114 2ND AVE S STE 101SNOHOMISH CO.
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Serving Brier, and 12425 Meridian Ave S
Mountlake Terrace Everett, WA 98208
DISTR
�� Phone (425) 551-1200
www FireDistricti. org Fax (425) 551-1272
LOCATIONI 14 2nd Avetwe S Suite 101 9862D
BUSINESS NAMELdrnnr►db WiI6- 01 1 rubL PHONE:4257'120270
MAILING
ADDRESS114 2nd Aw:nuc 5, SuiLc 101, Edmandb, 'WA 93020
BUSINESS OWNER(y1m, R.9y HOME PHONE:
EMERGENCY-1;Upp, 1;e1Ari HOME PHONE:
KEY ACCESS-2: HOME PHONE:
EMAIL:
PERSON CONTACTED: AA/,A/
NAME OF INSPECTOR: C , SM ( M Da
FIRE SYSTEW,; FE d
FIRE PREVENTION
INSPECTION REPORT
EDMONDS
❑ BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY I STATION & SHIFT
2 Year 1 1 17-B
SCHEDI p 2013
DATE D
CURRENT
CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
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O'Yll V�✓�. ; r
1
2
2
3
4
4
5
5
6
6
7
7
1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTED TO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
1 5
1 5
LETTER SENT
NUMBER:
4
CODE
5
2
6
2
6
DATE:
SECTION:
RETURN RECEIPT
6
3
7
3
7
RECEIVED
DISPOSITION:
4
8
4
8
DATE:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8
FIRE DEPARTMENT COPY
:,FIRE PREVENTION
R CITY OF EDMONDS SAFETY SURVEY
121. 5- AVENUE N. • EDMONDS, WASHINGTON 98020 • (425) 771-0215
FIRE �DEPARTMENT
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LOCATION:
114 2nd Avenue
`a 101
d•s
BUSINESS NAME:
Edmonds Wills & Trusts
PHONE:yT'4257120279
MAILING
114 2nd Ave S #101
\
ADDRESS:
Edmonds
98020
BUSINESS OWNER:
Kyle, Ray
HOME PHONE:
4257424058
o " EMERGENCY-1:
Copp, Kevin
HOME PHONE:
2068525017
KEY ACCESS-2:
HOME PHONE: -
ify
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FREQUENCY
STATION 8 SHIFT
731
17 C
SCHDATEEDUEE ►
11101/10
UFIR ► 591
1'202
ACTIVE
') 1
PERSON CONTACTED: �N(e } INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE FE S=la
SYSTEMS: � ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMU (CATIONS
1 G l�UC Ur�'�► �flf�t'7 L �o�CX
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ENTER CODE ONLY ONCE ►
VIOLATION CODE
1 EL-o(
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2
2
3
3
4
4
5
5
6
6
7
7
8
8
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
D 1
DATE: O �6 /
DATE:
DATE:
3
1 D VIOL ONS
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
-
4
8
4
B
DATE:
DISPOSITION:
7
}.
8
LETTER NEEDED YES ❑ NO
LETTER NEEDED [ YES NO
FIRE DEPARTMENT COPY