22511 HWY 99 STE 111Serving.Brier, 12425 Meridian Ave S
-e T
Mountlak erraceand Everett, WA 98208
�: Tthe Town of Woodway Phone (425) 551-1200
wwwFireDistrictl.org Fax (425) 551-1272
LOCATION: 22511 H" 99 ill
BUSINESS NAME: Vacant PHONE:
MAILING 22511 Hwy 99 #107
ADDRESS: Edmonds
BUSINESS OWNER: Tajimi, Inc
EMERGENCY-1: Inukai, Satoru
KEY ACCESS-2:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS:
98026
HOMEPHONE: 2063725002
HOMEPHONE: 2063725002
HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
E]WOODWAY
[I MOUNTLAKE TERRACE
0 UNINCORPORATED
I` FREQUENCY
STATION & SHIFT_*'
731
20 6
I
SCHEDULED
DATE DUE l' 04101/13
UFIR 11, 539 4107
CURRENT
CITY YES NO
BUSINESS
LICENSE El El
INITIAL INSPECTION DATE
FE / .
AI�NUZ
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:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
,INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
3
6
7
DATE:
CODE
SECTION:
5
3
7
RETURN RECEIPT
RECEIVED
6
14
is
4
18
DATE:
DISPOSITION:
LETTER NEEDED E] YES El NO
LETTER NEEDED [] YES NO
FIRE DEPARTMENT COPY
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
LOCATION: 22511 Hwy 99 ill
BUSINESS NAME: Vacant PHONE:
FIRE PREVENTION
SAFETY SURVEY
MAILING 22511 Hn 99 #107
ADDRESS:
Edmonds 98026
BUSINESS OWNER: Tajimi, Inc HOMEPHONE: 2063725002
EMERGENCY-1: I nukai, Satoru HOMEPHONE: 2063725002
KEY ACCESS-2: HOME PHONE:
FREQUENCY
STATION& SHIFT
73
20 D
SCHEDULED
DATE DUE 0
04/01/11
LIFIR � 539
4107
f
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR: 6 0,;711-L-lh
FIRE
SYSTEMS:
FE I
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE 11�
VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
7
8
8
'Ist RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
E 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-CRATION
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
a
DATE:
DISPOSITION:
7
8
�, LETTER NEEDED [] YES NO
LETTER NEEDED [7 YES NO
FIRE DEPARTMENT COPY