112 3RD AVE S-
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FIRE PREVENTION
Serving Brier EdiWonds, and
12425 Meridian Ave S
INSPECTION REPORT
ISNOTIOMISH
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Mozintlake Terrace
Everett, WA 98208
DEDMONDS
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112 3 rd Avenue S 98020
M?gENCY
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LOCATION:
Shepherd & Shepherd
4257761155
SCHEDULED Dec 2016
BUSINESS NAME:,
PHONE:
DATE DUE I` i
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MAILING
11 2,3rd Avenue S, Edmonds, WA 98020
LIFIR
ADDRESS:
Shepherd, Dean
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
HOME PHONE:
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
EMAIL:
LICENSE
'NAME
INITIAL INSPECTION DATE
PERSON CONTACTED:
OF INSPECTOR:
Date Last,Serviced:
SNOHOMISH CO.
FIRE
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Ser1'lllg l7el; EdBin`Onds, and
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Mountlake Tet"i'acc
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12425 Nfei•idian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
9DMONDS
BIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
LOCATION:
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112 3rd Avenue S 98020
2 Year
13 . 17-8
s
' BUSINESS NAME:
Shepherd & Shepherd
PHONE:
4257701155
Dec 2013
DATE DUEED
MAILING
UFIR 1, 591
ADDRESS:
112 3rd Avenue S, Edmunds, WA 53020
BUSINESS OWNER:
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HOME PHONE:(a0)
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EMERGENCY-1:
HOME PHONE:
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HOME PHONE:
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LICENSE
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PERSON CONTACTED:
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INITIAL INSPECTION DATE •
NAME OF INSPECTOR:
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HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
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2
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2
3
3
4
5
6
4
5
6
7
7
1 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:
PRE -CITATION
LETTER SENT
DATE:
CITATION ISSUED
NUMBER:
3
4
VIOLATIONS '
1 5
VIOLATIONS
1 5
2
6
2 6
DATE:
CODE
SECTION:
5
3
7
3 7
RETURN RECEIPT
RECEIVED
6
4
18
4 8
DATE:
DISPOSITION:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8
FIRE DEPARTMENT COPY
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SNOHOMISH CO. Serving Brier; Edmonds 12425 Meridian Ave S
E..-� Mountlake Terrace,and Everett, WA 98208
the Town of Woodway Phone (425) 551-1200
DISTR, wwwFireDistrictl.org Fax (425) 551-1272
FIR
LOCATION: 112 3rd Avenue S
1
y BUSINESS NAME: Shepherd & Shepherd PHONE: 4257761155
MAILING 112 3rd Ave S
ADDRESS: Edmonds
1 BUSINESS OWNER:
EMERGENCY-1: Shepherd, Dean
KEY ACCESS-2: Jamison, Susan
PERSON CONTACTED:
NAME OF INSPECTOR:
% FIRE
SYSTEMS:
All
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98020
HOME PHONE:
HOME PHONE: 4257762685
HOME PHONE: 3607104261
FIRE PREVENTION
INSPECTION REPORT
❑ EDMONDS
❑ BRIER
}❑ WOODWAY
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY STATION & SHIFT
731 17 D
SCHEDULED
DATE DUE
UFIR ► 591 1202-t.. _
ACTIVE
CURRENT
CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
FE
ANNUAL
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:
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
q
6
4
6
DATE:
DISPOSITION:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8
FIRE DEPARTMENT COPY ,;: