20901 76TH AVE WFIRE PREVENTION
Serving "i ter, zu1nonds, and
12425 Meridian Ave'S..
INSPECTION REPORT
SNOHO
FIRE
`
Mountlake Terrace
Everett, WA 98208
0 EDMONDS
0 BRIER
'tir�
DI., T
I '
T
Phone (425) 551-1200
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
.
www.FireDistrict].org
Fax (425) 551-1272
LOCATION: 20901 76 th Avenue W 98026'��..
BUSINESS NAME: Evergreen Apts
MAILING
ADDRESS: 16048 Greenwood Ave N, Shoreline, WA 98026
PHONE:
2067867124
FREQUENCY I STATION& SHIFT'*'
Annual 16-A
SCHEDULED May 2017
DATE DUE �
425207
LIFIR
BUSINESS OWNER:
HOME PHONE:
I EMERGENCY-1: Brown, Tracy
2067867124
"'CURRENT
HOME PHONE.
' 16
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS F
EMAIL:
LICENSE
PERSON CONTACTED:
INITIAL N3�14�ECTION PATE
NAME OF INSPECTOR:
FIRE SYSTEMS: FE 7116
Date Last Serviced:
SNOHOMISH CO.
cl
Serving Brier, Edmonds, and
Mountlake T�rrace
www.FireDistrictl. org
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Far (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
OBRIER
[3 MOUNTLAKE TERRACE
[3 UNINCORPORATED
FREQUENCY STATION & SHIFF"
LOCATION:
20901 76 th Avenue -W 98026 Ammus! %_'a
BUSINESS NAME: PHONE: SCHEDULED
Evergreen Apts DATE DUE 0 May 2946
MAILING LIFIR 0
ADDRESS: 425207
20901 76th Avenue W, Edmonds, WA 98026
BUSINESS OWNER: HOME PHONE:
.EMERGENCY-1: HOME PHONE: eCURRENT YES NO I
KEY ACCESS-2: Ainslie, Charles HOME PHONE: 0 CITY
EMAIL: BUSINESS F1
LICENSE L—J
INITIAL INSPECTION DATE
PERSON CONTACTED: --TfC<-<f
NAME OF INSPECTOR: co
FIRE SYSTEMS: FE 9/13
LNX%AW9ftWAQ0Q1bCATIONS;
/ CJ)MMUNICATIONS
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py-cDe�r q,
2
2
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
In our continuing effort to promote fire safety and prevention within the community, your fire department conducts
regularly scheduled "Fire Safety Survey Inspections" of all businesses and multi -family occupancies in the Cities
covered by Snohomish County Fire District 1.
You are to be congratulated on the relative good condition of your occupancy in regards to fire safety. Above you
will find the item(s) that were noted during. our inspection which require attention to bring them into compliance
with the minimum standards adopted by the above jurisdictions.
Any overlooked hazards or violations. of the fire regulations does not imply approval of such conditions or violation.
If you require additional information or to schedule a re -inspection for Edmonds, call (425) 775-7720; for
Mountlake Terrace or Brier, call (425) 744-6231.
FIRE PREVENTION
Serving &iei; Edmonds, and
12425 Meridian Ave S
INSPECTION REPORT
SNOR�� Co
untlake Terrace
FIRE" tW:iT
Everett, WA 98208
OEDMONDS
0 BRIER
ST R *4
Phone-(425) 551-1200
'Fax
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
wwwFireDistrictl. org
(425) 551-1272
20901 70 th Amerl6e W 980215
FREQUENCY I
Annual
STATION &SHIFT')
16-6-
LOCATION:
Evercireen Apts
SCHEDULED May 2014
BUSINESS NAME:
PHONE:
DATE DUE I`
(420 201
MAILING 20.q_01 7fith A -venue W, Edmonds, W4. 98026
UFIR
ADDRESS:
BUSINESS OWNER:
HOME PHONE:
Ainslie, Charles
0
EMERGENCY-1:
HOME PHONE:
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY NO
BUSINESS
EMAIL:
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR: yol*le ,2 P-,kl
Tr_- K A �Z. , FF
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
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2
2
3
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4
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6
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1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
1
INSPECTOR:5_6
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIC, 1(�NS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
—
1,7-
5
LETTER SENT
NUMBER:
4
CODE
5
2
6
2
6
DATE:
SECTION:
RETURN RECEIPT
6
3
7
3
7
RECEIVED
DISPOSITION:
4
8
4
8
DATE:
LETTER NEEDED YES NO
LETTER NEEDED YES NO
8
FIRE DEPARTMENT COPY
-FIRE PREVENTION
SNOHOMISH'CO. Serving Brier, Edmonds
1 2� M
'eridian'Ave,S,
INSPECTION REPORT
FIRE-
Mountlake Terrace, and
,25
Everett, WA 98208
�19EDMONDS
0 BRIER
0 j a -
't,". the Town of Woodway)-
Aone (425) 551-1200
E]WOODWAY
DI ILLUT
Is
- E] MOUNTLAKE TERRACE
'
www.FireDistrictl.org
Fax (425) 551-1272
0 UNINCORPORATED
20901 76th Avenue
W
4NCY
FRSW
STATJW4 &4HIF"'I
LOCATION:
BUSINESS NAME:
Evergreen Apts
PHONE:
SCHEDULED 05/01/13
DATE DUE
MAILING
316 Walnut #302
UFIR 1, 425 5207
ADDRESS:
Edmonds
98020
BUSINESS OWNER:
Ainslie, Charles
HOME PHONE:
ACTIVE
EMERGENCY-1:
Brown, Tracey
HOMEPHO 2067367124
NE:
U N
R E T
KEY ACCESS-2:
HOME PHONE:
I�R YES NO
ri USINESS
LICENSE
PERSON CONTACTED:
&
INITIAL IN ECTION DATE
7
NAME OF INSPECTOR:
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FIRE
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SYSTEMS:
ANNUAL
HAZARDS FOMAND., LOCATIONS COMMUNICATIONS!'
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2
2
3
07
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3
4
2-
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
D E DUE:
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
I
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
t? VIOLATIONS
1 15
VIOLATIONS
1 15
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
14
8
4
8
DISPOSITION:
7
LETTER NEEDED F] YES Ej NO
rLETTER NEEDED [] YES NO
8 1
FIRE DEPARTMENT COPY
FIRE PREVENTION
Serving Brier Edmonds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO. I
Mountlake Terraceand
FIRE
Everett, WA 98208
0EDMONDS
El BRIER
the Town of Woodway
DISTR T
Phone (425) 551-1200
El WOODWAY
0 MOUNTLAKE TERRACE
www.FireDistrict].org
Fax (425) 551-1272
0 UNINCORPORATED
FREQUENCY STATION & SHIFF)
LOCATION: 20901 76th Avenue
W
365 16 D
EfUSINESS NAME: Evergreen Apts
PHONE:
SCHEDULED
DATE DUE 1' 05/01/12
MAILING 316 Walnut #302
UFIR 425 5207
ADDRESS: Edmonds
98020
BUSINESS OWNER: Ainslie, Charles
HOME PHONE:
AC11VE
EMERGENCY-1: Brown, Tracey
HOME PHONE: 206786*7124
CURRENT S,
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR: DO wL,,/j
1/0 6 /0
5
FIRE
FE _a_LO
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
A /t/ /AJL-)A
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,/,,- P�
PERSON
CONTACTED:
PERSON
CONTACTED:
1 ,
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE: r'.42, 12
DATE:
DATE:
3
,,,,VIOLATIONS
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
4
18
4
18
DATE:
DISPOSITION:
7
LETTER NEEDED [-] YES El NO
LETTERNEEDED F] YES [I NO
FIRE DEPARTMENT COPY
FIRE PREVENTION
Seri,ing Briet: Edinon s
d
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO
Mountlake Terrace, and
�)FIR
Everett, WA 98208
OEDMCINDS
0 BRIER
the Town of Woodway
DISTR
Phone (425) 551-1200
DWOODWAY
0 MOUNTLAKE TERRACE
www.FireD.istrict].org
Fax (425) 551-1272
0 UNINCORPORATED
FREQUENCY
STATION & SHIFT
LOCATION: 20901 76th Avenue
W
365
16 C
BUSINESS NAME
Evergreen Apts
PHONE:
SCHEDULED
DATE DUE 05/01/11
MAILING 316 Walnut #302
LIFIR 1' 425 5207
ADDRESS: Edmonds
98020
BUSINESS OWNER:
Ainslie, Charles
HOME PHONE:
AC-nVE
EMERGENCY-1: Brown, Tracey
HOME PHONE: 2067867124
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
Ele
0
LICENSE
PERSON CONTACTED:
INITIAL IN
NAME OF INSPECTOR: 7;71Cm rf/,J j
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FIRE
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'SYST'EMS:
AWN U-Z7
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
---------- - C.
2
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$
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3
3
4
4
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5
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7
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:
P/4:1--1
2nd RE -INSPECTION
DATE DUE.
EXTENSION
GRANTEDTO-
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED.
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
I
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
3
VIOLATIONS
5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
-DATE:
CITATION ISSUED
NUMBER:
4
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
8
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED E] YES [I No
LETTER NEEDED YES NO
8
FIRE DEPARTMENT COPY
E360 691-\ 1-IS Z_ 0
COW OF EDMONDS ofi5�
BUSOMESS LOCEMSE APPLOCA7�OM- comx EPcq(aECEjVED
FEE: $125.00
CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION 5M
/oc, 1 121 5�' AVENUE NORTH, EDMONDS, WA 98020 PHONE: 425.775.252 AR 3
- - __ - _.�t I rff rinv
I OFFICE USE ONLY FLIMUIN r! 1 .
BL#
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Customer#
100 0'zk7C_2_1
1 gye0alt I
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1�5_3001
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Fee Paid
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Mailed
Delete
1
INSTRUCTIONS: Please complete the application In full and aftach tho requirad floor plan. Middle Initial or name required of all
parties concerned. If no middle name, please Indicate by w4ting NMM. Sign and return application with fee. Please advise of
any change In status. Now 111censo raquirod If business changes location or ownership. Notification to City 7f %monds mquirGd
If business closes. A*>
BUSINESS NAME
BUSINESS ADDRESS
Street Suite No. ZID Code
MAILING ADDRESS
Street or PO Box Suite No. City, State and Zip Code
BUSINESS PHONE NO. ( WA STATE TAX ID NO. (UBI NO.) 60.1co:1 � "9
BUSINESS E-MAIL BUSINESS WEBSITE
PROPERTY OWNER C'k a t ( ,e r. I I :e
Name Phone Number
EMERGENCY NOTIFICATION (For Premise Access in Emergency): O(La
srmt)n 4 -70"
Last Name First,Name—J Mi Phone No.
Last Name First,Name MI Phone No.
NATURE OF BUSINESS // U4:ZrAV9tMkaa
NUMBER OF EMPLOYEES
FOOTAGE OF BUSINESS SPACE
TYPE OF BUSINESS - PLEASE CHECK THE APPROPRIATE CATEGORY:
(3 CONSTRUCTION 0 FINANCE, INSURANCE, REAL ESTATE 0 LANDSCAPE, HORTICULTURAL 0 MANUFACTURING 0 NON-PROFIT
0 RETAIL 0 SECONDHAND DEALER 0 SERVICES (3 WHOLESALE OTHER i4--yj UtAcb
AMUSEMENT DEVICES ON PREMISES? 0 YES 0 NO IF YES, TOTAL NUMBER
LIQUOR SOLD ON PREMISES?: CB YES 0 NO GAMBLING? 0 YES 0 NO CIGARETTES SOLD ON PREMISES? 0 YES 0 NO
FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED?: 0 YES 0 NO IF YES. PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES:
PROPOSED OPENING DAY OF BUSINESS BUSINESS HOURS
DAYS OPEN 0 SUNDAY 0 MONDAY 0 TUESDAY 0 WEDNESDAY 0 THURSDAY 0 FRIDAY 0 SATURDAY
PARKING SPACES ON SITE: TOTAL ACCESSIBLE FOR PERSONS WITH DISABILITIES
DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES? 0 YES 0 NO
PREVIOUS BUSINESS USE AT THIS ADDRESS
2
SOLE
HOME PHONE NO. DOL NO. (DRIVERS LICENSE NO.) OR OTHER ID No. 42 f\nL C-7 4 0 1
DATE OF BIRTH I I - *7 - IftiZITY AND STATE OF BIRTH-_ OF BIRTH IA.'$
PARTNERSHIP - PARTNER I
NAME_ -
Last First MI
ADDRESS Street Apt, No., Unit No. City, State and Zip Code
HOME PHONE NO ( DOL NO. (DRIVERS LICENSE NO.) OR OTHER ID NO
DATE OF BIRTH_________PTY AND STATE OF BIRTH COUNTRY OF BIRTH
PARTNERSHIP - PARTNER 2
NAME Last First MI
ADDRESS Street .. Apt No., Unit No. City. State and Zip Code
HOME PHONE NO.(__ — DOL NO. (DRIVERS LICENSE NO.) OR OTHER ID NO.
DATE OF BIRTH AND STATE OF BIRTH COUNTRY OF BI
CORPORATION
NAME OF CORPORATION FEDERAL TAX ID NO
CORP. ADDRESS PHONE NOJ
Street Suite, Apt., Unit No. City. State and Zip Code
CORPORATE OFFICERS:
Last Name First Name
MI Tille Date of Birth DOL No. (Drivers License No.) or Other ID No.
LOCAL — I I
Last Name First Name 'MI Title Phone No. DOL No. (Drivers Lic. No.) or Other ID No,
y
APPLICANT IWI ��5 I-, ( - 6��
Name - Printed signature Title Date
PLANNING DEPT. 0 APPROVE 0 DISAPPROVE DATE SIGNATURE
ZONINGCODE CONDITIONAL USE PERMIT,
COMMENTS
BUILDING DEPT. 0 APPROVE 0 DISAPPROVE DATE SIGNATURE
OCCUPANT LOAD_BUILDING PERMIT OCCUPANCY GROUP
COMMENTS
FIRE DEPT. 0 APPROVE 0 DISAPPROVE DA-(E___________S1GNlATURE
I.I.F.I.R.
COMMENTS
POLICE DEPT. 0 APPROVE (3 DISAPPROVE DATE -----SIGNATURE
COMMENTS
0-1,
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINgjT,(?N 98020 - (425) 771-0215
FIRE DEPARTMENT
LOCATION: 20901 761h Avenue w
FIRE PREVENTION
SAFETY SURVEY
BUSINESS NAME: Evergreen Apts PHONE: 4257767099
MAILING 8022 212th St SW
FREQUENCY
STATION& SHIFT
365
16 6
SCHEDULED
DATE DUE 1`
05/0 1 /10
LIFIR 11, 425
ADDRESS: Edmonds 98026
BUSINESS OWNER: "Michel, Rob" HOME PHONE: 4257425684
EMERGENCY- 1: "Michel, Robin� HOME PHONE: "n?93?2445
KEY . ACCESS-2: HOME PHONE: 5'1 Ll I-L
ACTIVE
INITIAZINSPECTION DATE
PERSON CONTACTED: L
NAME OF INSPECTOR:
FIRE FE
SYSTEM' ):
ANNUAL
HAZARDS FOUND AND LOPATIONS / COMMUNICATIO S
ENTER CODE ONLY ONCE 11�
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:
EXTENSION
GRANTED TO:
;FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED: (21� (01
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR: S
INSPECTOR:
INSPECTOR:
-
2
DATE: _(0
DATE:
PATE:
3
OLATIONS
5
MOLATIONS
5
PRE-CRATION
LETTER SENT
-
CITATION ISSUED
NUMBER:
4
2
16
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
7
4
-8
4
18
DATE:
DISPOSITION:
8
\1 LETTER NEEDED [] YES NO
LETTER NEEDED 0 YES NO
FIRE DEPARTMENT COPY