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:- FIRE PREVENTION
Serving Brier, Edmonds, and
Mountlake Terrace
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
INSPECTION REPORT
❑ EDMONDS
❑ BRIER
❑ MOUNTLAKE TERRACE
;
❑ UNINCORPORATED
{ ;�
Annual 17-A
;
FREQUENCY
STATION & SHIFT
LOCATION:5th Avenue Condos
N
v 2017
SCHEDUL4i27 152
BUSINESS NAME: PHONE:
DATE DUE
600 1st Avenue S, Suite 66, Seattle, WA 95104
MAILING
UFIR /
ADDRESS.OIsen, Tim #14
BUSINESS OWNER: HOME PHONE:
17
EMERGENCY-1: HOME PHONE:
CURRENT
KEY ACCESS-2: HOME PHONE:
CITY YES NO
N
A
BUSINESS
EMAIL:
LICENSE
PERSON CONTACTED: NA
INITIAL INSPE TIONNDD TE
IRE SNAME OF INSPECT�i ,12/16
12:00:00 AM S I •
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HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1
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1 .
2
2
3
3
4
4.
5
5
6
6
7
Y
I AGREE TO CORRECT THE ABOVE VIOLATION(S)'IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
E)CTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
2 6
VIOLATIONS
1 5
2 6
3 7
4 8
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
DATE:
CODE
SECTION:
5
3
7
RETURN RECEIPT
RECEIVED
e
4
8
DATE:
DISPOSITION:
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
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