100 2ND AVE S STE 3901111111 rj'6'0
ZND � Lj_rf f i C34 0 FIRE PREVENTION
Serving Brier, Ea
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
FIRE Mountlake Terrace, and
Everett, WA 98208
❑❑RIERBRIER S
the Town of Woodway
DIS R
Phone (425) 551-1200
❑ WOODWAY
❑ AKE TERRACE
www.FireDistrictl.org
g
Fax 425 551-1272
( )
UNINCORPORATED
❑UNINCORPORATED
FREQUENCY STATION & SHIFT
LOCATION: 100 2nd Avenue S
390
730 17 B
BUSINESS NAME: Cory Heins
PHONE: 42464009g6SCHEDULED
DATE DATE DUE
LAQ'S aura—
MAILING 100 2nd Ave S #390
UFIR ► 591 1202
ADDRESS: Edmonds
98020
BUSINESS OWNER: Heins, Cory
HOME PHONE: 4257753421
ACTIVE
EMERGENCY-1:
HOME PHONE:
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
LICENSE
PERSON CONTACTED: 1 YI
'I
INITIAL INSPECTION DAT
17,
7 r
NAME OF INSPECTOR: � � �.
FIRE
SYSTEMS:
1A
ANNEAL,
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
,1
1
2
2
3
3
4
4,
a
5
5
6
6
7
7
1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:
1
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
8
4
18
DATE:
DISPOSITION:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8
FIRE DEPARTMENT COPY
- CITY- OF EDMONDS
121 5TM AVENUE N. • EDMONDS, WASHINGTON 98020 • (425) 771-0215
FIRE DEPARTMENT
46'S t 1 890
LOCATION: 100 2nd Avenue S
In
BUSINESS NAME: Cory Heins
MAILING 100 2nd Ave S #390
FIRE PREVENTION
SAFETY SURVEY
390
PHONE: 4256700285
ADDRESS: Edmonds 98020
BUSINESS OWNER: Heins, Dory HOME PHONE: 4257753421
EMERGENCY-1: HOME PHONE:
KEY ACCESS-2: HOME PHONE:
FREQUENCY
STATION & SHIFT
730
17 D
SCHEDULDATE DUES ►
11/01/10
UFIR ► 591
1202
ACTIVE
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR: I
FIRE FE _f fZ
1� SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1
ENTER CODE ONLY ONCE ►
VIOLATION CODE
1
2
Y ��
t x kl
2
3
3
4
4
5
5
6
6
7
7
8
8
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
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 [ YES NO
LETTER NEEDED [] YES E] NO
FIRE DEPARTMENT COPY