10117 EDMONDS WAY (3)Serving Brier, Edmonds, and 12425 Meridian Ave S
Mountlake Terrace Everett, WA 98208
Phone (425) 551-1200
www.FireDistrictl.org Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
❑ EDMONDS
❑ BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY STATION & SHIFT
LOCATIO1:10117 Edmonds Way 98020 Annual 20-B
BUSINESS NAMEPHONE: SCHEDULED
Seattle Goodwill 4259772090 DATE DUE ► Feb 2019
MAILING UFIR ► 581
ADDRESSi0117 Edmonds Way, Edmonds, WA 98020
BUSINESS OWNER juare2, Israel HOME PHONE:
EMERGENCY-1- eattle GOodW1II HOME PHONE: 2063291 OOO 01 CURRENT, YES NO
KEY ACCESS-2. HOME PHONE: CITY
20 BUSINESS
EMAIL: LICENSE
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR: C� `�'IYI 7;' K '061 O L/ holIq
FIRE SYSTEMS: AS 8/17 FA 8/17 FE 8/17 12:00:00 AM
D
2/ ,- e-3/Ise
LOCATIONS /COMMUNICATIONS
1
1
2
2
3
3
4
4
5
5
6
6
7
7
I AGREE TO CORRECTTHE 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:
S
VIOLATIONS
1 5
VKXATIONS
1 5
PRE -CITATION
LETTER SENT
Crwrm ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECENIED
4
8
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED Q YES ❑ NO
g
VV