550 MAIN ST STE A (2)/A
Serving Brier, Edn , ionas, and
SN0110MISH CO
Monnflake Terrace
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'www.Fir�Districtl.org
550 MainStreet SuiteA98020
LOCATION:
Next to Nature
BUSINESS NAME:
MAILING 550 Main Street, Suite A, Edmonds, WA 98020
ADDRESS:
FIRE PREVENTION
12425 Meridian Ave S INSPECTION REPORT.
Q,EDMONDS
Everett, WA 98208 -T-1 BRIER
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
[I UNINCORPORATED
Fax (425) 551-1272 -
PHONE:
425778t292
BUSINESS OWNER: HOME PHONE:
Mark, Clifford 2066501743
EMERGENCY-1: HOME PHONE: 17 CURRENT.
KEY ACCESS-2: CITY YES NO
N1 HOME PHONE:, BUSINESS
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Date Last Serviced:
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Serving Brier, Edmonds, and
Mountlake Terrace
www.FireDistrictl.org
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
El BRIER
0 MOUNTLAKE TERRACE
[I UNINCORPORATED
LOCATION:
,55,9 Main Street Suite A 98020-
FREQUENCY S N & SHIFT
Annua!
BUSINESS NAME:
Nek to Niature PHONE: 412,57780292
SCHEDULE Fvav 2014
DATE DUE
MAILING
UFIR�5@ 202�
ADDRESS:
550 Main Street, Suite.A, Edmonds, 98020
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
Mark-, Clifforcl HOME PHONE: 20156501743
CURR NT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
EMAIL:
BUSINESS �01' EJ
LICENSE Lr.;
PERSON CONTACTED: Q4 (YLA V1
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FiRE SYSTEMS:
HAZARDS FOUND AND LOCATIONS �COMMUNIC TIO
, 4
1 7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE-INSPECTIOR_
EXTENSION FINAL RE -INSPECTION
LDATE DUE
DATE DUE:
GRANTED TO: DATE DUE:
PERSON
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CONTACTED:
CONTACTED:
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INSPECTOR:
.�ATE
DATE:
VIOLATIONS
VIOLATIONS
5
5
PRE -CITATION
LETTER SENT
RATE
RETURN RECEIPT
8
RECEIVED
ATE
LETTER NEEDED F] YES [I NO
LETTER NEEDED E] YES El NO
FIRE DEPARTMENT COPY
CODE
DISPOSITION:
2
3
4
5
6
7
8
3
VA
VIOLATIONS
CITED:
CO.
Serving Brier, Edmoads,
TIRESNOHOMISH
Mountlake Terrace, and
D-11STRVIFIT
the Town of Woodway
www.FireDistrictl.org
550 Main Street
LOCATION:
Next to Nature
BUSINESS NAME:
isnUain St :#A
MAILING
Edmonds
ADDRESS:
fVlatt. Clifford
,,j BUSINESS OWNER:
14
Gombart-Mark, Beaffice
EMERGENCY-1:
KEY ACCESS-2:
PERSON CONTACTED:
OF INSPECTOR:
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
A
4257780292
PHONE:
98020
o,i�.-r2,66.,1743
HOME PHONE:
2066501926
HOME PHONE:
HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
OWOODWAY
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
A r n1VF-
CURRENT
CITY YES NO
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INITIAL INSPECTION DATE
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ANNUAL
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HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
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2
5
6
6
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
Ist RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
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DATE DUE:
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INSPECTOR:
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DATE�
DATE:
DATE: _____5TATION
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3
VIOLATIONS
VIOLATIONS
PRE -CITATION
IS
4
5
LETTER SENT
NUMBER:
6
2 6
DATE:
CODE
SECTION:
RETURN RECEIPT
6
RECEIVED
DISPOSITION:
4 8
4 8
DATE:
7
LETTER NEEDED F] YES 0 NO
LETTER NEEDED F] YES [I NO
8
FIRE DEPARTMENT COPY