21025 80TH AVE W_1;.2 Z.
FIRE PREVENTION
Serving Brier, Edmonds, and 124�5 Meridian Ave S INSPECTION REPORT
0 EDMONDS
Mountlake Terrace Everett, WA 98208 [3 BRIER
Phone (425) 551-1200 0 MOUNTLAKE TERRA ' CE
[3 UNINCORPORATED
www.FireDist'rictl.org Fax (425) 551-1272,
I' FREOUENCY
STATION& SHIFT
LOCATION:
21025 80 th Avenue W 98026
Annual
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BUSINESS NAME:
Wispy Willow Condos 21035,21101,03 PHONE:
4257714682
SCHEDULED
DATE DUE o Mar 2016
MAILING
LIFIR 425 206
ADDRESS:
21025 80th Avenue W, Suite C, Edmonds, WA 98026
BUSINESS OWNER:
Clisby, Elaine HOME PHONE:
EMERGENCY-1:
Vasconcellos, Sallie HOME PHONE:
42577146.82 CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY
YES NO
EMAIL:
BUSINESS
LICENSE
PERSON CONTACTED: A,114-
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
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I AGREE TO CORRECT THE�ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1 st RE -INSPECTION
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE:
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GRANTEDTO:
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Serving Brier, Edmonds, and
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www.FireDistrictl.orz
LOCATION: 2 1025) SO th ANettue ljV Q3W6
BUSINESS NAME: WitinvWillawCandm- 21L-1:35,21101,03
MAILING
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE: 4
FIRE PREVENTION
INSPECTION REPORT
0 EDM&NDS
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11 MOUNT LAKETERRACE
[I UNINCORPORATED
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SCHEDULED Mar 2014
DATE DUE
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ADDRESS: 2102f; 80111 Avcnuc *VV, Suitc C, EcIrmiruki, VVA 08026
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EMERGENCY-1: %Ar4cariccilos, sallic HOME PHONE: 42677114E82 "CURRENT
KEY ACCESS-2: HOME PHONE: CITY YES NO
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DATE DUE.
DATE DUE.
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DATE:
CODE
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DATE:
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8
FIRE DEPARTMENT COPY
SNOHOMISH CC
'['DIST
Serving Briei: Edmonds
Mountlake Terraceand
the Town of Woodway
www.FireDistrictl.org
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
LOCATION: 21025 80th Avenue W
BUSINESS NAME: �flspy Willow Condos 21035,21101,03 PHONE: 4257714682
MAILING 2-1035 8OTh Av W #C
ADDRESS:
I Edmonds 98026
BUSINESS OWNER- HOME PHONE: 4257714682
Vasconcellos, Sallie Trsr/21 035 #
EMERGENCY'-1: nClisby, Elaine Presp HOME PHONE:
KEY ACCESS-2: HOME PHONE:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS:
FIRE PREVENTION
INSPECTION REPORT
OEDMONDS
El BRIER
El WOODWAY
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SCHEDULED
DATE DUE 1'
03/01/12
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INITIAL INSPECTION DATE
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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:
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DATE DUE:
VIOLATIONS
CITED:
PERSON
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PERSON
CONTACTED:
PERSON
CONTACTED:
JNSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
D E:
PRE -CITATION
LETTER SENT
DATE:
CITATION ISSUED
NUMBER:
3
. 4
VIOLATIONS
1 5
VIOLATIONS
1 5
2
6
2
3
6
7
DATE:
CODE
SECTION:
5
3
7
RETURN RECEIPT
RECEIVED
6
4
8
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED [] YES NO
LETTER NEEDED C] YES El NO
8
FIRE DEPARTMENT COPY
FIRE PREVENTION
SAFETY SURVEY
CITY OF EDMONDS
121 5� AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
t Is
LOCATION: 21025 80th Avenue W
BUSINESS NAME: Wispy Willow Condos 21035,21101,03 PHONE: 4257714682
MAILING 21035 8OTh Av W #C
ADDRESS: Ed onds 98026
FREQUENCY
STATION & SHIFT
366
16 A
SCHEDULED
DATE DUE I�
03101/1-1
UFIR P- 425
3206
BUSINESS OWNER: "Vasconcellos, Sallie Trsr/21035 HOMEPHONE: 4257714682 ACTIVE
EMERGENCY-1: "Clisby, Elaine Presu HOME PHONE:
KEY ACCESS-2: HOME PHONE:
PERSON CONTACTED: INITIAL INSPECTION D TE
3/;� a //
NAME OF INSPECTOR: �z 7/
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SYSTEMS ANNUAL
HAZARDS FOUNDAND LOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE 0
VIOLATION CODE
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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:
"PERSON
CONTACTED:
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1
INSPECTOR:
INSPECTOR:
INSPECTOR:
—2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 6
VIOLATIONS
1 5
F4E-CITATION
LETTER SENT
CITATION 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:
%, LETTER NEEDED E] YES NO
LETTER NEEDED 0 YES NO
FIRE DEPARTMENT COPY
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
4's t 1
LOCATION: 21025 80th Avenue
BUSINESS NAME: Wispy Willow Condos 21035,21101,03
MAILING 21035 80Th Av W #C
ADDRESS: Edmonds
BUSINESS OWNER: "Vasconcellos, Sallie Trsr/21035 #
EMERGENCY-1: uClisby, Elaine Pres"
KEY ACCESS-2:
&TA
FIRE PREVENTION
SAFETY SURVEY
PHONE: 4257714682
98026
HOMEPHONE: 4257714682
HOME PHONE:
HOME PHONE:
FREQUENCY � STATION 11 SHIFT-"'
366 16 D
SCHEDULED
'DATE DUE 10 03/0 .1 / 10
UFIR 1, 425 3206
AC-"nVE
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PERSON CONTACTED:
NAME OF INSPECTOR: 9e CA
FIRE FE
SYSTEMS: -ANNUAL
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ENTER CODE ONLY ONCE I�
VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
7
8
8
'Ist 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
VIOLATIONS
i 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
8
4
DATE*
DISPOSITION:'
7
8
LETTER NEEDED YES NO
LETTER NEEDED 13 YES NO
I - P. t '�
FIRE DEPARTMENT COPY
Sq.