21212 SUMMIT LN (2)',FIRE,PREVENTION
Serving Brier, P-dmonds, and 12425 Meridian Ave S 'INSPECTION REPORT
OEDMONDS
Mountlake Terrace Everett, WA 98208 OBRIER '
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
UNINCORPORATED
www.FireDistrictl.org Fax (425) 551-1272
r- FREQUENCY
STATION 1, SHIFT
LOCATION: 21212 Summit Lane 98020
Annual
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Summit Lane Apts + 21106
4257767193
SCHEDULED Jun.2017
BUSINESSNAME:
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DATE DUE �
422
MAILING
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ADDRESS: 21106 Summit Lane, Edmonds, WA 98026
Burke, Marylyn
BUSINESS OWNER:
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4257717193 "'CURRENT
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161 -�2-4
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FIRE PREVENTION
CO.
Serving Brier, Edmonds, and
12425 Meridian Ave S
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FIRESNOHOMISH
Mountlake Terrace
Everett, WA 98208
-4EDMONDS
[3 BRIER
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0 MOUNTLAKE TERRACE
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21106 Summit Lane, Edmo'n ds, WA' 98026
BUSINESS OWNER:
,
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Burke, Marylyn
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"CURRENT'
KEY ACCESS-2:
Burke, Budd/Erick
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CITY YES NO
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INITIAL INSPECTION DATE
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I AGREE TO CO RREC-fTHE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1 st RE -INSPECTION
2nd RE -INSPECTION
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EXTENSION
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VIOLATIONS
DATE DUE:
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Serving Briei; Edmonds, and
Mountlake Terrace
Twww.FireDistrictl.org
21212 SumryiiLatie 23020
Surnmii. Lanr. ApIs + 21105
FIRE PREVENTION
12425 Meridian Ave S. INSPECTION REPORT
0 EDMONDS
Everett, WA 98208 OBRIER
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
0 UNINCORPORATED
Fax (425) 551-1272
FREQUENCY STATION & SHIFT
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SCHEDULED
PHONE: 426770133 DATE DUE Jurk 21314
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211DE Sumrr�l. Lanc, Edryminds, NJVA 0302E
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2
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3
4
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5
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6
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1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE"NEXT 30 DAYS X
lst RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
1
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3
VIOLATIONS
1 5
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LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
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5
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7
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RETURN RECEIPT
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6
4
8
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED E] YES El NO
LETTER NEEDED [:] YES NO
8
FIRE DEPARTMENT COPY
-ale,
FIRE PREVENTION
Serving Brier, Edmonds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
FIR 14
4 Mountlake Terraceand
1
Everett, WA 98208
0 EDMONDS
0 BRIER
_S T Rtfr
"'e Town of Woodway
Phone (425)"�51-1200
DWOODWAY
0 MOUNTLAKE TERRACE
www.FireDistrict.l.org
Fax (425) 551-1272
0 UNINCORPORATED
FREQUENCY
STATION 1, SHIFF",
LOCATION:
21212 Summit Lane
365
16 B
I
BUSINESS NAME:
Summit Lane Apts & 21106
PHONE: 4257767193
SCHEDULED
DATE DUEYII' 06f01/13
MAILING
21106 Summit Ln
UFIRO �22 6155
ADDRESS:
Edmonds
98026
BUSINESS OWNER:
Burke, Marylyn
HOME PHONE: 4257767193
ACTIVEI/ r-Z
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Burke, Buft(Erick
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DATE:
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DATE:
VIOLATIONS
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PRE -CITATION
CITATION ISSUED
1 5
1 5
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NUMBER:
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CODE
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2
6-
DATE:
SECTION:
RETURN RECEIPT
3
7
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DISPOSITION:
4
18
4
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DATE:
7
LETTERNEEDED F] YES NO
LETTERNEEDED [] YES El NO
8
FIRE DEPARTMENT COPY
FIRE PREVENTION
Serving Brier, Edmonds
12425 Meridian Ave S
INSPECTION REPORT
SNOROMISH CO.
Mountlake Terraceand
FIRE
Everett, WA 98208
'W:EDMONDS
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[1 MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY STATION & SHI
LOCATION: 212'12 Summit Lane
365 16 A
BUSINESS NAME: Summit Lane Apts & 21106
PHONE: 4257767193
SCHEDULED
DATE DUE 06/01112
MAILING 21106 Summit Ln
UFIR 1, 422 6155
ADDRESS: EAjagnds
98026
BUSINESS OWNER:
Burke, Marylyn '.
HOMEPHONE: 4257767193
ACTIVE
EMERGENCY-1: Burke, Budd/Erick
HOMEPHONE: 4257717193
'CURRENT
KEY ACCESS-2:-
HOME PHONE:
YES NO
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INITIAL INS CTION DATE
N�ME OF INSPECTOR: C�V,-::
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS
1st RE -INSPECTION
DATE DUE
2nd RE -INSPECTION
DATE DU E.
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
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VIOLATIONS
1 5
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—LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
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RETURN RECEIPT
RECEIVED
6
4
8
4
8
DATE:
DISPOSITION:
7
IN LETTER NEEDED I—] YES
rLETTER NEEDED E] YES [3 NO
8
FIRE DEPARTMENT COPY
FIRE PREVENTIW,'
Serving Brier, Edmonds
'(�Q
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
Mountlake Terraceand
TIRE
Everett, WA 98208
0 EDMONDS
0 BRIER
the Town of Woodway
'DISTRPIT
Phone (425) 551-1200
0 WOODWAY
0 MOUNTLAKE TERRACE
www.FireDistrictl.org
Fax (425) 551-1272
0 UNINCORPORATED
FREQUENCY
STATION & SHIFT_�
LOCATION: 21212 Summit Lane
365
16 D
BUSINESS NAME: Summit Lane Apts & 21106
PHONE: 4257767193
SCHEDULED
DATE DUE 0' 06,1010111
MAILING 21106 Summit Ln
LIFIR � 422 6155
ADDRESS: Edmonds
98026
BUSINESS OWNER: Burke, Marytyn
HOMEPHONE: 4257767193
AC71VE
j EMERGENCY-1: Burke, Budd/Erick
HOMEPHONE: 4257717193
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS Ej Ej
LICENSE
PERSON CONTACTED:.
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
/ / (
FIRE
FE Ij 0
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
2
2
VU
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3
3
4
4
5
5
6
6
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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
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
14
4
18
DATE:
DISPOSITION:
7
_18
LETTER NEEDED [-] YES NO
LETTER NEEDED E] YES [I NO
8
FIRE DEPARTMENT COPY
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
t . I S '�z
LOCATION: 21212 Summd Lane
BUSINESS NAME: Summil: Lane Apts & 21106
MAILING 21106 Summil: Ln
ADDRESS: Edmonds
BUSINESS OWNER: Burke, Marylyn
EMERGENCY-1: Burke, Budd/Erick
KEY ACCESS-2:
FIRE PREVENTION
SAFETY SURVEY
PHONE: 4257767193
98026
HOMEPHONE: 4257767193
HOMEPHONE: 4257717193
HOME PHONE:
FREQUENCY
STATION& SHIFT
365
16 C
SCHEDULED
DATE DUE 11�
06/01/10
LIFIR 1' 422
6155
ACTIVE
01 INITIAL INSPECTION DAT
PERSON CONTACTED:
NAME OF INSPECTOR:
ip�//j , '0'
FIRE
SYSTEMS:
FE
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS EN, R CODE ONLY ONCE I�
A
VIOLATION CODE
2
3
2
3
4
4
5
5
6
6
7
7
8
8
In our continuing effort to promote fire safety and prevention within the community, your fire department conducts
regularly scheduled "Fire Safety Survey Inspections" of all businesses and multi -family occupancies in the City of
Edmonds.
You are to be congratulated on the relative good condition of your occupancy in regards to fire safety. Above you
will find the item(s) that were noted during our inspection which require attention to bring them into compliance
with the minimum standards adopted by the City of Edmonds.
Please call (425) 775-7720 within 30 days to schedule a reinspection.
Any overlooked hazards or violations of the fire regulations does not imply approval of such condition or violation.
If you require additional information or assistance, please contact this office by calling (425) 775-7720 between
the hours of 8 a.m. and 5 p.m., Monday through Friday.
BUSINESS COPY
FIRE PREVENTION
C1W OF EDMONDS SAFETY SURVEY
121 5� AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FIRE DEPARTMENT
t FREQUENCY STATION & SHIFT""
LOCATION: 21212 Summit Lane 365 16 c
BUSINESS NAME: Summit Lane Apts & 21106 PHONE: 4257767193 SCHEDULED
DATE DUE 01 0,6101/10
MAILING 21106 Summit Ln LIFIR 0 422 6155
ADDRESS: Edmonds 98026
BUSINESS OWNEk Burke, Marylyn HOME PHONE: 4257767193 AC_nVE
N� 7193
EMERGENCY-1: Burke, Budd/Erick HOME PHb E:
KEY ACCESS-2: HOME PHONE:
INITIAL INSPECTION DATE�
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
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SYSTEMS:
ANNUAL
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HAZARDS FOUND AND LOCATIONS COMMUNIC'NTIO�s
ENTER CPDE ONLY ONCE
VIOLATION CODE
2
2
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3
4
4
5
5
6
6
7
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8
8
1st RE -INSPECTION
2nd RE -INSPECTION EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE:
DATE DUE: I GRANTED TO:
PERSON
DATE DUE:
PERSON
CITED:
PERSON
CONTACTED:
CONTACTED:
INSPECTOR:
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INSPECTOR:
2
.. .. ... .. . . .
INSPECTOR:
3
DATE:
DATE:
DATE:
4
1 aeOLATIONS
5
VIOLATIONS PRE -CITATION
1- 5 LETTER SENT
CITATION ISSUED
NUMBER:
CODE
5
2
6
2 6 DATE:
RETURN RECEIPT
SECTION:
6-
3
7
3 7 RECEIVED
'47
DISPOSITION:
4
_J
8
L4 RA
T�TEWN:EE ED E] YES NO
8
k. LETTER NEEDED E] YES NO
FIRE DEPARTMENT COPY