1041 5TH AVE S (2).pdfr
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SNOliomisli Co.Serving Brier, Edmonds, ' a ' nd 12425 Meridian Ave S'
FI��Mountlake Terrace.,. Everett, WA 98208'
Phone (425) 551-1200
DISTR T www.FireDistr.ict1.org Fax (425) 551-1272
1041 5 th Avenue S 98020L, FMOMY
STATItArAr-'8HIFT
LOCATION:
Dorchester Condos 42514424 _r 917117
BUSINESS NAME: PHONE: SCHEDULEDDATE DUQ7 153
MAILING1 041 5th Avenue S, #12, Edmonds, WA 98020 uFIR ►
ADDRESS:
BUSINESS OWNER: HOME PHONE:
C Ward, Joyce 41 254 76
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EMERGENCY-1: HOME PHONE: CURRENT
NO
A KEY ACCESS-2: HOME PHONE: CITY S
BUSINESS
EMAIL: LICENSE -
PERSON CONTACTED: w i A, 7kA INITIAL INSPECTION DATE
PECTOR: (Z- let — I
F RE
Date Last Serviced:
FIRE PREVENTION
INSPECTION REPORT
[XDMONDS
0 BRIER
0 MOUNTLAKE TERRACE
[I UNINCORPORATED
HAZARDS FOUND ANDILOCAT?,�N 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:
3
VIOLATIONS
1
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15
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VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
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DATE:
CODE
SECTION:
5
3
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RETURN RECEIPT
RECEIVED
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DATE:
DISPOSITION:
k�LETTER NEEDED El 'YES [_1 NO
LETTER NEEDED ,-�,p YES [-I NO
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