1011 PUGET DR_2SNOHOMISEi CO.
FIRE
IIII��III loll DP
Serving Brier, Edmonds, and 12425 Meridian Ave S
Mountlake Terrace Everett, WA 98208
Phone (425) 551-1200
DIST t Driww WistrictL org Fax (425) 551-1272
LocaTION:Olympic View Deli 425776089E
BUSINESS NAME: PHONE:
1011 Puget Drive, Edmonds, WA 98020
MAILING
ADDRESS:Chang, Moung
BUSINESS OWNER:PaI C, JIn HOME PHONE: �7184900633
FIRE PREVENTION
IN ECTION REPORT
EDMONDS
❑ BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
Annual 17-D
FREQUENCY R• . STATION 8 SHIFT
N v,2017
SCHEDULS71
DATE DUE
UFIR /
EMEG GY:1. HOME PHONE: CURRENT
�~—kE ACCESS-2: )} HOME PHONE; CITY YES NO
moo, t t,3 14,00- ccl+�a BUSINESS
EMAIL: hG PP I y LICENSE
PERSON CONTACTED: j I INITIAL INSPECTION DATE
IRE SYSTEMS: fRE 2/17 G C1 �-L —" \
NAME OF INSPECT ,
HAZARDS FOUND AND LOCAT ON
1V �� p
/ COMMUNICATIONS
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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:
DATE:
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VIOLATIONS
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VIOLATIONS
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PRE -CITATION
LETTER SENT
- CITATION ISSUED
NUMBER:
4
DATE:
CODE
SECTION:
5
3
7
RETURN RECEIPT
RECEIVED
8
4
8
DATE:
DISPOSITION:
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
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