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CITY OF EDMONDS SAFETY-
121:5114 AVENUE N. EDMONDS, WASHINGTO 98m o (4?5) 775-2525
FIRE;DEPARTMENT.
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BUSINESS NAME:
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kqpENCY STATION 11 SHIFT
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11 06/0112000
Car 6 306
VVA 98026
BUSINESS OWNER: -HOME PHONE- 4.25640*1053
EMERGENCY-1:
�HOME-PHONE::-,,.
YES NO
KEY ACCESS-2: -HOME,PHONE: - L&TER
NEEDED
- - - - - -
INITIAL INSPECTION DATE
PERSON CONTACTED::"��
NAME OF INSPECTOR:
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SYSTEMS:
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HAZARDS FOUND AND LOC�TIQNS-/--COMMUNICATl PNS
ENTER CODE ONLY ONCE 0-
VIOLATION CODE
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2
2
3
3
4
4
5
5
6
6
7
7
8
8
Ist RE -INSPECTION
�ZndRE-INSPECTION_.-_--_,_
' -.'-__EkTENSJON:.--.'
FINAL RE -INSPECTION,
VIOLATIONS
DATE DUE:
DATE DUE-
GRANTED -TO`
DATE DOE:
CITED:
PERSON
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PERSON
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INSPECTOR:
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2
DATE:
DATE:
DATE:
3
VIOLATIONS
MOLATIONS
PRE -CITATION
CITATION ISSUED
1 5
5
LETTER SENT
NUMBER:
4
2
6
DATE:..
CODE
SECTION:
5
3
7
7
RETURN.RECEIPT
AECEIVED
6
- - - - - - -
DISPOSITION:
7
4
18
DATE:.
8
,,LETTER NEED D YES E] FJO:
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