110 MAIN ST STE 10310 M a rN s7-- J'-1E / o 3
FIRE PREVENTION
Serving Brier, Edmonds, and 12425 Meridian Ave S INSPECTION REPORT
Mountlake Terrace Everett, WA 98208 DMONDS
VERIER
Phone (425) 551-1200 ❑ MOUNTLAKE TERRACE
ww. FireDistrictl. org Fax (425) 551-1272 UNINCORPORATED
w
LOCATION:
110 Main Street Suite 103/104 98020
rntvutrvc:Y
2015
STATION &SHIFT
17-D
BUSINESS NAME:
PHONE:
� 1
SCHEDUL26041
DATE DUEED NOV 2015
ID( 7� ^ it�S9
MAILING
uFIR ► 591 202
ADDRESS:
110 Main Street, Suite 103, Edmonds, WA 98020
BUSINESS OWNER:
P .R!-Sm"C
�)CeA � YLniStAt
1
HOME PHONE:
"t OS9
EMERGENCY-1:
E0 HIR9110 rq•
HOME PH61418r
CURRENT
KEY ACCESS-2:
EMAIL:
j
U ►' "1 Y� 5CSf
HOME PHONES
D j Cow►
CITY YES NO
BUSINESS
,-A ,
LICENSE
u
u
PERSON CONTACTED:' (
i t
INITIAL INSPECTION DATE
NAME OF INSPECTOR:0
.. "f s.�'
� �y (5-
FIRE SYSTEMS:'
Date LasIA$erviced:
HAZARDS O
LOC- COMMUINICAT NS
�
1
a S
m
�e._.. W_n .._.
M_..... ..� w._......
3
4
- 5.w.. . ,_.._.,....._ . .
s
7
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<<6
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTEDTO:
DATE DUB
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTAC f
t
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
_
DATE:
DATE;
3
VIOLATIONS
L2.
VIOLATIONS.-
PRE CITATION
CITATION ISSUED
5
1 5
LETTER SENT
NUMBER:46
2
6
DATE:
SECTION:b
��
RETURN RECEIPT
6
3 7
3
7
RECEIVED
DISPOSITION:~
4 8
4
8
DATE:
7
_M
LETTER NEEDED 0 YES ❑ NO
9
LETTER NEEDED I] YES ❑ No
CITY OF EDMONDS
121 5TM AVENUE N. • EDMONDS, WASHINGTON 98020 • (425) 771-0215
FIRE DEPARTMENT
BSc lago
LOCATION: 110 Main Street
y
BUSINESS NAME: Coast & Harbor Engineering
MAILING 110 Main St #103
FIRE PREVENTION
SAFETY SURVEY
103
PHONE: 42577E2542
ADDRESS: Edmonds 98020
BUSINESS OWNER: Phillips, R. Shane HOME PHONE: 425417601E
EMERGENCY-1: Shepsls, Vladimir HOME PHONE: 4252312488
KEY ACCESS-2: Evans, Nancy HOME PHONE: 2065420421
FREQUENCY STATION 8 SHIFT
730 17 C
SCHDATEEDUEE ► 11/01/10
UFIR ► 591 1 '202
ACTIVE
INITIAL INSPECTION DATE
PERSON CONTACTED: 1 jtI /�I
NAME OF INSPECTOR: v N T -Ev Ot V,
FIRE FE f /
SYSTEMS: e \ ANNUAL=
HAZARDS FOUND AND LOCATIONS / COM,, MNICATIONS /
1 EredUe Cpr�A eedae `x-/, rOl�ll�oH��t,Jte7
O
ZE�t C D5ONLY ONCE ►
✓
VIOLATION CODE
1
2 7,05 Id o V Ile �
CIO d C' /z �/4(1, ;If/, G2
3
3
4
4
5
5
6
6
7
7
8
8
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
INSPECTOR: (/(
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
2
DATE: (�.
DATE:
DATE:
3
OLATIONS
1 5
VIOLATIONS
1 5
PRE-CfRATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2 O �i
6
2
6
DATE:
CODE
SECTION:
5
3 O0
7
3
7
RETURN RECEIPT
RECEIVED
6
7
4
8
4
8
DATE:
DISPOSITION:
8
LETTER NEEDED ❑ YES r-] NO
LETTER NEEDED [_1 YES r] NO
FIRE DEPARTMENT COPY