23615 79TH AVE Wti �23(otS7
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FIRE PREVENTION
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9
12425 Meridian Ave S
INSPECTION REPO`hT
SNOHOMISH CO.
Mountlake Terrace
Everett, WA 98208
P EDMONDS
BRIER
DISTRI T
Phone (425) 551-1200
[1 MOUNTLAKE TERRACE
[I UNINCORPORATED
www.F"ireDistrictl.org
Fax (425) 551-1272
FREQUENCY
STATION & SHIF-**)
LOCATION: 2361579th AvemleW 08026
Amival
20-C
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BUSINESS NAME: VlilbAbrack, I-aur Apl!s
PHONE: 2M)782-110E�
SCHEDULED 0,_L 2014
DATE DUE
MAILING
UFIR I, 422b _Sb
ADDRESS: 23FAS 7!)Lh Awriuc \jV, 1,-dmandti, WA 0802E
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1: Jacubticn, Edvmrd J.
HOME PHONE: 2N7821190
'CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
EMAIL:
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR: �j (? SJ
I-IM- SYS ILMS: FE 8113
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HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
I st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION",
D E DUE,
EXTENSION
GRANTEDTO:
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DATE DUE:
VIOLATIONS
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VIOLATIONS
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PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:_______
5
3
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RETURN RECEIPT
RECEIVED
6
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18
4
DATE:
DISPOSITION:
LETTER NEEDED [-] YES NO
LETTER NEEDED YES NO
8
FIRE DEPARTMENT COPY
FIREPREVENTION
Sei-ving Bilet: Edmonds, and
124-15 Meildian.41,e S
INSPECTION REPORT
SNOHOMISH CO.
OEDMONDS
Mountlake,'Yet-t-ace
FIRR,
Everett, WA 98208
El BRIER
DIST T
Phone (425) 551-1200
[2MOUNTLAKE TERRACE
UNINCORPORATED
wwwFireDistrictl.org
Fax (42-5) 551-1272
FREQUENGY
STATION & SHIFT-')
LOCATION: 23615 79th Avenue W 98026
Annual
20-8
BUSINESS NAME:- WIlowbrook Four Apts
PHONE: 2067821'p'g
SCHEDULED
DATE DUE I` Oct 2013
MAILING
LIFIR � 422
ADDRESS: 23615 79th Avenue W, Edmonds, WA 98026
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BUSINESS OWNER: Schneider J
HOME PHONE:
EMERGENCY-1: Jacobsen, Edward J.
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CURRENT
HOME PHONE: 26(_�J7_821199
KEY ACCESS-2:
HOME PHONE:
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PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR: �Ald
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FIRE SYSTEMS: FE JJ3
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
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4
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
lst RE -INSPECTION
2nd RE -INSPECTION
FINAL RE
EXTENSION
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VIOLATIONS
DATE DUE,
DATE DUE-
GRANTEDTO:
DATE DUE:
CITED -
PERSON
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VIOLATIONS
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PRE -CITATION
CITATION ISSUED
1 5
1 15
LETTER SENT
NUMBER:
4
CODE
2
6
2
6
DATE:
SECTION:
RETURN RECEIPT
3
7
3
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RECEIVED
6
DISPOSITION:
7
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8
4
8
DATE:
LETTER NEEDED (] YES NO
LETTER NEEDED F] YES I—] NO
8
FIRE DEPARTMENT COPY
FIRE PREVENTION
SNOHOMISH CO. Serving Brier, Edmonds 12425 Meridian Ave S INSPECTION REPORT
Mountlake Terraceand Everett, WA 98208 El EDMONDS
0 BRIER
th Town of Woodway Phone (425) 551-1200 E]WOODWAY
0 MOUNTLAKE TERRACE
www.FireDistrictl.org Fax (425) 551-1272 0 UNINCORPORATED
FREQUENCY TION & SHIFT""
LOCATION: 23615 79th Avenue W 365 20 D
SCHEDULED
BUSINESS NAME: Willowbrook Four Apts PHONE: 2067821199 DATE DUE 0 10/01/11
MAILING 3617 NW 61st S5,41 LIFIR 0 422 1(006
ADDRESS: Seattle 98107
BUSINESS OWNER: uJacobsen, Edward J.' HOME PHONE: 2067821199 ACTIVE
EMERGENCY-1: Schneider J HOME PHONE: 4256723376
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KEY ACCESS-2: HOME PHONE: CITY YES NO
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XTE VIOLATIONS
-DATE DUE: DATE DUE: GRANTED TO: DATE DUE: CITED:
PERSON PERSON PERSON
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INSPECTOR: INSPECTOR: INSPECTOR: 2
DATE: DATE: DATE: 3
VIOLATIONS VIOLATIONS PRE -CITATION CITATIONISSUED
LETTER SENT NUMBER: 4
CODE
6 6 DATE: SECTION:
RETURN RECEIPT
3 RECEIVED 6
DISPOSITION:
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4 .8 :4 8 DATE:
LETTERNEEDED [I YES NO LETTER NEEDED E] YES El NO 8
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FIRE DEPARTMENT COPY
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CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FIRE DEPARTMENT
23615 79th Avenue W
LOCATION:
BUSINESS NAME: Willowbrook Four Apts
MAILING 3617 NW 61st St
FIRE PREVEN-nok
SAFETY SURVEY
PHONE: 2067821199
ADDRESS: Seaftle
98107
BUSINESS OWNER: uJacobsen, Edward J." 2067821199
HOME PHONE
EMERGENCY-1: Schneider J HOME PHONE: 4256723376
KEY ACCESS-2: HOME PHONE: —
FRMgNCY7j STATM & tHIFT
SCHEDULED
DATE DUE 0
UFIR 0 422 111306
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PERSON CONTACTED: 11 INITIAL INSPECTION DATE
NAME OF INSPECTOR: < 'I_)IO fl(,
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SYSTEMS: ANNUAL
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CITATION ISSUED
NUMBER:
4
2 16
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1 DATE:
CODE
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RETURN RECEIPT
6
17
�3 17
RECEIVED
7
14
DATE:
LETTER NEEDED YES NO
LETTER NEEDED YES NO
8
FIRE DEPARTMENT COPY