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110 5TH AVE Sr t t ,! Y d:,...•. - ,r ... (I L•II� I I � � � � V % is SNOHOMISH CO.. Serving Brier, Edmonds, and 12425 Meridian Ave S Mountlake Terrace Everett, WA 98208 ' Phone (425) 551-1200 DISTRIUT www.FireDistrictl.org Fax (425) 551-1272 LOCATION: 110 5 th Avenue S 98020 y : BUSINESS NAME: BOrgert AptS PHONE: 4257788758 ' Lt MAILING ADDRESS: A 751 Laurel Street, Edmonds, WA. 98020 1 BUSINESS OWNER: Springer, Jame HOME PHONE: ' EMERGENCY-1- Borgert, Bill HOME PHONE: 4257788758 KEY ACCESS-2: HOME PHONE: EMAIL: ' PERSON CONTACTED:' I . NAME OF INSPECTOR: !,, _I• FIRE SYSTEMS: natp FE I FIRE PREVENTION INSPECTION REPORT EDMONDS ❑ BRIER ❑ MOUNTLAKE TERRACE ❑ UNINCORPORATED FREQUENCY STATION & SHIFT Annual 17-D SCHEDULED DATE DUE ► Feb 2016 UFIR ► 422 202 CURRENT CITY YES NO 'BUSINESS LICENSE Ej INITIAL INSPECTION DATE HAZARDS FOUND -AND LpCATIONS / MMUNICATIONS 1 2 2 3 3 4 4 5 6 5 6 7 7 I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X 4St RE -INSPECTION DATE DUE: - 2nd RE -INSPECTION DATE DUE: EXTENSION GRANTED TO: FINAL RE -INSPECTION DATE DUE: VIOLATIONS CITED: PERSON CONTACTED: INSPECTOR DATE: _ PERSON CONTACTED: PERSON CONTACTED: 2 3 INSPECTOR: INSPECTOR: DATE: DATE: VIOLATIONS 1 5 VIOLATIONS: ••, 1 5 PRE -CITATION LETTER SENT __. .-.. _-.-.._.-..-, DATE: CITATION ISSUED NUMBER: 4 2 6 ........�.... 2 __ "_ 6 CODE ............. SECTION: 5 3 7 3 7 RETURN RECEIPT RECEIVED e 4- 8 INO 4 8 DATE: DISPOSITION: _ w T 11 LETTER NEEDED ❑ YES ❑ LETTER NEEDED ❑ YES ❑ NO e 1. SNOHOMISH CO. r Serving Brie\; Edinonds TIREMountlake Terrace,and DISTkffrk the Town of Woodway www FireDistrict]. org LOCATION: 110 51h Avenue BUSINESS NAME: Bvrgert AptS MAILING 751 Laurel St 4 I'\ 4 FIRE PREVENTION 12425 Meridian Ave S INSPECTION REPORT WA 98208 El BRIER S EDMOEverett, BRIER Phone (425) 551-1200 ❑ WOODWAY ❑ MOUNTLAKE TERRACE Fax (425) 551-1272 ❑ UNINCORPORATED PHONE: 4257788758 ADDRESS: Edmonds 93020 BUSINESS OWNER: "Borgert, Bill" HOME PHONE: 4257788758 EMERGENCY-1: "Springer, Jame" HOME PHONE: 4257768922 KEY ACCESS-2: HOME PHONE: PERSON CONTACTED: NAME OF INSPECTOR: FIRE SYSTEMS: FREQUENCY STATION & SHIFT 365 '17 D SCHEDULED ���® �f1 DATE DUE ► UFIR ► 422 2202 ACTIVE CURRENT CITY YES NO BUSINESS LICENSE INITIAL INSPECTION DATE FE ► LI.1._1 ANNUAL HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 1 _ _ 1 e 2 2 r 3 3 4 4 5 5 6 6 7 7 1 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: y 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 SECTION: 5 3 7 3 7 RETURN RECEIPT RECEIVED 5 4 8 4 18 DATE: DISPOSITION: 7 LETTER NEEDED ❑ YES ❑ NO LETTER NEEDED ❑ YES ❑ NO 8 FIRE DEPARTMENT COPY CITY OF EDMONDS ' 121 5TM AVENUE N. • EDMONDS, WASHINGTON 98020 (425) 771-0215 FIRE DEPARTMENT Fs t i B LOCATION: 110 5th Avenue S BUSINESS NAME: Borgert Apts 1 MAILING 751 Laurel St FIRE PREVENTION SAFETY SURVEY PHONE: 4257788758 ADDRESS: Edmonds 93020 BUSINESS OWNER: "Borgert, Bill° HOME PHONE: 4257788758 EMERGENCY-1: ©Springer, Jame" HOME PHONE: 4257768922 KEY ACCESS-2: HOME PHONE: FREQUENCY STATION & SHIFT 365 17 C SCHEDULED 0210.1/11 DATE DUE ► UFIR ► 422 2202 A C?1VE PERSON CONTACTED: INITIAL INSPECTION DATE NAME OF INSPECTOR: �-� 7�/ / / I FIRE FE _f_ SYSTEMS: ANNUAL HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 1 �n OIGC.�SS ENTER CODE ONLY ONCE ► VIOLATION CODE 1 2 2 3 3 4 4 5 5 6 w 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: PERSON CONTACTED: PERSON CONTACTED: 1 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 SECTION: _ 5 3 7 3 7 RETURN RECEIPT RECEIVED 6 7 4 8 4 8 DATE: DISPOSITION: 8 LETTER NEEDED ❑ YES Ej NO LETTER NEEDED C YES ❑ NO FIRE DEPARTMENT COPY