22600 96TH AVE WJill
00
FIRE PREVENTION
(S
7-
12425,.Mewidian Ave S
INSPECTION REPORT
SNOHOMISH CO. ..:11 . .1,11
Mountlake Terraceand
FIR
L: .
&erett, WA 98208
El EDMONDS_
0 BRIER
the Town of Woodway
DIST T'
Phone (425) 551-1200
0 WOODWAY
0 MOUNTLAKE TERRACE
www.FireDistrictl.org
Fax (425) 551 -1272
0 UNINCORPORATED
LOCATION: 2 2600 96th Avenue
W
FREQUENCY
365
TATION & SHIFF"'
2. D
BUSINESS NAME; Ldmond§- Presbyterian Church
PHONE: 4257764334
SCHEDULED
DATE DUE 1' 01/01/13
MAILING 2260b 96th Ave W
LIFIR � 131 1104
ADDRESS: Edrno nds
98026
11
BUSINESS OWNER: Delaney, Amy
HOME PHONE: 2063676804
ACTIVE 998
EMERGENCY-1: -Y=vtn-, ftetyl
HOME PHONE: *26W-44JS2 '
"CURRENT
YES NO
KEY ACCESS-2:
HOME PHONE:
CITY
BUSINES
Er El
LICENSES
PERSON CONTACTED: D /'a pl-r
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE Office HrsZ��. Mon - Thur
FE 00:j:'
SYSTEMS: 5- 1
ANNUAL
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
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 15
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
3
7
3
7
RETURN RECEIPT
RECEIVED
6
,4
8
4
8
DATE:
DISPOSITION:
LETTER NEEDED E] YES [I NO
LETTER NEEDED [] YES NO
8
FIRE DEPARTMENT COPY
APPLICATION FOR PERMIT
FOR MATERIALS OR PROCESSES
January 3, 2012
Please verify and correct the following information:
Name of Company (DBA):
Edmonds Presbyterian Church
Edmonds Location
22600 96th Avenue W
In conformity with the
terms of the Internationa I
Tl�ed6d_e, �p`plicifl6_n is,
hereby made to store, use
Places of Assembly - Occupant Load: 998
or maintain the following
activity, storage or pro-
cesses:
Mailing Address:
22600 96th Ave. W.
Edmonds, WA 98020
EFD UFIR #:
13199801C104
(for office use)
Your Signature
Your Name (print)
-Your-Title
-A-
Please make corrections, attach $40 payable to the City of Edmonds and mail to:
Fire Marshal
'7f. �—* r- , _# ) a\)- � � 16
Department of Fire Prevention
121-5 th Avenue North
Edmonds, WA 98020
FOR OFFICE USE ONLY
Rec'd
Check#
i.
APPLICATION FOR PERMIT
FOR MATERIALS OR PROCESSES MAR 1 7 pAja
Aia,
March 7, 2011 RECEIV EDMONDS FIRE'DEPT.
Please verify and correct the following information: 'E0,11IR 1 4 2011
Name of Company; DBA
Edmonds Presbyterian Church
Edmonds Location
22600 96th Avenue
In conformity with the terms of
Places of Assembly - Occupant Load: 998
the International Fire Code,
application is hereby made to
store, use or maintain the
following activity, storage or
processes:
Mailing Address:
22600 96th Ave. W.
Edmonds WA 98020
EFID UFIR #:
13199801C104
(for office use)
Your Signature
Your Name (print)
lva'P7 ev
Your Title
Please make corrections, attach $40 payable to the City of Edmonds, and mail to:
Fire Marshal
Department of Fire Prevention
121-5 th Avenue North PIAR 1 4' 2011
Edmonds, WA 98020
I . . t - C_K\ \1 1_3 4 G
i
CITY OF EDMONDS
DEPARTMENT OF FIRE PREVENTION
PERMIT
January 1, 2011 131-998-01 C-1 04 December 31, 2011
Date of Issue LIFIR Number Date of Expiration
I This PERMIT is issued to: I Edmonds Presbyterian Church
I located at: 122600 96th Avenue W I Edmonds, WA =
I To engage in the business, occupation or process of: I I
And shall constitute permission to maintain, store, use or handle materials or to conduct
process which produce conditions hazardous to life or property or to install equipment used in
connection with such activities as follows:
Places of Assembly - Occupant Load: 998
I Allowed Occupant Load: 1 99
Pursuant to the provisions of the International Fire Code, any violation of the Code may be
grounds for the revocation of this PERMIT.
This permit does not take the place of any
license required by law and is not
transferable. Any change in the use or
occupancy of premises shall require a new
permit.
rtment of Fire PreVention
This Permit Must Be Posted At All Times in The Premises Identified Above
City of Edmonds Community Development Code 19.25.020
J CITY -OF EDMONDS
121 5TH AVENUE N. . EDMONDS, WASHINGTON 98020 (425) 771-0215
FIRE DEPARTMENT
46' t
22600 96th Avenue w
LOCATION:
BUSINESS NAME: Edmonds Presbyterian Church
MAILING 22600 96th Ave W
FIRE PREVENTION
SAFETY; §Ui�iEY
PHONE: 4257764334-
ADDRESS: Edmonds 98026 906
�l �A2 - 1�1114 1� y
BUSINESS OWNER: wHeft-,Nvev4M HOME PHONE:
EMERGENCY-1: Yocom, Deryl HOME PHONE: 4257714752
KEY ACCESS-2: HOME PHONE:
FRE ENCY
ITA ON& SHIFT
T2"0
3 W5
13
SCHEDULED
01!01/11
DATE DUE 0'
LIFIR ll� 131
1 104
WA
ACTIVE 998
INITIAL INSPECTION DATE
PERSON CONTACTED: /-)Z- lee M e-
NAME OF INSPECTOR: 4,A- 3
FIRE Office Hrs 8,4?/ Mor) -,Thbr FE/� I..y
_ 40
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
LA 44
ENTER CODE ONLY ONCE 10
VIOLATION CODE
2
2
3
3
4
4
5
6
6
7
7
8
8
lst 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-CNATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
7
RETURN RECEIPT
RECEIVED
6
7
4
18
4
18
DATE:
DISPOSITION:
8
\1 LETTER NEEDED [] YES NO
LETTER NEEDED E] YES NO
FIRE DEPARTMENT COPY
OF EDMONDS
CITY
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FIRE DEPARTMENT
4j'
LOCATION: 22600 96th Avenue w
BUSINESS NAME: Edmonds Presbyterian Church
MAILING 22600 96th Ave W '
FIRE PREVENTION
SAFETY SURVEY
PHONE: 4257764334
ADDRESS: Edmonds 98026
BUSINESS OWNER: Nollette, Kevin HOMEPHONE: 4253085719
EMERGENCY-1: Yocom, Deryl HOME PHONE: 4257714752
KEY ACCESS-2: HOME PHONE:
4
FREQUENCY STATION& SHIFT
2 1 20 A
SCHEDULED
DATE DUE ll� 01/01/10
UFIR ll� 131 1104
AC_nVE 998
PERSON CONTACTED: p N-�j L_ '� ')I �_Ls INITIAL INSPECTION DATE
NAME OF INSPECTOR: V_J�-Ak_,\ Z-A k 0
FIRE Office Hrs 8- 12/ Mon - Thur FEd) 10�
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
wo P A? pf>
ENTER CODE ONLY ONCE 0
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
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
2ATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
18
14
8
IDATE:
DISPOSITION:
7
i 8
LETTER NEEDED 0 YES NT
I LETTER NEEDED E) YES C] NO
I
FIRE DEPARTMENT COPY