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Edmonds, and
SNO11OM1SH Co' Serving Brier, 12425 Meridian Ave S
F1E Mountlake Terrace Everett, WA 98208
Phone (425) 551-1200
DIST veftW19J64VMstrictl.org Fax (425) 551-1272
LOCATION: Edgewood Condos (self managed) 2066931W
BUSINESS NAME: PHONE:
1110 5th Avenue S, Suite 303, Edmonds, WA 98020
MAILING
ADDRESS:01ver, Jan/Rautenberg, Karen
BUSINESS OWNER:Blake, Barney HOME PHONE: 2069309658
Wana, George 17 -
EMERGENCY-1: HOME PHONE:
KEY ACCESS-2: HOME PHONE:
EMAIL:
PERSON CONTACTED:
RES�YATf-q%*PEC1'0::#8/15FE11/16 12:00:OOAM'SP5/16
ate tast Serviced:
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FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
D BRIER
[I MOUNTLAKE TERRACE
[I UNINCORPORATED
Annual 17-A
FREQUENCY TATION & SHIFT
4v 2017
SCHEDUW�?7 152
DATE DUE
LIFIR 0
CURRENT I / - I
CITY YZS,_ NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
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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
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
C NTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
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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
SECTIOM
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
4
DATE:
DISPOSITION:
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