210 5TH AVE S STE 102210
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FIRE PREVENTION,
H Co. Serving Brier, 'Edmonds, and 12425 Meridian Ave S INSPECTION REPORT
8NOHOMIS CO,
0 EDMONDS
Mountlake Terrace Everett, WA 98208 0 BRIER
FIR Phone (425) 551-1200 0 MOUNTLAKE TERRACE
[3 UNINCORPORATED
DIST T www.FireDistrictl.org Fax (425) 551-1272
0' FREQUENCY
STATION & SHIFT
LOCATI ON:
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210 5 th AVefid' IS,Suite 102 98020
201
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BUSINESS NAME:
PHONE:
SCHEDULED
Windermere Real Estate
4256721118
DATEDUE 0Apr2016
MAILING
P
LIFIR 0 591202
ADDRESS:
210 5th Avenue S, Suite 102, Edmonds, WA 98020
BUSINESS OWNER:
HOME PHONE:
Hoff, Greg
EMERGENCY-1:
HOME PHONE:
"CURRENT -'s
KEY-ACCESS-2: Windemere Real Estate
HOME PHONE: 4257q��
CITY YES NO
EMAI�1_ LJ
YY a q 6
BUSINESS
LICENSE
PERSON CONTACTED: 1-;4.
INITIAL INSPECTION DATE
6
NAME OF INSPECTOR:
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FIRE SYSTEMS: FE
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2
COMMUNICATIONS
2
3
3
4
4
6
7
5
6
7
I AGREE TO CORRECt THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
I st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION.
DATE DUE:
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
INSPECTOR:
PERSON
CONTACTED:
INSPECTOR:
PERSON
CONTACTED:
2
3
INSPECTOR:
DATE:
DATE:
DATE:
VIOLATIONS
VIOLATIONS.-
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4,
2
6
2
6
DATE:
CODE
ECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
18
DAT
DISPOSITION:
8
LETTERNEEDED F] YES F_]NO
LETTERNEEDED F] YES []NO
T.#
CITY OF EDMONDS"
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
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FIRE PREVENTION
SAFETY §URVEY
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LOCATION: 210 5th Avenue S 102
BUSINESS NAME: Windermere Real Estate PHONE: 4256721118
MAILING 210 5th Ave S #102
FREQUENCY
STATION 11 SHIFT
731
17 6
I
SCHEDULED
04/01111
DATE DUE 01
UFIR I� 591
ADDRESS: Edmonds 98020
BUSINESS OWNER: Windemere Real Estate HOMEPHONE: 4257751133
EMERGENCY-1: Hoff, Greg HOME PHONE: 4257751133 cj'�cj U
KEY ACCESS-2: Paulsen, Kay HOME PHONE: 4257715188 C-12-S) 2 ;1 1 L)-13
e INITIAL INSPECTION DATE
PERSON CONTACTED: al -) I
NAME OF INSPECTOR:
FIRE FE 4!&f_UD
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SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
I No 14A r-,q R
ENTER CODE ONLY ONCE lo
VIOLATION CODE
1
2
2
3
3
4
4
5
5
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:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
5
VIOLATIONS
5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
7
RETURN RECEIPT
RECEIVED
6
7
4
8
4
8
DATE:
DISPOSITION:
8
I, LETTER NEEDED Ej YES NO
LETTER NEEDED [] YES E] NO
FIRE DEPARTMENT COPY
I