420 5TH AVE S STE 107Serving Brier" Edmonds, and
Mwintlake Terrace
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LOCATION: 420 5 th Avenue S Suite 107 98020
BUSINESS NAME: Elegant Gems
/0 7 FIRE PREVENTION
12425 Meridian Ave S )LANSPECTION REPORT
-0 EDMONDS
Everett, WA 98208 0 BRIER
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
0 UNINCORPORATED
Fax (425) 551-1272
PHONE: 2
MAILING 420 5th Avenue S, Suite 107, Edmonds, WA 98020
ADDRESS:
—Metoriff,-Fr—e.pt 74 -3765'545
BUSINESS OWNER:V\AjC�AA,-J-
EMERGENCY-1: eed HOME PHONE: 5
KEY ACCESS-2: HOME PHONE: 17
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NAME OF INSPECTOR:
t-'Kt Sy,5 I Mb: FE 7/13
Date Last Serviced: I I I %A
FREQUENCY STATION &SHIFT
2017 1 17-B
SCHEDULED Apr 2017
DATE DUE 0
LIFIR 0 591 202
CURRENT
CITY Y S NO
BUSINESS
LICENSE ?� 1:1
INITIAL INSPECTION DATE
14 -.3- N-4
Serving Brier Edmonds, and
Mountlake Terrace
www.FireDistrict]. org
LOCATION: 420 r) th Awnue S,11ite 107 R8MQ
BUSINESS NAME: ukaf4w��
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MAILING
ADDRESS: 420 5Lh Aonur S,,9d Lc 197, bdrTurmb.�WA 08920
BUSINESS OWNER:
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE:
HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
OEDMONDS
0 BRIER
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
" FREQUENCY I STATION& SHIF'**�
2Yaw 14 17-C
SCHEDULED
DATE DUE Apr 2014
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EMERGENCY-1: HOME PHONE: 42&3?swm I CURRENT YES NO
KEY ACCESS-2: HOME PHONE: CITY
0 BUSINESS
EMAIL: LICENSE El 0
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR:
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HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
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2
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4
5
5
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DATE DUE.
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DATE:
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3
VIOLATIONS
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LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
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RETURN RECEIPT
RECEIVED
6
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18
4
18
DATE:
DISPOSITION:
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LETTER NEEDED C] YES NO
LETTER NEEDED F] YES Cl NO
FIRE DEPARTMENT COPY
Serving Briet: Edinonds
Mountlake Terraceand
Tthe Town of Woodway
www.FireDistrict].org
LOCATION:
420 5th Ave S
BUSINESS NAME:
Bluefish Designs
MAILING
420 51h AVe S #107
ADDRESS:
Edmonds
BUSINESS OWNER:
McNaughton, Barbara
EMERGENCY-1:
Crozier, Philippe
KEY ACCESS-2:
I I PERSON CONTACTED
NAME OF INSPECTOR
FIRE
SYSTEMS:
I
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12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
107
PHONE: 4256737450
98020
HOME PHONE: 4257780738
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HOME PHONE:
HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
E]WOODWAY
[I MOUNTLAKE TERRACE
0 UNINCORPORATED
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STATION & SHIFT'**'
730
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17 A
SCHEDULED
DATE DUE 0 04/0 1 /12
LIFIR � 591
4202
CURRENT
CITY YES NO
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2
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3
3
4
4
5
5
6
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1 st RE -INSPECTION
DATE DUE
2nd RE -INSPECTION
DATE DUE
EXTENSION
GRANTED TO,
FINAL RE-INSPECTIC)N.,,_
DATE DUE:
VIOLATIONS
CITED
PERSON
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INSPECTOR:
2
DATE:
D E:
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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
14
18
4
18
DATE:
DISPOSITION:
7
LETTER NEEDED F] YES [I NO
LETTER,NEEDED E] YES [I NO
8
'FIRE DEPARTMENT COPY
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FIRE DEPARTMENT
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LOCATION:
Rhopfik-i-k nPc1innz
BUSINESS NAME:
MAILING 420 5th AVe S #107
FIRE PREVENTION
SAFETY SURVEY
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4256737450
PHONE:
Edmonds
93020
ADDRESS:
McNaughton, Barbara
4257780738
BUSINESS OWNER:
HOME PHONE:
Crozier, Philippe
V
EMERGENCY-1:
HOME PHONE:
KEY ACCESS-2:
HOME PHONE:
FREPW
%NCY STATIff & tHIFT
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DATE DUE 1�
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SYSTEMS: ANNUAL
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2
DATE:
DATE:
DATE:
-3
VIOLATIONS -
1 5
VIOLATIONS
1 15
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
I
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
1 7
t'
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4�
18
4
8
DATE:
DISPOSITION:
1 8
ER NEEDED 0 YES NIT,
�TTER
—NEEDED [:] YES 0 NO
FIRE DEPARTMENT COPY