122 4TH AVE SSNOHONIISII CO.
(II I�lI�I I ZZ L4 !� ut S FIRE PREVENTION
k INSPECTIOWREPORT
Serving Brier, Lam*onds, and 12425 Meridian Ave S
Mou❑BRIERntlake Terrace.. Everett, WA 98208 ❑ S
BRIER
I Phone (425) 551-1200 ❑ MOUNTLAKE TERRACE
www.FireDistrictl.org Fax (425) 551-1272 ❑UNINCORPORATED
FREQUENCY
STATION & SHIFT
LOCATION: 122 4 th Avenue S 98020
2017
17-C
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BUSINESS NAME: Bountiful Home
PHONE: 4257753800
SCHEDULED Jan 2017
/
DATE DUE
MAILING
UFIR / 547 202
ADDRESS: 122 4th Avenue S, Edmonds, WA 98020
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1: Waddell, Todd
HOME PHONE: 2069408877 eCURRENT
KEY ACC
HOME PHONE: 17
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Date Last Serviced: >�
- CITY OF EDMONDS
121 5TM AVENUE N. • EDMONDS, WASHINGTON 98020 • (425) 771-0215
FIRE DEPARTMENT
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LOCATION: 122 4th Avenue S
BUSINESS NAME: Bountiful Home
MAILING 122 4th Ave S
FIRE PREVENTION
SAFETY SURVEY
PHONE: 4257753800
ADDRESS: Edmonds 98020
�• BUSINESS'OWNER: Waddell, TodHOME PHONE:.' ` 206940$$77
EMERGENCY-1: Hackey, Patricia HOME PHONE:
4257718965
KEY ACCESS-2: HOME PHONE:
FREQUENCY
STATION & SHIFT
731
17 A
SCHEDULED
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DATE DUE
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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
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1
INSPECTOR:
INSPECTOR: 7
INSPECTOR:
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DATE: `� � �
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DATE:
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•IVIOLATIONS
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NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
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7
3
7
RETURN RECEIPT
RECEIVED
6
4
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4
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DATE:
DISPOSITION:
7
8
LETTER NEEDED YES NO
LETTER NEEDED YES NO
FIRE DEPARTMENT COPY