107 5TH AVE N STE 102IIII��III o �-� N1I1ILI a Z
v ` FIRE PREVENTION
CITY OF E D M O N DS SAFETY SURVEY
121 5TM AVENUE N. • EDMONDS, WASHINGTON 98020 • (425) 771-0215
FIRE DEPARTMENT
"'st.
1890
LOCATION:
107 5th Avenue
BUSINESS NAME:
Edward Janes
MAILING
107 5th Ave N #102
ADDRESS:
Edmonds
BUSINESS OWNER:
Edward D. Janes & Co.
EMERGENCY-1:
�--n RQQ L 1 k-` M
KEY ACCESS-2:
Lawrence, Alan
N 102
PHONE: 4256701988 ,
98020
FREQUENCY
STATION 8 SHIFT
730,
17 C
SCH'DATEEDUEE ►
02101111
UFIR ► 591
2202
HOME PHONE: ACTIVE
HOME PHONE: 4@ ZO ai I 25'S Z
HOMEPHONE: 3605094402
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE FE k!
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
r4 6 fo itv o
ENTER CODE ONLY ONCE ►
VIOLATION CODE
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 J
CONTACTED:
PERSON
CONTACTED:
1
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
8
4
8
DATE:
DISPOSITION:
7
8
LETTER NEEDED YES NO
LETTER NEEDED [ YES NO
FIRE DEPARTMENT COPY