22816 100TH AVE W (2)FIRE -PREVENTION
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Ing I C., iA and `12425 Meridian Ave S INS�RECTION, REPORT
,�MONDS
Moiintlake Terrace Everett, WA 98208 []'�RIER
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
UNINCORPORATED
"A%.0 Fax (425) 551-1272
wwwFireDistrictLorg
LOCATION: 22816 100 th Avenue W 98026
BUSINESS NAME: State Farm Insurance PHONE: V42/57754664
MAILING
ADDRESS: 22816 1 00th Avenue W, Edmonds, WA 98026
BUSINESS OWNER: HOME PHONE:
EMERGENCY-1: Schuster, Earl G HOME PHONE: _42-96542-744&—
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2015 20-B
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INITIAL INSPECTION DATE
VOL . L615
HAZARDS FOUND AND LOCATIONS OM�ATIONS
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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-I!�E-INSP'ECTION
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2
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DATE:
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LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
DATE:
CODE
SECTION:
5
3
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3
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RETURN RECEIPT
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6
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DISPOSITION:
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LETTER NEEDED E) YES El NO
LETTER NEEDED F] YES NO
8
., FIRE DEPARTMENT COPY'
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FIRE PREVENTION
Serving Brier, Edrhonds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH. CO.
FIRE
Moun' ke T�
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Everett, WA 98208
0EDMONDS
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Phone (425) 551-1200
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LOCATION:
22816 1 00th Avenue
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BUSINESS NAME:
State Farm Insurance
PHONE: 4257754664
SCHEDULED (12/01/12
DATE DUE 0
14AILING
22816 1 OOTh Ave W
UFIR 1, 591 253
ADDRESS:
Edmonds
98020
BUSINESS OWNER:
"Schuster, Earl Gn
HOME PHONE: 2065427448
ACTIVE
EMERGENCY-1:
bell, Kathy
HOME PHONE: 4257439650
KEY ACCESS-2:
HOME PHONE:
[-�URRENT
ITY YES NO
BUSINESS
El
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
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NAME OF INSPECTOR:
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HAZARDS FOUND AND LOCATIONS COMMUNICATIO
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2
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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:
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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
8
4
8
DATE:
DISPOSITION:
LETTER NEEDED [] YES NO
N,
LETTER NEEDED ff YES NO
8
FIRE DEPARTMENT COPY
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CITY OF EDMONDS
121 5T" AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
LOCATION: 22816 1 00th Avenue w
FIRE PREVENTION
SAFETY`SURVEY
BUSINESS NAME:
State Farm Insurance
PHONE:
4257754664
MAILING
22816 1 00Th Ave W
ADDRESS:
Edmonds
98020
BUSINESS.OWNER:
"Schuster, Earl G"
HOME PHONE:
2065427448
EMERGENCY-1:
Bell, Kathy
HOME PHONE:
4257439650
KEY ACCESS-2:
HOME PHONE:
FREQUENCY STATION& SHIFT
730 20 A
SCHEDULED
DATE DUE 01 02/01/10
UFIR 11- 591 253
ACTIVE
INITIAL INSPECTION DATE
PERSON CONTACTED: l5tcll
NAME OF INSPECTOR:
FIRE FEO_� L0_5
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
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ENTER CODE ONLY ONCE I�
VIOLATION CODE
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3
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4
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5
5
6
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8
8
Ist RE -INSPECTION
DATE DUE
2nd RE -INSPECTION
DATE DUE
PERSON
CONTACTED:
INSPECTOR:
DATE
VIOLATIONS
1 5
2 6
8
LETTER NEEDED C] YES NO
EXTENSION
GRANTED TO:
WE-CITA ON
LETTER SENT
DATE:
RETURN RECEIPT
RECEIVED
DATE:
I
FINAL RE -INSPECTION
DATE DUE
PERSON
CONTACTED:
INSPECTOR:
DATE
CITATION ISSUED
NUMBER:
CODE
SECTION:
DISPOSITION:
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VIOLATIONS
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PERSON
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DATE
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VIOLATIONS
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FIRE DEPARTMENT COPY