105 MAIN STSNOI9.ONIISIi CO. Serving Brier, Edmonds, and 12425 Meridian Ave S
FIRE Mountlake Terrace Everett, WA 98208
1-12
Phone (425) 55 00
DISTR T www.FireDistrictl.org Fax (425) 551-1272
LOCATION: 105 Main Street 98020
BUSINESS NAME; Ory's Of Edmonds PHONE: 42577
MAILING
ADDRESS: 105 Main Street, Edmonds, WA 98020
FIRE PREVENTION
INSPECTION REPORT
OtDMONDS
❑ BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY STATION & SHIFT
Annual 17-C
SCHEDULED Oct 2018
DATE DUE
UFIR / 161 202
BUSINESS OWNER: Norton, Mlke HOME PHONE:
EMERGENCY-1: Rory'S Inc HOME PHONE:'' CURRENT
KEY ACCESS-2: HOME PHONE: 17 CITY YES NO
BUSINESS 2,-'❑
EMAIL: LICENSE
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR: _
FIRE SYSTEMS: FE 7/16 HD 7/16
Date Last Serviced: I IN y 11 1C,� �
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
K. t4 4
2
2
3
3
4,
4
5
5
.z
6
f r,:
6
r
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:
I
INSPECTOR:
's
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE: '
3
VIOLATIONS
1 5
2 _ 6
3 7
4 8
VIOLATIONS
1 5 _
2 6
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
DATE:
CODE
SECTION:
5
-
3
7
RETURN RECEIPT
RECEIVED
6
4
--�—•
b
DATE:
DISPOSITION:
7
I 8 — _ _
LETTER NEEDED ❑ YES- - ❑ NO
LETTER NEEDED ❑ YES ❑ NO