102 MAIN ST02 11.14Ta f Re
s n�isx Co.Serving Brier, Edmonds, and 12425 Meridian Ave S rroxa
FIREMountlake Terrace Everett, WA 98208
DISTR T Phone (425) 551-1200
www FireDistrictl. org Fax (425) 551-1272
LOCATION: 102 Main Street 98020
BUSINESS NAME:Copper Pot Indian Bar and Grill PHONE: 4254637&
MAILING
ADDRESS:1,0653 Avondale Rd NE, Redmond, WA 98052
BUSINESS OWNERpadmanabha, Mamatha +u OME PHONE:
f EMERGENCY-1: t HOME PHONE:
KEY ACCESS-2: HOME PHONE: 4254637808
17
EMAIL:
PERSON CONTACTED: o
NAME OF INSPECTOR: A V J /Se ^�� �Cj
FIRE SYSTEMS: FE 9/15 UL300 2/16
FIRE PREVENTION
IN PECTION REPORT
EDMONDS
BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY STATION & SHIFT
Annual 17-B
SCHEDULED
DATE DUE ► Nov 2018
UFIR ► 0 202
CURRENT CITY YES No
BUSINESS ❑
LICENSE
INITIAL INSPECTION DATE
1-3-19
('LOCATIONS / COMMUNICATIONS
t
a
2
3
-
—
2
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:
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
Z 7—
3
7
3
7
RETURN RECEIPT
RECEIVED
4
8
4
8
DATE:
DISPOSITION:
WV/
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑. NO
d.