110 MAIN ST STE 102SNOHOMISH CO
III�/ o ,9� sr
Serving Brier, Edmonds, and
Mountlake Terrace
www.FireDistrictl.org
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
pSDMONDS
❑ BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY I STATION & SHIFT
LOCATION:11 O Main Street Suite 102 98020 2018 17-C
BUSINESS NAME I �n SCHEDULED
�. ��4 } f ..n C ,,� �pi` u, PHONE: DATE DUE ► Nov 2018
MAILING UFIR ► 0202
ADDRESS:
BUSINESS OWNER: �j �HOME PHONE:
_ 1
EMERGENCY-1: p,A n(.1 I S-� HOME PHONE: q t - 3 � t - 6 CURRENT
KEY ACCESS 2: �1(.{/, J f (� [/1t HOME PHONE: CITY YE
EMAIL: %' t,R SC�C�`e(' I��ift"� "Molr�" O( 17 BUSINESS
LICENSE 10�!W
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE SYSTEMS:
D
F
FE = 3 Jlk
y
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
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:
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
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