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FIRE DEPARTMENT COPY
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LOCATION: 22906 O'Way , Edmonds 98020
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FIRE PREVENTIO N
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NUMBER:
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DATE:
DISPOSITION:
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8
FIRE DEPARTMENT COPY
FIRE PREVENTION
Serving Brier, Edinonds
12425 Meridian Ave S
INSPECTION REPORT
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Mountlake Terraceand
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Everett, WA 98208
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IRE DEPARTMENT COPY
FIRE PREVENTION
Serving Briet: Edinonds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
Mountlake Terracevnd
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Everett, WA 98208
El EDMONDS
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SCHEDULED 08/01 . Ill
DATE DUE
MAILING 22906 Edmonds Way
UFIR10 427 854
ADDRESS: Edmonds
98020
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ANNUAL
:j�
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
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION,
DATE DUE:
VIOLATIONS
CITED:
PERSON
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PERSON
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1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DA E:
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
REd"EIVED
6
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4
8
DATE:
DISPOSITION:
LETTER NEEDED YES NO
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LETTER NEEDED E] YES I—] NO
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FIRE bEPARTMENT COPY
CITY OF EDMONDS
121 5� AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FIR DEPARTMENT
t
LOCATION:
22906 Edmonds Way
BUSINESS NAME:
Montavo Park PHONE:
MAILING
22906 Edmonds Way
ADDRESS:
Edmonds 98020
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
HOME PHONE:
KEY ACCESS-2:
HOME PHONE:
FIRE PREVENTION
SAFETY SURVEY
FREQUENCY
STATION 1, SHIFT
20 A
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SCHEDULED
DATE DUE 01 08/01/10
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DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
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PERSON
CONTACTED:
PERSON
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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:
6
3
7
13
7
RETURN RECEIPT
RECEIVED
6
7
4
8
1 4
8
DATE:
DISPOSITION:
8
� LETTER NEEDED [] YES [3 NO
I LETTER NEEDED 0 YES NO
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FIRE DEPARTMENT COPY