21021 76TH AVE W (2)J,
7 ('�' *
FIRE PREVENTION
S."rvl rier. Edmonds, and 12425 Meridian Ave S
INSPECTION'REPORT
SI%IOHOI%IlSH Co
FIRE
Mountlake Terrace
Everett, WA 98208
DEDMONDS
0 BRIER
Phone (425) 551-1200
0 MOUNTLAKE TERRACE
DISTRT
[1 UNINCORPORATED
www.FireDistrict].org
Fax (425) 551-1272
e FREQUENCY STATION & SHIF
LOCATION: 21021 76 th
Avenue W 98026
Annual 16-A
The Woods
BUSINESS NAME:
(21623, 21025)
2064479234
PHONE:
SCHEDULED May 2017
MAILING
ADDRESS: 21021 76th Avenue W, Edmonds, WA 98026
427207.
LIFIR
__j
BUSINESS OWNER: HOME PHONE:
EMERGENCY-1: Samaras Assoc., Inc 4257715756
HOME PHONE: 16 CURRENT YES NO
KEY ACCESS-2: HOME PHONE: CITY
BUSINESS F
EMAIL: LICENSE
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE SYSTEMS: FE 1/14
.'Serving Brier, Edmonds, and
Mountlake Terrace
www.FireDistrictl.org
LOCATION:
FIRE PREVENTION
12425 Meridian Ave S
INSPECTION REPORT
Everett, WA 98208
DEDMONDS.
[1 BRIER
Phone (425) 551-1206,
[3 MOUNTLAKE TERRACE
Fax (425) 551-1272
-
[3 UNINCORPORATED
-- - ---------
21021 76 th Avenue W 98026
BUSINESS NAME: PHONE:
The Woods (21023, 21025)
MAILING
ADDRESS:
21021 76t� �v'enue W, Edmonds, WA 98026
BUSINESS OWNER: HOME PHONE:
2064479234
EMERGENCY-1: HOME PHONE: "'CURRENT
KEY ACCESS-2: Samaras Assoc.' Inc HOME PHONE:' 42�f�l 57'56 CITY YES NO
EMAIL: BUSINESS
LICENSE
PERSON CONTACTED: INITIAL RSPECTION DATE
NAME OF INSPECTOR:
FIRESYSTEMS: FE 1/14
Dw,p@I§f))%&#t"CATIQNS/ COMMUNICATIONS,
2
2
3
3
...........
4
4
5
5
6
6
7
7
I AGREE TO.cbRRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X::j:5:
1 st RE -INSPECTION
2nd RE -INSPECTION
FINAL REIINSPkTION
EXTENSION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTED TO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
.E�LAC�TED...
CONTACTED:
CONTACTED:
..... .........
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2
INSPECTOR:
INSPECTOR:
DATE:
DATE:
_jNSPECT0
DATE:
3
VIOLATIONS
VIOLATI6NSl�_,*"__,.
PRE -CITATION
CITATION ISSUED
15
1
LETTER SENT
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
RETURN RECEIPT
7
RECEIVED
DISP SI I N::
18
4
18
DATE:
7
QETTER NEEDED [] YES NO
LETTER NEEDED [] YES NO
FIRE PREVENTION
Serving Bi- I i . ei - Edmonds, and
1121425 Meridian Ave S
INSPECTION REPORT,
SNOHOMISH CO.
OEDMONDS
FIRE
Mountlake Terrace
Everett, WA 98208
0 BRIER
DISTR
T
Phone (425) 551-1200
0 MOUNTLAKE TERRACE
[1 UNINCORPORATED
www.FireDistrictl.org
Fax (425) 551-1272
FREQUENCY
STATION & SHIF'**'
LOCATION:
"1021 76 th Avenue W 98026
Annual
16-B
I
BUSINESS NAME..,
TheWoods (21023,21025)
PHONE: 20644792,A4
SCHEDULEDNJaV 2014
DATE DUE
MAILING
LIFIR 127207
ADDRESS:
21021 76thAvenue W, Edmonds, VVA 0802t3
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
SamarasA'ssoc., Inc
HOME PHONE: 4257715756
CU�RENT /-_E
KEY ACCESS-2:
HOME PHONE:
CIT y , S NO
BUSINES�
El
E�/'
EMAIL:
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION
NAME OF INSPECTOR:
YOAKVM q C�o :;7-
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
7t
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
I st 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
7
3
7
RETURN RECEIPT
RECEIVED
6
_3
4
18
4
18
DATE:
DISPOSITION:
7
%� LETTER NEEDED [] YES NO
LETTER NEEDED [-] YES El NO
1
8
FIRE DEPARTMENT COPY
FIRE PREVENTION
Serving Brier, EdM6*�ds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
Mountlake Terraceand
FIRE
Everett, WA 98208
OEDMONDS
0 BRIER
e Town of Woodway
DISTR IT tw`ww.FireDistrict1.org
Phone (4'25) 551-1200
E]WOODWAY
[I MOUNTLAKE TERRACE
Fax (425) 551-1272
0 UNINCORPORATED
LOCATION: 21021 76th Avenue W
FREQUENCY I STATION &4HIFF*'
365 16
13USINESS NAME: The Woods (21023, 21025)
PHONE: 2064479234
SCHEDULED 05/01/13
DATE DUE
MAILING 5017 196th St SW #103
LIFIR 1. 427 5207
ADDRESS: Lynnwood 98036
BUSINESS OWNER: Samaras Assoc., Inc
HOMEPHONE: 4257715756
ACTIVE
EMERGENCY11:
HOME PHONE:
CURRENT
KEY ACCESS22:
HOME PHONE:
CITY YES NO
BUSINESS 0
LICENSE
PERSON CONTACTED:
I,
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE
FE!2-p
SYSTEMS:
Af� Z_�_L
i f
A
H AZARDS 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:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINALRE-INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
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
7
RETURN RECEIPT
RECEIVED
6
4 18
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED YES No
LETTER NEEDED [] YES NO
8
FIRE DEPARTMENT COPY
SNOHOMISH CO. Serving Brier, Edmonds
Mountlake Terrace,and
IRE the Town of Woodway
I.DISTR - T www.FireDistrictl.org
LOCATION: 21021 76th Avenue
BUSINESS NAME: The Woods (21023, 21025)
MAILING 5017 196th St SW #103
ADDRESS: Lynnwood
BUSINESS OWNER: Samaras Assoc., Inc
EMERGENCY-1:
KEY ACCESS-2:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS:
W
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE: 2064479234
98036
HOME PHONE: 4257715756
HOME PHONE:
HOME PHONE:
AJO f� I J-,),
POF)IA,) 50
FIRE PREVENTION
INSPECTION REPORT
EIEDMONDS
El BRIER
0 WOODWAY
[I MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY I STATION & SHIFF***'
365 16 D
SCHEDULED
DATE DUE � 05/01/12
LIFIR � 427 5207
ACTIVE
CURRENT
CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
5— 7�d 1 _? -
FE _Zzjj _?_
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2 0
A)
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
lst RE -INSPECTION
DATE DUE.
2nd RE -INSPECTION
DATE DUE.
EXTENSION
GRANTEDTO*
FINAL RE -INSPECTION
DATE DUE:
VIOLATION'S
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
-INSPECTOR:--
INSPECTOR:
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
4
18
4
18
DATE:
DISPOSITION:
7
\1 LETTER NEEDED C] YES 0 NO
LETTER NEEDED [] YES NO
1
8
FIRE DEPARTMENT COPY
FIRE PREVENTION
ServiLig Brier, Edmonds
12425 Meridian Ave S
INSPECTION REPORT
'SNOHOMISH CO.
FIRE
Mouinitlake Terraceand
6, ere'tt,' WA 98208
OEDMONDS
0 BRIER
DISTR
the Town qj'Woodway
T
Phone (425) 551-1200
EIWOODWAY
[I MOUNTLAKE TERRACE
www.FireDistrictl.org
Fax (425) 551-J272
0 UNINCORPORATED .
FREQUENCY
STATION & SHIFT�
LOCATION:
21021 76th Avenue
W
365
16 C
BUSINESS NAME:
The Woods (21023, 21025)
PHONE: 2064479234
SCHEDULED
DATE DUE 05/01/11
MAILING
5017 196th St SW #103
FIR
427 5207
4'kDDRESS:
Lynnwood
98036
BUSINESS,OWNER:
SaMaras Assoc-, Inc
HOME PHONE: 4257715756
ACTIVE
EME141GENCY-1:
i
HOME PHONE:
CURRENT 7
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
LICENSE
NIT fACINSPECTION-DATE -
PERSON CONTACTED:
NAME OF INSPECTOR:
ly)
FIRE
FEZ
SYSTEMS:
ANNUAL
HAZARDS FOUND ANY LOCATIONS COMMUNIC TION
2
2
3
3
4
4
5
5
6
6
p
7
7
r
,I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
lst RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
D
_RATE DUE:
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
LETTER SENT
CITATION ISSUED
NUMBER:
4
0
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 F] YES El No
LETTER NEEDED YES NO
8
FIRE DEPARTMENT COPY
4
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FIRE DEPARTMENT
t . I , *
0,q
LOCATION: 21021 76th Avenue
BUSINESS NAME: Tlie Woods (21023, 21025)
MAILING 1930-Northgate Wy'
ADDRESS: Seattle
�v
BUSINESS OWNER: erm �p_o
EMERGENCY-1: Sumdahl, Mary 9
KEY ACCESS-2: 4
-5"/ 1 4,�S5 4 C. tA/C, -
W
98133
FIRE PREVENTION
SAFETY SURVEY
PHONE: _206*47S2,dl4
FREQUENCY
STATION& SHIFT
2
16 B
SCHEDULED
111-
-
DATE DUE
UFIR P� 427
5207
HOME PHONE. 2663ffjsm ACTIVE
HOME PHONE: -42&748;3989 4,c-f1-A44(4&,-'
HOME PHONE: 42624964H
A4,
A 0 1 -7 1 47
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
/-< /-- 7? " Aj __,5e"Aj e> '?,VA
FIP-7 FP 7 1 1
SYSTEMS: A NOU, �L'
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1
ENTER CODE ONLY ONCE ll�
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VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
7
8
8
lst RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
E DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTE
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
LATE.
DATE:
3
VIOLATIONS'
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
113
4
8
DATE:
DISPOSITION:
7
8
%,LETTER NEEDED [:] YES N.
IT'JTER NEEDED 0 YES NO
FIRE DEPARTMENT COPY