21405 82ND PL W STE A (2)FIRE PREVENTION
(J. J-:jc. A
Serving Brier, . EdMA111IT111
12425 Meridian Ave S
INSPECTION REPORT
I' SNOHOM19H CO.
FIRE Is
Mountlake Terraceand
Everett, WA 98208
OEDMONDS
0 BRIER
DISTRtc,,
the Town of Woodway
T
Phone (425) 551-1200
E]WOODWAY
0 MOUNTLAKE TERRACE
www.FireDistrictl.org
Fax (425) 551-1272
0 UNINCORPORATED
FREQUENCY
STATION & SHIFT
LOCATION:
21405 82nd Place
W A
365
16 D
BbSINE8S NAME:
St Albans Portable
PHONE:
SCHEDULED
DATE DUE 11' 06101/13
MAILING
21405 82nd Place W
LIFIR 0 -132 6156
ADDRESS:
Edmonds
98026
BUSINESS OWNER:
St. Albans Episcopal
HOME PHONE: 4257780371
ACTIVE
EMERGENCY-1:
Forsberg, Lee
HOME PHONE: 425771571
-'s
" CURRENT
KEY ACCESS-2:
Nichols, Jim
HOME PHONE: 4257717025
CITY YES NO
BUSINESS
LICENSE Li Lj
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR: )A)
FIRE FE
SYSTEMS: (0 ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
2
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3
3 1
4
4
5
5
6
6
7
7
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
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
2
6
DATE:
CODE
SECTION:
5
3
7
13
7
RETURN RECEIPT
RECEIVED _
6
4
8
41
8
DATE:
DISPOSITION:
7
\1 LETTER NEEDED [] YES NO
LETTER NEEDED [] YES NO
FIRE DEPARTMENT COPY
FIRE PREVENTION
koll MT N/'
Serving Brierl� kdinonds 12425 Meridian Ave S INSPECTION REPORT
9NOHOMISH CO. []EDMONDS
Mountlake T�r'raiceand Everett, WA 98208 0 BRIER
TIRE the Town of Woodway Phone (425) 551-1200 [3WOODWAY
M 0 MOUNTLAKE TERRACE
I w7i www.FireDistrictl.org 0 UNINCORPORATED
S Fax (425) 551-1272
,' FREQUENCY STATION & SHIF")
LOCATION: 21405 82nd Place W A 365 16 6
BUSINESS NAME: PHONE: SCHEDULED
St Albans Portable DATE DUE � 06/01/11
MAILING 21405 82nd Place W UFIR � 132 6156
ADDRESS: Edmonds 98026
BUSINESS OWNER: St. Alb.arfs Episcopal HOME PHONE: 4257780371 ACTIVE
EMERGENCY-1: Forsberg, Lee HOME PHONE: 4257744571 CURRENT YES NO
KEY ACCESS-2: HOME PHONE: 4257717025 CITY
Nichols, Jim BUSINESS
LICENSE
PERSON CONTACTED: a's" -4, F�' A INITIAL INSPECTION DATE
NAME OF INSPECTOR: t"fj_6±i'
FIRE FE 2-J - (1(
SYSTEMS: ANNUAL
HAZARDS FOUND AND L
CkTIONS COMMUNICATIONS
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
1st RE -INSPECTION
2nd RE -INSPECTION
FINAL RE -INSPECTION
EXTENSION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTED TO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
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:
14
8
4
8
DATE,
LETTER NEEDED [I YES NO
I LE-17ER NEEDED C] YES [:1 NO
1
8
FIRE DEPARTMENT COPY
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
LOCATION: 21405 82nd Place W A
BUSINESS NAME: St Albans Portable PHONE:
MAILING 21405 82nd Place W
FIRE PREVENTION
SAFETY SURVEY
ADDREES: Edmonds 98026
BUSINESS OWNER:' St. Albans Episcopal HOMEPHONE:-4257780371
EMERGENCY-1: Forsberg, Lee HOMEPHONE: 4257744571
KEY ACCESS-2: Nichols, Jim H . OMEPHONE: 4257717025
FREQUENCY
STATION 1, SHIFT
365
I
16 A
SCHEDULED
11
06/01/10
DATE DUE
LIFIR 0 132
- 6156
AC_nVE
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTO R:
SYSTEMS:
I - i-
ANNUAL
HAZARDS FOVND AND LOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE 1�
VIOLATION CODE
'y
----------- -
2
2
3
3
4
4
5
5
er
6
6
7
7
8
0
8
11st RE -INSPECTION
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE,
DATE DUE,
GRANTED TO:
DATE DUE,
CITED:
PERSON
PERSON
PERSON
CONTACTED:
C NTACTED:
INSPECTOR:
CONTACTED:
INSPECTOR:
1
2
INSPECTOR:
-_ ---- ----
DATE.
DATE.
VIOLATIONS
PRE -CITATION
DATE.
CITATION ISSUED
3
-
VIOLATIONS
1 5
5
LETTER SENT
NUMBER:
CODE
4
5
2
6
2
6
DATE:
SECTION:
RETURN RECEIPT
3
7
3
7
RECEIVED
DISPOSITION:
7
4
18
4
L ETTER NEEDED
18 DATE.
C] YES NO
I
13
LETTER NEEDED C] YES NO
FIRE DEPARTMENT COPY