1123 5TH AVE S (3)SM
F
Serving Brier,. Edmonds, and
Mountlake Terrace
1L3 JL J L%j J. www.FireDistrictl.org
1123 5 th Avenue S 98020
I
LOCATION:
` Laurel Apts
BUSINESS NAME:
MAILING 8238 NE 115 PI, Kirkland, WA 98034
ADDRESS:
Mansfield, John
BUSINESS OWNER:
Mansfield, John D.
EMERGENCY-1:
KEY ACCESS-2:
EMAIL:
PERSON CONTACTED: 1 _ y� j'•f -
NAME OF INSPECTOR:
Date Last Serviced:
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
4258236454
PHONE:
HOME PHONE:
4258236454
HOME PHONE:
HOME PHONE:
FIRE PREVENTION
INSPECTION'REPORT
❑ EDMONDS
❑ BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FAnnualCY
sTATI _N SHIFT
Dec 2016
SCHEDULED
DATE DUE /
UFIR /
CURRENT
CITY
YES NO
BUSINESS
LICENSE
INITIAL INSPECTIONDATE
Serving Brier, Edmonds, and 12425 Meridian Ave S
Mountlake Terrace Everett, WA 98208
Phone (425) 551-1200
www FireDistrictl. org Fax (425) 551-1272
„
LOCATION:
1123 5 th Avenue S 98020
BUSINESS NAME:
Laurel Apts
MAILING
ADDRESS:
8238 NE 115 PI, Kirkland, WA 98034
BUSINESS OWNER:
Mansfield, John
EMERGENCY-1:
Mansfield, John D.
KEY ACCESS-2:
EMAIL:
PERSON CONTACTED:yV
NAME OF INSPECTOR: C. S 4\ 1-7—
FIRE SYSTEMS:
FE 5/14
PHONE: 4258236454
HOME PHONE:
HOME PHONE: 4258236454
HOME PHONE:
n
FIRE PREVENTION
INSPECTION REPORT
❑ EDMONDS
❑ BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY 717-B
ON &SHIFT
Annual
SCHEDULED
DATE DUE ► Dec 2015
UFIR ► 427 153
CURRENT
CITY YES NO
BUSINESS
LICENSE
TNSP� ION DAT�///6
.
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
3
•
t
4
.4
5
--- T°-
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X '.
1 st RE -INSPECTION
2nd RE -INSPECTION
FINAL RE -INSPECTION
EXTENSION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTED TO:
DATE DUE:
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECTOR:
2
3
-
INSPECTOR:
INSPECTOR:
DATE:
DATE:
DATE:
VIOLATIONS
VIOLATIONS:'-`;-
PRE -CITATION
CITATION ISSUED
1 5
1 5
LETTER SENT
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
RETURN RECEIPT
3
7
3
7
RECEIVED
e
DISPOSITION:
4
8_..
_
4
8
DATEmm
_
_
LETTER NEEDED 13 YES ElNO
_
LETTER NEEDED ❑ YES ❑ NO
8
i
-y' 1
FIRE PREVENTION
Serving Brier; Edmonds, and
12425 Meridian Ave S
INSPECTION REPORT
sNoxoMisx co.
❑ S
FIRE
Mountlake Terrace
Ei Brett, WA 98208
BRIER
❑ BRIER
Phone (4 25) 551-1200
❑ MOUNTLAKE TERRACE
DISTR
T
El UNINCORPORATED
www.FireDistrictl.org
Fax (425) 551-1272
fin,
FREQUENCY STATION & SHIFT
LOCATION:
1 123 J th AVmtwe S 98WO
Annual 17-A
BUSINESS NAME:
Laurel ApLi
PHONE: 426823&45A
SCHEDULED Dm 2014
DATE DUE
MAILING
UFIR / 427 lt."l
ADDRESS:
8238 NE 115 PI, Iirldand, WA 98034
BUSINESS OWNER:
Mansfirlrl, 30 In
HOME PHONE:
EMERGENCY-1:
W- rtbflcld, Jahn D.
HOME PHONE: 42582364,64
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
EMAIL:
BUSINESS � ❑
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
Sr (
FIRE SYS IEMS:
FE
HAZARDS FOUND AND LOCATIONS / COMM N CATIONS
2
�
2
3
3
4 _ .. -
- --- _
_. _. _...
4
6
6
7
7
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:
PERSON
CONTACTED:
VIOLATIONS
CITED:
1
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
VIOLATIONS
1 5
DATE:
3
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
4
J8
4 8
DATE:
DISPOSITION:
7
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
8
FIRE DEPARTMENT COPY