22618 HWY 99 STE 113 (2)Sr"OriONIIS14 Co.
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Serving Bt ter, umonds, and 12425 Meridian Ave S
0 EDMONDS
Mountlake Terrace Everett, WA 98208 0 BRIER
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
UNINCORPORATED
JLO A JMJ. A. www-FireDistrictl-org Fax (425) 551-1272
22618 Highway99 Suite11398026
FRE ENCY
20?Y
ST16t& SHIFT
LOCATION:
Italy Optical
SCHEDULED Mar 2017
BUSINESS NAME:
PHONE:
DATE DUE �
MAILING
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ADDRESS:
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BUSINESS OWNER: Yoon,Duke
HOME PHONE: w's, 3x.
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Yoon,Young
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EMERGENCY-1:
HOME PHONE:
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY
YES NO
EMAIL: Oqg�6- gcit-J
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BUSINESS-
LICENSE
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF I NSPECTOR:
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Date Last Serviced:
5i
SNOHOMISH CO. Serving Briet; Edmonds, and
FIREMountlake Terrace
DISTRl T wwwFireDistrictl. org
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
0 MOUNTLAKE TERRACE
[I UNINCORPORATED
FREQUENCY
STATION &SHIFT
LOCATION:
226 IS Hiqhwav M Suite 113 08026
2 Year 14
20-D
BUSINESS NAME:
Ha1v Opuf.al
PHONE
SCHEDULED M
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DATE DUE
MAILING
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BUSINESS OWNER:
Ynr)n, Dijk-�-
HOME PHONE:
EMERGENCY-1:
ymn, young
HOME PHONE:
CUR -RENT
KEY ACCESS-2:
HOME PHONE:
CITY YES No
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1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
lst RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
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NUMBER:
4
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6
2
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DATE:
CODE
SECTION:
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7
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RETURN RECEIPT
RECEIVED
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DATE:
DISPOSITION:
7
LETTER NEEDED [] YES El No
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1
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FIRE DEPARTMENT COPY
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
It 89
LOCATION:
22618 Hwy 99
BUSINESS NAME:
Italy Optical
6.
MAILING
7
ADDRESS:
BUSINESS OWNER:
Yoon, Duke
EMERGENCY-1:
Yoonjoung
KEY ACCESS-2:
FIRE PREVENTION
SAFETY SURVEY
113
PHONE:
HOMEPHONE: 2535822630
HOMEPHONE: 2532235,952
HOME PHONE:
FREQUENCY
STATION & SHIFT"'
731
20 D
SCHEDULED "10
11 03/0
DATE DUE
LIFIR o� 593
3106
01 INITIA INSPECTION DATE
PERSON CONTACTED: 3.16
NAME OF INSPECTOR:
FIRE FE C 0�3'
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
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VIOLATION CODE
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2
3
3
4
4
5
5
6
6
7
7
8
8
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
E DUE:
1
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECTOR: IVAVA
INSPECTOR:
INSPECTOR:
2
DATE: 2ijy
DATE.
DATE
3
MOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CRATION ISSUED
NUMBER: -
4
2
6
2
6
DATE:
CODE
SECTION: -
5
3
7
7
18
RETURN RECEIPT
RECEIVED
6
7
4
18
4
DATE:
DISPOSITION:
8
�UETTERNEEDED [:] YES NO
LETTER NEEDED 0 YES NO
FIRE DEPARTMENT COPY