110 MAIN ST+_. SNOHOMISH CO.
6 -Alm
Serving Brier, Edmonds, and
Mountlake Terrace
www.FireDistrictl.org
LOCATION:110 Main Street Bldg 98020
BUSINESS NAME:110 Main St Bldg
MAILING
ADDRESS:110 Main Street, Bldg, Edmonds, WA 98020.
BUSINESS OWNER:Greiner, Kirk
EMERGENCY-1:
KEY ACCESS-2:Starlite Inv. LLC
EMAIL:
PERSON CONTACTED:
NAME OF INSPECTOR:
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE:
HOME PHONE:
HOME PHONE: 4257434600
HOME PHONE:
17
FIRE SYSTEMS: FA 4116 FE 3/15_3l
FIRE PREVENTION
INSPECTION REPORT
QE6MONDS
❑ BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY STATION & SHIFT
Annual 17-C
SCHEDULED
DATE DUE ► Nov 2018
UFIR / 509 202
CURRENT
I\)ES
CITY
I No
BUSINESS
LICENSE
INITIAL INSPECTION DATE
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LOCATIONS / COMMUNICATIONS
2
2
3
3
4
4
5 `
5
6
_
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1S1 RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON 4
CONTACTED: l
,
1
INSPECTOR:
INSPECTOR:
INSPECTOR: \�
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
8
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
3