525 MAIN ST_11n4_cj
Serving,'Briet;1 12425 Meridian Aye:'S,
SNOHOMISH CO.
Mountlake Terraceand Everett, WA 98208
F I R E e Town of Woodway Phone (425) 551-1200
www.FireDistrictl.org Fax (425) 551-1272
m E
DISrRflu t17
FREQUENCY STATION & SHIFT_'�
LOCATION: 525 Main Street 731 17 D
BUSINESS NAME: Farmees Insurance Group PHONE: 4257745118 SCHEDULED 05/01/12
DATE DUE
MAILING 525 Main St UFIR 0 591 5203
ADDRESS:
Ed onds 98020
Bristol, J HOME PHONE: 4259714800
,BUSINESS OWNER
/ I ; 1 4257746860
FIRE PREV ENTION
INSPECTION REPORT
OEDMONDS
0 BRIER
E]WOODWAY
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
ACTIVE
EMERGENGY-1: 0 S101, HOME PHONE: CURRENT
KEY ACPSS-j,'. 4 0 HOME PHONE: CITY YES NO
BUSINESS —1 1:1
LICENSE E
PERSON CONTACTED:,*,hi�—j VIE- I L^4 INITIAL INSPECTION DATE
it I -Z 1 J6
NAME OF INSPECTOR:
FIRE FE 1"117
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATI107N C9MMUNICATIONS
P
2
2
3
3
4
4
5
5
6
6
7
7
1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE'
2nd RE -INSPECTION
D TE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
D E:
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
14
18
14
18
DATE:
DISPOSITION:
7
LETTER NEEDED [:] YES NO
LETTER NEEDED E] YES [__1 NO
8
FIRE DEPARTMENT COPY
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
,FIRE DEPARTMENT
4�' 8 t
LOCATION:-' 525 Main Street
BUSINESS NAME: Farmees Insurance Group
MAILING 525 Main St
ADDRESS: Eilmonds
BUSINESS OWNER: Bristol, J
EMERGENCY-1: Bristol, J
KEY ACCESS-2:
FIRE PREVENTION
SAFETY SURVEY
PHONE: 4257745118
98020
HOMEPHONE: 4259714800
HOMEPHONE: 4257746860
HOME PHONE:
FREQUENCY
STATION 11 SHIFT
731
17 6
SCHEDULED
DATE DUE
0510110
UFIR 1- 591
5203
ACTIVE
INITIAL INSPECJION DATE
PERSON CONTACTED: J7 Ar.5�0(
NAME OF INSPECTOR: Qmh,f r) I fA CPO
FIRE 1-t
SYSTEMS: ANNUAL f
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
0 k (06 —S
ENTER CODE ONLY ONCE 1�
VIOLATION CODE
2
2
3
3
4
4
5
5
/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
CONTACTED:
PERSON
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1
PRE -CITATION
TTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
-5
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
18
4
18
DATE:
DISPOSITION:
7
8
� LET79 NEEDED [] YES N 0
LETTER NEEDED [] YES NO
FIRE DEPARTMENT COPY