615 5TH AVE S1#111
Serving Brier,
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FIRE PREVENTION
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SNOHOMISH CO.
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FIRE
Mountlake Terrace
Everett, WA 98208
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Phone (425) 551-1200
0 MOUNTLAKE TERRACE
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www.FireDistric'tl.org
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LOCATION: 615 c9th Avenue S 98020
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FREQUE CY
2 Year
STATION & SHIFT__"�
13 17-A
BUSINESS NAME: Janison, Jeffrey B. DDS
PHONE: 4257751134
SCHEDULED Oct 2013
DATE DUE r
MAILING
LIFIR � 5193
ADDRESS:
615 5th Avenue S, Edmonds, WA 98020
BUSINESS OWNER:
Janisor, M HOME PHONE:
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
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2nd RE -INSPECTION
EXTENSION FINAL RE -INSPECTION
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DATE DUE:
GRANTEDTO:
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FIRE DEPARTMENT COPY
CODE
DISPOSITION:
2
3
4
5
6
7
8
I
4
6
VIOLATIONS
CITED:
Serving Brier, Edinonds
TIRESNOHOMISH CO., Mountlake Terrace,and
- the Town of Woodway
IE� www.FireDistrictl.org
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LOCATION: 615 5th Avenue
BUSINESS NAME: Janison, Jeffrey B. DDS
MAILING 615 5th Ave S
ADDRESS: Edmonds
BUSINESS OWNER: Janison, JeffTey
EMERGENCY-1: Janison, Andrew
KEY ACCESS-2:
PERSON CONTACTED:
NAME OF INSPECTOR:
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FIRE
SYSTEMS:
FIRE PREVENTION
12425 Meridian Ave S
INSPECTION REPORT
Everett, WA 98208
0 EDMONDS
0 BRIER
Phone (425) 551-1200
0 WOODWAY
El MOUNTLAKE TERRACE
Fax (425) 551-1272
0 UNINCORPORATED
S
PHONE: 4257751134
93020
FREQUENCY I STATION & SHIF"
731 17 C
SCHEDULED
DATE DUE 0 10101/11
UFIR 0 593 11153
HOME PHONE: 4258817120 ACTIVE
2067793858
HOME PHONE: CURRENT
HOME PHONE: CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
FE.al&
ANNUAL
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
lst 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:
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INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE. 3 2-
DATE:
DATE:
3
vi(SLATioNs' —
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 [] YES NO
�LETTERNEEDED [:] YES NO
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1
8
FIRE DEPARTMENT COPY