404 4TH AVE SP 0
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40�14 L14-h !1q(1E
Serving Bri )nds 12,425 Meridian Ave S
Moun" tlakekrrace, and Everett, WA 98208
'N Tthe Town of �fbodwqy Phone (425) 551-1200
www.FireDistr'ictl.org Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT.-
OEDMONDS
0 BRIER
CIWOODWAY
El MOUNTLAKE TERRACE
-[I UNINCORPORATED
FREQUENCY
STATION & SHIFT
LOCATION: 404 4th Avenue
S
366
17
6
BUSINESS NAME: hnichel Three-Plex
PHONE: 4257762211
SCHEDULED
DATE DUE � 04101/13
MAILING C-022 212th St SW
UFIR 1, 422 4152
ADDRESS: Edmonds
98026
BUSINESS OWNER: Wichel, Robin W"
HOMEPHONE: 4257425684,,
_x..r�'ACTIVE
EMERGENCY-1: "Hensley, Lisa"
HOMEPHONE: 4257762211
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INITIAL INSPECTION DATE
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1 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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INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
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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 F] YES El NO
LETTER NEEDED [_-] YES El NO
FIRE DEPARTMENT COPY
FIRE PREVENTION
Serving Brier, Edmonds
MISR Co. 12425 Meridian Ave S INSPECTION REPORT
OEDMONDS
Mountlake Terrace, and Everett, WA 98208 0 BRIER
the Town of Woodway Phone (425) 551-1200 E]WOODWAY
0 MOUNTLAKE TERRACE
www, FireDistrict]. org Fax (425) 551-1272 0 UNINCORPORATED
FREQUEN TIONA HIFT"
LOCATION: 404 4th Avenue S 366 17
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BUSINES$ NAME: Michel Three-Plex PHONE: 4257762211 SCHEDULED 94
DATE DUE �'jgj /12
MAILING 8022 212th St SW UFIR 0422 4152
ADDRESS: Edmonds 93026
BUSINESS OWNER: "Michel, Robin W" HOME PHONE: 4257425684 ACTIVE
EMERGENCY-1: ul-lensley, Lisa" 4257762211
HOME PHONE: CURRENT
KEY ACCESS-2: HOME PHONE: ITY YES NO
BUSINESS
LICENSE El 1:1
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE FE
SYSTEMS'i
ANNUAL
FIRE DEPARTMENT COPY
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CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
-fIRE DEPARTMENT
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LOCATION: 404 4th Avenue
BUSINESS NAME Michel Three-Plex
MAILING 8022 212th St &W
FIRE PREVENTION
SAFETY SURVEY
PHONE: 4257762211
rujUrfr-oc): Edmonds 98026
BUSINESS OWNER: "Michel, Robin W" HOMEPHONE: 4257425684
EMERGENCY-1: "Hensley, Lisa" HOMEPHONE: 4257762211
KEY ACCESS-2: HOME PHONE:
FREQUENCY
STATION & SHIFT
366
17 D
SCHEDULED
DATE DUE 0
04/01/11
LIFIR lo 422
4152
AC-PVE
PERSON CONTACTED:— INITIAL INSPECTION DATE
NAME OF INSPECTOR: — / /
FIRE FE
SYSTEMS: ANNUAL
FIRE DER
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CITY OF EDMONDS
121 5� AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FIRE DEPARTMENT
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LOCATION:
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PHONE:
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ADDRESS:
"Michel, Robin W"
BUSINESS OWNER-
HOME PHONE:
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KEY ACCESS-2:
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FIRE PREVENTION
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4257762211
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DATE DUE 11�
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4257425684 A.r-nVF
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INITIAL INSPECTION DATE
PERSON CONTACTED:
%ME OF INSPECTOR:
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ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
LIL
ENTER CODE ONLY ONCE 10
VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
7
8
8
1st RE -INSPECTION
DATE DUE;
2nd RE -INSPECTION
E DUE.
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION'
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE;
E:
DATE:
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
'8
DATE:
DISPOSITION:
8 .10
LETTER NEEDED C] YES No
LETTER NEEDED [] YES NO
FIRE DEPARTMENT COPY