100 2ND AVE S (3)IIII�lIII
)Oo ;RA Atie 5a"4h
SNOHOMISH CO. A"fil
Serving Brier, Edmonds, and
Mountlake Terrace
www.FireDistrictl.org
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
LOCATION:100 2 nd Avenue S Bldg 98020
BUSINESS NAMEHarbof Bldg PHONE: 425771 17!
MAILING
ADDRESS:100 2nd Avenue S, Bldg, Edmonds, WA 98020
BUSINESS OWNERHaSSen, Rick HOME PHONE:
EMERGENCY-1 • HOME PHONE:
KEY ACCESS 2Hassen, Rick HOME PHONE: 2066171692
17
EMAIL:
PERSON CONTACTED:
NAME OF INSPECTOR: _ CI ioq_
FIRE SYSTEMS: FA 4/117 FE�4/17� 12:00:00 AM '—
t4
FIRE PREVENTION
INSPPCTION REPORT
005'MONDS
❑ BRIER
❑ MOUNTCAKE TERRACE
❑ UNINCORPORATED
FREQUENCY STATION & SHIFT
Annual 17-D
SCHEDULED
DATE DUE ► Nov 2018
UFIR ► 509 202
CURRENT
CITY
YES
BUSINESS
LICENSE
^�
INITIAL INSPECTION DATE
11' 11 .
Ila
c 1 LOCATIONS/COMMUNICATIONS
/
2 — ---- --- — - - .
3
2
_
3
4
4
5
5
7
6
7
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:
I
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
5
4
W-
8
4
8
DATE:
DISPOSITION:
7
_
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8