110 MAIN ST STE 104FIRE PREVENTION/ c Y
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' CITY OF E D M'O N DS SAFETY SURVEY
.' 121 5TM AVENUE N. • EDMONDS, WASHINGTON 98020 • (425) 771 0215
FIRE DEPARTMENT
�S �' 1 a9° ( #1 6/A./C � d
LOCATION: 110 Main St ,{ � N)�'�P 104
BUSINESS NAME: BrilBsteio, Inc (r/�o� PHONE: 4257767710
MAILING
ADDRESS:
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BUSINESS OWNER: CBVIneSS, Cherie HOME PHONE: 3606595353
EMERGENCY-1: Mes@nger, Karen HOME PHONE: 2069319525
KEY ACCESS-2: HOME PHONE:
1
.T
FREQUENCY
STATION 8 SHIFT 1
730
17 C
I r:
SCH
11/01/10
DATEEDUEE ►
UFIR ► 591 1202
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR: N-u
FIRE FE 47tf
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
ENTER CODE ONLY ONCE ►
VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
7
8
8
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
/
I
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 -ORATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION: _
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
7
'
4
8
4
8
DATE:
DISPOSITION:
-
8
LETTER NEEDED ❑ YES [3 NO
LETTER NEEDED YES NO
i
FIRE DEPART ENT COPY
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