104 5TH AVE N (2)r
:)xoMiSx co. Serving Brier, Edmonds, and 12425 Meridian Ave S
1IR- Mountlake Terrace Everett, WA 98208
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Phone (425) 551-1200
www.FireDistrictl.org Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
❑ RIERNDS
IER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY
STATION & SHIFT
LOCATION:
{
104 5 th Avenue N 98020
BUSINESS NAME:
PHONE:
SCHEDULED
Advanced Hearing Systems
4257713886
DATE DUE
MAILING
UFIR /
ADDRESS:
593 203
104 5th Avenue N, Edmonds, WA 98020
BUSINESS OWNER:
HOME PHONE:
'EMERGENCY-1:
HOME PHONE: -
CURRENT
KEY-ACCESS-2: Ault, Arthur
HOME PHONE: 4255016501
CITY
YES NO
EMAIL:
BUSINESS
-
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION
DWE
NAME OF INSPECTOR: (, \ A A 1 '4
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1
2
2
3
3
4
4
5
6 _
6
7
7
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
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
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INSPECTOR:
INSPECTOR: -
INSPECTOR:
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DATE:
DATE:
DATE:
9
VIOLATIONS
VIOLATIONS:'
:
PRE -CITATION
CITATION ISSUED
6 .. _. _ _..... _ _.
DATE:
LETTER SENT
NUMBER:
CODE
- --- ...._ .-...
5SECTION•
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RETURN RECEIPT
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3
7
3
7
RECEIVED
DISPOSITION:
6
4
8
4
8
DATE:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8
ServingBrier Edmonds
_.`` 1 425=Meridian Ave S
SNOHOMISH CO.
1' ? .�
FIREMountlake
Terrace,and '
Everett, WA 98208
,DIS��
the Town of Woodway
Twww.FireDistrictl.org
Phone (425) 551-1200
Fax (425) 551-1272
LOCATION:
104 Sth Avenue
N
BUSINESS NAME:
Advanced Hearing Systems
PHONE: 4257713886
MAILING
104 6$h Ave N
ADDRESS:
Edmonds
98020
BUSINESS OWNER:
Ault, Arthur
HOME PHONE: 4255016501
EMERGENCY-1:
Cambell, Terry
HOME PHONE: 4257767900
KEY ACCESS-2:
HOME PHONE:
PERSON CONTACTED: ����/ O !� t ^ l� cc .r r
NAME OF INSPECTOR: S I�
FIRE
SYSTEMS:
FIRE PREVENTION
INSPECTION REPORT
❑ EDMONDS
❑ BRIER
❑ WOODWAY
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY STATION & SHIFT
365 17 A
SCHEDULED
DATE DUE ► 06/01/13
UFIR / 593 6203
ACTIVE
CURRENT
CITY YES NO
BUSINESS
LICENSE El El
INITIAL INSPECTION DATE
�oIioji3
FE LiZ3
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
•1
1
2
2
3
3
4
4
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:
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
5
4
18
4
18
DATE:
DISPOSITION:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8 �t '
FIRE DEPARTMENT COPY
Serving Brier, Edmonds
SNOHOMISH CO.
FIREthe
Mountlake Terrace,and
DISThfifNEIT
Town of Woodway
FireDistrict].
www org
1 LOCATION:
104 5th Avenue
f BUSINESS NAME:
Advanced Hewing Systems
MAILING
104 5th Ave N
ADDRESS:
Edmonds
BUSINESS OWNER:
Atilt, At1hur
EMERGENCY-1:
Cambell, Terry
KEY ACCESS-2:
PERSON CONTACTED: 'I r--LULL
NAME OF INSPECTOR:
FIRE
SYSTEMS:
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
N
PHONE: 4257713386
98020
FIRE PREVENTION
INSPECTION REPORT
❑ EDMONDS
❑ BRIER
❑ WOODWAY
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY
STATION & SHIFT
365
17 C
SCHEDULED
DATE DUE ► 06/01/11
UFIR ► 593
6203
HOME PHONE: 4255016501
A.C11VE
�'-r 7a�Ts6t3
HOME PHONE:
CURRENT
HOME PHONE: '12C)- t116710 0
CITY YES NO
BUSINESS
LICENSE i
INITIAL INSPECTION DATE
FE jj
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
2
2
3
3
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
3
7
3
7
RETURN RECEIPT
RECEIVED
6
ELEjER
8
[LETTER
8
DATE:
DISPOSITION:
NEEDED [3 YES ❑ NO
NEEDED ❑ YES ❑ NO
B
FIRE DEPARTMENT COPY