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Serving Brier, Ed... _ nd 1..4.., 5 Meridian Ave S INSPECTION REPORT
EDMONDS
Mountlake Terrace Everett, WA 98208 BRIER
Phone (425) 551-1200 ❑ MOUNTLAKE TERRACE
wwwFireDistrict].org Fax (425) 551-1272 ❑UNINCORPORATED
LOCATION;) 14 2tx1 Avenue S S.it, 1{lrs QW21)
BUSINESS NAMQLinA 1t mLern In mUmnlb PHONE:4267,76ELIOD
MAILING
ADDRESS114 grid Awnue S, SUItc 105, EdtTmn&-, VVA 08020
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FIRE SYSTEMS: FE!
FREQUENCY I STATION & SHIFT
2 Year i3 17-B
SCHEDI}��Q,�� 1
DATE Dl1E"'Y
CURRENT
CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
HAZARDS FOUND AND LOCATIONS
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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
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PERSON
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INSPECTOR:
INSPECTOR:
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DATE:
DATE:
DATE:
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VIOLATIONS
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LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
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RETURN RECEIPT
RECEIVED
6
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6
4
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DATE:
DISPOSITION:
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
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FIRE DEPARTMENT COPY
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CITY OF EDMONDS
121 5TM AVENUE N. • EDMONDS, WASHINGTON 98020 • (425) 771-0215
FIRE DEPARTMENT
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FIRE PREVENTION
SAFETY SURVEY
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LOCATION: 114 2nd Avenue S 105
BUSINESS NAME: First Western Investments PHONE: 4257756000
MAILING 114 2nd Ave S #105
ADDRESS: Edmonds 98020
BUSINESS OWNER: Zenger, Mark HOME PHONE: 4257783689
EMERGENCY-1: Maloney, [Ian HOME PHONE: 4257128203
KEY ACCESS-2: HOME PHONE:
FREQUENCY
STATION & SHIFT
731
17 C
SCHEDULDATE DUES ►
11, 01/10
UFIR ► 591
1202
ACTIVE
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR: 57- / 7- " 1/
FIRE FE _!j�:1_4/Z
SYSTEMS: ANNUAL
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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:
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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
4
8
4
8
DATE:
DISPOSITION:
-
7
8
LETTER NEEDED YES NO
LETTER NEEDED ❑ YES (] NO
' FIRE DEPARTMENT COPY
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