120 5TH AVE N (2)0 ; ; ,FIRE -PREVENTION
Serving Brier, Edmonds, and 12425 Meridian Ave S INSPECTION REPORT
SIVOHOIvTISEi CO. ❑ EDMONDS
FIRS Mountlake Terrace Everett, WA 98208 ❑ BRIER
�'hg ❑ MOUNTLAKE TERRACE
DI �� � Phone (425) 551-1200 www.FireDistrictl.org Fax (425) 551-1272 ❑UNINCORPORATED
LOCATION: 120 5 th Avenue N 98020
BUSINESS NAME: Edmond's Chamber/Log House
MAILING 120 5th Avenue N, Edmonds, WA 98020
ADDRESS:
PHONE:
4257766711
FAnnualCY STA7l( _t4 SHIFT
SCHEDULED Jun.:2017
DATE DUE
UFIR /
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BUSINESS OWNER: HOME PHONE:
(47V;
EMERGENCY -ire HOME PHONE:7CBN
KEY ACCESS-2: ��0 �� N ` c 'I �'� HOME PHONE: YES NO
EMAIL:,
PERSON CONTACTED: Su `f INITIAL INSPECTION DATE
NAME OF INSPECTOR: t4 /•- A -"-r � A �'c. w4
Date Last Serviced:
FIRE PREVENTION
Serving Brier, Edmonds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
FIRE
Mountlake Terrace,and
Everett, WA 98208
❑ EDMONDS
❑BRIER
DIST R
_ the Town of Woodway
Phone (425) 551-1200
❑ WOODWAY
❑ TERRACE
wwwFireDistrictl.org
Fax (42S) SS1-1272
UNINCORPORATED
❑UNINCORPORATED
FREQUENCY
STATION & SHIFT
LOCATION:
120 Sth Avenue
IN
730
17 C
I
BUSINESS NAME:
Edmond's ChamberiLog House
PHONE: 4257766791
DATE DUE SCHEDULED► 0610 1113
MAILING
pOB #146
UFIR ► 591 6203
ADDRESS:
Edmonds
98020
BUSINESS OWNER:
City Of Edmonds
HOME PHONE: 4257752525
ACTIVE
a,
EMERGENCY-1:
Vance, Jan
HOME PHONE:
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS F1 E]
LICENSE
PERSON CONTACTED: Po0 0 0 kk
INITIAL INSPECTION DATE
NAME OF INSPECTOR: S . FD Q
Z"2
FIRE FD LkBx
FED J_3
SYSTEMS.
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1 Ne'(lilak� �idN9
1
2
2
3
3
4
4
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 3( 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
5
4
18
4
18
DATE:
DISPOSITION:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8
FIRE DEPARTMENT COPY