22925 HWY 99 STE I�Zzvzs
FIRE PREVENTI=
Serving Brier, Edmonds, and
SNOHOMISH CO.
12425 Meridian Ave S
INSPECTION REPORT-`
Mountlake Terrace
Everett, WA 98208
0 EDMONDS
D BRIER
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Phone (425) 551-1200
0 MOUNTLAKE TERRACE
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[3 UNINCORPORATED
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www.FireDistrictl.org
Fax (425) 551-1272
FREQUENCY
STATION & SHIFF"'
LOCATION:
22925 Highway99 98026
2016**
20-C
BUSINESS NAME:
Rancho Grande 111
PHONE:
42527551521,
SCHEDULED
DATEDUE 'Apr2016
MAILING
FIR
ADDRESS:
22925 Highway 99, Edmonds, WA 98026
BUSINESS OWNER:
HOME PHONE:
:,EMERGENCY-1:
HOME PHONE:
eCURRENT
KEY ACCESS-2: Emigdio, Esparzo
HOME PHONE: 2068172065
CITY YES NO
EMAIL:
BUSINESS' F-1
LICENSE
01
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE SYSTEMS: FE 10/12
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RATE DUE:
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CODE
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LETTER NEEDED YES El NO
LETTER NEEDED YES NO
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SNOHOMISH CO. Set -ving Brier, Edmonds
�,O�
FIREMountlake Terraceand
12425 Meridian Ave S
Everett, WA 98208
_�00 the Town of Woodway
DISTh W"T www.FireDistrictl.org
Phone (425) 551-1200
Fax (425) 551-1272
LOCATION: 22925 Highway 99
BUSINESS NAME: Rancho Grande III
PHONE: 4252755152
MAILING 2625 Highway 99
ADDRESS:
Edmonds 98026
BUSINESS OWNER: Emigdio, Esparzo
HOME PHONE: 2063172065
EMERGENCY-1: Esparza, Bendo
KEY ACCESS-2: e jM
HOME PHONE: 4254226047
HOME PHONE:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS:
FIRE PREVENTION
INSPECTION'REOORT
0 EDMONDS
0 BRIER
E]WOODWAY
[I MOUNTLAKE TERRACE
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FREQUENCY STATION & SHIFF**'
366 20 D
SCHEDULED
DATE DUE � 04/011113
UFIR o 513 4056
ACTIVE
CURRENT
CITY YES NO
BUSINESS
LICENSE K 1:1
INITIAL INSPECTION 6ATE
FELQa2C?12_
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
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5
5
6
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7
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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:
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CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE: j 1
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DATE:
3
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VIOLATIONS
1 15
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LETTER SENT_
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NUMBER:
4
2
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2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
18
0
8
DATE:
DISPOSITION:
7
LETTER NEEDED F] YES NO
LETTER NEEDED YES NO
8
FIRE DEPARTMENT COPY
FIRE PREVENTION
Serving Briet; Edmonds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH
'FIR
CO.
Mountlake Terraceand
Everett, WA 98208
OEDMONDS
El BRIER
t wn of Woodway
0
Phone (425) 551-1200
0 WOODWAY
STR
0 MOUNTLAKE TERRACE
wwwTFireDistrictl.org
Fax (425) 551-1272
0 UNINCORPORATED
LOCATION:
22925 Highway 99
e- FREQUENCY
366
I STATION 1, SHIF'�l
20 C
BUSINESS NAME:
Rancho Grande III
PHONE: 4252755152
SCHEDULED 04/011-12
DATE DUE �
MAILING
22925 Highway 99
LIFIR 1, 513 4056
ADDRESS:
Edmonds
98026
BUSINESS OWNER:
Emigdio, Esparzo
HOME PHONE: 2068172065
-n
ACI VE
EMERGENCY-1:
Esparza, Benito
HOME PHONE: 42,54226047
KEY ACCESS-2:
HOME PHONE:
FCURRENT
CITY YES NO
BUSINESS
1?f
F-1
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR: C
FIRE
FElc>J ti
S�STEM&
APiP_JU7Z_
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
tsl omkiz.
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
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:
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
RECEIVED
6
4
18
4
18
DATE:
DISPOSITION:
7
LETTER NEEDED [] YES NO
LETTER NEEDED [] YES NO
8
FIRE DEPARTMENT COPY
.. ......... . FIRE PREVENTION
if ITY OF EDMONDR,� SAFETY SURVEY
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
41
LOCATION: 22925 Highway 99
BUSINESS NAME: Rancho Grande III
MAILING 22925 Highway 99
ADDRESS: Edmonds
BUSINESS OWNER: Emigdio, Esparzo
EMERGENCY- 1: Esparza, Bendo
KEY ACCESS-2:
PHONE: 4252755152
98026
HOMEPHONE: 2068172065
HOMEPHONE: 4254226047
HOME PHONE:
FREQUENCY
STATION& SHIFT
2
20 A
SCHEDULED
DATE DUE 0'
04/01,110
LIFIR 01 513
4056
ACTIVE
PERSON CONTACTED: ")P," � N F-.-, P-\ I INITIAL INSPECTION DATE
NAME OF INSPEC TOR: vLo Ht'l I �' to
FIRE
SYSTEMS:
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ANNUAL
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ENTER CODE ONLY ONCE ll�
VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
7
8
8
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:
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
7
4
18
4
18
1 E:
DISPOSITION:
8
D YES N
LETTER NEEDE YES
LETTER NEEDED [3 YES NO
FIRE DEPARTMENT COPY