22508 76TH AVE W)0
(V FIRE'�PR'EVENTION
7 V
X
INSPECTION REPORT
r3WOHOI� H 0 Serving Brier, Larrlurtuj, and 12425 Meridian Ave S
EDMONDS
Moinitlake Terrace Everett, WA 98208 SBRIER
S jcvj Phone (425) 551-1200 0 MOUNTLAKE TERRACE
D1C.4— rr [] UNINCORPORATED
6:311 JL www.FireDistrict].org Fax (425) 551-1272
22508 76 th Avenue W 98026
LOCATION:
Ben Holt Industries Inc
BUSINESS NAME:
MAILING 22508 76th Avenue W, Edmonds, WA 98026
ADDRESS:
Holt, Ben
BUSINESS OWNER:
EMERGENCY-1: Lachapelle, Natalie
KEY ACCESS-2:
EMAIL:
P ERSON CONTACTED: A, VO le -
NAME OF INSPECTOR: V .to\
bate Last Se'r'viced-
k
4 k�'
4257754616
PHONE:
HOME PHONE:
4253478439
HOME PHONE: . ...........
HOME PHONE:
fffyENCY STY&V SHIFT-'*)
SCHEDULED Mar 2U1 f
DATE DUE 0
091
UFIR 0
CURRENT
CITY YES
BUSINESS
LICE
INITIAL INSPECTION DATE
Ll /1'2) � 1 -7
NO
F
SNOHOMISH
FIR'�
DIS ,
Serving Brier, Edmonds, and
Mountlake Terrace
www.FireDistrict].org
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1260
Fax (425) 551-1272
'01RE PREVENTION
INSPECTION REPORT
OEDMONDS
[3 BRIER
[3 MOUNTLAKE TERRA CE
[3 UNINCORPORATED
e FREOUENCY
T"
STATEN & SHIFT
1111IN:
22508 76 th Avenue W 98026
2016*
720-D
BUSINESS NAME:
Ben Holt Industries Inc PHONE:
4257754616
SCHEDULED
DATE DUE 0 Mar 2016
MAILING
UFIR 591 106
ADDRESS:
22508 76th Avenue W, Edmonds, WA 98026
J
BUSINESS OWNER:
Holt, Ben HOME PHONE:
EMERGENCY-1
Lachapelle, Natalie HOME PHONE:
4253478439 e-CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
EMAIL:
r'. I<
6.we!�� - -to r C"!3,2 C
BUSINESS
5d
1:1
LICENSE
PERSON CONTACTED: r\ o,
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
C.,
FIRE SYSTEMS:
FE-7
D,qtp I q--,t Sprvirpd-.
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
A_ ------
2
2
3
3
4
4
5 ........ . .
6
5
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1 st RE -INSPECTION
DATE DUE:
PERSON
CONTACTED:
2nd RE -INSPECTION
DATE DUE:
��RSO_N
CONTACTED:
EXTENSION
GRANTEDTO:
. .....
FINAL RE-INSPECfION
DATE DUE:
VIOLATIONS
CITED:
�ERSON
CONTACTED:
I
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
15
2 _16
VIOLATIONS'- k
1 5
2 6
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
DATE:
CODE
SECTION:
5
3
3
7
RETURN RECEIPT
RECEIVED
6
LETTERNEEDED YES NO
4
8
DATE:
DISPOSITION:
LETTER NEEDED [] YES NO
8
CITY OF EDMONDS
121 5� AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FIRE DEPARTMENT
x
LOCATION.
22508 76th Avenue w
BUSINESS NAME:
Ben Holt Industries Inc
MAILING
22503 76th Ave W
FIRE PREVENTION -
SAFETY SURVEY
PHONE: 4257754616
ADDRESS: Edmonds 98026
BUSINESS OWNER: nHolt, Senn HOMEPHONE: 4257769708
EMERGENCY- 1: wLa . chapelle, Natalie" HOME PHONE: 4253478439
KEY ACCESS-2: HOME PHONE: t
FREQUENCY
—STATION &SHIFT
7 � i,,'
31
20 6
SCHEDULED
10 03/0411/16',
DATE DUE
UFIR I� 591
31 106
PERSON CONTACTED: RA(2- f5A A WIA17 7� INITIAL INSPECTION DATE
I I --z' — S" z
NAME OF INSPECTOR: �-z 6 8
IC)
FIRE FE
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
ENTER CODE ONLY ONCE 10
VIOLATION CODE
2
2
3
3
4
4
5
5'
6
6
7
7
8
8
.1st RE -INSPECTION
PATE DUE:
2nd RE -INSPECTION
DATE DUE:
1
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
C NTACTED:
PERSON
CONTACTED:
14PECTOR:
INSPECTOR:
INSPECTOR:
2
D ATE:
DATE,
DATE:
3
VIOLATIONS
5
VIOLATIONS
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
L3
7
RETURN RECEIPT
RECEIVED
6
7
4 4
--A
18
4
18
DATE:
DISPOSITION:
8
� LE TTE� NEEDED [] YES NO
LETTER NEEDED [-] YES NO
FIRE DEPARTMENT COPY