614 5TH AVE SONE 111
5+11 11 L/C
FIRE PREVENTION
Seri,ing Bl' 6nds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
Mountlake Terrace, and
FIRE
fl
Everett, WA 98208
EDMONDS
BRIER
the Town of Woodway
DISTT.
Phone (425) 551-1200
0 WOODWAY
0 MOUNTLAKE TERRACE
www.FireDistrictl.org
Fax (425) 551-1272
0 UNINCORPORATED
LOCATION: 614 5th Avenue
FREQUENCY I STATION &SHIFT'*)
365, 17 D
BUSINESS NAME: Edmonds Baskin Robbins
PHONE: 4257782005
SCHEDULED 11/01/12
DATE DUE
MAILING 614 5th Ave S
UFIR 1. 515 1152
ADDRESS: Edmonds
98020
11
BUSINESS OWNER: Kim, Un
HOMEPHONE: 4257490610
ACTIVE
EMERGENCY-1: Kim, Tony
2538649007
HOME PHONE:
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KEY ACCESS-2:
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INITIAL INSPECTION DATE
NAME OF INSPECTOR: [�klg GeM;6A)
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2
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3
3
4
4
5
5
6
6
7
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X/
101
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
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PERSON
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VIOLATIONS
1 15
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PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
6
2
6
DATE:
CODE
SECTION:
5
7
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RETURN RECEIPT
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6
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8
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DATE:
DISPOSITION:
7
LETTER NEEDED [] YES NO
LETTER NEEDED [] YES NO
8
FIRE DEPARTMENT COPY
Am
FIRE PREVENTION
Set-ving Briei; EdniOnds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
Mountlake Terraceand
FIRE
Everett, WA 98208
0 EDMONDS
0 BRIER
the Town of Woodway
DISThffT
Phone (425) 551-1200
WOODWAY
MOUNTLAKE TERRACE
www.FireDistrictl.org
Fax (425) 551-1272
0 UNINCORPORATED
e- FREQUENCY
STATION 1, SHIF"*'
LOCATION: 614 5th Avenue
365
17 C
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BUSINESS NAME: -Edmonds Baskin Robbins
PHONE: 4257782005
SCHEDULED
DATE DUE � 11/01/11
MAILING 614 5th Ave S
UFIR � 515 1152
ADDRESS: Edmonds
98020
BUSINESS OWNER
: Kim, Un
HOME PHONE: 4257490610
ACTIVE
-12-577-1 1% 06 11
EMERGENCY-1: Kim, Tony
HOME PHONE: 2538649007
—CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
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FIRE
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S�YSTEMS:
ANNUAL
`4'
11�
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
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
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
_RATE
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
7
RETURN RECEIPT
RECEIVED
6
4
18
4
8
DATE:
DISPOSITION:
7
\1 LETTER NEEDED 0 YES NO
LETTER NEEDED [] YES El NO
1
8
FIRE DEPARTMENT COPY
FIRE PREVENTION
CITY OF EDMONDS SAFETY SURVEY
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
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LOCATION: 614 5th Avenue S
BUSINESS NAME: Edmonds Baskin Robbins PHONE: 4257782005
MAILING 614 5th Ave S
ll_� ADDRESS: Edmonds 9802C
FREQUENCY
STATION 1, SHIFT
365
17 6
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SCHEDULED
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11/01/10
DATE DUE
UFIR � 515
1152
BUSINESS OWNER:.. Kim, Un HOMEPHONE: 4257490610 ACTIVE
2538649007
EMERGENCY-1: Kim, Tony HOME PHONE:
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NAME OF INSPECTOR: C �v 1 0
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SYSTEMS: ANNUAL
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ENTER CODE ONLY ONCE 10
VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
7
8
8
lst RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
,:,77777
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
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PERSON
CONTACTED:
PERSON
CONTACTED:
1
I SPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
3
VIOLATIONS
1
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
18
4
18
D,�TE;. '
DISPOSITION:
7
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8
LETTER NEEDED 0 YES NO
LETTER NEEDED p YES NO
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FIRE DEPARTMENTWIPY�