109 MAIN ST STE 1- %} M � ,I III I�! III v � , r / � �� ✓ % IC �
SNO
F
D
Serving Brier, Edmonds, and
Mountlake Terrace
www.FireDistrictl.org
LOCATION: 109 Main Street Suite 1 98020
BUSINESS NAME: Gafe
l
MAILING
ADDRESS: PO BOX #674, Edmonds, WA 98020
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
� : i�� : � ��Y'►riii��.r.
INSPECTION REPORT
EDMONDS
❑ BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY STATION & SHIFT
Annual 17-C
PHONE: _42,C7_7_i23'5SCHEDULED Oct 2018
DATE DUE
LijC- (e-7i;- UFIR / 513202
BUSINESS OWNER:Firmin, Bercla HOME PHONE:
EMERGENCY-1: j e,1 /1, i (G TJ'" HOME PHONE: ,
CURRENT YEs No
KEY ACCESS-2: HOME PHONE: 17 CITY ❑
BUSINESS
EMAIL: �� v / ti t . �'S ' %.n- LICENSE
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE SYSTEMS: FE 8/15 HD 8/15
Date Last Serviced: I I I I I I I'd
HAZARDS FOUND AND 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
_
8
3
7
3
7
RETURN RECEIPT
RECEIVED
4
8
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED 0 YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8