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Mountlake Terrace Everett, WA 98208 0 BRIER
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LOCATION: 21603 34 th A�mnue W 08026 1 20-D
BUSINESS NAME: Fan� hj YMCA Daycarc PHONE: SCHEDULED Scp 2014
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
Ist RE -INSPECTION
DATE DUE.
2nd RE -INSPECTION
DATE DUE.
EXTENSION
GRANTEDTO-
FINAL RE -INSPECTION
DATE DUE:
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INSPECTOR:
INSPECTOR:
2
DATE:
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VIOLATIONS
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PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
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3
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RETURN RECEIPT
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6
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DISPOSITION:
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LETTER NEEDED [-] YES No
LETTER NEEDED E] YES [I NO
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FIRE C&ARTMENT COPY
FIRE PREVENTION
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... Serving —Brier, nds
12425 -Meridian Ave S
INSPECTION REPORT
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LOCATION:
21603 64"'Avenue W 98026
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BUSINESS NAME:
Family YMCA Daycare
PHONE:
SCHEDULED Sep
DATE DUE
MAILING
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ADDRESS:
21603 84th Avenue W, Edmonds, WA 98026
BUSINESS OWNER:
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Shoreline Family Ymca
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1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
&TE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
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PERSON
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INSPECTOR:
INSPECTOR:
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2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
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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
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4
8
DATE:
DISPOSITION:
7
"I LETTER NEEDED [-] YES NO
LETTER NEEDED C] YES [I NO
8
FIRE DEPARTMENT COPY
SNOHOMISH CO.
FIRE
ST
FIRE PREVENTION
INSPECTI ON REPORT
0 EDMONDS
0 BRIER
E]WOODWAY
[I MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY STATION & SHIFT—,
LOCATION: 21603 84th Ave W 365 16 D
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BUSINESS NAME: PHONE: _6ATE DUE II' 09JI1311112
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MAILING _124@-NE-+76th-R_t LIFIR 11, 253 9156
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FIRE FE f LIZ-
SYSTEMS: ANNUAL
Serving Brier, Edmonds
Mountlake Terraceand
the Town of Woodway
www.FireDistrictl.org
.1242"�'U�Hdia'n Ave'S.
Everett, WA 98208 \
Phone (425) 551-1200
Fax (425) 551-1272
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
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2
2
3
3
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4
4
5
5
6
6
7
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE -INSPECTION
FINAL R�IINSPECTION
EXTENSION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTED TO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON,,."
CONTACTED:
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
DATE:
DATE:
DATE:
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
8
4
8
DATE:
LETTER NEEDED YES NO
EETTER NEEDED [:]�YES NO
8
FIRE DEPARTMENT COPY
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