108 5TH AVE S (2)SNOHOMISII CO.
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Serving Brier, Edmonds, and 12425 Meridian Ave S
Mountlake Terrace Everett, WA 98208
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LocarloN: 108 5 th Avenue S 98020
BUSINESS NAME: Coldwell Banker Bain Assoc
MAILING
ADDRESS: 108 5th Avenue S, Edmonds, WA 98020
BUSINESS OWNER: Purser, Wayne
EMERGENCY-1: -bYe 14a N2,S
KEY ACCESS-2: pp
EMAIL: (46t+�s' er
PERSON CONTACTED:1. (� TL�ow•o-�
NAME OF INSPECTOR:
FIRE SYSTEMS: FE /
Phone (425) 551-1200
Fax (425) 551-1272
PHONE: 4257711000
FIRE PREVENTION
INSPECTION REPORT
.0t`&MONDS
❑ BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY 7STATION &SHIFT .
2016* D
SCHEDULED
DATE DUE ► Feb 2016,
FRO591 202
HOME PHONE:
HOME PHONE:61647 05-330
CURRENT
HOME PHONE:
CITY YES NO
BUSINESS r
LICENSE
INITIAL INSPECTION DATE
Date Last Serviced:
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE: 3 �Z/
PERSON j
CONTACTED: J,S
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
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INSPECTOR: C_. ' l 7 "I
INSPECTOR:
INSPECTOR:
2
DATE: _
DATE:
DATE:
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10LLATIONS-�
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
8
4 -
8
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8
CITY OF EDMONDS
121 5TM AVENUE N. • EDMONDS, WASHINGTON 98020 • (425) 771-0215
FIRE DEPARTMENT
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LOCATION: 1O8 5th Avenue S
BUSINESS NAME: ColdWell Banker Bain Assoc.
MAILING 108 5th Ave S
FIRE PREVENTION
SAFETY SURVEY
PHONE: 4257711000
ADDRESS: Edmonds 98020
BUSINESS OWNER: Nurser, Wayne HOME PHONE: 2062352693
EMERGENCY-1: HOME PHONE:
KEY ACCESS-2: Betchzoff, Jane HOME PHONE: 4253435665
FREQUENCY STATION & SHIFT
731 17 C
SCHEDULDATE DUES ► 02/01/11
UFIR ► 591 2202
ACTIVE
PERSON CONTACTED: Sv-ti^ INITIAL INSPECTION DATE
NAME OF INSPECTOR: 4 B (p 1/ 11 1 if
FIRE FE 1r If
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS /
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
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
, +,
7
4
18
4 18
1 DATE:
DISPOSITION:
8
LETTER NEEDED YES NO
LETTER NEEDED 0 YES NO
FIRE DEPARTMENT COPY