180 W DAYTON ST BLDGSNOHOMISH CO.
SeIrving Brier, Edmonds, and
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LOCATION: 180 West Dayton Street 98020
BUSIN ESS NAME: 180 W Dayton Bldg
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12425 Meridian Ave S I�PPECTION REPORT
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Everett, WA 98208 0 BRIER
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PHONE: 4257741511
MAILING
ADDRESS:1 80 West Dayton Street, Edmonds, WA 98020
Conner, Jan
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S&ving Brier, Edmonds, and
12425 Meridian Ave S
SNOHOMISH CO
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Everett, WA 98208
DS T I T FireDistrict].
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BUSINESS NAME:. 180 W Dayton Bldg q
PHONE: 4257741511
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180 West Dayton Street, Edmonds, WA 98020
BUSINESS OWNER: Conner, Jan
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LETTER NEEDED P. YES El Nol
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FIRE DEPARTMENT COPY
FIRE PREVENTION
)imz Serving Brier, Edinonds, and
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
FIRE
Mountlake Terrace
Everett, WA 98208
0EDMONDS
0 BRIER
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Fax
[]MOUNTLAKE TERRACE
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(425) 551-1272
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LOCATION:
180 West Dayton Street 98020
Annual 17-D
BUSINESS NAME:
180 W Dayton Bldg
PHONE: 4213774151-1 SCHEDULED Oct 2013
DATE DUE
MAILING
LIFIR � 509
ADDRESS:
180 West Dayton Street, Edmonds, WA 98020
BUSINESS OWNER:
Conner, Jan HOME PHONE:
EMERGENCY-1:
Conner, Jar HOME PHONE: 42577 Ell(
'CURRENT
KEY ACCESS-2:
EMAIL:
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HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
3
4
4
5
5
6
6
7
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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
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
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DATE:
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VIOLATIONS
1 5
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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:
7
LETTER NEEDED 0 YES 0 NO
LETTER NEEDED [] YES El NO
8
FIRE DEPARTMENT COPY
SNOI
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Serving Briet; Edinonds
Mountlake Terraceand
Tthe Town of Woodway
www.FireDistrictl.org
LOCATION:
180 W Dayton Street
BUSINESS NAME:
180 W Dayton Bldg
MAILING
120 W Dayton #136
ADDRESS:
Edmonds
BUSINESS OWNER:
Conner, Jan
EMERGENCY-1:
KEY ACCESS-2:
�; IPERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS:
FIRE PREVENTION
12425 Meridian Ave S
INSPECTION REPORT
Everett, WA 98208
OEDMONDS
0 BRIER
Phone (425) 551-1200
E]WOODWAY
[] MOUNTLAKE TERRACE
Fax (425) 551-1272
0 UNINCORPORATED
FREQUENCY STATION 1, SHIFT"'�
366 17 6
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PHONE: 4257741511
SCHEDULED
DATE DUE 11' 10/01/11
LIFIR � 509 1(202
98020'
HOMEPHONE: 4257741511
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CURRENT
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BUSINESS
LICENSE
INITIAL INSPECTION DATE
FE I
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
/ A a 1
1
z
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:
I
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
1
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
,4
'8
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED C] YES [I NO
rLETTER NEEDED E] YES NO
8
' FIRE DEPARTMENT COPY