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SNOHOMISH CO.
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12425 Meridian Ave S
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Everett, WA 98208
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LOCATION: 22315 Highway
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Annual 20-C
BUSINESS NAME: Tapioca Express
PHONE: 425.7746764
SCHEDULED
DATE DUE I,, Nov 2015
MAILING
ADDRESS: 22315 Highway 99, Suite A, Edmonds, WA 98026
BUSINESS OWNER: 'NW Tea Station, Inc HOME PHONE:
EMERGENCY1�- Won, James
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HOME PHONE: 4257022112
HOME PHONE:
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INITIAL INSPECTION DATE
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DATE DUE:
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Serving Brie.i: Edmonds, and
Mountlake Terrace
www.FireDistrictl.org
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LOCATION: 2281L HighwayBO SuiteAQ8826
BUSINESSNAME:
FIRE PREVENTION
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12425 Meridian Ave S ;PECTION REPORT
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Everett, WA 98208 El BRIER
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PHONE: 42J-7,74E7641/ DATE DUE rOV 20 14
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HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
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DATE DUE:
DATE DUE:
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VIOLATIONS
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DATE:
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FIRE DEPARTMENT COPY
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FIRE PREVENTION
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Serving Briet; Edmonds, and5
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO. -
FIRE-
Mountlake Terrace
Everett, WA 98208
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0 BRIER
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Phone (425) 551-1200
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
www.FireDistrictl.org
Fa_x (425) 551-1272
LOCATION: 223 15 Highway ED Suite A 98026
BUSINESS NAME: lapima Express PHONE: 4267.740F54
MAILING
ADDRESS: 22315 1 ligIvAray 90, Sufte A, Edmands, WA 380215
BUSINESS OWNER: "JV Tr.A.I%tafirm, 11w. HOME PHONE:
EMERGENCY-1: WU?j, Jjnjj_
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FREQUENCY I STATION & SHIF'*)
20-A
SCHEDULED
DATEDUE �Nov2f)113
(UFIR 03 __j
CURRENT
CITY YES NO
BUSINESS
LICENSE 9 El
INITIAL INSPECTION DATE
-b / �Z. 5 / I �—
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
3
4
4
5
5
6
6
7
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1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
lst RE -INSPECTION
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTED TO:
DATE DUE:
CITED:
PERSON
PERSON
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CONTACTED:
CONTACTED:
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INSPECTOR:
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DATE:
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VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
5
1 5
LETTER SENT
NUMBER:
4
CODE
5
2
6
2
6
DATE:
SECTION:
RETURN RECEIPT
3
7
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RECEIVED
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DISPOSITION:
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8
DATE:
LETTER NEEDED E] YES El NO
f"LETTER NEEDED E] YES El NO
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FIRE DEPARTMENT COPY
FIRE PREVENTION
rServin . B let; Edinonds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
�jountlake Terraceand
TIRE
Everett, WA 98208
0 EDMONDS
0 BRIER
the Town of Woodway
DISTR T
Phoize (425) 551-1200
E]WOODWAY
0 MOUNTLAKE TERRACE
www.FireDistrictl.org
Fax (425) 551-1272
0 UNINbORPORATED
FREQUENCY STATION& SHIFT
LOCATION: 22315 Highway 99
A
3155 20 C
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BUSINESS NAME: Tapioca Fj(press
PHONE: 4257746764
SCHEDULED
DATE DUE 0 11/01,111
MAILING 22315 Highway 99 #A
LIFIR 0 513 1107
ADDRESS: Edmonds
93026
BUSINESS OWNER
NW Tea Station, Inc. '7
HOME PHONE: 4257022112
ACTIVE 30
EMERGENCY-1: Won, James
HOME PHONE: 4257022112
e- CURRENT -'s
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
LICENSE
PERSON CONTACTED: 7W 'N CA mcs
INITIAL INSPECTION DATE'
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NAME OF INSPECTOR:
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FIRE HD 3109 UL300
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HAZARDS FOUND AND LOCATIONS / 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
lst RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
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INSPEQTOR:
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DATE:
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DATE:
3
VIOLATIONS
1 15
VIOLATIONS
1 5
PRE -CITATION
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
14
18
4
18
DATE:
DISPOSITION:
7
LETTER NEEDED C] YES El No'
LETTERNEEDED [] YES 0 NO
1
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FIRE DEPARTMENT COPY