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7 FIRE PREVENTION
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x, Serving Brier, Edmonas, and 12425 Meridian Ave S INSPECTION REPORT
SNOY10 OEDMONDS
Mozintlake Terrace Everett, WA 98208 0 BRIER
FUMMA Phone (425) 551-1200 0 MOUNTLAKE TERRACE
DIST, T www.FireDistrictl.org Fax (425) 551-1272 0 UNINCORPORATED
FREQUENCY STATION & SHIFT
21 Pine Street 98020 Annual 17-C
LOCATION:
Pt Edwards Amenties Cntr 2 SCHEDULED Apr 2017
BUSINESS NAME: PHONE: DATE DUE 11'
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Date Last Serviced: I � I
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2nd RE -INSPECTION
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DATEDUE:
DATE DUE;
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DATE DUE: CITED:
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Serving Brier, Edmonds, and
SNOHOrvllSH CO.
Mountlake Terrace
Fl
DI TR Twww. -FireDistrictl. org
12425 Meridian Ave S
Everett, WA �8208 .-
Phone (425) 551-1200
Fax (425) 551-1272
. FIRE PREVENTION
INSPECTION REPORT
, 0 EDMONDS
5 Q BRIER
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[I UNINCORPORATED
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DATEDUE I'Apr2016
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CURRENT
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DATE DUE:
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CITATION ISSUED
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NUMBER:
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6
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DATE:
CODE
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6
3
7
3
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DISPOSITION:
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8
LETTER NEEDED [] YES 0 NO
FIRE PREVENTION
SNIOH&A 0. Sei-ving Bilei; Edmonds, and
12425 Mei-idian Ave S
INSPECTION REPORT.
Molintlake Tei-i-ace
F11
Everett, WA 98208
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El BRIER
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Phone (425) 551-1200
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Annual 17-A
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BUSINESS NAME:
PHONE:
SCHEDULEDApr 2015
DATE DUE
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BUSINESS OWNER:
HOME PHONE:
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HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
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4
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5
6
5
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7
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1 St RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
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1
INSPECTOR:
INSPECTOR:
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DATE:
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VIOLATIONS
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LETTER SENT
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CITATION ISSUED
NUMBER:
4
2
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2 6
3 7
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DATE:
CODE
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DATE:
DISPOSITION:
7
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LETTER NEEDED El YES [_1 NO
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FIRE DEPARTMENT COPY
lei;
SNOHOMISH Serl4ng Bi , Edmonds, and
FIREMountlake Terrace
STRT www'. FireD is tric t 1. o rg
LOCATION:
21 RneStriyeq E&M
BUSINESS NAME: PL6lmmrdsArrcnIJm;CnLr 2
MAILING
ADDRESS: 21 F) ric SLrcc� EdamrKib. %tVA OW20
I BUSINESS OWNER:
FIRE PREVENTION
INSPECTION REPORT
12425 Aleridian Ave S
JgEDMONDS
Everett, WA 98208 0 BRIER
Phone (425) 551-1200 El MOUNTLAKE TERRACE
El UNINCORPORATED
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
lst RE -INSPECTION
DATE DUE,
2nd RE -INSPECTION
DATE DUE*
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED -
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
D E:
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
4
8
4
18
DATE:
DISPOSITION:
11 LETTER NEEDED C] YES I—] NO
I LETTERNEEDED [] YES NO
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FIRE DEPARTMENT COPY
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SNOHOMISH C41 Serving Brier, Edmonds
Moun'tlake Terraceand
FIRE(,AW*_""')l
tM&i
I the Town of Woodway
STR - T www.FireDistrictl.org
LOCATION: 21 Pirle Sf,,
13USINESSNAME: PtEdWai&Amenfiestntr2
MAILING
ADDRESS:
BUSINESS OWNER:
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fav (425) 551-1272
F IRE PREVENTION
INSPECTION REPORT
0 EDMONDS
El BRIER
El WOODWAY
0 MOUNTLAKE TERRACE
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DATE DUE 0
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SYSTEMS:
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HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
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3
3
4
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5
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6
6
7
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
lst RE -INSPECTION
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTED TO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
1
,INSPECTOR:
INSPECTOR:
INSPECTOR:
2
[DATE:
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
1 5
1 5
LETTER SENT
NUMBER:
4
CODE
5
2
6
2
6
DATE:
SECTION:
RETURN RECEIPT
6
3
7
1
7
RECEIVED
DISPOSITION:
14
18
4
8
DATE:
7
LETTER NEEDED YES No
LE�TER NEEDED F-1 YES NO
8
FIRE DEPARTMENT COPY
FIRE PREVENTION
INSPECTION REPORT
....... Sei-Wnk 'Bt-iet;'Edmbnds lzj.z_-� iiet-idian Ave S
SNOHOMISH CO. OEDMONDS
Mountlake Terraceand. 4 tverett, WA 98208
0 BRIER
FIR t e Town of Woodway Phone (425) 551-1200 OWOODWAY
0 MOUNTLAKE TERRACE
DISTR www.FireQistrictl.org Fax.(425) 551-1272 0 UNINCORPORATED
21 Pine St
" FREQUENCY
365
I STATION& SHIF"'
17 6
LOCATION:
BUSINESS NAME: Pt Edwards Amenties Cntr 2
PHONE:
SCHEDULED 04/01/12
DATE DUE �
MAILING
FIR � 142 4152
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ADDRESS:
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1- Prop Manger
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HOME PHONE: CURRENT
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KEY A,CCESS-2:. II Hill, Jason//Maint.
HOME PHONE: 2064234433
YES NO
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LICENSE
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INITIAL INSPECTION DATE
NAME OF INSPECTOR: /V\ I
FIRE FA 9/11 FD-T_kI3x
FIE11 141
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
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2
2
3
3
4
4
5
5
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
D TE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
D E:
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
4
8
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED [] YES NO
LETTER NEEDED (] YES C3 NO
8
FIRE DEPARTMENT COPY
SMITH FIRE SYSTEMS MANAGEMENT, LLC DATE 2 - - //
�9F CONFIDENCE TESTING FIRE ALARM JOB# — qqS4, �j
1106 54th Avenue East, Tacoma, WA 98424
Phone: (253) 248-2000 Fax: (253) 248-2360
SITE NAME PT. EDWARDS AMMENITIES CENTER 2
ADDRESS 21 PINE STREET, EDMONDS, WA 98020
CONTACT 10YAN COPELAND PHONE (206) 388-0180
NAME OF TESTER JQ -SO -T-y C Ke/' CERTIFICATION NO. IJ-00 73
DATE OF INSPECTION AQ - I I TYPE OF INSPECTION
CONTROL PANEL MANUFACTURER SILENT KNIGHT MODEL NO. 5808
NUMBER OF INITIATING CIRCUITS 3 NO. OF SIGNAL CIRCUITS 2
BATTERY VOLTAGE 4(4--s VOLTS CHARGE CIRCUIT VOLTAGE -,97-V VOLTS
BATTERY VOLTAGE UNDER FULL LOAD Q5� k10 VOLTS (SIGNALS OPERATING)
1. Trouble signal with AC power off
2. System operates satisfactory on standby power
3. AJI signals operate on AC power
4. Have all alarm notification appliances been checked for proper operation?
5. All circuits checked for electrical supervision
6. Control panel checks made per manufacturer's instructions
7. All auxiliary equipment operates (Elevators, fans, dampers)
8. Central station or remote connection
Name of Monitodng Company
9. Key to panel available
10. Operating instructions at panel?
11. Service Label or Tag (SFC Appendix 111-13)
12. Did you sign off Item 8 on the Elevator Log
YES
NO
[:1
N/A
YES
NO
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N/A
[3
YES
NO
[:1
N/A
0
YES
NO
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N/A
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YES
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NO
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1-12"
PT. EDWARDS AMMENITIES CENTER 2
1 of 2
EQUIPMENT TESTED
TYPE OF EQUIPMENT
NUMBERSOF
UNITS TESTED
SATISFACTORY
NO. OF UNITS
IN BUILDING
YES
NO
N/A
Bells, Homs, Chimes
Voice Alarm Speakers
3
3
5
1
Visual Alarm Device
Trouble Indicators
.Super. Switch (Auto. Spr.)
Auto Spr. Flow Switches
Smoke Detectoqs)
2
3
2
Heat Detectoqs)
Manual Pull Stations
Ventilation Controls Operate
Central Station
I
Annunciators
Elevator Call Down
Fire Damper/Smoke Dampers
Phone Jacks
Auto. Door Unlocks - (Failsafe)
Auto. Door Release
10ther
PROBLEMS FOUND:
CORRECTIONS MADE:
DATE CORRECTED BY
THIS IS TO CERTIFY THAT THE FIRE ALARM SYSTEM HAS BEEN PROPERLY TESTED AND INSPECTED FOR
RELIABILITY TO COVER THE ITEMS LISTED IN THIS REPORT.
PT. EDWARDS AMMENITIES CENTER 2 2 of 2
SMITH FIRE SYSTEMS MANAGEMENT, LLC
DATE
Comm
vwpoftm CONFIDEN&E INESTING FIRE ALARM JOB #
1106 54th Avenue East, Tacoma, WA 98424
Phone: (253) 248-2000 Fax: (253) 248-2360
SITE NAME PT. EDWARDS AMMENITIES CENTER 2
ADDRESS 21 PINE STREET, EDMONDS, WA 98020
CONTACT TOYAN COPELAND PHONE (206) 388-0180
'I.
NAME OF TESTER CERTIFICATION NO.
DATE OF INSPECTION lb - -30 - 1. ID TYPE OF INSPECTION ftA " U qn,"t-
CONTROL PANEL MANUFACTURER SILENT KNIGHT MODEL NO. 5808
NUMBER OF INITIATING CIRCUITS
q NO. OF SIGNAL CIRCUITS 2
BATTERY VOLTAGE 2-1p VOLTS CHARGE CIRCUIT VOLTAGE VOLTS
BATTERY VOLTAGE UNDER FULL LOAD VOLTS (SIGNALS OPERATING)
1.
Trouble signal with AC power off
YES
NO
N/A
2.
System operates satisfactory on standby power
YES
NO
El
N/A
El
3.
All signals operate on AC power
YES
;�r
N 6
Ej
N/A
[-I
—4.
Have all alarm notification appliances been checked for proper operation?
YES
NO
NIA
El
5.
All circuits checked for electrical supervision
YES
NO
[:1
N/A
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6.
Control panel checks made per manufacturer's instructions
YES
NO
0
N/A
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7.
All auxiliary equipment operates (Elevators, fans, dampers)
YES
NO
[-]
N/A
;�r
8.
Central station or remote connection
YES
NO
[:1
N/A
El
Name of Monitoring Company
SFSM
@ AVANTGUARD 89-6952
9.
Key to panel available
YES
No
El
N/A
El
10.
Operating instructions at panel?
YES
NO
El
N/A
0
11.
Service Label or Tag (SFC Appendix
YES
NO
El
N/A
.0
12.
Did you sign off Item 8 on the Elevator Log:-
YES
El
No
El
N/A
PT. EDWARDS AMMENITIES CENTER 2
1 of. 2
EQUIPMENT TESTED
TYPE OF EQUIPMENT
NUMBERS OF
UNITS TESTED
SATISFACTORY
NO. OF UNITS
IN BUILDING
YES
NO
N/A
Bells, Horns, Chimes
Voice Alarm Speakers
3
3
Visual Alarm Device
5
z
5
Trouble Indicators
I
Super. Switch (Auto. Spr.)
Auto Spr. Flow Switches
Smoke Detector(s)
2
17—
2
Heat Detector(s)
3
3
Manual Pull Stations
2
2
Ventilation Controls Operate
Central Station
I
I
Annunciators
Elevator Call Down
Fire Damper/Smoke Dampers
Phone Jacks
Auto. Door Unlocks - (Failsafe)
Auto. Door Release
Other
PROBLEMS FOUND:
CORRECTIONS MADE:
DATE CORRECTED BY
THIS IS TO CERTIFY THAT THE FIRE ALARM SYSTEM HAS BEEN PROPERLY TESTED AND INSPECTED FOR
RELIABILITY TO COVER THE ITEMS LISTED IN THIS REPORT.
PT. EDWARDS AMMENITIES CENTER 2 2 of '2