1005 5TH AVE SFIRE PREVENTION
".I INSPECTION REPORT
ss�c���um>s�� co Serving Brier, Edmonds, and 12425 Meridian Ave S
Mountlake Terrace Everett, 4A 98208 ❑ EDMONDS
FI E ❑BRIER
DI TitT Phone (425) 551-1200 ❑ UNINCORPORATED
AKE TERRACE
www.FireDistrictl.org org Fax (425) 551-1272 UNINCORPORATED
1005 5 th Avenue S 98020 I'MOMMY STAT HIFr
LOCATION:
Executive Condos(&1001) 4257753207
BUSINESS NAME: PHONE: SCHEDULED
DATE DUE
MAILIN . UFIR ►
ADDRESS:
Johnson, Kurt - IbA ('r,S
BUSINESS OWNER: s;'S a'-'^ P o.1 1%t - p_ 1 HOME PHONE:l5Ng
GlflfiS, ,4rtCly 426709192
EMERGENCY-1: HOME PHONE: 17 CURRENT
KEY ACCESS-2: HOME PHONE: CITY YES NO
1
EMAIL: S�QW (�i' Eo v �I (!c . e. rr BUSINESS CJ
LICENSE
PERSON CONTACTED: 5V5&A- PW-4r it.. l INITIAL INSPECTION DATE
F SPECTOR:a�.-1
Date Last Serviced: F.
kt. ,z ka�s
HAZARDS FOUND AND eLOCATIONS
(/ COMMUNICATI NS
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION 2nd RE -INSPECTION EXTENSION FINAL RE -INSPECTION
VIOLATIONS
DATE DUE. DATE DUE: GRANTED TO _' DATE DUE: CITED.
PERSON PERSON
PERSON
CONTACTED: CONTACTED: I
CONTACTED:
INSPECTOR: INSPECTOR: ;INSPECTOR: 2
I
3
DATE: [DATE:
VIOLATIONS VIOLATIONS PRE -CITATION CITATION ISSUED
i ! NUMBER:1 4
RSENT
LEfTE
;CODE I
2 3 6 2 16 GATE i SECTION: ` 5
,........ ....... .. »-..,.. .._,_»__.�_,.__,.._._.A..._ ... _�ds._ _.... i-___�___.......___.�.. RETURN RECEIPT
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DtsPoslnoN:
7
LETTER NEEDED ❑ YES El NO LETTER NEEDED ❑ YES El NO ' 8