110 4TH AVE NIill�llll ii0 elm /-7vre ti
IS OHOMisx Co.Serving Brier, Edmonds, and 12425 Meridian Ave S
FIREMountlake Terrace Everett, WA 98208
DISTR,ivp,Twww.FireDistrictl.orgPhone (425) 551-1200
Fax (425) 551-1272
FREQUENCY STATION & SHIFT
LocATION:110 4 th Avenue N 98020 2019 17-D
BUSINESS NAME- PHONE: SCHEDULED
RE/MAX Direct Realty 2067149823 DATE DUE ► Jan 2019
MAILING UFIR ► 544 202
ADDRESS:
110 4th Avenue N, Edmonds, WA 98020
BUSINESS OWNER: HOME PHONE:
Schiffman, Leonard
EMERGENCY-1: HOME PHONE: 2(�a `> CURRENT Yes NO
KEY ACCESS-2: HOME PHONE: CITY
EMAIL: 17 BUSINESS EMAIL: ❑
LICENSE
PERSON CONTACTED: `ru y i/'I•� INITIAL INSPECTION DATE
t
NAME OF INSPECTOR:
FIRE SYSTEMS: FE 11/13
FIRE PREVENTION
INSPECTION REPORT
�MONDS
❑ BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
D :LOCATIONS / COMMUNICATIONS
2
%
2
3
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s
3
4
4
5
5
6
6
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1I
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE -INSPECTION
FINAL RE -INSPECTION
EXTENSION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTED TO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
1 5
1 5 -
LETTER SENT
NUMBER:
4
CODE
5
2
6
2
6
DATE:
SECTION:
RETURN RECEIPT
3
7
3
7
RECEIVED
6
DISPOSITION:
. 4
8
4
B
DATE:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8
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