51 W DAYTON ST STE 301Jill V1111— 5-1 L,) 1.20,q . TOA..) 'f7_ J-1Z _301 FIRE PREVENTION
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Serving Briet; E, 5 Meridian Ave S INSPECTION REPORT
S140HOMISH Co. 1 0 EDMONDS
Mountlake Terraceand Ei>erett, WA 98208 [1 BRIER
FIRE 111111010t i OWOODWAY
the Town of Woodway Phone (425) 551-1200 0 MOUNTLAKE TERRACE
DT-STR T www.FireDistrictl.org Fax (425) 551-1272 [1 UNINCORPORATED
o" FREQUENCY I STATION & SHIF'*'
LOCATION: 51 W Dayton 301 730 17 B
BUSINESS NAME: Edmonds Bay Dental PHONE: 4257755162 SCHEDULED
DATE DUE 07/01/12
MAILING 151 W Dayton #301 UFIR � 593 7202
ADDRESS: Edmonds 98020
- 4252400 75
BUSINESS OWNER: Tomar, Meenaksui HOME PHONE: 5.o8) ',Oct 073
EMERGENCY-1: Brice Corp HOME PHONE: 5036828012 '--CURRENT
KEY ACCESS-2: HOME PHONE: CITY YES NO
BUSINESS
LICENSE M_ El
INITIAL INSPECTION DATE
PERSON CONTACTED:— I,= M -ee m c,
NAME OF INSPECTOR: e 2-
FIRE FE — I —
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUN CATIONS
2
2
3
4
4
5
5
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6
7
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
1
EXTENSION
GRANTED TO,
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
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PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 15
VIOLATIONS
1 15
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
8
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED 0 YES NO
rLETTERNEEDED YES [Ell NO
8
FIRE DEPARTMENT COPY
'CITY OF EDMONDS
1 il 5- AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FiRE DEPARTMENT
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LOCATION: 5 1 W Dayton
BUSINESS NAME: EdmondsO,ay Dental
MAILING 51 W Dayton #301
FIRE PREVENTION
SAFETY SURVEY
301
PHONE: 4257755162
ADDRESS: Edmonds 98020
BUSINESS OWNER: Tomar, Meenaksui HOMEPHONE: 4252130016
EMERGENCY-1: Brice Corp HOMEPHONE: 5036328012
KEY ACCESS-2: HOME PHONE:
FREQUENCY
STATION& SHIFT
3
17 D
SCHEDULED
DATE DUE 11-
07/01/10
UFIR 01 593
7202
ON DAT
INITIAL INSPECT1,1
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE FE I
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE I�
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:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
C NTACTED:
PERSON
CONTACTED:
I
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE
DATE
DATE
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
7
-
4-
18
4
8
DATE:
DISPOSITION:
13
.UETTER NEEDED [I YES NO
LETTER NEEDED [] YES NO
FIRE DEPARTMENT COPY