22727 HWY 99 STE 10471
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12425 Meridian Ave S INSPECTION REPORT.
Serving Brier, -�umvttds, and
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Mmintlake Terrace Evered, WA 98208
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Phone (425) 551-1200 0 MOUNTLAKE TERRACE
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LOCATION: 22727 Highway 99 Suite 104 98026
BUS.INESS NAME: Vacant PHONE:
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BUSINESS OWNER: HOME PHONE:
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Date Last Serviced:
FREQUENCY I STATION 1, SHIFT
2016 20-D
SCHEDULED Oct 2016
DATE DUE 0
1 591
LIFIR 0
CURRENT
CITY YES NO
BUSINESS f7l
LICENSE ILL
INITIAL INSPECTION DATE
lo- /-7-41�
FIRE PREVENTION
. Set-ving Bilet; Edmonds, and 12425 Meridian Ave S INSPECTION REPORT
MISH Everett, WA 98208 KEDMONDS
Mountlake Terrace —.1 0 BRIER
FIRE 0 MOUNTLAKE TERRACE
Phone (425) 551-1200 [1 UNINCORPORATE . D
DISTR T wwwFireDistriq�jl. org Fax (425) 551-1272
FREQUENCY STAT ION & qSHIFT
LOCATION: 22727 Higbia 9 Suite 04)98026 2 Year 1 13 20-)�
SCHEDULED
BUSINESS NAME: CAJIState insurance PHONE: 4256708900 Oct 20-13
DATE DUE I`
MAILING �r"lovzo 10 Icb UFIR ll� 591
ADDRESS: 22727 Highway 99, Suite 104, Edmonds,'WA 98026
BUSINESS OWNER: Kwon, John HOME PHONE:
EMERGENCY-1: Kwon, John HOME PHONE: 4257456667[ CURRENT YES NO
KEY ACCESS-2: HOME PHONE: CITY
BUSINESS F�
EMAIL: LICENSE
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR: Ku 0 t'-1 10 Z2_/ 1'2,
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
2nd RE -INSPECTION
FINAL RE -INSPECTION
EXTENSION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTED TO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
ONTACTED:
CONTACTED:
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
E:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
1 5
1 5
LETTER SENT
NUMBER:
4
CODE
5
2
6
2
6
DATE:
SECTION:
RETURN RECEIPT
3
7
3
7
RECEIVED
6
DISPOSITION:
14
18
4
18
DATE:
LETTERNEEDED [:] YES El NO
LETTERNEEDED E] YES [:1 NO
8
FIRE DEPARTMENT COP*