110 3RD AVE N STE 201Ate""-•• IIII It I (� �?�D ✓�vE /l� fT�20/ FIRE PREVENTION
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Serving Brier, Eamonas, and 12425 Meridian Ave S I DMOND ON REPORT
EMONDS
Mountlake Terrace Everett, WA 98208 BRIER
Phone (425) 551-1200 ❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
10 .L JMJ %i ri. www.FireDistrictl.org Fax (425) 551-1272
110 3 rd Avenue N Suite 201 98020
LOCATION:
The Hagen Firm, PLLC 4257713346
BUSINESS NAME: PHONE:
MAILING 110 3rd Avenue N, Suite 201, Edmonds, WA 98020
ADDRESS:
Hagen, Norman
BUSINESS OWNER: HOME PHONE:
Hagen, Norman 4257715556
EMERGENCY-1: HOME PHONE:
KEY ACCESS 2: C.+ HOME PHONE:
EMAIL: A (2 i �"b�,.% f /L�, (9M
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Date Last Serviced: POP 1
F1�6?FNCY STAT�_%4 SHIFT
SCHEDULED Oct 2016
DATE DUE
UFIR /
CURRENT CITY YES No
BUSINESS � ❑
LICENSE
INITIAL INSPECTION DATE
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CITY OF EDMONDS
121 5TM AVENUE N. • EDMONDS, WASHINGTON 98020 • (425) 771-0215
FIRE DEPARTMENT
�'St. 1890
LOCATION: 110 3rd Ave N
BUSINESS NAME: The Hagen Firm, PLLC
MAILING 807 7th Ave N
FIRE PREVENTION
SAFETY SURVEY
201
PHONE: 4-23771-3346
ZS 771- SSS-C
ADDRESS: Edmonds 98020
BUSINESS OWNER: Hagen, Norman HOME PHONE: 4257714460
EMERGENCY-1: HOME PHONE:
2063688688
KEY ACCESS-2: Hagen, Brent HOME PHONE:
r FRE yjNCY
8 SHIFT
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SCHEDULED
IOfO�J�®
DATE DUE ►
UFIR ► 591
11202
INITIAL INSPECTION DATE
PERSON CONTACTED:
�IIG 16�
NAME OF INSPECTOR: I,�J (}.(y 2iGr`-� > � ' v
SYSTEMS: ANNUAL
HAZARDP FOUND AND LOCATIONS / COMMUNICATIONS
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ENTER CODE ONLY ONCE ►
VIOLATION CODE
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2
2
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3
4
5
3
4
5
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7
6
7
8
8
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
�
PERSON
CONTACTED:
INSPECTOR:
DATE:
VIOLATIONS
1 5
2 6
3 7
_..-..�.
4 8
LETTER NEEDED ! , YES 7 NO
EXTENSION
GRANTED TO:
_
FINAL RE -INSPECTION
DATE DUE:
x
PERSON
CONTACTED:
VIOLATIONS
CITED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
DATE:
_ PRE -CITATION CITATION ISSUED _
LETTER SENT NUMBER:
CODE
DATE: SECTION:
RETURN RECEIPT
RECEIVED
___...__......_.. _...�_.� DISPOSITION:
2
3 �-
4
DATE:
VIOLATIONS
1 5
2
6
8
3
7
4
8
7
8
LETTER NEEDED ❑ YES J _; NO
FIRE DEPARTMENT COPY