170 W DAYTON ST STE 106BL
t II�I��IIh170 (tit -,D'9yTOrJ ST_ J(� I061? FIRE PREVENTION
Serving Brier, -EG 12425 Meridian Ave S INSPECTION REPORT
Mountlake TerraceBRIER
❑ BRIER
,and Everett, WA 98208 ❑S
the Town of Woodway Phone (425) 551-1200 ❑ WOODWAY
❑ MOUNTLAKE TERRACE
www.FireDistrictl.org Fax (425) 551-1272 ❑ UNINCORPORATED
FREQUENCY STATION & SHIFT
LOCATION: 170 W Dayton St 106/1056CD 365 17 D
BUSINESS NAME: Vacant PHONE: 4257764946 SCHEDULED 10!01112
MAILING 51 W Dayton #301
ADDRESS: Edmonds
BUSINESS OWNER:
EMERGENCY-1:
KEY ACCESS-2:
PERSON CONTACTED:
NAME OF INSPECTOR: / YI0,17 ;)
FIRE //
SYSTEMS:
HOME PHONE:
HOME PHONE:
HOME PHONE:
DATE DUE
UFIR ► 775 1 [202
CURRENT CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
FE
ANNUAL
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 1
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
18
4
_
18
DATE:
DISPOSITION:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
.. -
8
FIRE DEPARTMENT COPY
I ,,
Iso
O
FIRE PREVENTION
CITY OF EDMONDS SAFETII SURVEY
121 5TM AVENUE N. EDMONDS, WASHINGTON 98020' • (425) 771-0215
FIRE DEPARTMENT
�St 89�
1 FRM&NCY STATff (j
& $NIFT
LOCATION: 170 !ii Dayton St 106/105BCD �((�?
Electric Mirror LLCIOOB 4257764946 SCHEDULED 10f®jf1®
BUSINESS NAME: PHONE: DATE DUE ►
MAILING 51 IN Dayton #301 UFIR ► 775 11202
i
ADDRESS: ^ Edmonds 98020
BUSINESS OWNER: Mischel, James HOME PHONE: 4257764946
EMERGENCY-1: HOME PHONE:
KEY ACCESS-2: HOME PHONE:
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE FE 1
SYSTEMS: i a/�� ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1
ENTER CODE ONLY ONCE ►
VIOLATION CODE
1
2
2
4
4
5 _. J
5
<<1 4 •
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
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:
8
LETTER NEEDED ❑ YES NO
LETTER NEEDED YES NO
FIRE DEPARTMENT COPY