSINESS
NUMBER OF EMPLOYEES 3 SQUARE FOOTAGE. OF BUSINESS SPACE I!466
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 SERVICES O WHOLESALE O OTHER
AMUSEMENT DEVICES ON PREMISES? O YES KNO IF YES, TOTAL NUMBER
LIQUOR SOLD ON PREMISES?: O YES XNO GAMBLING? O YES )(NO CIGARETTES SOLD ON PREMISES? O YES XNO
FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED?: O YES KNO IF YES, PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES:
PROPOSED OPENING DAY OF BUSINESS D� f BUSINESS HOURS
Tu-IF 9-.-
DAYS OPEN O SUNDAY O MONDAY (!lFTUESDAY VWEDNESDAY X HURSDAY )a FRIDAY O SATURDAY
PARKING SPACES ON SITE: TOTAL ACCESSIBLE FOR PERSONS WITH DISABILITIES LIeS
DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES? YES O NO
PREVIOUS BUSINESS USE AT THIS ADDRESS 1Me1j (4i�j 0�ckC-e k2r—
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HOME PHONE NOH(
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CRY USE ONLY:
PLANNINGDEPT.
OAPPRCVE
C EISAPPROVE
DATE
SIGNATURE
ZONING CODE
CONDITIONAL USE PERMIT
COMMENTS
BUILDING DEPT.
OAPPROVE
O DISAPPROVE
DATE
SIGNATURE
OCCUPANT LOAD
BUILDING PERMIT
OCCUPANCYGROUP
COMMENTS
FIRE DEPT.
0APPROVE
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DATE
SIGNATURE
U.F.I.R.
COMMENTS
POLICE DEPT.
OAPPROVE
ODISAPPROVE
DATE
SIGNATURE
COMMENTS
CEWWF� 1ITY OF EDMONDS
SINESS LICENSE APPLICATION.
FEE: $65
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N 14 2007 CITY CLERK'S OFFICE, BUSINESS LICEI`
121 5T" AVENUE NORTH, EDMONDS, WA 98020
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parties concerned. If no middle name, please indicate by writing NMN. Sign and return application with fee. Please advise of
any change in status. N license required if business changes lotion or ow ership. Notification to City of Edmonds required
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CUSIBUSINESS NAME
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NATURE OF BUSINESS
NUMBER OF EMPLOYEES SQUARE FOOTAGE OF BUSINESS SPACE 67C�r
TYPE OF BUSINESS - PLEASE CHECK THE APPROPRIATE CATEGORY:
O CONSTRUCTION O FINANCE, INSURANEAL ESTATE O LANDSCAPE, HORTICULTURAL O MANUFACTURING O NON-PROFIT
O RETAIL O SECONDHAND DEALER SERVICES O WHOLESALE O OTHER
AMUSEMENT DEVICES ON PREMISES? Cl YES MIN 0 IF YES, TOTAL NUMBER
LIQUOR SOLD ON PREMISES?: O YES 2<01 GAMBLING? O YES 91N0 CIGARETTES SOLD ON PREMISES? O YES WAO
FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED?: O YES VIVO IF YES, PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES:
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7500 Building Mai
EDMONDS, WASHINGTON
Floor
N, SCALE: 3/32'.I'-0'
Partners
PROJECT: 15M WILDING
LOCATION, EDMONDS, WASHMGTON
DATE, JUNE 14, 2006
STATE OF WASHINGTON
HEALTH PROFESSIONS QUALITY ASSURANCE DIVISION
THIS CERTIFIES THAT THE PERSON OR ESTABLISHMENT NAMED HEREON IS AUTHORIZED AS PROVIDED BY LAW AS A
I�
SECRETAR ' V
NUMBER
------------
MA00010027
DATE ISSUED EXPIRATION DATE
i
j 01-22-97 03-22-08
PERSONAL COPY OF YOUR LICENSE
STATE OF WASHINGTON
HEALTH PROFESSIONS QUALITY ASSURANCE DIVISION
:MASSAGE PRACTITIONER
ACTIVE
OLIVETO. RYONG B.
5524 ORCA DR NE
-TACOMA. WA 984 r,
SECRETARY
NUMBER EXPIRATION DATE
MA00010027 03-22-08