21016 76TH AVE WN, 7 to
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Serving Brier, Ed, onds, and
Mountlake Terrace
www.FireDistrictl.org
LOCATION:
21016 76 th Avenue W 98026
BUSINESS NAME:
Aurora Stamps
MAILING
ADDRESS:
21016* 76th Avenue W, Edmonds, WA 98026
BUSINESS OWNER:
EMERGENCY-1:
K I EY ACCESS-2: Van Bergyk, Art
EMAIL:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE SYSTEMS: FE
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE:
4257758885
HOME PHONE:
HOME PHONE:
HOME PHONE: 2065265147,
FIRE PREVENTION
INSPECTION REPORT
M EDMONDS
E3 BRIER
0 MOUNTLAKE TERRACE
[3 UNINCORPORATED
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?016* 16, Q
SCHEDULED
DATE DUE 'Apr 2016
LIFIR 0 551206
CURRENT
CITY YES NO
BUSINESS )v_j [:]
LICENSE iaJ
INITIAL INSPECTION DATE
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_§RMfl9t0
-EATIONS /COMMUNICATIONS
vo 0
2
2
3
.3
4
4
5
5
6
--------- ---- -
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7
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I AGREE TO cbRRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
lst RE -INSPECTION
2nd RE-INSPECTIOR
FINAL RE
EXTENSION
-INSPECTION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTED TO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
INSPECTOR:
INSPECTOR:
INSP.ECT0.R:'
2
3
DATE:
DATE:
DATE:
VIOLATIO 4S
VIOLATIONS',,
PRE -CITATION
SSUED
5
LETTER SENT
NU!�B.ER:
4
5
2
6
2
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6
DATE:
CODE
SECTION:
RETURN RECEIPT
7
3
7
RECEIVED
6
DISPOSITION:
4
8
4
8
DATE:
7
LETTER NEEDED C] YES [I NO
LETTER NEEDED YES NO
8
FIRE PREVENTION
Serving Brier, Edmonds
sNoHomiSH CO.
12425 Meridian Ave S
PECTION REPORT
Mountlake Terraceand
FIRE
Everett, WA 98208
DmONDS
0 BRIER
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Phone (425) 551-1200
0 WOODWAY
0 MOUNTLAKE TERRACE
w"`ww.FireDistrict1.org
Fax (425) 551-1272
0 UNINCORPORATED
e- FREQUENCY
131
STATION 9 SHIFT�
LOCATION: 21016 76th Avenue
W
16 A
BUSINESS NAME: Aurora Starrips
PHONE: 4257758885
SCHEDULED
DATE DUE 0 04,'01/13
MAILING 21016 76th Ave W
UFIR 0 551 4206
ADDRESS: Edrnonds
98026
BUSINESS OWNER: Van Bergyk, Art
HOME PHONE: 2065265147
ACTIVE
EMERGENCY-1: Clawson, Sa
H . 2063656183
OME PHONE:
CURRENT
KEY ACCESS-2: Judd,John
HOME PHONE:
CITY YES NO
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BUSINESS �fl El
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INITIAL INSPECTION DATE
NAME OF INSPECTOR:
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15/
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FIRE
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SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOTI NIS /COMMUNICATIONS
Oc 0
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
1 st 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
1 5
VIOLATIONS
5
PRE -CITATION
LETTEq SENT
CITATION ISSUED
NUMBER:
4
2
6
6
DATE:
CODE
SECTION:
5
3
7
7
RETURN RECEIPT
RECEIVED
6
4
18
4
18
DATE:
DISPOSITION:
7
LETTERNEEDED [-] YES N 0
LETTERNEEDED C] YES [I NO
8
FIRE DEPARTMENT COPY
CITY OF EDMONDS
1 121 5- AVENUE N. - EDMONDS, wA'SHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
4�'
LOCATION: 21016 76th Avenue W
BUSINESS NAME: Aurora Stamps.
MAILING 21016 76th Ave W
-- — — ------ -- —
FIRE PREVENTION
SAFETY SURVEY
PHONE: 4257758885
AUUhr_00: Edmonds 98026
T TYK
BUSINESS OWNER: VAPJ (3 �F424C AP-7 HOME PHONE: 2065265147
vallZeNA-1 Art
EMERGENCY-1: Clawson, Sam HOMEPHONE: 2063656183
KEY ACCESS-2: Judd,John HOMEPHONE: 4257761538
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS:
1ct-<'<
L7t"I
FREQUENCY
STATION 11 SHIFT"'
731
16 C
I
SCHEDULED
DATE DUE 11'
04/01/11
LIFIR � 551
4206
AC71VE
INITIAL INSPECTION DATE
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
ENTER CODE ONLY ONCE I�
VIOLATION CODE
7vo
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:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
RETURN RECEIPT
RECEIVED
CODE
SECTION:
5
3
7
3
7
6
4
18
4
18
DATE:
DISPOSITION:
7
8
�, LETTER NEEDED [] YES NO
LETTER NEEDED [:] YES E) NO
FIRE DEPARTMENT COPY