110 W DAYTON ST STE 206'; IIII��III I J,�� roN ; J', e', �n� FIRE PREVENTION
INSPECTION REPORT
Serving Brier, Edmo. __-_ - 12425 Meridian Ave S
Mountlake Terrace,and A Everett, WA 98208 BRIER S
_ "❑BRIER
the Town of Woo Phone (425) 551-1200 ❑ WOODWAY
❑ MOUNTLAKE TERRACE
www.FireDistrlct1.org Fax (425) 551-1272 ❑UNINCORPORATED
FREQUENCY STATION & SHIFT
LOCATION: 110 West Da}ton Street Suited (38020 2 Year 113 17-8
nnF�d' e Ins. J� 4257747211 SCHEDULED Sep
BUSINESS NAME: J {;, PHONE: DATE DUE ►
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MAILING UFIR ►
ADDRESS: 110 West Dayton Stree , Suitei206, Edmonds, WA 98020
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BUSINESS OWNER: HOME PHONE:
Email:
EMERGENCY-1: Zweifach, Steven HOME PHONE: 2062275405 CURRENT
KEY ACCESS-2: HOME PHONE: CITY YES NO
BUSINESS
LICENSE El
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE SYSTEMS: FE ! 1
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1 ��r
2
2
3
?3
4"
4
5
5
6
6
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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:
1
INSPECTOR:
INSPECTOR:
INSPECTOR: I
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6 \1
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
8
4
8
DATE:
DISPOSITION:
r�
LETTER NEEDED ❑,,,YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
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FIRE DEPARTMENT COPY