23830 HWY 99 STE 204CSNOHOMISH CO,
FIRE
23830 P!&"tJk1L( S7-9- Oq—C—
FIRE PREVENTION
Serving Brier, Edmonds, and 12425 Meridian Ave S INSPECTION REPORT
OEDMONDS
Mountlake T�rrace Everett, WA 98208 0 BRIER
Phone (425) 551-1200 [3 MOUNTLAKE TERRACE
[3 UNINCORPORATED
www.FireDistrictl.org Fax (425) 551-1272
LOCATION: -Z,0 -(
23830 Highway 99 - Suite 2040-98026
BUSINESS NAME: PHONE:
Vacant
MAILING
ADDRESS:
23830 Highway 99, Suite 204C, Edmonds, WA 98026
BUSINESS OWNER: HOME PHONE:
4257748170
e' FREQUENCY STATI N & SHIFT
2816 2 O-A
SCHEDULED
DATE DUE - �
Aug 2946
UFIR �
776
.EMERGENCY-1: HOME PHONE: CURRENT
KEY ACCESS-2: Dong,Kang HOME PHONE: 4256701327 CITY YES NO
EMAIL: BUSINESS M [:]
LICENSE LiW.
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE SYSTEMS: FIE
IAAftF4AsbUwv=cbcATIONS
COMMUNICATIONS
2
2
3
3
4
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
In our continuing effort to promote fire safety and prevention within the community, your fire department conducts
regularly scheduled "Fire Safety Survey Inspections" of all businesses and multi -family occupancies in the Cities
covered by Snohomish County Fire District 1.
You are to be congratulated on the relative good condition of your occupancy in regards to fire safety. Above you
will find the item(s) that were noted during, our inspection which require attention to bring them into compliance
with the minimum standards adopted by the above jurisdictions.
Any overlooked hazards or violations. of the fire regulations does not imply approval of such conditions or violation
If you require additional information or to schedule a re -inspection for Edmonds, call (425) 775-7720; for
Mountlake Terrace or Brier, call (425) 744-6231.
I ol: Z �'_
FIRE PREVENTION
SAFETY SURVEY
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
4�'
t
LOCATION:
23830 Highway 99
BUSINESS NAME:
Vacant
MAILING
23830 Highway 99 #204C
ADDRESS:
Edmonds
BUSINESS OWNER:
Dong, Kang
EMERGENCY-1:
Dong,Kang
KEY ACCESS-2:
204C
PHONE: 4257748170
98026
HOMEPHONE: 4256701327
HOMEPHONE: 2065339182
HOME PHONE:
FREQUENCY7STATION
1, SHIFT
730
20 C
SCHEDULED
DATE DUE
LIFIR 10 591
8006
ACTIVE
eo INITIALANSPECTION I DATE
PERSON CONTACTED: 7
NAME OF INSPECTOR:
FIRE FE
SYSTEMS: ANNUAL
HAZARDS FOUND ANPILOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE I�
VIOLATION CODE
r
2
2
3
3
4
4
5
5
6
6
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7
8
8
lst RE -INSPECTION
2nd RE -INSPECTION
EXTENSION FINAL RE -INSPECTION
VIOLATIONS
DATE DUE.
DATE DUE.
PERSON
GRANTED TO: DATE DUE:
PERSON
CITED:
PERSON
CONTACTED.
CONTACTED:
I PECTOR:
DATE.
VIOLATIONS
CONTACTED:
. .................. . .. . . . .. .... INSPECTOR:
DATE.
PRE-CITAMON CITATION ISSUED
1
1111 N P E R:
2
.. . ..... ....
DATE.
3
VIOLATIONS
1 5
1
5
LETTER SENT NUMBER:
CODE
4
5
2
6
2
6
DATE: SECTION:
RETURN RECEIPT
3
7
3
7
RECEIVED DISPOSITION:
4
18
TT�______
R NEEDED [] YES NO
DATE:
8
LETTER NEEDED C] YES NO
FIRE DEPARTMENT COPY