21006 80TH PL Wo 4h (,j
FIRE PREVENTION
Serving
'110OU
bnonds, and
1242 A
keridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
Mountlake Terrace
FIRE I
Everett, WA 98208
0 EDMONDS
OBRIER
DISTRIVEILIT
Phone (425) 551-1200
Fax 551-1272
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
wwwFireDistrictl.org
(425)
FREQUENCY
STATION & SHIFT-'
LOCATION: 21006 BO th Place W 98026
Annual
I 16-B
BUSINESS NAME: Payton Triplex
PHONE: 42577155650
SCHEDULED Feb 2014
DATE DUE
MAILING
UFIF422 206
ADDRESS: PO Box 952, Edmonds, WA. 98026
BUSINESS OWNER: Bell, Fred
HOME PHONE:
EMERGENCY-1:
HOME PHONE:
CURRENT ��ES
KEY ACCESS-2:
EMAIL:
HOME PHONE:
CITY 110
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LICENSE
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2
2
3
3
4
4
5
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
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
E:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
1 5
1 5
LETTER SENT
NUMBER:
12
CODE
5
6
2
6
DATE:
SECTION:
RETURN RECEIPT
3
7
3
7
RECEIVED
6
DISPOSITION:
7
14
18
4
18
DATE:
( LETTER NEEDED F] YES [__1 NO
LETTER NEEDED E) YES El NO
FIRE DEPARTMENT COPY
FIRE PREVENTION
Serv,ing Brier, Edinonds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
4 Mountlake Terrace, and
FIRE
Everett, WA 98208
\gOMONDS
El BRIER
STRtOil the Town of Woodway
Twww.FireDistrictl.org
Phone (425) 551-1200
0 WOODWAY
0 MOUNTLAKE TERRACE
Fax (425) 551-1272
0 UNINCORPORATED
FREQUENCY
STATION & SHIFT"'
LOCATION: 21006 80th Place
w
365
16 A
I
BUSINESS NAME: Peyton Triplex
PHONE: 4257755650
SCHEDULED
DATE DUE 1' MO -V 13
MAILING POB #952
UFIR � 422 2206
ADDRESS: Edmonds
98020
BUSINESS OWNER: 013ell, Fred 0"
HOMEPHONE: 4257755650
ACTIVE
EMERGENCY-1:
HOME PHONE:
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
El 1:1
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FL � L3
FIRE
_j
FE I
SYSTEMS:
AN—NU-A—L
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
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:
I
2nd RE -INSPECTION
DATE DUE:
I
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
.PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
D TE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LE17ER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTIOM
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
18
4
8
DATE:
DISPOSITION:
7
\1 LETTER NEEDED F] YES El NO
I LETTER NEEDED YES NO
1
8
FIRE DEPARTMENT COPY
CITY OF EDMONDS
121 5TH AVENUE N. EDMONDS, WASHINGTON 98020 (425) 771-0215
'01 RE DEPARTMENT
LOCATION: 21006 80th Place w
FIRE PREVENTION
SAFETY SURVEY
BUSINESS NAME: Peyton Triplex PHONE: 4257755650
MAILING POB #952
ADDRESS: Edmonds 98020
r BUSINESS OWNER: "Bell, Fred On HOMEPHONE: 4257755650
EMERGENCY-1: HOME PHONE:
KEY ACCESS-2: HOME PHONE:
I
FREQUENCY
STATION& SHIFT
365
16 C
SCHEDULED
11
DATE DUE
UFIR o 422
2206
ACTIVE
e INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR: k)�A I- �-C Vj
FIRE
SYSTEMS:
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ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE 1�
VIOLATION CODE
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2
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�
PERSON
CONTACTED;
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOL IONS
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
18
4
8
DATE:
DISPOSITION:
7
8
\,UETTER NEEDED 0 YES NO
LETTER NEEDED E] YES NO
1
FIRE DEPARTMENT COPY