10514 243RD PL SWZ q'390
;R FIRE PREVENTION
CITY OF EDMONDS SAFETY SURVEY
121 5T";AVENUE N. • EDMONDS, WASHINGTON 98020 • (425) 771-0215
FIRE DEPARTMENT
�St.I r%j
LOCATION: 10514 243rd Place SW
BUSINESS NAME: Silver Olen AFH PHONE: 2065424025
MAILING 10514 243rd Place SW
ADDRESS: Edmunds 98026
STAT,g6& SHIFT -)
SCHEDULED 06l01109
DATE DUE ►
UFIR ► 411 311 6 003
BUSINESS OWNER: °13uxton, Karen° HOME PHONE: 2065424025 ACTIVE
EMERGENCY-1 HOME PHONE:
KEY ACCESS-2: HOME PHONE:
INITIAL INSPECTION DATE
PERSON CONTACTED: % '
NAME OF INSPECTOR: `3
FIRE
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1
ENTER CODE ONLY ONCE ►
VIOLATION CODE
1
2.
2
3
3
4
4
5
5
6
6
7
7
8
8
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: of
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
7
4
18
4
8
DATE:
DISPOSITION:
8
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
FIRE DEPARTMENT COPY
MEMORANDUM
DATE
REPORTED BY W�� OF
SUBJECT
ADDRESS: �� S I Z� �L • S"V
CONCERNS/
HAZARDS:
g () I-lra�pV
FOLLOW-UP:
rNTEREaI
I.D.
411131I06#W-3
�C-
SIGNED
l/1/ �C/s v-s� c.v� �,ia�,�,�.� .J eve-.�.,� 3 �'•) Y /ZS.
SIGNED %,. '` 1
r
City of Edmonds Office of Fire Prevention