1041 5TH AVE SW
II
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
LOCATION- FREQUENCY
5 th Avenue S 98020 Annual 17-A
BUSINESS NAME PHONE: SCHEDULED
Dorchester Condos 4257714424 DATE DUE ► Dec 2018
MAILING UFIR ► 427 153
ADDRESS'
041 5th Avenue S, #12, Edmonds, WA 98020
BUSINESS OWNER: HOME PHONE:
EMERGENCY-1: HOME PHONE: CURRENT
KEY ACCESS-2Ward, Joyce HOME PHONE: 4257752076 CITY YES NO
EMAIL: 17 BUSINESS
LICENSE El 1:1
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE SYSTEMS
DWww
FE 2/17
iTQ LOCATIONS / COMMUNICATIONS
1
1
2
2
3 ---�- -- --- - -- —
4
3
4
5
5
6
6
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:`
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
A
2
8
2
8
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
g
4
18
4
8
DATE:
DISPOSITION:
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8