110 3RD AVE N%`
Serving Brier, Edmonds, and 12425 Meridian Ave S
,3NOROMISH Co
FIRountlake Terrace Everett, WA 98208
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Phone (425) 551-1200
Twww.FireDistricti.org Fax (425) 551-1272
LOCATION: 110 3 rd Avenue N Bldg 98020
BUSINESS NAME:
Bayview Plaza PHONE: 4256702444
MAILING 110 3rd Avenue N, Bldg, Edmonds, WA 98020
ADDRESS:
Jim
BUSINESS OWNER: HOME PHONE:
EMERGENCY-1:
Markezinis, Jimmy HOME PHONE: 4254784603
17
KEY ACCESS-2: HOME PHONE:
EMAIL:
PERSON CONTACTED: 00 1/10(A- x c
NAME OF INSPECTOR: I4,,,�. >r„✓
Date Last Serviced:
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
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FIRE PREVENTION
INSPECTION REPORT
❑ EDMONDS
❑ BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
AnnualcY STATION SHIFT
SCHEDULED Oct 2017
DATE DUE 1'
509202
UFIR /
CURRENT
CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
(163
1
K
4
6
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE -INSPECTION
FINAL RE -INSPECTION
EXTENSION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTED TO:
I DATE DUE:
CITED:
PERSON
PERSON
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CONTACTED:
CONTACTED:
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INSPECTOR:
INSPECTOR:
`•, INSPECTOR:
2
DATE:
DATE:
;DATE:
' 3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
1 5
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LETTER SENT
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NUMBER:
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CODE
5
2 6
2 6
DATE:
SECTION:
RETURN RECEIPT
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3 7
RECEIVED
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DISPOSITION:
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LETTER NEEDED ❑ YES El NO
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LETTER NEEDED ❑ YES ❑ NO
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