110 W DAYTON ST0, . � fT- 7-0eJ J19&
SNO
F
D
Serving Brier, Edmonds, and 12425 Meridian Ave S
Mountlake Terrace Everett, WA 98208
Phone (425) 551-1200
www.FireDistrict].org Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
❑ EDMONDS
❑ BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY
STATION & SHIFT
LOCATION:110 West Dayton Street Bldg 98020
Annual
17-C
BUSINESS NAME:110 W Dayton Bldg PHONE:
4257741511
SCHEDULED Sep 2018
DATE DUE
MAILING
UFIR / 591
ADDRESS:110 West Dayton Street, Bldg, Edmonds, WA 98020
BUSINESS OWNER:Conner, Jan HOME PHONE:
EMERGENCY-1.d3nn644" (�(/,�/� � � HOME PHONE:
4257741511 CURRENT
KEY ACCESS-2:"HOME PHONE:
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17
CITY YES NO
BCEINSEEl 1:1
EMAIL:
PERSON CONTACTED: r A o-t4 `'� LAJ;(Itac.+^ S
INITIAL INSPECTION DATE
NAME OF INSPECTOR: I^ t' t '`C •� (a-� , �� Uj. If
FIRE SYSTEMS: FE lvi 8
Date Last Serviced:
HAZARDS FOUND AND LOCATIONS / COMMUr(CATION
2
2
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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:
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VIOLATIONS
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VIOLATIONS
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PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
—' _
2
6
DATE:
CODE
SECTION:
5
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7
3
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7
RETURN RECEIPT
RECEIVED
DATE:
DISPOSITION:
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LETTER NEEDED 0 YES ❑ NO
. LETTER NEEDED ❑ YES ❑ NO