21004 82ND PL WSNOHOMISH CO.
FIRE
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FIRE PREVENTION
Serving Brier, Edmonds, and 12425 Meridian Ave S, INSPECTION REPORT
EDMONDS
Mountla . ke Terrace Everett, WA 98208! BRIER
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Phone (425) 551-1200 0 MOUNTLAKE TERRACE
ww' W.FireDistrict]. org Fax (425) 551-1272 [3 UNINCORPORATED
LOCATION:
21214 82 nd Place*W 98026
BUSINESS NAME:
Ben Cain & Associates
MAILING
ADDRESS:
21214 82nd Place W, Edmonds, WA 98026
BUSINESS OWNER-
EMERGENCY-1:
KEY ACCESS-2:—GeO,,434n
EMAIL:
PERSON CONTACTED:
NAME OF INSPECTOR:
L_zo pj !SWIF
..FIRE SYSTEMS: FEB
PHONE:
4257748924
HOME PHONE:
FREQUENCY STATION & SHIFF"'
2046* 1
SCHEDULED
DATE DUE 0 -h in 9n1F;
LIFIR 0
591 206
HOME PHONE:14LC-91i>-3874 CURREN
HOME PHONE: -4Q63i-196113 CITY YES NO
BUSINESS
LICE
INITIAL INSPECTION DATE
9130111,
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2
13
3
4
4
5
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I AGREE�TO CO . RRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
I st RE -INSPECTION
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
GRANTEDTO:
VIOLATION\
DATE DUE:
DATE DUE:
DATE DUE:
CITED:
PERSON
CONTACTED:
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PERSON
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INSPECTOR:
INSPECTOR:
DATE:
INSPECTOR:
2
DATE:
DATE:
VF0_LTT1_0NS
VIOLATIONS
PRE-C TATION
CITATION ISSUED
------
ETTER SENT
NUMBER:
4
DATE:
CODE
SECTION:
6
2
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RETURN RECEIPT
7
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RECEIVED
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LET7ERNEEDED 0 YES [:1 NO
DATE:
�'LETTERNEEOED [] YES
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SNOHOMISH CO.
Serving Brier, Edmonds
Mountl,ake Terraceand
the Town of Woodway
www.FireDistrictl.org
FIRE PREVENTION
Meridia'n''Avie''S'
INSPECTION REPORT
Everett, WA 98208
0 EDMONDS
0 BRIER'
_Phone (42�) 551-1200
0 WOODWAY
0 MOUNTLAKE TERRACE
Fax (425) 551-1272
0 UNINCORPORATED
I'— FREQUENCY I STATION& SHIFT"'
LOCATION: 21004 82nd PI W 365 HQ FP
SCHEDULED
BUSINESS NAME: Tommy AFH PHONE: 4257120489 DATE DUE 06/01/13
MAILING LIFIR � 411 3116206
ADDRESS:
BUSINESS OWNER: Pa.la-ngeanu, Seniamuin HOMEPHONE: 4257120489
EMERGENCY-1: HOME PHONE: "'CURRENT YES NO
KEY ACCESS-2: HOME PHONE: CITY
BUSINESS
LICENSE 1:1 El
PERSON CONTACTED: A20 AA� 5 vV F L INITIAL INSPECTION DATE
NAME OF INSPECTOR:
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I AGREE TO CORRECT THE ABOVE VIOLATION(S)-fN THE NEXT 30 DAYS X
1 st RE -INSPECTION
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTED TO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
I
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
D TE:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
1 5
1 5
LETTER SENT
NUMBER:
4
CODE
5
2
6
2
6
DATE:
SECTION:
RETURN RECEIPT
3
7
3
7
RECEIVED
6
DISPOSITION:
4
18
4
18
DATE:
QILETTER NEEDED C] YES No
ETTER NEEDED 0 YES NO
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8
FIRE DEPARTMENT COPY