22511 HWY 99 STE 107F4
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FIRE PREVENTION
Serving Brier, Edmonds, and 12425 Meridian Ave S INSPECTION REPORT
Mountlake Terrace Everett, WA 98208 OEDMONDS
0 BRIER
Phone (425) 551-1200 [3 MOUNTLAKE TERRACE
www.FireDistrictl.org Fa;�.(425)j5l-1272 [3 UNINCORPORATED
FREOUENCY STATION & SHIFT
LOCATION:,
22511" Highway 99 Suite, 107 98026 2nis __20-A
BUSINESS NAME: (!PHON�E: SCHEDULED
AAA Pacific Herbs 42516732998 DATE DUE 11' Apr 2016
MAILING LIFIR 0
ADDRESS: 513
22511 Highway 99, Suite� 107, Edmonds, WA 98026
BUSINESS OWNER: HOME PHONE:
A �)o v--
EMERGENCY-1: HOME PHONE: CURRENT
KEY ACCESS-2: Mar's investment, Inc. HOME PHONE: -42-55=9K. CITY YES NO
EMAIL: BUSINESS
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INITIAL INSPECTION DATE
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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 RE
EXTENSION
-INSPECTION
VIOLATIONS
DATE DUE:
E DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON'
CONTACTED:
CONTACTED:
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
VIOLATIONS
VIOLATIONS,-�`
PRE -CITATION
CITATION ISSUED
SENT�
4
____LETTE�R
CODE
5
6
2 6
DATE:
SECTION:
RETURN RECEIPT
3
7
3
7
RECEIVED
6
DISPOSITION:
4
18
4
8
DATE:
7
k—LETTER NE EDED [] YES NO
LETTERNEEDED [] YES NO
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Serving Brier, EA7onds
Mountlake Terraceand
the Town of Woodway
www.FireDistrictl.org
LOCATION:
22511 Hwy 99
BUSINESS NAME:
AAA Pacific Herbs
MAILING
22511 Hwy 99 #111
ADDRESS:
Edmonds
BUSINESS OWNER:
Maes Investment, Inc
EMERGENCY-1:
Mar, Mindy
KEY ACCESS-2:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS:
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-12 72
107
PHONE: 4256732998
9BD26
HOMEPHONE: 4256732998
HOMEPHONE: 2063406411
HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
DEDMONDS
0 BRIER
0 WOODWAY
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY
STATION & SHIFT_*'
730
20 6
SCHEDULED
DATE DUE 11' 04/0111-13
LIFIR o 513 4107
CURRENT
CITY YES NO
BUSINESS El
LICENSE
INITIAL SPECTIO
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ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
3
4
4
5
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5
6
6
7 Ll
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:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
I
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
RATE:
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
8
4
8
DATE:
DISPOSITION:
LETTER NEEDED [] YES El NO
LETTER NEEDED [-] YES NO
8
FIRE DEPARTMENT COPY
CITY OF EDMONDS
121 STm AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
LOCATION: 22511 HM 99
BUSINESS NAME: AAA Pacific Herbs
MAILING 22511 Hwy 99 #111
ADDRESS: Edmonds
BUSINESS OWNER: Mars Investment, Inc
EMERGENCY-1: Mar, Mindy
KEY ACCESS-2:
FIRE PREVENTION
SAFETY SURVEY
107
PHONE: 4256732998
98026
HOMEPHONE: 4256732998
HOMEPHONE: 2063406411
HOME PHONE:
FREQUENCY STATION & SHIFT
730 21) D
SCHEDULED
DATE DUE 01 04/01/11
LIFIR 11' 513 4107
01 PERSON CONTACTED: Mo I*,-- INIII IAL INSPECTION DATE
NAME OF INSPECTOR: -7 1,2 -� t
FIRE j FE j�' �LL
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
ENTER CODE ONLY ONCE lo
VIOLATION CODE
2
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3
4
4
5
5
6
6
7
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8
8
lst 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:
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
7
4
18
4
8;
INO
DATE:
DISPOSITION:
8
1,, LETTER NEEDED E] YES NO
LETTER NEEDED [ YES
FIRE DEPARTMENT COPY
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