110 MAIN ST STE 101.�' III I�! III.�-
1
Serving Brier, Edmonds, and 12425 Meridian Ave S
SNOHOMISH CO. FIRE Mountlake Terrace Everett, WA 98208
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Phone (425) 551-1200
DISTR T FireDistrictl. org Fax (425) 551-1272
X
LOCATION:110 Main Street Suite 101 98020
BUSINESS NAME enter for Structural Medicine PHONE:
MAILING
ADDRESS:110 Main Street, Suite 101, Edmonds, WA 98020
BUSINESS OWNER: HOME PHONE:
42577
FIRE PREVENTION
INSPECTION REPORT
DMONDS
❑ BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY
STATION & SHIFT
2018
17-C
SCHEDULED
DATE DUE ►
Nov 2018
UFIR ► 593 202
EMERGENCY-1 • HOME PHONE: CURRENT
KEY ACCESS 2))aVIS, Bruce HOME PHONE: 4257742$04 CITY YES NO
17 BUSINESS^/
EMAIL: LICENSE
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR: K' • Fe A . r -7O Z le
FIRE SYSTEMS:
D
FED? -J' 3)j9
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:
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
8
4
8
4
8
DATE:
DISPOSITION:
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8