103 5TH AVE S (2) FIRE INSPSNOHOMISH Co.
FIRE
DISTI
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F IIII�lIII 103 V 1 h V j 6 FIRE PREVENTION
Serving Brier Camurids, and 12425 Meridian Ave S EIN�SPECTION REPORT
Mountlake Terrace Everett, WA 98208 B
❑ BRIER
Phone (425) 551-1200 ❑ MOUNTLAKE TERRACE
www.FireDistrict].org Fax (425) 551-1272 ❑UNINCORPORATED
LOCATION: 103 5 th Avenue S 98020
BUSINESS NAME: Leyda Bldg Apts
MAILING 103 5th Avenue S, Edmonds, WA 98020
ADDRESS:
BUSINESS OWNER: Mayo, Jacque
EMERGENCY-1: Mayo, Jacque
KEY ACCESS-2:
EMAIL:
PERSON CONTACTED: 11
NAME OF INSPECTOR: ; �ci't� f -7
Date Last Serviced: 2�1
2065241000
PHONE:
HOME PHONE: .-?
2065241000
HOME PHONE: 17
HOME PHONE:
FAnnu81CY STATVP6 SHIFT
SCHEDULED May 2017
DATE DUE
423203
UFIR /
CURRENT V YES , NO
CITY
BUSINESS
LICENSE
INITIAL IN DATE
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Serving Brier, Edmonds, and
Mountlake Terrace
www.FireDistrictl.org
LOCATION:
103 5 th Avenue S 98020
BUSINESS NAME:
Leyda Bldg Apts
MAILING
ADDRESS:
103 5th Avenue S, Edmonds, WA 98020
BUSINESS OWNER:
Mayo, Jacque
FIRE PREVENTION
12425. Meridian Ave S INSPECTION REPORT
Everett, WA 98208 [3 [3
S
❑BRIER
Phone '(425) 551-1200 ❑ MOUNTLAKE TERRACE
Fax (425) 551-1272 [3 UNINCORPORATED
FREQUENCY STATION & SHIFT
PHONE:
HOME PHONE:
2065241000
SCHEDULED
tDATE DUE II'UFIR /
423 203
EMERGE11CY-1: HOME PHONE: CURRENT
KEY ACCESS-2: Mayo, Jacque HOME PHONE: 2065241000 CITY YES NO .
EMAIL: BUSINESS ❑ ❑
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE SYSTEMS:. FED
Datakastc[ReDasedOCATIONS
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
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1st RE -INSPECTION
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2nd RE -INSPECTION
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EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
_
DATE DUE:
d•'
DATE DUE: k4
GRANTED TO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
VIOLATION5
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PRE -CITATION
_
CITATION ISSUED
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LETTER SENT
NUMBER:
4
_DATE:
CODE
SECTION:
5 -
RETURN
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RECEIPT
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RECEIVED
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DISPOSITION: -�•��
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DATE:
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LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
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