116 4TH AVE N (2)SNOHO
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Serving Brier,,;I12425 Meridian Ave S
Mountlake Terrace, and Everett, WA 98208
Tthe Town of Woodway Phone (425) 551-1200
www FireDistrictl. org Fax (425) 551-1272
LOCATION:
116 41h Ave N
BUSINESS NAME:
Pennies from Heaven/Beeson House
MAILING
116 4th Ave N
ADDRESS:
Edmonds
BUSINESS OWNER:
Jones, Rebecca,,
EMERGENCY-1:
Bellingham, Sandra
KEY ACCESS-2:
PERSON CONTACTED: if-JV) ` a.,.,,'\ --tC r-
NAME OF INSPECTOR: �C j4rJ /Jt, sa-i 01 1 Q S
FIRE
SYSTEPAS:
PHONE: 4257764147
98020
HOME PHONE: 2067157043
HOME PHONE: 4255822944
HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
❑ EDMONDS
❑ BRIER
❑ WOODWAY
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY I STATION & SHIFT
-365 17 B
SCHEDULED
DATE DUE ► 01/01113
LIFIR ► 545 1202
ACTIVE
CURRENT
CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
FE
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
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1
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3
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:
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2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
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PERSON
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LETTER SENT
CITATION ISSUED
NUMBER:
4
2
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DATE:
CODE
SECTION:
5
3
7
3
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RETURN RECEIPT
RECEIVED
6
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4
$
_
DATE:
DISPOSITION:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
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FIRE DEPARTMENT COPY
SNO
F
D
Serving Brier; Edmonds
Mountlake Terrace,and
the Town of Woodway
www.FireDistrictl.org
LOCATION:
116 4th Ave N
BUSINESS NAME:
Pennies f om Heaven/Beeson House
MAILING
116 4th Ave N
ADDRESS:
Edmonds
BUSINESS OWNER:
Jones, Rebecca
EMERGENCY-1:
Bellingham, Sandra
KEY ACCESS-2:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS:
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE: 4257764147
98020
HOME PHONE: 2067157048
HOME PHONE: 4255822944
HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
❑ EDMONDS
❑ BRIER
❑ WOODWAY
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY I STATION & SHIFT
365 '17 A
SCHEDULED
DATE DUE ► 01/01/12
UFIR ► 545 1202
ACTIVE
CURRENT
CITY YES NO
BUSINESS
LICENSE El 0
INITIAL INSPECTION DATE
FE
APJNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1
1
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
g
Q
8
DATE:
DISPOSITION:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
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FIRE DEPARTMENT COPY
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FIRE PREVENTION
CITY OF'EDMONDS SAFETY SURVEY
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
-FIRE DEPARTME'N'TV
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LOCATION: 116 4th Ave N
BUSINESS NAME: Pennies from Heaven/Beeson House PHONE: 4257764147
MAILING 116 4th Ave N
FREQUENCY STATION & SHIFT
365 17 D
SCHEDULED 01/01/11
DATE DUE 0'
UFIR 0- 545 1202
ADDRESS: Edmonds 93020
BUSINESS OWNER: Jones, Rebecca HOME PHONE: 2067157048 ACTIVE
Bellin hamrSandra 4255822944
EMERGENCY-1: HOME PHONE:
KEY ACCESS-2: HOME PHONE:
INITIAL,INSPECTION DATE
-PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE FE
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE 10
VIOLATION CODE
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FINAL RE -INSPECTION
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DATE DUE:
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PERSON
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CODE
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DATE:
7
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LETTER NEEDED iD YES "—I NO
FIRE DEPARTMENT COPY
FIRE PREVENTION
CITY OF EDMONDS SAFETY SURVEY
121 5TH AVENUE N. • EDMONDS, WASHINGTON 98020 • (425) 771-0215
o FIRE DEPARTMENT ,
S 89 �5 es
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116 4th Avg �1 � L 365 17 C
LOCATION.
BUSINESS NAME: - ---_ PHONE: 4257764147
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MAILING 1164th Ave N
ADDRESS: Edmonds '98020
BUSINESS OWNER: Jones, Rebecca HOME PHONE: 2067157048
EMERGENCY-1: Bellingham, Sandra HOME PHONE: 4255822944
KEY ACCESS-2: HOME PHONE:
DATEDUEE ► 61fa1f1O
UFIR ► 545 1202
AcwE .
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE FE ,l
SYS Elms: ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1
ENTER CODE ONLY ONCE ►
VIOLATION CODE
1
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 s
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
7
4
8
4
8
DATE:
DISPOSITION:
-
1 8
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
FIRE DEPARTMENT COPY