110 3RD AVE N (2)SNOliOM1SH CO.
FIRE
DISTR
IIII��III i r v 390 /90Z A)
Serving Brier, Edmonds, and 12425 Meridian Ave S
Mountlake Terrace Everett, WA 98208
Phone (425) 551-1200
www.FireDistrictl.org Fax (425) 551-1272
LOCATION: 110 3 rd Avenue N Bldg 98020
BUSINESS NAME: BayvieW Plaza PHONE: 42567024,
MAILING
ADDRESS:110 3rd Avenue N, Bldg, Edmonds, WA 98020
BUSINESS OWNER: Jim HOME PHONE:
EMERGENCY-1:MarkeziniS, Jimmy HOME PHONE: 4254784603
KEY ACCESS-2: HOME PHONE: 17
EMAIL:
PERSON CONTACTED:
NAME OF INSPECTOR: G ;
`G
FIRE SYSTEMS: , 'AS a?l)b FA 121t? FE 4117012:00:00 AM
FIRERREVENTION
INSPECTION REPORT
❑ EDMONDS
❑ BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY STATION & SHIFT
Annual 17-D
SCHEDULED
DATE DUE Oct 2018
UFIR ► 509 202
CURRENT
CITY YES JNO/
BUSINESS
LICENSE
INITIAL INSPECTION DATE
I0--4--( s
/s r a
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
GRANTEDTO:
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
2 6
VIOLATIONS
1 5
2 6
3 7
--�
4 8
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
DATE:
CODE
SECTION:
5
3
7
RETURN RECEIPT
RECEIVED
5 _
7
_
8
4
8
DATE:11
DISPOSITION:
LETTER NEEDED 0 YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO