23416 HWY 99 STE E7
Z34" . FIRE PREVENTION
Serving Brier, P-amonds, and 12425 Meridian Ave S INSffiCTION REPORT
SNOHOA11SH CO. nEDIVIONDS
Mountlake Terrace Everett, WA 98208 BRIER
FIRE Phone (425) 551-1200 0 MOUNTLAKE TERRACE
UNINCORPORATED
DIST T wwwF�ireDistrict].org Fax (425) 551-1272
' 7 e' FREQUENCY ]ON & SHIFT`�
LOCATION: 23416 Highway 99 Suite E 98026 2017 sTA2TO-B
BUSINESS NAME: Vacant PHONE: 4257442742 SCHEDULED May 2017
DATE DUE
MAILING LIFIR 11, 0
ADDRESS:
BUSINESS OWNER: HOME PHONE:
Shin, Daniel 4256102541
EMERGENCY-11: HOME PHONE. 20 "CURRENT YES NO
KEY ACCESS-2: HOME PHONE: CITY
BUSINESS
EMAIL: LICENSE
PERSON CONTACTED: f/ �zrfg INITIAL INSPECTION DATE
NAME OF INSPECTOR: na
Date Last Serviced:
HAZARDS FOUND AND LOCATIO S / COMMUNICATIONS
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1 St RE -INSPECTION
2nd RE -INSPECTION
FINAL RE -INSPECTION
EXTENSION VIOLATIONS
DATE DUE:
DATE DUE
GRANTEDTO- DATE DUE. CITED.
PERSON
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CONTACTED.
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INSPECTOR.
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VIOLATIONS
VIOLATIONS
CITATION ISSUED
PRE -CITATION
1 5
1 5
LETTER SENT NUMBER 4
CODE 5
2 :6
2 6
DATE S ECTION.
RETURN RECEIPT
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DISPOSITION*
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LETTER NEEDED [] YES [:1 NO
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Serving Brier Edmonds
Mountlake Terraceand
Tthe Town of Woodway
wwwFireDistrictLorg
LOCATION:
23416 Highway 99
BUSINESS NAME:
Vacant
MAILING
23416 Highway 99 VE
ADDRESS:
Edmonds
BUSINESS OWNER:
'Na, AlisaS.'
EMERGENCY-1:
Shin, Daniel
KEY ACCESS-2:
1, �
MIL
PERSON CONTACTED:
NAME OF INSPECTOR:
F1 RE
SYSTEMS:
f2425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
E
PHONE: 4257442742
98026
HOME PHONE: 4257425006
HOME PHONE: 4256102545
HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
OWOODWAY
0 MOUNTLAKE TERRA6E
0 UNINCORPORATED
FREQUENCY I STATION 8, SHIFT"
731 20 C
SCHEDULED
DATE DUE 1' 05,101/12
LIFIR 1, 591 . 556
ACTIVE
CURRENT
CITY
YES NO
BUSINESS
1:1 11
LICENSE
INITIAL INSPECTION DATE
i�
FE
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
1
1
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
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
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
14:
8
4
8
DATE:
DISPOSITION:
7
LETTERNEEDED [] YES El No
LETTER NEEDED [] YES NO
8
FIRE DEPARTMENT COPY
V�_
C1W OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-
FIRE DEPARTMENT
4j' t VN Cj
LOCATION: 23416 Highway 99 E
BUSINESS NAME: Vacant
MAILING 23416 Highway 99 #E_
ADDRESS: Ed onds 98026
FIRE PREVENTION
SAFETY SURVEY
PHONE: 4257442742
FREQUENCY
STATION &SHIFT
3
20 A
SCHEDULED
DATE DUE 1�
05/01/10
UFIR 11� 1,;91
556
BUSINESS OWNER: "Na, Alisa S." HOME PHONE: 4257425006 AC71VE
EMERGENCY-1: Shin, Daniel HOME PHONE: '4256102545
KEY ACCESS-2: HOME PHONE:
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE FE
9YSTEMS: ANNUAL'
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
ENTER UO_Q�ONLY ONCE
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:
PERSON
CONTACTED:
INSPECTOR:
E:
VIOLATIONS
1 5
2 6
3 7
4 '18
TTER NEEDED El YES 0 NO
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
2
DATE:
. ............. .. . ......... . .... . --I.NS'PECTOR:
DAT
PRE -CITATION CITATION ISSUED
LETTER SENT NUMBER:
CODE
DATE: SECTION:
RETURN RECEIPT
RECEIVED
3
VIOLATIONS
1 5
4
2
3
6
7
5
6
7
4
18
F1 POSITION:
DA�E:
ff
8
LETTER NEEDED [] YES NO
FIRE DEPARTMENT COPY