114 4TH AVE N (2)IIII��III (�
U +1 11L)E N i
FIRE PREVENTION
Serving Brie:. ids
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
FIREthe
Mountlake Terrace,and
Everett, WA 98208
❑ EDMONDS
❑BRIER
DISTR-IfT
Town of Woodway
Phone (425) 551-1200
❑ WOODWAY
❑ AKE TERRACE
www.FireDistrictl.org
Fax (425) 551-1272
UNINCORPORATED
❑UNINCORPORATED
''
FREQUENCY STATION & SHIFT
I
1 LOCATION:
114 4th Avenue
N
731 17 R
I
BUSINESS NAME:
Salon Pena
PHONE: 4257718939
SCHEDULED
DATE DUE ► 01/01/13
MAILING
114 4th Ave N
UFIR ► 557 1202
ADDRESS:
Edmonds
88020
BUSINESS OWNER:
Pena -Ross, Lori Anne
HOME PHONE: 4257768442
ACTIVE
EMERGENCY-1:
Madison, Linda
HOME PHONE: 4252181445
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
LICENSE
PERSON CONTACTED: Lo J CAd19
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
�� i L � � 9 �QS�
N19 l/Zo 1 3
FIRE
FE —t_
SYSTEMS:
ANNUAL
I r`
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
2
2
3
3
4
4
5
5
9,
6
6
7 f
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
i
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
4
6
4
6
DATE:
DISPOSITION:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
g
FIRE DEPARTMENT COPY
SNOIiOMISH CO.' :< Serving Brier, Edmonds, and
I
FIREMountlake Terrace
DISTRT www.FireDistrictl.org
12425 Meridian Ave S
Everett, WA 98208 .
Phone (425) 551-1200
Fax (425) 551-1272
ME PREVENTION
INSPECTION REPORT
❑ EDMONDS
❑ BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY
STATION & SHIFT
LOCATION:
114 4 th Avenue N 98020
2016
17-A
BUSINESS NAME:
Salon Pena
PHONE: 4257718939
SCHEDULED
DATE DUE ► Jan 2016
MAILING
UFIR 1 557 202
ADDRESS:
114 4th Avenue N, Edmonds, WA 98020
__j
BUSINESS OWNER:
Ross, Mac
HOME PHONE:
EMERGENCY-1:
Pena -Ross, Lori Anne
HOME PHONE:
4257768442
CURRENT
KEY ACCESS-2:
�p 1-
��
HOME PHONE:
CITY Y NO
BUS'S
EMAIL"
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❑
LICENSE
•PERSON CONTACTED:
INITIAL INS PECTION ATE
NAME OF INSPECTOR: � � � I . IN
� I� � �' � n
�
,
FIRE SYSTEMS: FE 4/-40
ate Last Servicedd
HAZARDS FOUND AND LOCATIONS
/ COMMUNICATIONS
/
2
s
2
3
3
4 _..
4
5 .
6
g.
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE -INSPECTION
FINAL RE
EXTENSION
-INSPECTION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTED TO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
INSPECTOR:
INSPECTOR:
2
INSPECTOR:
DATE:
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS:-
PRE -CITATION
_
CITATION ISSUED
1 5
1 5
LETTER SENT
NUMBER:
4
CODE�._._.�._....._......_.._-,.-,....,.._....
6
2
6
2
6
DATE:
SECTION:
RETURN RECEIPT
3
7
3
7
RECEIVED
6
DISPOSITION:
4
8
4
8
DATE:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8