144 RAILROAD AVE STE 101illII�III
yy QAV_A1dj4A fives /OI FIRE PREVENTION
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Serving Brier, Ed . _ .. _._
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
FIRE,
Mountlake Terrace,and
Everett, WA 98208
❑ EDMONDS
❑BRIER
DISTR
the Town of Woodway
T FireDistrictl.
Phone (425) SSl -1200
❑ WOODWAY
❑ TERRACE
www org
Fax (425) SS1-1272
UNINCORPORATED
❑UNINCORPORATED
FREQUENCY
STATION & SHIFT
LOCATION:
144. Railroad Avenue
101
731
17 D
I
BUSINESS NAME:
Gram Sage Graves, Inc.
PHONE: 4257719349
DATE DUE SCHEDULED► 06l01/13
MAILING
144 Railroad Ave #206
UFIR ► 591 6202
. ADDRESS:
Edmonds
98020
BUSINESS OWNER:
Sage, Doug
HOME PHONE: 2062953064
ACTIVE
EMERGENCY-1:
'McNoughton, Mark
HOME PHONE: 4257712813
eCURRENT
KEY ACCESS-2:
Uiummy, Greg
HOME PHONE: 2063990312
YES NO
*�
.
BCITY S NESS
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR: V Y_� t � I'
FIRE
FE% f3
SYSTEMS:
ANNUAL
HAZARDS FOUND AN{D LOCATIONS / COMMUNICATIONS
/�
1 1 C)rv, G rc>`1
2
2
3
3
4
4
5
5
6
6
7
7
1 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
4
8
4
8
DATE:
DISPOSITION:
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8
FIRE DEPARTMENT COPY
Serving
Brier Edtn n o s
i SNOHOMISH CO.
FIREMountlake Terrace,and
II . DISTR'
f44 w the Town of Woodway
wwFireDistrict]. org
LOCATION:
144 Railroad Avenue
I/ BUSINESS NAME:
Gram Sage Gravies, Inc.
MAILING
144 Rallroad,AYe #206
ADDRESS:
Edmonds
} BUSINESS OWNER:
,Stage, Doug
EMERGENCY-1:
MCNvughton, Marla
KEY ACCESS-2:
Mummy, Greg
PERSON CONTACTED
NAME OF INSPECTOR
FIRE
SYSTEMS:
A
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
101
PHONE: 4257719349
98020
HOME PHONE: 2062953064
HOME PHONE: 4257712813
HOME PHONE: 2063990312
FIRE PREVENTION
INSPECTION REPORT
❑ EDMONDS
❑ BRIER
❑ WOODWAY
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY STATION & SHIFT
731 17 B
SCHEDULED
DATE DUE ► 06101/11
UFIR ► 591 6202
ACTIVE
CURRENT
CITY YES NO
BUSINESS �❑
LICENSE
INITIAL INSPECTION DATE I
FE _f '' 1
ANNUAL
HAZARDS FOUN/D� AND LOCATIONS / COMMUNICATIONS
2
2
3
3
4
4
5
5
6
6
7
7
1 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
5
4
8
4
8
DATE:
DISPOSITION:
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8
FIRE DEPARTMENT COPY