22828 100TH AVE W STE ASNOHO
F1
DI
/00 4-4 tq-L)e'_ 4J SrC,(+ FIRE PREVENTION
2 Z
INSPECTION REPORT
Serving B146., �ds 12425 Meridian Ave S 0 EDMONDS
Mountlake Terrace, and Everett, WA 98208 0 BRIER
the Town of Woodway Phone (425) 551-1200 E]WOODWAY
[I MOUNTLAKE TERRACE
T www.FireDistrictl.org Fax (425) 551-1272 0 UNINCORPORATED
0' FREQUENCY
STATION & SHIFT"'�
LOCATION:
22828 100th Avenue
W A
365
20
D
BUSINESS NAME:
Starbucks Coffee
PHONE: 42564-07275
SCHEDULED
DATE DUE 11' 02,,01,113
MAILING
LIFIR 11' '169 2 05�,,.,
ADDRESS:
BUSINESS OWNER:
Part of QFC
HOME PHONE:
ACTIVE
EMERGENCY-1:
HOME PHONE:
"CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY , YES
NO
BUSINESS
F]
LICENSE
PERSON CONTACTED: 'tSArfk
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
,47
1.1-A
I
FIRE
FE I I is
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUN16ATION S
kb L ikt sy 143 ru \j s�
4v.
2
t
'2
3
3
4
4
5
5
6�
6
7
7
1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1 st 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:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
5
VIOLATIONS
1 5
PRE -CITATION
LETTE SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
ZI
7
3
7
RETURN RECEIPT
RECEIVED
6
4
18
4
18
I
%
DATE:
DISPOSITION:
7
LETTER NEEDED [] YES NO
LETTER NEEDED E] YES [I NO
8
FIRE DEPOTMENT COPY
TT,
's�
";E�m.on,ds
ISH CO. ...... 11
-Mountlake Terrace, and
'bFIR the Town of Woodway
ISTR www.FireDistrictl.org
LOCATION: 22828 1 00th Avenue
BUSINESS NAME: Starbucks Coffee
MAILING
ADDRESS:
BUSINESS OWNER: Part of QFC
EMERGENCY-1:
KEY ACCESS-2:
PERSON CONTACTED: z /<—
NAME OF INSPECTOR:
FIRE
SYSTEMS:
FIRE PREVENTION
112425 IMeridian Ave:S
IN.SPECTION REPORT
Evereti, WA 98208
0 EDMONDS
0 BRIER
Phone (425) 551-1200
E]WOODWAY
[I MOUNTLAKE TERRACE
Fax (425) 551-1272
0 UNINCORPORATED
FREQUENCY
STATION & SHIF"'
W A
365
1 20 C
PHONE: 4256407275
SCHEDULED
DATE DUE 1" 02/01/12
UFIR 1� 169 2053
HOME PHONE: ACTIVE
HOME PHONE: "CURRENT
HOME PHONE: CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
YX �
FE
ANNUAL
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
Ist 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:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
D E:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2----'-
2
6
DATE:
CODE
SECTION:
5
3
7
3
RETURN RECEIPT
RECEIVED
,4
8
4
8
DATE:
DISPOSITION:
LETTERNEEDED [] YES NO
LETTERNEEDED [] YES El NO
8
FIRE DEPARTMENT COPY