23616 EDMONDS WAY0236/& r=ADoloAjDf t,,-)AV
el-ving Briei: Ei,... and .42425 Meridiaii Ave S
SNOHOMISH CO.
Mountlake �errace i _gverett, WA 98208
FIRE pi. . * ." A . -1200
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DISTR 11 F' istrict]. 0�9
.f ww. ireD Fax (425) 551-1272
FREQUENCY I STATION& SHIFT_'�
LOCATION: 2,3616 Edrn�atj'ds %jv�, QLK2fj Antlual 20-A
BUSINESS NAME PHONE: SCHEDULED
NaNarrmApI8 DATE DUE Nov 2014
MAILING UFIRr_i.'4
ADDRESS:
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FIRE PREVENTION
INSPECTION REPORT I
,-�EDMONDS
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0 MOUNTLAKE TERRACE
0 UNINCORPORATED
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KEY ACCESS-2: HOME PHONE: CITY
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EMAIL: LICEN,$E'
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR:
I P. E SYS I �- MS: PE 41111
4-/k4
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
2
2
3
3
4
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5
5
6
6
7
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
lst RE -INSPECTION
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIO�TT�ION
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VIOLATIONS
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NUMBER:
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2
6
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DISPOSITION:
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\1 LETTER NEEDED C] YES NO
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FIRE DEPARTMENT COPY
FIRE, PREVENTION
Serving Brier, Edmonds,
and t, 11425 Meridian AveS
INSPECTION REPORT
SNOHOMISH CO.
FIRE
Mountlake Terrace
�k4ett, WA 98208
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r FREQUENCY STATION & SHIFT--*'
LOCATION:
23616 EdnmtWs Way Suite E 08020
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BUSINESS NAME:
Na Nam ApLb
PHONE:
SCHEDULED Nav2013
DATE DUE
MAILING
UFIR 423
ADDRESS:
2351E Edrrmrm:L- Way, Suilc B, Edr7mri&i.
08b20
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
Mr. IlLter
HOME PHONE:
_[2SI
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6
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
lst RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
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INSPECTOR:
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DATE:
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3
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
18
4
18
DATE:
DISPOSITION:
7
"I LETTER NEEDED E] YES El NO
I LETTER NEEDED E3 YES [I NO I
FIRE DEPARTMENT COPY
Serving Brier, Edmonds
SNOHOMISH CO. I ..-. -
in lake T�rraceand
TIRE ItAW*' t ' `0'1� *"
IMP I the Town of Woodway
&cp a R Twww.FireDistrictl.or-a
LOCATION: 23616 Edmonds Way
BUSINESS NAME: No Name Apts
MAILING 23616 Edmonds Wy #6
ADDRESS: Edmonds
BUSINESS OWNER: Mr. Butter
EMERGENCY-1:
KEY ACCESS-2:
I PERSON CONTACTED: A --/-
I NAME OF INSPECTOR: C-6 "/ 5
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FIRE
SYSTEMS:
014E'PREVENTION
12425 Meridian Ave S
INSPECTION REPORT,
Everett, WA 98208
0 EDMONDS
0 BRIER
Phone (425) 551-1200
El WOODWAY
0 MOUNTLAKE TERRACE
Fax (425) 551-1272
0 UNINCORPORATED
PHONE:
98026
HOME PHONE:
HOME PHONE:
HOME PHONE:
FREQUENCY
STATION 1, SHIFT')
365
20 6
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SCHEDULED
DATE DUE 11/01/11
UFIR 1, 423 1'005
ACTIVE
CURRENT
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INITIAL INSPECTION DATE
FE
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ANNUAL
HAZARDS FOUND AND LOCATIONS COMYIUNICATIONS
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
lst RE -INSPECTION
2nd RE -INSPECTION
FINAL RE -INSPECTION
EXTENSION
VIOLATIONS
DATE DUE:
D E DUE:
GRANTED TO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
1 5
1 5
LETTER SENT
NUMBER:
4
CODE
5
2
6
2
6
DATE:
-SECTION:
RETURN RECEIPT
3
7
3
7
RECEIVED
6
DISPOSITION:
4
18
4
8
DATE:
LETTER NEEDED E] YES El N�
LETTER NEEDED F] YES NO
8
I
1
FIRE DEPARTMENT COPY
FIRE PREVENTION
CITY OF EDMONDS SAFETY SURVEY
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
LOCATION: 23616 Edmonds Way i
BUSINESS NAME: No Name Apts PHONE:
MAILING 23616 Edmonds. Wy #6
ADDRESS: Edmonds 98026
FREQUENCY
STATION 1, SHIFT
365
20 A
SCHEDULED
DATE DUE 01
11/01/10
LIFIR V423
11005
A.
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BUSINESS OWNER: Mr. Butler HOME PHONE: AC
EMERGENCY-1: HO ME PHONE:
KEY ACCESS-2: HOME PHONE:
lo INITIAL INSPECTION DATE
PERS I ON CONTACTED: W001-k IF— I �1/7'7 /10
NAME OF INSPECTOR: Vu (w '�'_rtQlE_4_n T
FIRF i FEC173
SYSTEMS:
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ENTER CODE ONLY ONCE ll�
VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
7
8
8
lst RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
2ATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
---
PERSON
CONTACTED:
INSPECTOR:
PERSON
CONTACTED:
INSPECTOR:
1
2
INSPECTOR:
DATE:
DATE:
PRE-C[TATION
LETTER SENT
DATE:
CITATION ISSUED
NUMBER:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
4
5
2
6
2
6
DATE:
CODE
SECTION:
3
7
3
7
.�RETURN RECEIPT
RECEIVED
6
7
4
18
4
18
DATE:
DISPOSITION:
8
",LETTER NEEDED iD YES E] NO
LETTER NEEDED El YES 0 NO
FIRE DEPARTMENT COPY