104 5TH AVE SCC
III I��III 10 qt)C
Serving Brier, Edmonds, and 12425 Meridian Ave S
Mountlake Terrace Everett, WA 98208
Phone (425) 551-1200
www.FireDistrictl.org Fax (425) 551-1272
LOCATION: 104 5 th Avenue S 98020
BUSINESS NAME: Wooden Spoon
MAILING
ADDRESS: 104 5th Avenue S, Edmonds, WA 98020
BUSINESSbWNER:
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FIRE PREVENTION
INSPECTION REPORT
OfDMONDS
BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY STATION & SHIFT
2015 17-D
SCHEDULED
DATE DUE ► Feb 2016
UFIR ► 582 202
HOME PHONE:
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HOME PHONE: 42577$m
CURRENT
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BUSINESS
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INITIAL INSPECTION DATE
FIRE SYSTEMS: FE 3 / %J Z eX� T•JG u,rJN��2S ��dC�
NO
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
2
2
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4.
5
6
4
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:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
2 6
3 7
VIOLATIONS:-
1 _
2
3
5 ".
6
7
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
DATE:
CODE
SECTION:
DISPOSITION: -�
5
5
RETURN RECEIPT
RECEIVED
DATE: _
4
8
7
8
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES. ❑ NO
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r Serving Brier Edihondq
SNOHOMIsx CO.,.
'Mountlake Terraceland
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the Town of Woodway
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www.FireDistrictl.org
LOCATION:
104 51h Avenue
BUSINESS NAME:
Wooden Spoon
MAILING
104 5th Ave S
ADDRESS:
�
Edmonds
BUSINESS OWNER:
,
EMERGENCY-1:
Shure, Jennifer
`x KEY ACCESS-2:
Null, Joan
I PERSON CONTACTED: UO<7/)
\ NAME OF INSPECTOR:
FIRE
SYSTEMS:
1M
S
r3i`!
FIRE PREVENTION
12425 Meridian Ave S INSPECTION REPORT
Everett, WA 98208 ❑ ❑ BRIER S
BRIER
Phone (425) 551-1200 ❑ WOODWAY
KE
Fax (425) 551-1272 D UNINCORPORAT DACE
PHONE: 4257753344
98020
HOME PHONE: 462$6
HOME PHONE: 4257743038
HOME PHONE: 4257712649
r
FREQUENCY
`- . 365
STATION & SHIFT
17 D
SCHEDULED ®21r0 i11i
DATE DUE
UFIR'/ 582
2202
ACTIVE
CURRENT CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
ZZ- /Z
FE Mfj
ANNUAL.
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
2
2
3
3
:.3
4
4
5
,'
5
6
6
u
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:
i
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED: i
t
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
4
18
4
18
DATE:
DISPOSITION:
7
LETTER NEEDED ,❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
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FIRE DEPARTMENT COPY