22720 HWY 99 STE 1027-77�
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700 Z641 FIRE PREVENTION
INSPECTION REPORT
Serving Brier, P�amortds, and .12425 Meridian Ave S
VN,OlfONllSH Co. 0 EDMONDS
Mountlake Terrace Everett, WA 98208 �SRIER
FIRE Phone (425) 551-1200 0 MOUNTLAKE TERRACE
DIS., "Im R wr www.FireDistrictl.org Fax (425) 551-1272 0 UNINCORPORATED
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22720 Highway99 Suite 8026
LOCATION: 91
Vacant
BUSINESS NAME: PHONE:
MAILING
ADDRESS:
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
HOME PHONE:
KEY ACCESS-2:
HOME PHONE:
EMAIL:
PERSON CONTACTED:
NAME OF INSPECTOR:
Date Last Serviced:
0- ffffENCY STy&Q
6& SHIFT
SCHEDULED mar 2ul 7
DATE DUE 0
LIFIR 10
CURRENT,
CITY YES NO
BUSINESS F--j
LICENSE I 1 0
INITIAL INSPECTION DATE
-3 /1 C, // -1
FIRE PREVENTION
Serving Brier, Edmonds
ISH Co.
12425 Meridian Ave S
INSPECTION REPORT
F1 'E Mountlake Terraceand
Everett, WA 98208
0 EDMONDS
0 BRIER
the Town of Woodway
DISTRh T
Phone (425) 551-1j00
0WOODWAY
0 MOUNTLAKE TERRACE
www.FireDistrictl.org
Fax (425) 551-1272
0 UNINCORPORATED
LOCATION: 22720 Highway 99
102
r' FREQUENCY TATION & SHIFT"'
365 20 A
T
BUSINESS NAME: Vacant
PHONE:
SCHEDULED
DATE DUE 1' 03/0112
MAILING 22720 Highway 99
LIFIR � 538 3106
ADDRESS: Edmonds
98026
BUSINESS OWNER:
HOME PHONE:
ACTIVE
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HOME PHONE:
CURRENT
KEY ACCESS-2:
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CITY YES NO
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[INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE
FE i
SYSTEMS:
AN�iZ�L_
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
3
.... ... ... ..
--------------
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
'Ist RE -INSPECTION 2nd RE -INSPECTION
EXTENSION FINAL RE -INSPECTION VIOLATIONS
DATE DUE: DATE DUE: GRANTED TO: DATE DUE: CITED:
PERSON PERSON _�ERSON
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DATE: DATE: 3
DATE:
VIOLATIONS VIOLATIONS —CITATION ISSUED
PRE -CITATION 4
-LETTER SENT NUMBER:
CODE
2 6 2 6 DATE: SECTION: 5
RETURN RECEIPT
3 7 -RECEIVED 6
DIiP_0S1TION-.
7
RATE
LETTER NEEDED E3 YES F-1 NO LETTER NEEDED M YES NO 1 8
FIRE DEPARTMENT COPY
I
FIRE PREVENTION
Sj�ving Brier, Edmonds, and
12425 Meridian Ave S
INSPECTION REPORT
3NOliOMISH CO.
Mountlake Terrace
Everett, WA 98208
0 EDMONDS
0 BRIER
D11 R
Phone (425) 551-1200
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
www.FireDistrictl.org
Fax (425) 551-1272
FREQUENCY
ION & SHIFT_`�
LOCATION: 22720 H'iqh%Aay
W Suite ia2 DFL26
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BUSINESS NAME: -JaLanL
PH/ONE:
SCHEDULED Mar 2014
DATE DUE
MAILING
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ADDRESS: 22720 1 iiahAa-V
00, SuiLc 102. Ed= -I&. '14VA
091)2fa
BUSINESS OWNER:
HOM ONE:
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04
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HOME PHONE:
'CURRENT
KEY ACCESS-2:
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J EMAIL:
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LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
I R�- SYS I LIMB: FE
HAZARDS FOUND AND LOC� UIONS I COMMUNICATIONS
2 2
— --------- _3_
--- -------- ----
5 5
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION 2nd RE -INSPECTION EXTENSION FINAL RE -INSPECTION VIOLATIONS
2ATE DUE DATE DUE: GRANTEDTO: DATE DUE: CITED:
PERSON PERSON
PERSON
CONTACTED: CONTACTED: CONTACTED:
INSPECTOR: INSPECTOR: INSPECTOR: 2
R�TE 2ATE DATE: 3
VIOLATIONS VIOLATIONS PRE -CITATION CITATION ISSUED
1 5 1 5 LETTER SENT NUMBER: 4
CODE 5
DATE: SECTION:
RETURN RECEIPT
3 7 7 RECEIVED 6
TDISPOSI—TION: 7
4 4 8 ATE
18—
rLETTIERNEEDED [] �ES NO LETTER NEEDED YES [t__1 INO 8
FIRE DEPARTMENT COPY
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
LOCATION: 22721) Highway 99
BUSINESS NAME: (Vi:3Ca�)
MAILING 22720 Highway 99
ADDRESS: Edmonds
BUSINESS OWNER:
EMERGENCY-1:
KEY ACCESS-2:
102
PHONE:
98026
HOME PHONE:
HOME PHONE:
HOME PHONE:
FIRE PREVENTION
SAFETY SURVEY
FREQUENCY STATION & SHIFT
365 f-D c
SCHEDULED
DATE DUE ll� 03/01/10
UFIR 01 538 3106
AC'nVE
PERSON CONTACTED: INITIA 17E7;N I DATE
NAME OF INSPECTOR: (4 j
FIRE FE I
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
1
ENTER CODE ONLY ONCE ll�
VIOLATION CODE
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
lst RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE 6UE:
1
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSO�.
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
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
4
18
4
8
DATE:
DISPOSITION:
7
8
1,, LETTER NEEDED 0 YES N;
LETTER NEEDED 0 YES NO
FIRE DEPARTMENT COPY