21016 80TH PL Wolu 60+% FIRE PREVENTION
Set -iei ve S INSPECTION REPORT
SNOHOMISH CO. -vingBi Is, and 12425 Meridian A 0 EDMONDS
Mountlake'Terrace Everett, WA 98208 0 BRIER
FIRE Phone (425) 551-1200 0 MOUNTLAKE TERRACE
STRTwww.FireDistr'ict1.org Fax (425) 551-1272 0 UNINC I ORPORATED
LOCATION: 21016 80 th Place W _Q8026 e- FREQUENCY I STATION 1, SHIFT-")
Annual 16-B
BUSINESS NAME: Kl6ven Xptz,. 4257741063 SCHEDULED Feb 2014
PHONE: DATE DUE
MAILING UFIRV2
ADDRESS: 21016 80th PlaceW, Edmonds, INA 98026
BUSINESS OWNER: HOME PHONE:
EMERGENCY-1: Kleven, Roqer HOME PHONE: 425774'1663
KEY ACCESS-2: HOME PHONE:
EMAIL:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE SYSTEMS: F�E L) 3
CIT�',_--y� 'f
BUSINESS F-1
LICENSE I I
INITIAL INSPE.CTION DAT
. i�Q ) 711-
M
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
.16t RE -INSPECTION
DATE DU E%
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
CITED:
PERSON
-CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECTOIi."'
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIO IONS
5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6 x
.4
18
4
.8
DATE:
DISPOSITION:
LETTER NEEDED [-] YES E3 NO
LETTER NEEDED [] YES NO
1
8
FIRE DEPARTMENT COPY
39L.
Serving Brier, Edmonds
SNOHOMISH CO.
FIRE'
*4 Mountlake Terrace, and
T,
14WO"
DISTR
w T the Town of Woodway
www.FireDistrictl.org
LOCATION:
21016 80th Place
BUSINESS NAME:
Kleven Apts
MAILING
3300 234th St SW
ADDRESS:
Edmonds
BUSINESS OWNER:
Kleven, Roger
EMERGENCY-1:
Kleven, Roger/J.
KEY ACCESS-2:
I PERSON CONTACTED
NAME OF INSPECT R: I_f--
0
FIRE ,
SYSTEMS
M
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fay (425) 551-1272
PHONE: 4257741663
98026
HOME PHONE: 4257741663
HOMEPHONE: 4257741663
HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
IWIDIVIONDS
0 BRIER
0 WOODWAY
[I MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY STATION & SHIFT_"�
365 16 A
SCHEDULED
DATE DUE 11' 02/01/13
I U 2206
FIR � '422 ni
ACTIVE
CURRENT
CITY
YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
(2—
FE
A 14 N-U, �L_
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
2
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:
I
INSPECTOR:
IN PECTOR:
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
14
8
4
8
�DATE:
DISPOSITION:
7
LETTER NEEDED [] YES Nod
I LETTER NEEDED F] YES NO
8
FIRE DEPARTMENT COPY
FIRE PREVENTION
SNOHOMISH CO. Serving Brier, Edn7onds 12425 Meridian Ave S INSPECTION REPORT
0 EDMONDS
Mountlake Terraceand Everett, WA 98208 0 BRIER
TIRE the Town o Woodway Phone (425) 551-1200 OWOODWAY
DISfuM_ �f 0 MOUNTLAKE TERRACE
l - www.FireDistrictl.org Fax (425) 551-1272 0 UNINCORPORATED
0, r- FRE%IgNCY I STAJIgN &dHIFF`*'
LOCATION: 21016 80th Place W 3
BUSINESS NAME: Kleven Apts PHONE: 4257741663 SCHEDULED 0210-1/12
DATE DUE 1'
MAILING 8300 234th St SW UFIR 1, 422 2206
ADDRESS: Edmonds 98026
BUSINESS OWNER: Kleven, Roger HOME PHONE: 425-1741663 AC-nVE
EMERGENCY-1: Kleven, Roger/J. HOME PHONE: 4257741663 CURRENT
KEY ACCESS-2: HOME PHONE: CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR: C) ]A)
FIRE FE 11 f 1i
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
2 AJO \/I 0 I=A 0 A2�)
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 E DUE:
1 .
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
D E:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 15
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
1
4
8
DATE:
DISPOSITION:
I
7
LETTER NEEDED [] YES NO
1%
LETTER NEEDED E] YES El NO
1
I
8
FIRE DEPARTMENT COPY
1 1
CITY OF EDMONDS
121 5T" AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FIRE'DEPARTMENT
LOCATION: 21016 80th Place w
BUSINESS NAME: Kleven Apts
MAILING 8300 234th St SW
FIRE PREVENTION
SAFETY SURVEY
PHONE: 4257741663
ADDRESS: Edmonds 98026
HOMEPHONE: 4257741663
BUSINESS OWNER: Kleven, Roger
EMERGENCY-1: Kleven, Ro'ger/J. HOME PHONE: 4257741663
KEY ACCESS-2: HOME PHONE:
FREQUENCY STATION& SHIFT
365 16 C
SCHEDULED
DATE DUE 11� 02/0 ". /11
LIFIR o 422 2206
ACTIVE
e INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR: bm�zag�"A_)
FIRE FE/1 I /a
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS / commu TICJ
14v)vl QC-, liov- 0 0 rA NIS _t �e �o
) -.e
ENTER CODE ONLY ONCE 11�
VIOLATION CODE
L., CD
2
2
3
3
4
4
5
5
6
6
7
7
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
MOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
�ITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
7
4
18
4
8
DATE:
DISPOSITION:
8
1,, LETTER NEEDED E] YES E] N
[EiTMR NEEDED E, YES E] NO
FIRE DEPARTMENT COPY
CITY OF EDMONDS
121 5� AVENUE N. - EDMONDS, WASHINGTON 98020 (42�) 771-0215
FIRE DEPARTMENT
4�' t I
LOCATION: 21016 80ttv, Place w
BUSINESS NAME: Kleven Apts
MAILING" �1&2300 234th St SW
FIRE PREVENTION
'SAFETY SURVEY
PHONE: 4257741663
ADDRESS: . Edmonds 98026
BUSINESS OWNER: rKleven, Roger HOME PHONE: 4257741'663
EMERGENCY-1: Klevefij_ Roger/j. HOME PHONE: 4257741663
KEY ACCESS-2: HOME PHONE:
0- FREQUENCY STATION & SHIFT '
365 -16 B.
SCHEDULED
DATE DUE 01 02/01110
UFIR 1, 422 2206
ACTIVE
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE FE W_Cj!c�
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
3
4
5
ENTER CODE ONLY ONCE I�
VIOLATION CODE
2
4
5
6
6
7
8
8
1st RE -INSPECTION
DATE DUE:
PERSON
CONTACTED:
INSPECTOR:
DATE,
VIOLATIONS
1- 5
2 6
3 7
4 8
LETTER NEEDED C] YES N I
2nd RE -INSPECTION
DATE DUE:
PERSON
NTACTED:
INSPECTOR:
DATE,
VIOLiTIONS
1 5
2 6
13 7_
14- 8
P
LETTER NEEDED [I YES F] NO
EXTENSION
GRANTED TO.
PRE -CITATION
LETTER SENT
DATE:
RETURN RECEIPT
RECEIVED
FI-NAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:,
1
INSPECTOR:
2
DATE:
3
CRATION ISSUED
NUMBER:
4
CODE
SECTION:
5
6
8
FIRE DEPARTMENT COPY