651 EDMONDS WAYSNOHOMISH CO
FIRE
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way
FIRE PREVENTION
'Prier, Ednionds, and 1 2425 Meridian Ave S INSPECTION REPORT
Serving,.
1, EDMONDS
Mountfi7ke Terrace Everett, WA 98208 11
(113 BRIER
-1200 .1� [3 MOUNTLAKE TERRACE.
Thone (425) 551 [1 UNINCORPORATED
www.,PireDistrictl.org Fax (425) 551-1272
FREQUENCY
STATION & SHIFT
LOCATION:
.651 Edmonds Way 98020
29i6*
BUSINESS NAME:
PHONE:
SCHEDULED
DATE DUE
David Apatoff, �DDS
4257127200
9016
MAILING
UFIR 0
ADDRESS:
593
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.651 Edmonds Way, Edmonds, WA 98020
BUSINESS OWNER:
HOME PHONE.C%b-
Cax/
EMERGENCY-1:
HOME PHONE:
"CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUS INESS
EMAIL:
C4
LICENSE
PERSON CONTACTED:
INITIAL IN�PECT!qN DATE
NAME OF INSPECTOR:
FIRE SYSTEMS:. FE 10/13
DabAkastd9amedoCATIONS! COMMUNICATIONS
. ... ... ....
2
2
3
3
4
4
6
5
6
7
7
1. AGREE TO CORRECT,THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
lst RE -INSPECTION
2ATE DUE:
km
2nd RE -INS PECTION
DATE DUE:
EXTENSION
GRANTEDTO.-
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
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PERSON
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CONTACTED:
1
INSPECTOR: WW�;%fJ
INSPECTOR:
INSPECTOR:
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DATE:
DATE:
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3
4
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VIOLATIONS
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2 6
VIOLATIONS:-
5
6
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
CODE
SECTION:
DATE:
3
7
7
RETURN RECEIPT
RECEIVED
6
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED [] YES NO
LETTER NEEDED 0 YES 0 NO
—
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FIRE PREVENTION
Servin Briei; Edmonds, and
12425 MeridianAve S
INSPECTION REPORT
SNOHOMISH CO.
EDMONDS
FIR
Mo�intlake Terrace
rgow
Everett, WA 98208
0 BRIER
fto
Phone (425) 551-1200
0 MOUNTLAKE TERRACE
DISTRI
I
Tw"'�wRreDistrictl.otg
Fax (425) 551-1272
El UNINCORPORATED
FREQUENCY
STATION & SHIF'*)
LOCATION:
I
65-1 Edmonds Way 98020
11 �
17-R
BUSINESS NAME:
Davi d Apatoff DOS
PHONE: 4257127200
SCHEDULED
DATE DUE 'I'vlay 2014
MAILING
FIR
�U
ADDRESS:
651 Edmonds Way, Edmonds, WA 98020
__j
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
HOME PHONE:
'CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
EMAIL:
BUSINESS
2
LICENSE
PERSON CONTACTED: ju 14e.
INITIAL INSPECTION DATE
NAME OF INSPECTOR: - 4 R40 ro
�S -7
FIRE SYSTEMS:
FE _A1
HAZARDS FOUND AND LGCATIONS COMMUNICATION§
2
2-
3
3
4
4
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS,-X.
1 st RE -INSPECTION
,DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
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
4
18
4
18
DATE:
DISPOSITION:
7
11 LETTER NEEDED 0 YES El NO
LETTER NEEDED F] YES El NO
FIRE DEPARTMENT COPY
CITY OF EDIVIONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
41 4-t 9"z"
FIRE PREVENTION
SAFETY SURVEY
FREQUENCY
STATION& SHIFT
LOcATIoN.-
651 Edmonds Way
730
20 6
ss N
BUSINE kkMg..__R§
PHONE: 4257127200
SCHEDULE D
DATE DUE 051,01110
MAILIN(f'
651 Edmon,4s Wy
LIFIR o, 593 5103
ADDRESS:
Edmonds
990, i0f
BUSINESS OWNER:
Apatoff, David
HOME PHONE: 2063673154
ACTIVE
EMERGENCY-1:
Kirschner, Richard
HOME PHONE: 4257451944
KEY ACCESS-2:
HOME PHONE:
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE FE
w 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
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
GRANTED TO:
CITED:
DATE DUE,
R�TE DIJE-
DATE DUE,
PERSON
PERSON
PERSON
CONTACTED.
CONTACTED:
INSPECTOR:
DATE.
VIOLATIONS
CONTACTED:
INSPECTOR:
1
2
INSPECTOR:
DATE.
PRE -CITATION
CITATION ISSUED
3
VIOLATIONS
1 5
5
LETTER SENT
NUMBER:
4
CODE
6
2
6
6
DATE:
SECTION:
RETURN RECEIPT
6
3
7
RECEIVED
DISPOSITION:
7
4
ILETTERNEEDED [] YES NO
?�TE:
1
-
8
j
�UETTERNEEDED C] YES NO
FIRE DEPARTMENT COPY