22617 76TH AVE W STE 204 (2)e2lo
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F RE10RIEVENTIOU
Ser�ihg Brier, Edihonds, and 12425 Meridian Ave S INSPECTIONiBE PORT
;NOHOMISH CO.
I
uh, tla,ke Terrade Everett, WA 98208 B R I E R
j6xiX i mo li` Phone (425) 551-1200'. [3 MOUNTLAKE TERRACE
[3 UNINCORPORATED
DISTR T www."FireDistrii"ct'l.org Fax (425) 551-1272
FREQUENCY STATION & SHIFT
ON: 2261 61
LOCATI h - Ave U'e 4�6` 204,qW ?6 2015 20-B
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BUSINESS NA�J Vacant
BUSINESS OWNER:'
EMERGENCY-1: Wentworth, Scott
KEY ACCESS-2:
EMAIL:
PERSON CONTACTED:
NAME OF, INSPECTOR:
FIRE SYSTEMS: - FE
Date Last Serviced:.
HAZARD FOUND AND LOCATIONS /COMMUNICATIONS
PHONE:
HOME PHONE:
HOME PHONE: 4253877370
HOME PHONE:
SCHEDULED
DATE DUE ii, Oct 2015
E591 107
CURRENT
CITY
YES
NO
BUSINESS
El
1:1
LICENSE
INITIAL INSPECTION DATE
2
k
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
I st RE -INSPECTION
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS.`1
PRE -CITATION
CITATION ISSUED
4
LETTER SENT
NUMBER:
2
6
2
6
DATE:
CODE
SECTION:
5
RETURN RECEIPT
6
7
3
7
RECEIVED
DISPOSITION:
4
-8
4
DATE:
LETTERNEEDED F] YES NO
LETTERNEEDED YES NO
I
FIRE PREVENTION
Serving Brier, Edinonds, and
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
FIRE
Mountlak;e,Terrace. �_,q
Everett, WA 98208
0 EDMONDS
0 BRIER
DISTR
W:IT wwwFireDistrictl.org
Phone (425) 551-1200
Fax (425) 551-1272
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY
STATION & SHIF_*)
LOCATION:
22617 76th Avenue W Suite 204 98026
2 Year
1 13 2G-D
BUSINESS NAME:
Vacant
PHONE: 4257754871
SCHEDULED
DATE DUE I` Oct 2013
MAILING
LIFIR � 591
11
ADDRESS:
22617 76th Avenue W, Suite 204, Edmonds, WA 98026
I .
BUSINESS OWNER:
HOME PHONE:
EMERGENCY
Wentworth, Scott
HOME PHONE: 42538777'35770
KEY ACCESS-2:
HOME PHONE:
=CURRENT
CITY YES NO
EMAIL:
BUSINESS
E] 1:1
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE SYSTEMS:
FE_/__
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:
I
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
I
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1
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
18
4
18
DATE:
DISPOSITION:
7
\1 LETTER NEEDED [] YES El NO
LETTER NEEDED E] YES NO
FIRE DEPARTMENT COPY
Serving Briei: Edtnon&
SNOHOMISH CO. Mountlake Terrace,and
FIRE
the Town of Woodway
DISTRiuT www.FireDistrictl.org
LOCATION: 22617 76th Avenue W
BUSINESSNAME: Vacant
MAILING 22617 76th Ave W #204
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
204
PHONE: 4257754871
ADDRESS: Edmonds 98026
BUSINESS OWNER: Wentworth, Scoff HOMEPHONE: 4253877370
EMERGENCY-1: Wentworth, Jack HOME PHONE: 4257436302
KEY ACCESS-2: HOME PHONE:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS:
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
E]WOODWAY
[I MOUNTLAKE TERRACE
OUNINCORPORATED , '
FREQUENCY I STATION &SHIFT"
731 20 C
SCHEDULED
DATE DUE � 10101/12
UFIR � 551 1(107
ACTIVE
"'CURRENT
CITY YES NO
BUSINESS
LICENSE 1:1 1:1
INITIAL INSPECTION DATE
FE I
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2 f A on A
2
14j
3
3
4
4
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st 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:
DATE:
DATE:
3
f VIOI:ATIONS
1 16
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
4
8
4
8
DATE:
DISPOSITION:
7
\1 LETTER NEEDED E] YES 0 No
rLETTER NEEDED YES NO
8
FIRE DEPARTMENT COPY
CITY OF EDMONDS
121'5T�l AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FIRE DEPARTMENT
LOCATION: 22617 76th Avenue W
BUSINESS NAME: Fantastic Games & Toys
MAILING 22617 76th Ave W #204
FIRE PREVENTION
SAFETY SURVEY
204
PHONE: 4257754871
ADDRESS: Edmonds 98026
BUSINESS OWNER: Wentworth, Scoff HOMEPHONE: 4253877370
EMERGENCY-11: Wentworth, Jack HOME PHONE: 4257436302
KEY ACCESS-2: HOME PHONE:
ViC*CC_C>'
r FR wt NCY I STATjd & R41FT
SCHEDULED 10101/10
DATE DUE 11'
LIAR 1� 551 10107
AC-nVE
III ITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR: Y-"3 �Aq a v I Z_ z-o \ a
FIRE FE
SYSTEMS: ANNUAL
I
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
lst RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
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
5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
--------------
3
7
7
RETURN RECEIPT
RECEIVED
6
4
8
4
8
DATE:
DISPOSITION:
7
8
k,LETTERNEEDED E] YES E] NO
LETTER NEEDED E] YES E] NO
FIRE DEPARTMENT COPY