100 2ND AVE S STE 320illll��lll too zNo 14uc s s,� 3Zv
Serving Br-, )nds 12425 Meridian Ave S
Mountlake Terrace,and Everett, WA 98208
the Town of Woodway Phone (425) 551-1200
www.FireDistrictl.org Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
❑ EDMONDS
❑ BRIER
❑ WOODWAY
[3 MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY STATION & SHIFT
LOCATION:
100 2nd Avenue S
320
731 17
I
6
Vey N�"12A
BUSINESS NAME:
Clarke White & Vecustra--
PHONE: 42571459--4
SCHEDULED DATE DUE � .910 1 j t 2
MAILING
100 2nd Ave S #320
UFIR ► 593 1202
ADDRESS:
Edmonds
98020
BUSINESS OWNER:
Clarke, Kevin
HOME PHONE: 2065429503
ACTIVE
EMERGENCY-1:
White, Andy
HOME PHONE: 3606688173
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES
NO
BUSINESS Z]
❑
LICENSE
PERSON CONTACTED: � NIA ?-,A
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
1-" I ,z
FIRE
FE __JL� 10
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
2
2
1
3
3
4
4
5
5
6
6
I
7
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
6
4
8
4
6
DATE:
DISPOSITION:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8
FIRE DEPARTMENT COPY
�A CITY OF EDMONDS
�j 121 5TM AVENUE N. • EDMONDS, WASHINGTON 98020 • (425) 771.0215
T FIRE DEPARTMENT
�St 1a913
LOCATION: 1011 2nd Avenue S
BUSINESS NAME: Clarke, White & Vecustra
MAILING 100 2nd Ave S #I320
FIRE PREVENTION
SAFETY SURVEY
320
PHONE: 4257745954
ADDRESS: Edmonds 98020
BUSINESS OWNER: Clarke, Kevin HOME PHONE: 2065429503
EMERGENCY-1: While, Andy HOME PHONE: 3606688173
KEY ACCESS-2: HOME PHONE:
' FREQUENCY
STATION & SHIFT
731
17 D
SCHEDULDATE DUES ►
1101/10
UFIR ► 593
1202
ACTIVE
PERSON CONTACTED: I G/Z< y INITIAL INSPECTION DATE
NAME OF INSPECTOR: O� ��/off V 11
FIRE FE vly o
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1
ENTER CODE ONLY ONCE ►
VIOLATION CODE
1
2
�—
2
i
3
3
4
4
5
5
6
6
7
7
8
8
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:
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
7
4
8
4
8
DATE:
DISPOSITION:
8
LETTER NEEDED ❑ YES NO
LETTER NEEDED ❑ YES NO
FIRE DEPARTMENT COPY