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Serving Brier, 1 III I�� III 12425 Meridian Ave S INSPECTION REPORT
Mountlake Terrace❑BRIERand . Everett, WA 98208 ❑S
BRIER
the Town of Woodway Phone (425) 551-1200 ❑ WOODWAY
❑ MOUNTLAKE TERRACE
www.FireDistrictl.org Fax (425) 551-1272 ❑ UNINCORPORATED
FREQUENCY STATION & SHIFT
II LOCATION:
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144 Railroad Avenue
217
731 17
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BU INESS NAME:
Haensly, T. F. Attorney /JOB
PHONE:
4257754�803
SCHEDULEDATEDUE ► 06/01/13
MAILING
144 Railroad Ave #217
UFIR ► 591 6202
`/ADDRESS:
Edmonds
98020
BUSINESS OWNER:
uHaensly, Thomas F."
HOME PHONE:
2065425022
ACTIVE :
EMERGENCY-1:
HOME PHONE:
CURRENT
KEY ACCESS-2:
HOME PHONE:
uMcnaughton,
CITY YES
NO
BUSINESS
LICENSE
PERSON CONTACTED: %%J(i'/t�iaJ
INITIAL INSPECTION DATE
NAME OF INSPECTOR.
FIRE
FE 1
SYSTEMS:
m
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1 o
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
ISt 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
Q
8
DATE:
DISPOSITION:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
i
8
FIRE DEPARTMENT COPY '"
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Serving Brier; Edmonds
Mountlake Terrace,and
the Town of Woodway
www.FireDistrictl.org
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
❑ EDMONDS
❑ BRIER
❑ WOODWAY
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY STATION & SHIFT
LOCATION:
144 Railroad avenue
217
731 17
I
B
BUSINESS NAME:
Haensly, T F Attorney /006
PHONE:
4257754803
DATE DUEED► 06/01/11
MAILING
144 Railroad Ave #I217
uFIR / 591 6202
ADDRESS:
Edmonds
98020
BUSINESS OWNER:
°Haensly, Thomas 0= °
HOME PHONE:
2065425022
ACTIVE
EMERGENCY-1:
HOME PHONE:
CURRENT
KEY ACCESS-2:
HOME PHONE:
uMcnaughfon,
CITY YES
NO
BUSINESS
E]
[L
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
J
FIRE
EE
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1 ututw&dr— hq1
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:
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
6
DATE:
DISPOSITION:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8
FIRE DEPARTMENT COPY