21028 80TH PL W; -'z FIRE PREVENTION
vo 8 go4l, p c Li
INSPECTION REPORT
-idian Ave S
SNOHOMISH CO. Serving B.' __...10 ds' and 12425 Met 0 EDMONDS
Mountlake Terrace Everett, WA 98208 El BRIER
4,0/
FIRE El MOUNTLAKE TERRACE
DISTRO:ffr., Phone (425) 551-1200 [1 UNINCORPORATED
T wwwFireDistrictl. org Fax (425) 551-1272
FREQUENCY I STATION& SHIF'**'
LOCATION: 21028 80 th Place W 98026 Annual 16-B
BUSINESS NAME: CarusoApts PHONE: 4257767099 SCHEDULED Feb 2014
DATE DUE
MAILING UFIR�V2206
ADDRESS: 21028 80th Place W, Edmonds, WA 98026
BUSINESS OWNER: RPA Realty Nan HOME PHONE: F',
EMERGENCY-1: Caruso, Steven G HOME PHONE: 2063621102 �__CURRENT
KEY ACCESS-2: HOME PHONE: CITY NO %
BUSINESS
EMAIL: LICENSE
INITIAL INSPECT
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE SYSTEMS: IzE
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
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2
2
3
4Z
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 I
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:
DATE:
DATE:
3
VIOLATIONS
1 15
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
18
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED F] YES El NO
LETTER NEEDED F] YES NO
8
FIRE DEPARTMENT COPY
t
FIRE PREVENTION
MAO
Serving Briet: Edmonds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
FIRE
Mozintlak� Terrace, and
Everett, WA 98208
*DMONDS
El BRIER
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1(*4*44WWe)F
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I the Town of Woodway
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Phone (425) 551-1200
0 WOODWAY
0 MOUNTLAKE TERRACE
www-.FireDistrictl.org
Fax (425) 551-1272
0 UNINCORPORATED
I
" FREQUENCY STATION & SHIFT
LOCATION:
21028 80th Place
W
365 16 A
I
BUSINESS NAME:
Caruso Apts
PHONE: 4257767099
SCHEDULED
DATE DUE 0 02/01/13
MAILING
22937 Highway 99
LIFIR � 422 2206
ADDRESS:
Edmonds
98026
BUSINESS OWNER:
"Caruso, Steven G"
HOMEPHONE: 2063621102
ACTIVE
EMERGENCY-1:
RPA Realty.- Nancy Land
42577670
HOME PHONE:
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
El 0
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
31f2- I :�'
FIRE
FE --I
SYSTEMS:
A14_NU�_L
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
ZV1
1
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:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DAfE:
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
18
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED [-] YES El NO
LETTER NEEDED [] YES NO
1
8
FIRE DEPARTMENT COPY
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Serv,ing Brier, kdmonds
SNO
FIREHOMISH CO. t Mountlake Terrace, and
the Town of Woodway
DIST11- T www.FireDistrictl.org
LOCATION: 21028 80th Place
BUSINESS NAME: Caruso Apts
MAILING 22937 Highway 99
ADDRESS: Edmonds
BUSINESS OWNER: uCaruso, Steven G"
EMERGENCY-11 : RPA Really: Nancy Land
KEY ACCESS-2:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS:
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12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE: 4257767099
98026
HOME PHONE: 2063621102
HOME PHONE: 4257767099
HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
E]WOODWAY
MOUNTLAKE TERRACE
UNINCORPORATED
FREQUENCY STATION & SHI FT_*1
365 16 D
SCHEDULED
DATE DUE � 112/01/12
LIFIR � 422 2206
ACT1VE
CURRENT
CITY YES NO
BUSINESS
LICENSE 1:1 El
INITIAL INSPECTION DATE
17 _j
FE11111 -
ANNUAL
ARDS 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-
FINAL RE -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
3
7
RETURN RECEIPT
RECEIVED
6
,4
8
4
8
DISPOSITION:
7
LETTERNEEDED F] YES No
fLE;7EI NEEDED [I YES NO
IDATE:______
8
FIRE DEPARTMENT COPY
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FIRE DEPARTMENT
"!� '. '.� 1. %
A
LOCATION:
21028 811th Place VV
BUSINESS NAME:
Caruso Apts
MAILING
22937 Highway 99
FIRE PREVENTION
SAFETY SURVEY
PHONE: 4257767099
ADDRESS: Edmonds 98026
BUSINESS OWNER: uCaruso, Steven Gn HOMEPHONE: 2063621102
EMERGENCY-1: RPA ReaftV: Nancy Land HOME PHONE: 4257767099
KEY ACCESS-2: HOME PHONE:
FREQUENCY
STATION& SHIFT
365
16 C
SCHEDULED
DATE DUE 11'
LIFIR � 422
2206
ACTIVE
e INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR: �J49y1zjF_V__1 17/U
FIRE FE —/—
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE 0
VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
7
8
8
Ast 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
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
1 RECEIVED
6
4'
.8
4
8
1 DATE:
DISPOSITION:
7
8
\,UETTER NEEDED D YES 0 No
LETTER NEEDED E] YES P NO
1
FIRE DEPARTMENT COPY
FIRE PREVENTION
CITY OF EDMONDS SAFETY SURVEY
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
t
21028 80th Place
LOCATION:
BUSINESS NAME:
Caruso Apts
MAILING"
22937 Highway 99
ADDRESS:
Edmonds
BUSINESS OWNER:
"Caruso,'Steven G"
EMERGENCY-1:
RPA Realty. Nancy Land
KEY ACCESS-2:
M
- PHONE: 4257767099
98026
HOMEPHONE: 2063621102
HOMEPHONE: 4257767099
HOME PHONE:
FREQUENCY
STATION 8 SHIFT
365
16 B
I
SCHEDULED
02/01/10
DATE DUE 11'
UFIR 1, 422
2206
ACTIVE
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR: 6 Fr-i- E D,414 PTA-6, .As 1F .2,6.
FIRE FE/// S�.
SYSTEMS: ANNLJAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
-7 :r
ENTER CODE ONLY ONCE I�
VIOLATION CODE
2
2
3
3
.4
4
5.1
5
6
6
7
7
8
8
1st RE -INSPECTION
DATE DUE*
1
1
2nd RE -INSPECTION
DATE DUE-
1
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE,
VIOLATIONS
CITED:
PERSON
CONIACTED�.�"
PERSON
CONTACTED:
PERSON
CONTACTED:
I
...............
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
tv-
DATE- �' 10
DATE,
DATE,
3
VIO�ATIONS
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
7
4
18
4
8
DISPOSITION:
8
\1 LETTER NEEDED [] YES C] NO
1 LETTER NEEDED [] YES E] NO
FIRE DEPARTMENT COPY