320 DAYTON ST STE 260SNOHOMISH CC
FIRE
DIST
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Serving Br - .9 nds 12425 Meridian Ave S
Mountlake Terraceand Everett, WA 98208
the Town of Woodway Phone (425) 551-1200
www.FireDistrictl.org Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
`,eEDMONDS
CrBRIER
0 WOODWAY
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
e- FREQUENCY
STATION 9 SHIFF')
LOCATION:
320 Dayton Street
260
731
17 6
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BUSINESS NAME:
VAC� �J
PHONE: 4252759457
SCHEDULED
DATEDUE 11' 03,101/113
MAILING
320 Dayton St #260
LIFIR � 591 3202
ADDRESS:
Edmonds
98020
BUSINESS OWNER:
Cloutier, Priya
HOME PHONE: 4252314749
ACTIVE
EMERGENCY-1:
Engle, Chris
HOMEPHONE: 2063069889
CURRENT
KEY ACCESS-2:
HOME PHONE:
YES NO
CITY
BUSINESS,
19
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE
_j
FE f
SYSTEMS:
AI4_NUZ_
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
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE�
3
'5 OLATIONS
V1
1 15
VIOLATIONS
1 15
PRE -CITATION
LE TER SENT
CITATION ISSUED
NUMBER:
4
2
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
8
4
8
DATE:
DISPOSITION:
7
E] YES El NO
LET 0
TER NEEDED C] YES NJ
8
FIRE DEPARTMENT COPY
FIRE PREVENTION
SAFETY SURVEY
C1W OF EDMON"68;
121 5� AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
N
1'�
LOCATION: 320 Dayton Street 260
BUSINESS NAME: Cloutier & Engle PLLC PHONE: 4252759457
MAILING 320 Dayton St #260
�ADDRESS:
Edmonds 98020
'FREQUENCY
ION& SHIFT
STAT1
731
7 D
SCHEDULED
(13/111/11
DATE DUE 01
LIFIR o. 591
3202
BUSINESb OWNER: Cloutier, Priya HOMEPHONE: 4252314749 ACMVE
Engle, Chris 2063069889
EMERGFNCY-1: HOME PHONE:
NKEY AC'6,ESS-2: HOME PHONE:
INITIAL INSPECTION DATE
PERSON
N.�ONTACTED:
I
NAME '*OF)INSPECTOR:
FIRE
XN
S Y S T E
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE,*
VIOLATION CODE
1.2
2
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:
PEASON
C4?NIACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE,
DATE:
DX�E:
3
VIOLATIONS
5
VIOLATIONS
5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
—i --- -_
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
.4
18
4
8
DATE:
DISPOSITION:
7
8
� LETTER NEEDED [D YES NO
LETTER NEEDED [] YES NO
FIRE DEPARTMENT COPY