110 MAIN ST STE 100 (2)SNOHOMISH <
FIR]
DISI
f; s; G /00.._
FIRE PREVENTION
Serving Brier, Edmonds, and 12425 Meridian Ave S '�SPECTION REPORT,:
Mountlake Terrace Everett, WA 98208 BEIEs
❑BRIERRIER
Phone (425) 551-1200 ❑ MOUNTLAKE TERRACE
www.FireDistrictl.org Fax (425) 551-1272 ❑UNINCORPORATED
LOCATION: 110 Main Street
Suite 100 98020
BUSINESS NAME: Vacant
MAILING
ADDRESS:
BUSINESS OWNER:
EMERGENCY-1:
KEY ACCESS-2:
EMAIL:
PERSON CONTACTED:
NAME OF INSPECTOR: Cy -' OZ
I rLIV
FIRE SYSTEMS: FE
Date Last Serviced
PHONE:
HOME PHONE:
HOME PHONE:
HOME PHONE:
FREQUENCY I STATION & SHIFT
2015 17-D
SCHEDULED Nov 2015
DATE DUE
UFIR / 0 202
CURRENT
CITY . YES NO
BUSINESS a
LICENSE
INITIAL INSPECTION DATE
7]
�2-►y-�s�
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1
_
_
1
2
4
-_------ .
4
•
5
5
i
6
6
-
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1 st RE -INSPECTION
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE: -
DATE DUE:
GRANTED TO:
DATE DUE:
- CITED:
PERSON
PERSON
CONTACTED:
CONTACTED:
PERSON
.....W..,-,..-.;___,.,,......
CONTACTED:
INSPECTOR:
2
INSPECTOR:
INSPECTOR:
DATE:
DATE: _
DATE:
3
VIOLATIONS
VIOLATIONS:-,,- -
PRE -CITATION
CITATION ISSUED
1 i 5
1 5
LETTER SENT
NUMBER:
4
2
6
2,
6.
DATE:
CODE
SECTION,
5
RETURN RECEIPT
3
7
9
7
RECEIVED
6
DISPOSITION:
4
8-
4
8
DATE:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ ❑ NO
.YES
8
:a
FIRE PREVENTION
i
Serving Brier•, Edmonds, and
12425 Meridian Ave S
INSPECTION REPORT
3NOHOMISH CO.
FIRE
Mountlake Terrace
Everett, WA 98208
EDMONDS
BRIER
Phone (425) 551-1200
❑ MOUNTLAKE TERRACE
STR
❑UNINCORPORATED
www.FireDistrictl.org
Fax (425) 551-1272
FREQUENCY
STATION & SHIFT
LOCATION:
110 Main Street Suite 100 QM20
2 Year 13
17-H
BUSINESS NAME:
Law 011icc cI Ann Jrhnsan
PHONE: $2577EFSi600
DATE DUE SCHEDULED �v 2013
MAILING
UFIR�
ADDRESS:
110 Main Slrccl, SuiLc 100, Edmands, WA MW20
i
BUSINESS OWNER:
.)dmi rin, Ann
HOME PHONE:
V
EMERGENCY-1:
HOME PHONE:
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
EMAIL:
LICENSE
?
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR: Gck I
FIRE SYS,TEVS;
s
FE _t
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1
1
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
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:
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:
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8
FIRE DEPARTMENT COPY