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107 5TH AVE N
-.;._r ' IIII�IIII /D7 "sue igVE Aj /// Serving Brier, Edmonds`, and SNOHOMISH CO. TTU rj \` „ Mountlake Terrace • www.FireDistrictl.org 12425 Meridian Ave S Everett, WA 98208 Phone (425) 551-1200 Fax (425) 551-1272 LOCATION: 107 5 th Avenue N Suite 102 98020 BUSINESS NAME:RUSty Pelican Cafe PHONE: 425299601 MAILING ADDRESS:107 5th Avenue N, Suite 102, Edmonds, WA 98020 BUSINESS OWNER: HOME PHONE: EMERGENCY-1- imberopoulos, Marilyn HOME PHONE: 4253495628 KEY ACCESS-2: HOME PHONE: EMAIL: ` 17 PERSON CONTACTED: NAME OF INSPECTOR: \ FIRE SYSTEMS: FE 4/18 HD 4Me 101/ 8 D FIRE PREVENTION INSPECTION REPORT REDMONDS BRIER ❑ MOUNTLAKE TERRACE ❑ UNINCORPORATED FREQUENCY I STATION 8 SHIFT Annual 17-C SCHEDULED DATE DUE ► Feb 2019 UFIR ► 161 203 CURRENT CITY YES NO BUSINESS ©� LICENSE INITIAL INSPECTION DATE -- 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: 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 8 4 8 DATE: DISPOSITION: 7 _ LETTER NEEDED ❑ YES ❑ NO LETTER NEEDED ❑ YES ' ❑. NO• 8