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1AJ FIRE PREVENTION
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Phone (425) 551-1200 0 MOUNr�AKE TERRACE
0 UNINCORPORATED
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4
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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
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
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PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
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LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
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RETURN RECEIPT
RECEIVED
6
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18
4
8
DATE:
DISPOSITION:
7
11 LETTER NEEDED [] YES NO
LETTER NEEDED [] YES El NO
8
FIRE DEPARTMENT COPY
FIRE PREVENTION
'Serving Brio: Edmonds, und
12425 Mei -idian Ave S
INSPECTION REPORT
SNOHOMISH CO.
untlake Terrace
FIRE
Everett, WA 98208,
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LOCATION: 21510 73rd Place W 98025
Annuall
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BUSINESS NAME: Lieu Apts
PHONE: 4257427786
SCHEDULED Dec 2013
DATE DUE
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HAZARD LIND AND LOCATIONS / COMMUNICAIJONS
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DATE DUE:
DATE DUE:
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PERSON
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6
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DATE:
SECTION:
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DATE:
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FIRE DEPARTMENT COPY
Serving Brier, Edmonds
Mountlake Terraceand
the Town of Woodway
www.FireDistrictl.org
LOCATION: 21510 73rd Place W
BUSINESS NAME:
Lieu Apts
MAILING
17515 53rd PI W
ADDRESS:
Lynnwood,,
BUSINESS OWNER:
"Lieu, Brian"
EMERGENCY-1:
KEY ACCESS-2:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS:
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425).551-1272
PHONE: 4257427786
98037
HOMEPHONE: 4257424486
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1st RE -INSPECTION
DATE DUE.
2nd RE -INSPECTION
DATE DUE.
EXTENSION
GRANTED TO-
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
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PERSON
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INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
VIOLATIONS
15
VIOLATIONS
1 5
PRE -CITATION
LE77ER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
18
4
8
DATE:
DISPOSITION:
7
%� LETTER NEEDED C] YES [I NO
LETTER NEEDED C] YES [I NO
8
FIRE DEPARTMENT COPY
FIRE PREVENTION
S6-ving Briet; Edmonds
12425 Meridian Ave S
INSPECTION REPORT
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SNOHOMISH CO
Mountlake Terraceand
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Everett, WA 98208
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0 UNINCORPORATED
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SCHEDULED 12g)1111
DATE DUE �
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ADDRESS: Lynnwood
98037
BUSINESS OWNER: nLieu, Briann
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KEY ACCESS-2:
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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
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
8
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED YES NO
LET-rER NEEDED C] YES NO
FIRE DEPARTMENT COPY
t
C1W 00 EDMONDS
121 STH AVENUE N. - EDMONDS, WASHINGTON 98020 v (425) 771-0215
FIRE DEPARTMENT
LOCATION: 21510 73rd Place vv
BUSINESS NAME: Lieu Apts
MAILING 17515 53rd PI V61
FIRE PREVENTION
SAFETY SURVEY '
PHONE: 4257427786
ADDRESS: Lynnwood 93037
BUSINESS OWNER: "Lieu, Brian' HOMEPHONE: 4257424486
EMERGENCY-1: HOME PHONE:
KEY ACCESS-2: HOME PHONE:
FREQUENCY
STATION & SHIFT"'
366
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SCHEDULED
12/01/10
DATE DUE 01
LIFIR o. 422
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ACTIVE
INITIAL INSPECTION DATE
PERSON CONTACTED: 0 1
NAME OF INSPECTOR 12-12
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ENTER CODE ONLY ONCE 11�
VIOLATION CODE
1
2
2
3
3
4
4
5
5
6
6
7
AJ
7
8
8
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONIIACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DA�E:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
5
PRE-CRATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
7
4
18
4
18
DATE:
DISPOSITION:
a j
1,, LETTER NEEDED E] YES E] No
LETTER NEEDED [-] YES F] NO
FIRE DEPARTMENT COPY
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