7533 OLYMPIC VIEW DR STE C.pdfSIVOHOMISH CO.
FIRE
_ 1111�1111 _7 5 33 0/-yMf0`c v.�w DR �-:
,f�lf 8 FIRE PREVENTION
Y Serving Brier, Edmonds,. and 12425 Meridian Ave S INSPECTION REPORT
Mountlake Terrace Everett, WA 98208 ❑ EDMONDS
❑ BRIER
Phone (425) 551-1200 ❑ MOUNTLAKE TERRACE
DISTR T FireDistrictl. org Fax (425) 551-1272 ❑UNINCORPORATED
7533 Olympic View Drive Suite C 98020
LOCATION:
j Gary 'J. Jacky, DDS
BUSINESS NAME: PHONE:
F NCY STAT HIFT
SCHEDULED
DATE DU
96
MAILING7533 Olympic View Drive, Suite C, Edmonds, WA 98020 I ' L UFIR /
ADDRESS: 17:',m ,�p_� G
Jacky, Gary '"""'vuU `f MoVt�f * tMq
BUSINESS OWNER: HOME PHONE:�25 35S _
Jacky; Gary � 52 5
EMERGENCY-1: HOME PHONE: 16
KEY ACCESS-2: HOME PHONE:
EMAIL:
PERSON CONTACTED:
Date Last Serviced:
4256702392
CURRENT
CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
11-24 - R
HAZARDS FOUND AND• LOCATIONS / COMMUNICATIONS
1 f �0�
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1
2
2
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3
4
4
5
5
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I 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:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
9
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
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4
8
-
4
6
DATE:
DISPOSITION:
7
LETTER NEEDED ❑ YES 0 NO
LETTER NEEDED ❑ YES ❑ NO
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