23825 HWY 99 (2)SN0110 ServingBriler,L�Ufflonds, and .12425 Meridian Ave S
Mountlake Terrace Everett, WA 98208
FIR Phone (425) 5514200
__ST T www..FireDistrictl.org Fax (425) 551-1272
LOCATION: 23825 Highway 99 98026
BUSINESS NAME: Travelodge PHONE: .4257718008
MAILING
23825 Highway 99, Edmonds, WA 98026
ADDRESS:
BUSINESS OWNER: HOME PHONE:
EMERGENCY-1: Kim, John HOME PHONE: 2062357577
KEY ACCESS-2: HOME PHONE: 20
EMAIL:
PERSON CONTACTED:
b,
NAME OF INSPECTOR: v 0 Lv'3'
STEVS---AS 8/16 FA 8/16\FE 8/15
Date Last Serviced: ,/, "
, i L 1 ��j "ll yjj A
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
'FIRE PREVENTION
INSPECTION REPORT
OEDMONDS
0 BRIER
El MOUNTLAKE TERRACE
[I UNINCORPORATED
" WE UE STAffrff SH I FT
nQnUalcy I .
SCHEDULED Jun 2017
DATE DUE
IU443
FIR ll�
CURRENT
CITY YES NO
BUSINESS 471
LICENSE "Ej 1:1
INITIAL INSPECTION DATE
1 Y-\ k) \.f 1�7
2 2
3
3
4
4
5
6
6
71
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:
DATE DUE:
GRANTEDTO-
DATE DUE- CITED:
PERSON
PERSON
1 PERSON
CONTACTED:
CONTACTED-
C ONTACTED
INSPECTOR:
INSPECTOR:
2
INSPECTOR:
DATE:
DATE:
3
DATE,
VIOLATIONS
VIOLATIONS
CITATION ISSUE6
PRE -CITATION
1
'5
4
LETTER SENT NUMBER,
CODE
2 6
2 6
DATE SECTION'
X8
RETURN RECEIPT
3 �7
3 7
RECEIVED 6
DISPOSITION: !7
4 .8
4 8
DATE ... .. .....
LETTER NEEDED [] YES Cl NO
LETTER NEEDED YES NO
�
0
Serving Brier, Edmonds, and 12425 Meridian Ave S
Mounfla.ke Terrace Everett, WA 98208
Phone (425) 551-1200
www.FireDistrictl.org Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
e FREQUENCY STATION & SHIFT -'s
LOCATION:
23825 Highway 99 98026
ARR--
BUSINESS NAME:
PHONE:
SCHEDULED
DATE DUE II'
Travelodge
4257718008 it in 917116
MAILING
LIFIR
ADDRESS:
443
23825 Highway 99, Edmonds, WA 98026
BUSINESS OWNER:
HOME PHONE:
EME*RGENCY-1:
HOME PHONE�
CURR NT
,,AACCESS-2:
KE��
Kim, John
HOME PHONE:
YES
2062357577 CITY 0
BUSINESS
EMAIL:
LICENSE
ON CONTAC ED:
PERS' T 60
INITIAL INSPECTION D TE
A
NAME OFINSPECTOR:
/11 7-H
FIRE SYSTEMS:
AS 8/15 FA 8/15 FE,8/15
F_,� c
SKS A
Dhl(2FQaffV%6"ht0A�MCATIONS /COMMUNICATIONS
�C-PL A U
. M-1 A4, - r-- ll?e-'-
cil
1& 41
L5A�,-,f_ Ak' Ro(� (�9 (D� 2
-7
4�
4
5
5
6
6
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1 st RE -INSPECTION 2nd RE -INSPECTION EXTENSION FINAL RE -INSPECTION VIOL . AfIONS-
PATEDUE: 946 -16 DATE DUE: GIINTEIT
R-S-0 N_ 0-' TE P�E: CITED:'-;
PE _hn
PERSON PERSON
CONTACTED: CONTACTED: ONTACTED,
C
INSPECTOR: WIA)5Md INSPECTOR: 12 z
INSPECTOR,
DATE: �_w DATE: DATE, 3
, Oid CITAfIdN ISSUED
N PRE -CITATION
4
LETTER SENT NUMBER:
- ---- ---- 16 2 6 DATE: CODE
S IONO.
RETURN RECEIPT
3 7 RECEIVED 6
DISPOSITION:
4 18 8 DATE:
YES NO
_'�EWCR EEDED YE NO
18
TT�R
Confidence Test Report
1002 CENTRAL AVE NORTH
KENT WA 98032
PHONE: 253-852-1962
FAX: 253-852-2049
FIRE ALARM SYSTEM
Certification Given
(One System per Report)
RED E]
I YELLOW 0
[ WHITE
CONFIDENCE TEST
Z
I REPAIRS
Sprinkler Monitoring Panel? Z
Occupancy Address: 23825 Highway 99 Occupancy Name: Travelodge
Responsible Person
First & Last Name: John Phone Number: (206) 235-7577
Responsible Person Responsible Party
Address, City, State, Zip: E—Mail Address
Date of Inspection: Inspection QuarterlyElHigh-rise Only)
08-29-2016 Frequency/Type: Annual
Testers Name Nicet
(Please Print): Richard Narayan —Number: N-07104
Identification
Number: System Location FACP room behind reception desk
Central station monitodng? Yes El No Monitoring Evergreen
Monitodng Required? Yes El No Company Name:
System Make: Napco System Model: Magnum Fire Alert 6000 Series
FIRE CODE VIOLATIONs FoUND: (if additional room is needed, please add a separate sheet)
(2)12v7ah batteries due to be replaced
No unit acces
CORRECTIONS MADE: Date Corrected: 08-29-2016 Corrected By: Richard Narayan
(If additional room is needed, please add a separate sheet) N i cet N u m be r: - N -07104
Replaced (2) 12v7ah batteries in FACP
This certifies that this fire and life safety system has been properly inspected for reliability to cover the
Items listed in this report and is consistent with Authority Having Jurisdiction standards, and that
discrepancies are noted and have been rep he building Owner/Manager for corrective action.
-0 1
Signature of Tester: Phone # (253) 852-1962
Building Representative (signature)
23825 Highway 99
Fire Alarm Systems
Page 1 of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required inspecting and
testing of the fire and life safety system. Refer to the Fire Department Code for inspecting and testing requirements.
Alarm System Functionality
1. Trouble signal with AC power off?
2. System operates properly on battery backup?
3. Battery voltage (no load) 26.5 volts
4. Battery voltage (full load) 25.1 volts (signals operating)
5. Charge circuit voltage 2 I.0 volts
6. System operartes, propefly on standby power?
7. All signals operate on AC power?
8. Number of initiating circuits 3
9. Number of signal circuits 1
10. Does alarm system meet audibility standards as accepted?
11. All circuits checked for electrical supervision?
12. AD au)dliary equipment operates (Elevators, fans, dampers)? N/A FX_
13. Ventilation controls operate? N/A X
14. Key to panetavaillabW, W/A
15. Materials and equipment needed to restore pull stations are available at the N/A
main panel, e.g. glass rods, and plates; keys and alien wrenches, etc?
16. Operating hi�twctfbii�J# -panel?
17. Trouble indicators function properly?
18. Remote Anninclibi 44n0lis furtcItion property?
to. Elevator Call Down functions properly? N/A X
,20. Test irecord pesW at #atW?
21. General alarm automatic time delay
- (minutes) N/A
22. Wa� a skpW,receive(l at the Central Station FWnitoft company? N/A:
23. Other Devices (Specify)
Yes IZAJ No LJ
x NO 0
Yes No El
Yes No El
Yes X
No�
Yes X
No'---'
Yes
No
Yes
No' -
Yes 'L
No
Yes X
No
YesX
NoF__-
Yes X
No
Yin
NaL P
Yes
No
Yes X
_j
Yes,X: " -_,WoIL,_ I -
Yes , No,X,
System Devices
Total Number of
Units in Building
Total Number
Units Tested
Test Results Acceptable
24. Bells, Horns, Chimes
61
4
N/A
X
Yes!,-.-,
No
25. Voice Speakers (Voice Clarity)
N/A X
Yes
No
26. Visual Alarm Devices
1
1
N/A
Yes X
NoL 1
27. Smoke Detectors
N/A !X
Yes J
No
28 * Heat Detectors
N/A X
Yes-F
No'
29. Duct Detectors
N/A
Yes
No
30. Sprinkler Flow Switches
1
1
N/A
Yes X
No
31. Sprinkler Supervisory Switches
1
1
N/A
Yes X
No
32. Manual Pull Stations
7
7
N/A
Yes
t46
33. Annunciator(s)
N/A x
Yes
No:
34. Beam Detectors
N/A X
Yes
NO
35. Automatic Door Unlocks
N/A
Yes
No'
36. Automatic Door Release
N/A X
Yes'
NO
37. Fire Dampers
N/A X
Yes
No
Total Number of Units
Total Number Units
Communication Equipment
in Buildinq
Tested
Test Results Acceptable
38. Phone Sets
N/A 1XI Yes No
39. Phone lacks
N/A X Yes No
40. Call -in Signal
N/A Yes No-!
Fire Alarm Systems Page 2 of 2
F. I R E. P R 0 T E IC T t Ol N
Confidence Test Report
1002 CENTRAL AVE NORTH
KENT WA 98032
PHONE: 253-852-1962
FAX: 253-852-2049
SPRINKLER — WET SYSTEM
Certification Given
(One System per Report)
___1
RED
Lj
I YELLOW
�WHI
CONFIDENCE TEST X� REPAIRS
F
Occupancy Address: 23825 Highway 99 Occupancy Name: Travelodge
Responsible Person
First & Last Name: John Phone Number: (206) 235-7577
Responsible Person Responsible Party
Address, City, State, Zip: E-Mail Address
Date of Inspection: 08-29-2016 Inspection Annual 0
Testers Name Frequency/Type: 1:1
(Please Print): Richard Narayan Nicet N-07104
Number:
Identification
Number: System Location: Riser room behind reception desk
Central station monitoring? Yes E] No[] Monitoring
Monitoring Required? Yes Im No Company Name: Evergreen
System Make: Shotgun System Model: 2
FIRE CODE VIOLATIONs FoUND: (if additional room is needed, please add a separate sheet)
No unit access
Ao record of FDC flush
CORRECTIONS MADE: Date Corrected: Corrected By:
(If additional room is needed, please add a separate sheet) Nicet Certification Number:
This certifies that this fire and life safety system has been properly inspected for reliability to cover the
Items listed in this report and is consisten wit� Authority haveing Jurisdiction Fire Code standards, and that
discrepancies are noted and ha - _JLLd to the building Owner/Manager for corrective action.
V7777
Signature of Tester: — Phone# (253) 852-1962
Building Representative (signature)
23825 Highway 99
Sprinklers - Wet Page 1 of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required
inspecting and testing of the fire and life safety system. Refer to the Fire Department Fire Code for inspecting
and testing requirements.
General
1
Main Drain an� Inspectors Drain flow test conducted?
ye�§'N
No[]
2.
Static pressure: 55 p.s.i. Flow pressure: 40 P. S.
3.
Number of Spfinkler Heads:
4.
2-inch drain? Other
ED
Yes 11
No E]
5.
Flow switch e&.supervisory switches and alarm bells tested? VA
'El
s�
Ye 0 go
mN
, [0[3,
6.
Pressure regulating valves tested? N/A
Yes
No[]
7.
Alarm bell ope;ates'� N/A
M\7
Yes I^
_J
No
8.
System inspected and lubricated?
M",
Yes LN
NoL-j
9.
Valves are sealed or supervised?
. Ili,
M\7
Yes Ed
�NoCll
10.
-
Signs are provided on valves?
Yes - ] .
N . o
11.
-'P6 r oi ti6ns and clapper valves unobstructed and turn freely?
mpe c nnpc
Yes Lnj
f4'd,[:]
-1-2.-Sprinkler-coverage-is-acceptable?
--Yesla-�
M\7
No-m-
4
13. Have the spfifili
tPer heaid's been replacedoy successfully sample test jqi;ofhJ6 -
14s pqyeafs? 7"DW-of last test:
14. Proper number of spare sprinkler heads available with appropriate wrenches M\7
for each? Yes L2j,
M\7
15. System left in service? Yes L,�Nj
16. System gauges replaced or calibrated within the last 5 years?
V k A 2013 Yes
117. Sprinkler head's free of corrosion, paint, obstructions and/or physical
damage?
18. Was debris found in the Fire Department Connection (FDC)?
19. Was. the Fire Department Connedti6n (FDC) back flushed within the last 5
of L fl s h No Record
y, rs? 'Date ast back � u
20. Was an internal pipe and valve inspection performed within the last 5 years?
Date Performed Hard Lid
21. Is the hydrau'lid1nameolate installed ar�d visible on risef, if Nothen' YelloW`Taf�.
(Rgf:, N150A 25 5 2-7) Yes
Yes
Yes
Yes El
Yes IN
No E]
N, o
No
NoE]
NoO
M\7
No L^-J'
No r\77
YesEl L^-i
01 Koz
22. Was a signal received at the Central Station monitoring N/A Yes No[]
company?
23825 Highway 99
Sprinklers - Wet Page 2 of 2
FIRE.
_-REVENTION
INSPECTION REPORT
SNOHQ!n i .,in g B E nonds -'and 12425 Meridian Ave S
4 �iei.: di
-0 EDMONDS
Mountlake Terrace Everett, WA 98208 El BRIER
FIRE Phone (425) 551-1200 El MOUNTLAKE TERRACE
DIS1TiiffT wwwFireDistrictl.org Fax (425) 551-1272 [1 UNINCORPORATED
e' FREQUENCY I STATION 11 SHIF'*)
LOCATION: / 23825 Highway 99 98026 Annual- 20-B
/Travelodge 4257718OOr SCHEDULEDjun 2015
BUSINESS NAME: PHONE: DATE DUE
443
MAILING/ 23825 Highway 99, Edmonds, WA 98026 LIFIR
ADDRESS:
BUSINESS OWNER: HOME PHONE:
EMERGENCY-1: Kim, John /co W N Y_A�) HOME PHONE: 2062357577 CURRENT YES
KEY ACCESS-2: HOME PHONE: CITY NO
BUSINESS
EMAIL: LICENSE 2r 1-1
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR: xv 0-0
�4A-Z'/ ft % / o�'
HAIZA FOUND AND LOCATIONS / COMMUNICATIONS
1,
b KL9'-
ig V_)k (I e- jkb6YA 0(1- fi/y'� b f� k (:�6
97L, 00/
e,
1\ \f 1. R.L> 0 "A
1 2
9
2
L. L' VA 1� �26 LA TY\ t�� \.A I kkT b�
kK14 I Ct
3
4
4
J/ G I A) t) P C fA I L
'V
5
L6
6
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
1
CONTACTED:
CONTACTED:
CONTACTED:
INSPECTOR:
0—
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
4
1 5
1 5
LETTER SENT
NUMBER:
2
6
2
6
DATE:
CODE
SECTION:
5
RETURN RECEIPT
6
3
7
3
7
RECEIVED
DISPOSITION:
7
14
18
4
18
DATE:
LETTER NEEDED C] YES [I N 01
LETTER NEEDED [I YES NO
1
8
q I
FIRE DEPARTMENT, COPY
e I
Confidence Tes't Report
1002 CENTRAL AVE NORTH
KENT WA 98032
PHONE: 253-852-1962
FAX: 253-852-2049
FIRE ALARM SYSTEM
Certification Given
r (One System per Report)
RED
YELLOW 0 ]
WHITE
CONFIDENCE TEST
IN
I REPAIRS
Sprinkler Monitoring Panel? M
Occupancy Address: 23825 Highway 99
Occupancy Name: Travelodge
Responsible Person
First & Last Name: John
Phone Number: 235-7577
Responsible Person
Address, City, State, Zip:
-(206)
Responsible Party
E—Mail Address
Date of Inspection:
08-03-2015
Inspection Quarterly [:](High-rise Only)
Frequency/Type: Annual
Testers Name
(Please Print): Richard Narayan
Nice't
N-07104
—Number:
Identification
Number:
System Location FACP room behind reception desk
Central station monitoring? Yes No
Monitoring Required? Yes No
Monitoring Evergreen
Company Name:
System Make.- Napco
System Model: Magnum Fire Alert 6000 Series
FIRE CODE VIOLATIONs FOUND: (if additi nal room is needed, please add a separate sheet)
No unit access
CORRECTIONS MADE: Date Corrected:
Corrected By:
(if additional room is needed, please add a separate sheet) Nicet Number:
This certifies that this fire and life safety system has been properly inspected for reliability to cover the
Items listed in this report and is consistent with Authority
Having Jurisdiction standards, and that
discrepancies are noted and have been rep he building
Owner/Manager for corrective action.
4)
Signature of Tester:
Phone # (253) 852-1962
Building Representative (signature)
23825 Highway 99
Fire Alarm Systems
IM7, AUG 2 6 2015 Page 1 of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required inspecting and
testing of the fire and life safety system, Refer to the Fire Department Code for inspecting and testing requirements.
Alarm System Functionali
1. Trouble signal with AC power off?
2. System operates properly on battery backup?
3. Battery voltage (no load) 26.7 volts
4. Battery voltage (full load) 25,3 volts (signals operating)
5. Charge circuit voltage 27.0 volts
Yes UX No
Yes El No
6. System operates properly on standby power?
Yes rx-I
No El
7. All signals operate on AC power?
Yes FX]
No
8. Number of initiating circuits 3
9. Number of signal circuits 1
10. Does alarm system meet audibility standards as accepted?
Yes iX
No
11, All circuits checked for electrical supervision?
Yes X
No
12. All auxiliary equipment operates (Elevators, fans, dampers)?
N/A
Yes
No
13. Ventilation controls operate?
N/A
Yes
No
14. Key to panel available?
N/A
Yes
No
15. Materials and equipment needed to restore pull stations are available at the
N/A
Yes'X
No
main panel, e.g. glass rods, and plates; keys and allen wrenches, etc?
16. Operating instructions at panel?
Yes
No
17. Trouble indicators function properly?
Yes
No
18. Remote Annunciator Panels function properly?
N/A !X
Yes
No
19. Elevator Call Down functions properly?
N/A
Yes
No
20. Test record posted at panel?
Yes X--
No
21. General alarm automatic time delay - (minutes)
N/A FX�
22. Was a signal. received, at the Central Statilim monitoring company?
N/A
Yes tX
No 1,
23. Other Devices (Specify)
Yes
No X
System Devices
Total Number of
Units in Building
Total Number
Units Tested
Test Results Acceptable.
24. Bells, Horns, Chimes
61
4
N/A
Yes 'X
No
25. Voice Speakers (Voice Clarity)
N/A X
Yes
No
26. Visual Alarm Devices
N/A
Yes X
No
27. Smoke Detectors
N/A XI
Yes
No
28. Heat Detectors
N/A X
Yes,-
No
29. Duct Detectors
N/A X
Yes
No
30. Sprinkler Flow Switches
1
1
N/A
Yes X
No
31. Sprinkler Supervisory Switches
1
1
N/A
Yes X
No
32. Manual Pull Stations
7
7
N/A
Yes 5<
No
33. Annunciator(s)
N/A X
Yes
No
34. Beam Detectors
N/A X
Yes --
No
35. Automatic Door Unlocks
N/A X
Yes
No
36. Automatic Door Release
N/A �X
Yes
No
37. Fire Dampers
N/A X
Yes
No
mmunication Equipment
Total Number of Units
in Building
Total Number Units
Tested
Test Results Acceptable
38. Phone Sets
N/A X Yes No
39. Phone lacks
N/A X Yes No
40. Call -in Signal
N/A X Yes No
Fire Alarm Systems Page 2 of 2
Confidence Test Report
1002 CENTRAL AVE NORTH
KENT WA 98032
PHONE: 253-852-1962
FAX: 253-852-2049
SPRINKLER — WET SYSTEM
Certification Given
(One System per Report)
RED
Lj
I YELLOW
F WHITE
F�
CONFIDENCE TEST REPAIRS
Occupancy Address- 23825 Highway 99 Travelodge
Occupancy Name -
Responsible Person
First & Last Name: John Phone Number: (206) 235-7577
Responsible Person Responsible Party
Address, City, State, Zip: E—Mail Address
Date of Inspection: 08-03-2015 Inspection Annual
Frequencyrrype: 0
Testers Name Nicet
(Please Print): Richard Narayan Number: N-07104
Identification
Number: System Location: Riser room behind reception desk
Central station monitoring? Yes No rl Monitoring -
Monitoring Required? Yes El No D Company Name: Evergreen
System Make: Shotgun System Model- 2 It
FIRE CODE VIOLATIONs FOUND: (If additional room is needed, please add a separate sheet)
No unit access
No record of FDC flush
CORRECTIONS MADE: Date Corrected- Corrected By:
(if additional room is needed, please add a separate sheet) Nicet Certification Number:
This certifies that this fire and life safety system has been properly inspected for reliability to cover the
Items listed in this report and is consistent with Authority haveing Jurisdiction Fire Code standards, and that
discrepancies are noted and ha e d to the building Owner/Manager for corrective action.
In it
Signature of Tester: — Phone # (253) 852-1962
Building Representative (signature)
23825 Highway 99
Sprinklers - Wet "E-, AUGI 2 6 2015 Page 1 of 2
Fj
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required
inspecting and testing of the fire and life safety system. Refer to the Fire Department Fire Code for inspecting
and testing requirements.
General
1. Main Drain and lnsr)ector's Drain flow test conducted ? Yes.
No
1"� 'q
2. Static pressure: 55 p.s.i. Flow pressure- 40
P. S. i.
3. Number of Sprinkler Heads:
4.
2-inch drain? Other
M\7
inj
Yes[]
NoF
5.
es upery I is
Flow switch ory switches and alarm bells tested?
0
'Y Fx
w-
6.
Pressure regulating valves tested? N/A
1, -j
Yes F
NoF
7.
Alarm bell operates? N/A
E]
Y e s r\7/
Lnj
NO[]
8.
System inspected and lubricated?
Yes FX
NoEl
9.
Valves are sealed or supervised?
Yes Z
Nol]
10.
Signs are provided on valves?
Yes F
NoF
11.
Pumper connections and clapper valves unobstructed and turn freely?
Yes FX
Non
12.-
S.Drinkler coverage is acceptable?
-Yes-mx
Noo-
13.
Have the sprinkler heads been replaced or successfully -sample test in,,.the
-last-50 years?"tT -Date of last t6ft
Yes
_'lANO' F
14.
Proper number of spare sprinkler heads available with appropriate wrenches
Yes
No D
for each?
15.
Systern left in sservirce?
e s F77
[K—%j
N o
16.
System gauges replaced or calibrated within the last 5 years?
Yes FX
No
Year changed: 2013
17.
Sprinkler head's free of corrosion, paint, obstructions and/or physical
Yes
No[]
damage?
18.
Was debris found in the Fire Department Connection (FDC)?
Yes
No FX
19�.
Was the Fire Department Connection (FDC) back flus h ed with ihl th e as t 5
�7
Yet 'D
No'1/\1
years? Date of last b4dk flush No Rbcord
20.
Was an internal pipe and valve inspection performed within the last 5 years?
Yes E]
No FX
Date Performed Hard Lid
21.
Is the hydraulic.inameplate installed and visible on riser, if -No then Yellow Tag.
Yes F7
No FX
(Ref: NFPA 25 5.2.7)
0 ,
22.
Was a signal received at the Central Station monitoring N/A F
Yes M
1^1
NoD
company?
23825 Highway 99
Sprinklers - Wet Page 2 of 2
W
ohn J. Wesffall
From: John J. Westfall
Sent: Thursday, October 08, 2015 11:46 AM
To: 'Startzman, Jeanne'
Cc: John J. Westfall
Subject: FW: Records Request 23825 Highway 99 rcv'd 10-1 -15
Attachments: 23825 Highway 99, Edmonds, WA Request—for—Public—Records.pdf
Jeanne:
The Edmonds Department of Fire Prevention office has an address file on this property dating to hotel construction in
1986. Building is construction type VA with sprinklers. Regular annual fire inspections have been conducted since this
time and building owner has been prompt with fire protection system services over the years.
Per attached request, no public health issues or drinking wells are documented.
Building Department will have access to any building and underground tank permits or plans, as available, for this site
through the Edmonds municipal permitting database.
For hazardous spill and emergency incident records since 2010, requester is directed to contact Snohomish Fire District
#1, 425.551.1200 or www.firedistrictl.org for emergency information. Prior to this date, emergency response incidents
can only be searched by date. If you have specific dates to retrieve, please add to your request.
This satisfies all available city fire information by attached request.
Request Made By: Nicolas Pushckor
Request Received: October 1, 2015
Request (Summary): PCA Travelodge 23825 Highway 99, Edmonds
Your Name Time Spent
John Westfall 45 minutes d
TOTAL
John 3. Westfall
Deputy Chief/Fire Marshal
Fire Prevention Services
425-771-0213 Desk
425-775-7721 Fax
425-231-3644 Mobile
al"M1,091-911 CO
From: Nicolas Pushckor [mailto:npushckorCa)aeqwa.com]
Sent: Thursday, October 01, 2015 3:45 PM
45 minutes
To: Records Requests
Subject: 23825 Highway 99, Edmonds, Washington 98026
ir .
Hello,
Attached is a public records request for the address 23825 Highway 99, Edmonds, Washington 98026.
Thank you,
Nicolas Pushckor
AssoctATED
ENVIRONMENTAL
GROUP. LLC
605 11'4 Avenue SE, Suite 201
Olympia, WA 98501
P: (360) 352-9835
C: (360) 791-2082
F.- (360) 349-0851
nPushckorP,aejzwa.com
www.ae.awa.com
. * 1 �6.
CITY OF EDMONDS-Request for'Public Records Tracking No.
For police records return to:
Edmonds Police DeRartment
250 5th AVE North
Edmonds, WA 98020
425.771.0200 (Phone)
425.771.0208 (Fax)
policedisclosure@edmondswa.gov
Date of Request: 10/01/15
Requester Name.- Nicolas Pushckor
Requester Address: 605 1 1th Ave SE, Suite 201
For other city records return to:
Edmonds City Hall
121 5th AVE North
Edmonds, WA 98020
425.775.2525 (Phone)
425.771.0266 (Fax)
prr@edmondswa.gov
Street SuitelApt.
Olympia WA 98501
City state zip
Email Address: npushckor@aegwa.com
Phone Number.- (360) 352-9835
Request Made- E] In Person E] In Writing [] Telephone [:] Fax R] Email
How would you prefer to be notified when the records are available?
[] In Writing Ej Telephone Ej Fax F71 Email
DESCRIPTION OF REQUEST:
Be Spec and provide as much detail as possible; include address and owner of property; file name
or number, time period; incident location and date; case number, any other names associated with
your request; etc.):
I am looking for records associated with public health information, drinking water wells,
permit information for buildings or underground storage tanks, and any calls to the fire
department other than medical stuff for the address:
23825 Highway 99, Edmonds, Washington 98206
I agree to pay for any requested copies per the City's adopted fee schedule. Yes Fl/�
Is the information requested a list of individuals to be used for a mailing list for commercial
purposes? Yes F] No [Z] if Yes, please complete the additional form found on page 3.
"Responses to requests for public records shall be made promptly by agencies, the office of the secretary of the senate, and the
office of the chief clerk of the house of representatives. ffithin five business days of receiving a public record request, an agency,
the office of the secretary of the senate, or the office of the chief clerk of the house of representatives must respond by either (1)
providing the record; (2) providing an internet address and link on the agency's web site to the specific records requested, except
that ff the requester notifies the agency that he or she cannot access the records through the internet, then the agency must provide
copies of the record or allow the requester to view copies using an agency computer; (3) acknowledging that the agency, the office
of the secretary of the senate, or the office of the chief clerk of the house of representatives has received the request and providing
a reasonable estimate of the time the agency, the office of the secretary of the senate, or the office of the chief clerk of the house of
representatives will require to respond to the request; or (4) denying the public record request.. In acknowledging receipt of a public
record request that is unclear, an agency may ask the requestor to clarify what information the requestor is seeking. If the requestor
fails to clarffy the request, the agency need not respond to it. " RCW 42.56.520 (in part)
Page -1-
L-1
Confidence Test Report
1002 CENTRAL AVE NORTH
KENT WA 98032 OCT 17 2V14
PHONE: 253-852-1962
FAX: 253-852-2049
FIRE ALARM SYSTEM
Certification Given
(One System per Report)
RED
YELLOW
0
1 WHITE —
CONFIDENCE TEST
0
1 REPAIR
Sprinkler Monitoring Panel? 0
Occupancy Address: 23825 Highway 99 Occupancy Name: Travelodge
Responsible Person wyyltx�
First & Last Name: John Phone Number: (206) 235-7577
Responsible Person Responsible Party
Address, City, State, Zip: E—Mail-Address
Date of Inspection: Inspection Quarterly ElHigh-rise Only)
09-25-2014 Frequency/Type: Annual
Testers Name Nicet
(Please Print): Richard Narayan Number: N-07104
Identification
Number: System�'�(iocation FACP room behind reception desk
Central station monitoring? Yes No Monitoring
�t Evergreen
Monitoring Required? Yes FRI No E:1 Company Name:
System Make: Napco tystem Model: Magnum Fire Alert 6000 Series
W
FIRE CODE VIOLATIONs FOUND: (if additi nal room is needed, please add a separate sheet)
No unit access
Pull station by unit 119
CORRECTIONS MADE: Date Corrected: Corrected By:
(If additional room is needed, please add a separate sheet) Nicet Number: -
This certifies that this fire and life safety system has been properly inspected for reliability to cover the
Items listed in this report and is consistent with Authority Having Jurisdiction standards, and that
")o"', tot
discrepancies are noted and have been re.—,, d he building Owner/Manager for corrective action.
Signature of Tester: Phone # (253) 852-1962
Building Representative (signature)
23825 Highway 99
Fire Alarm Systems
Page 1 of 2
.The items on the checklists below shall be inspected and tested. This list does not constitute all of the required inspecting and
testing of the fire and life safety system. Refer to the Fire Department Code for inspecting and tesbng requirements.
Alarm System Functionality
1. Trouble signal with AC power off?
Yes
No El
2. System operates properly on battery backup?
Yes
No El
3. Battery voltage (no load) 26.9 volts
4. Battery voltage (full load) 25.4 volts (signals operating)
5. Charge circuit voltage 27.2 volts
6. System operates properly on standby power?
Yes
No El
7. All signals operate on AC power?
Yes
No El
8. Number of initiating circuits 3
9. Number of signal circuits 1
10. Does alarm system meet audibility standards as accepted?
Yes X
NoEl
11. All circuits checked for electrical supervision?
Yes X
NoE]
12. All auxiliary equipment operates (Elevators, fans, dampers)?
N/A
Yes
No [:1
13. Ventilation controls operate?
N/A
Yes
NoE
14. Key to panel available?
N/A F-�
Yes FX
Noo
15. Materials and equipment needed to restore pull stations are available at the
N/A F
Yes FX
No
main panel, e.g. glass rods, and plates; keys and allen wrenches, etc?
16. Operating instructions at panel?
Yes IX
No
17. Trouble indicators function properly?
Yes X
No El
18. Remote Annunciator Panels function properly?
N/A FX
Yes 7,
NoEl
19. Elevator Call Down functions properly?
N/A
Yes F-I
Noo
20. Test record posted at panel?
Yes FX
No
21. General alarm automatic time delay - (minutes)
N/A
22. Was a signal received at the Central Station monitoring company?
N/A
Yes X
NoEl
23. Other Devices (Specify)
Yes El
NoX
System Devices
Total Number of
Units in Building
Total Number
Units Tested
Test Results Acceptable
24. Bells, Horns, Chimes
61
4
N/A El
Yes X
No El
25. Voice Speakers (Voice Clarity)
N/A X
Yes [:1
No El
26. Visual Alarm Devices
1
1
N/A El
Yes X
No El
27. Smoke Detectors
N/A FRI
Yes El
No El
28. Heat Detectors
N/A
Yes El
No 0
29. Duct Detectors
---
Yes
No
30. Sprinkler Flow Switches
1
1
--N/A
N/A E:1
Yes [9
No
31. Sprinkler Supervisory Switches
1
1
N/A E:1
Yes X
No El
32. Manual Pull Stations
7
7
N/A
Yes [g
60 [:1
33. Annunciator(s)
N/A
Yes EJ
NoD
34. Beam Detectors
N/A FX-1
Yes El
No El
35. Automatic Door Unlocks
N/A
Yes 0
No E]
36. Automatic Door Release
N/A
Yes El
No El
37. Fire Dampers
N/A
Yes El
No El
Communication Equipment
Total Number of Units
in Building
Total Number Units
Tested
Test Results Acceptable
38. Phone Sets
N/A Yes El No 0
39. Phone lacks
N/A X Yes 0 No 0
40. Call -in Signal
N/A 7X Yes E] No El
Fire Alarm Systems Page 2 of 2
Confidence Test kgpb�JVN
1002 CENTRAL AVE NORTH
KENT WA 98032
PHONE: 253-852-1962
FAX: 253-852-2049
SPRINKLER — WET SYSTEM
Certification Given
(One System per Report)
RED
YELLOW
LXJ
I WHITE
F]
CONFIDENCE TEST IN 1 REPAIRS F-1
Is- 23825 Highway 99
Occupancy Addres Occupancy Name: Travelodge
Responsible Person
First & Last Name: John Phone Number: (206) 235-7577
Responsible Person Responsible Party
Address, City, State, Zip: E—Mail Address
Date of Inspection: 09-25-2014 Inspection Annual
Testers Name Frequency/Type:
(Please Print): Richard Narayan Nicet N-07104
Number:
Identification
Number: System Location: Riser room behind reception desk
Central station monitoring? Yes El No Monitoring
Monitoring Required? Yes El NoEl Company Name: Evergreen
System Make: Shotgun System Model: 2 11
FIRE CODE VIOLATIONs FOUND: (if additional room is needed, please add a separate sheet)
No unit access
No record of FDC flush
CORRECTIONS MADE: Date Corrected: Corrected By:
(if additional room is needed, please add a separate sheet) Nicet Certification Number:
This certifies that this fire and life safety system has been properly inspected for reliability to cover the
Items listed in this report and is consistent with Authority haveing Jurisdiction Fire Code standards, and that
discrepancies are noted and hav epcj�7he building Owner/Manager for corrective action.
Signature of Tester: Phone # (253) 852-1962
Building Representative (signature)
23825 Highway 99
Sprinklers - Wet Page 1 of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required'
inspecting and testing of the fire and life safety system. Refer to the Fire Department Fire Code for inspecting
and testing requirements.
General
1. Main Drain and Inspector's Drain flow test conducted?
2
3
4
Static pressure: 55 p.s.i. Flow pressure
Number of Sprinkler Heads:
2-inch drain?
40 P. S. i.
5. Flow switches, supervisory switches and alarm bells tested?
6. Pressure regulating valves tested?
7. Alarm bell operates?
8. System inspected and lubricated?
9. Valves are sealed or supervised?
10. Signs are provided on valves?
Other F/7
N/A
N/A
N/A
11. Pumper connections and clapper valves unobstructed and turn freely?
12. Sprinkler coverage is acceptable?
13. Have the sprinkler heads been replaced or successfully sample test in the
last 50 years? Date of last test:
14. Proper number of spare sprinkler heads available with appropriate wrenches
for each?
15. System left in service?
16. System gauges replaced or calibrated within the last 5 years?
Year changed: 2013
17. -Sprinkler- heads free of -corrosion, paint, obstructions and/or physical
damage?
18. Was debris found in the Fire Department Connection (FDC)?
19. Was the Fire Department Connection (FDC) back flushed within the last 5
years? Date of last back flush No Record
20. Was an internal pi'e and valve inspection performed within the last 5 years?
p
Date Performed Hard Lid
M\7
Yes 1^1 NoF
Yes F
r\77
Yes 1/'\l
Yes
Yes 1^1
Yes 17777
Yes X
Yes F]
17777
Yes 1^1
Yes
Yes FX
NoD
1777
Yes 1/'\l
NoD
Yes 0
NoF
r\77
YesI^l
NoF
M\7 -
Yes 1^1
NoD
Yes D
N o FX]
M
Yes No1^l
NoFYes x
21. Is the hydraulic nameplate installed and visible on riser, if No then Yellow Tag.
(Ref: NFPA 25 5.2.7) Yes No
22. Was a signal received at the Central Station monitoring N/A Y e s No
company? D
23825 Highway 99
Sprinklers - Wet Page 2 of 2
Confidence Test Report
1002 CENTRAL AVE NORTH
KENT WA 98032 AUG 2 3 2RI,?
PHONE: 253-852-1962
FAX: 253-852-2049
FIRE ALARM SYSTEM
(One System per Report)
Certification Given
RED
YELLow
F-1
I WHITE
CONFIDENCE TESTZ
I REPAIRS
Sprinkler Monitoring Panel?
Occupancy Address: 23825 HWY 99 Edmonds wa. 98026
Responsible Person
First & Last Name: John kim
Responsible Person
Address, City, State, Zip:
Date of Inspection:
8/15/13
Testers Name
(Please Print): Thomas murphy
Identification
Number:
Central station monitoring? Yes FX-� No El
Monitoring Required? Yes El No D
System Make: Napco
Occupancy Name: Travel lodge
Phone Number: (206)235-7577
Responsible Party
E—M5il Address
Inspection Quarterly
Frequency/Type: Annual
Nicet
Number: — 010410
Off ice closet
System Location
Monitoring
Company Name:
System Model: 6000
FIRE CODE VIOLATIONs FOUND: (if additional room is needed, please add a separate sheet)
None
CORRECTIONS MADE: Date Corrected: Corrected By:
(If additional room is needed, please add a separate sheet) Nicet Certification Number:
This certifies that this fire a nd lif9Argrety system has been properly inspected for reliability to cover the
r ( .
Items listed in this repo t an — consistent with Fire Department Fire Code standards, and that
discrepancies are noted d have been reported to the building Owner/Manager for corrective action.
Signa ture of Tester: -Ph o n e 4 (425)429-4679
Building Representative signature)
23825 HWY 99 Edmonds wa 98026
Fire Alarm Systems Page 1 of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required inspecting and
testing of the fire and life safety system. Refer to the Fire Code for inspecting and testing requirements.
Alarm System Functionalit
1. Trouble signal with AC power off?
Yes
No M
2. System operates properly on battery backup?
Yes
No El
3. Battery voltage (no load) 26.1 volts
4. Battery voltage (full load) 25.3 volts (signals operating)
5. Charge circuit voltage 26.9 volts
6. System operates properly on standby power?
Yes
No El
7. All signals operate on AC power?
Yes
No El
8. Number of initiating circuits 3
9. Number of signal circuits 1
10. Does alarm system meet audibility standards as accepted?
Yes X
No F
11. All circuits checked for electrical supervision?
Yes [7'
j
No
12. All auxiliary equipment operates (El evators, fans, dampers)?
N/A
Yes 0
No
13. Ventilation controls operate?
N/A X
Yes 11
No
14-Kpy to panqt,�a'Mllab!O',',�
N/k"Ej-
I Y6 S'XI
No E
15. Materials and equipment needed to restore pull stations are available at the
N/A
Yes X
No
main panel, e.g. glass rods, and plates; keys and alien wrenches, etc?
Operating jqstrictio ns,� el
Otp�n
y S
No
17. Trouble i n'dicators function properly?
Yes X
No
I 18.Remo e nhuoc ator,�P� e,s., unctiom r
t i P, oper y.
V-0
Y es,
Ni
0
19. Elevator Call Down functions
N/A X
Yes P,
No
bstecl�at oa�nel,?
20.�'T'e'st recior'd,p'
, 11 ,
,
Y
, �,_�,,_es,
6 El
21. General alarm automatic time delay (minutes)
N/A MX
al,,reteive a
22-Was a sig'n"" & e,, entra!`,Statiomm'ohitorin'g company?,,
N/A_:LI`
No
23. Other Devices (Specify)
Yes I
No X
System Devices
Total Number of
Units in Building
Total Number
Units Tested
Test Results Acceptable
24. Bells, Horns, Chimes
40
40
N/A
'Yes X
No
25. Voice Speakers (Voice Clarity)
N/A X
Yes El
No
26. Visual Alarm Devices
N/A
Yes
No
27. Smoke Detectors
N/A
Yes X
No L- 1
28. Heat Detectors
Yes
No
29. Duct Detectors
N/A X
Yes Fj
No LI
30. Sprinkler Flow Switches
Yes X
Noo
31. Sprinkler Supervisory Switches
3
3
N/A
Yes X
No [-j
32. Manual 'Pull Stations'
9
9
N/A
Yes IX
No
33. Annunciator(s)
N/A X
Yes Ll
Nolf -I
34. Beam Detectors
N/A X
Yes El
No E-1
35. Automatic Door Unlocks
N/A X
Yes El
No
36. Automatic Door Release,
N/A
Yes
No
37. Fire Dampers
N/A X
Yes L.]
No FL
Communication Equipment
Total Number of Units
in Building
Total Number Units
Tested
Test Results Acceptable
38. Phone Sets
N/A X Yes 0 No D
1 39. Phone Jacks
N/A Yes X 'No L-jj
1 40, Call -in Signal
N/A Yes X No 01
Fire Alarm Systems Page 2 of 2
Confidence Test Report
1002 CENTRAL AVE NORTH
KENT WA 98032
PHONE: 253-852-19R 232013
FAX: 253-852-2049
SPRINKLER — WET SYSTEM
Certification Given
(One System per Report)
RED
Lj
I YELLOW
N]
WHITE
F_�
CONFIDENCE TEST JFX� I REPAIRS [7,
Occupancy Address: 23825 HWY 99 Edmonds wa 980 26
Occupancy Name: Travel lodge
Responsible Person
First & Last Name: John kim
Phone Number: (206)235-7577
Responsible Person -
Address, City�State_, Zip:
Respp_qsible- Party
E-Mail Address
Date of Inspection: 8/15/13
Testers Name
(Please Print): Thomas murphy
Inspection Annual
Frequency/Type: F]
Nicet Certification
Number: 010410
Identification
Number:
System Location: Office closet
Central station monitoring? Yes No r7I
Monitoring
Monitoring Required? Yes IE No El
Company Name:
System Make: Shotgun
System Model: 2
FIRE CODE VIOLATIONs FoUND: (if additional room is needed, please add a separate sheet)
No record of FDC 5yr inspection
CORRECTIONS MADE: Date Corrected:
Corrected By:
(If additional room is needed, please add a separate sheet) Nicet Certification
Number:
This certifies that this fire andjV�ety system has been properly inspected for reliability to cover the
Items listed in th is report 'is consistent with Fire Code
En �have
standards, and that
discrepancies are note, been reported to the building Owner/Manager for corrective action.
Signature of Tester: V_'���P
h o n e # (425)429-4679
Building Represent ive (signature)
23825 HWY 99 Edmonds wa 98026
Sprinklers - Wet Page 1 of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required
inspecting and testing of the fire and life safety system. Refer to the Fire Code for inspecting
and testing requirements.
General
1.
Main Drain-'andlfhspector's. Drain flow test conducted?
Ye' s,. .,No
2.
Static pressure: 70 p. s. i. Flow pressure: 50 P.S.I.
.3.,,,,
NU mber-'of Sprinkler, Heads:
4.
Full Flow? 2" Drain
Yes FX
NoEl
5.
Flow switches, supervisory. s "Witches, and ala'r m' be'lls'tested?. N/A:-.I.--D
e
Y, s I^—j
N6F
6.
Pressure regulating valves tested? N/A
Yes F
NoEl
7.
Alarm bell operates? N/A F
Yes FXJ
No
8.
System inspected and lubric . ated?
Yes
NoEl
9.
Va Ives. are sealed or s * upervised?
Yes
0 El
10.
Signs are provided on valves?
r\77
Yes 1^1
NoEl
11.
Pumper connections and clapper valves, unobstructed, and turn freely?,
M\17
Yes 1^1
NoF
12.
Sprinkler coverage is acceptable?
YesM
NoE
13.
.',Iast;50,'
41br beEih:eepla6ed�or�s'u'c6es'§fully.sampIL-,tL-�t'�inthe'",i�--;
Hlave:tke.sprink
;ve6 Ir bat'e of, last tdk
'Y' -NoF
14.
Proper number of spare sprinkler heads available with appropriate wrenches
Yes Lnj
NoEl
for each?
15.�System]eftin
service?,
M\7
,Yes 1^1''
6
, S- yst' e m'g- alu- * g e . s , re . p I - ace - d or ca libir . at ed within 't-he* ... la-s-t-5 ye-a"rs-?-'
Yes
Nob
Year changed: 2013
17;,,,Sprinkler'headsi,fr6e'�of'tbrrbsion,
p'aint,, obstructions, and/or physical
Yes
dar�nage?
18.
Was debris found in the Fire Department Connection (FDC)?
YesEl
S77
No Inj
19.
Ms the-Fire'Department. ion-.(FDC), 4dk.flushed Within the'Jast5:
I-OLJ
years..., ate b I JIUS fi'Ndredordi
20. Was an internal pipe and valve inspection performed within the last 5 years? Yes El N o M
Date Performed Hard lid LL�j
23825 HWY 99 Edmonds wa 980�
Sprinklers - Wet Page 2 of 2
FIRE PREVENTION
Serving Brier, Edmonds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
FIRE,0*4W*l Mountlake Terraceand
Everett, WA 98208
OEDMONDS
0 BRIER
STRt e Town of Woodway
T
Phone (425) 551-1200
EIWOODWAY
0 MOUNTLAKE TERRACE
w"ww.FireDistrictLorg
Fax (425) 551-1272
0 UNINCORPORATED
e- FREQUENCY
—STATION & SHIFT�
LOCATION: 23825 Highway 99
365
20 C
BUSINESS NAME: Travelodge
PHONE: 4257718003
SCHEDULED
DATE DUE 06/01/13
MAILING 23825 Highway 99
UFIR 0 443 6006
ADDRESS: Edmonds 98026
BUSINESS OWNER: Kim, John
HOMEPHONE: 2062357577
ACTIVE
EMERGENCY-1:
HOME PHONE:
"CURRENT
KElY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
F-1
LICENSE '[�q
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
6
FIRE ASIJ11FAl/11
_j
FE
SYSTEKAS: t/6-F dof
ANNUAL
HAZARDS FOIND AND LOCATIONS7/ Cr�OMMUN�ITIONS
1 ccos <� 4--a t
D�A"o
2 r\ a
4-e 5 V
2
AS 6 )1
3
5,
3
A(_0j
4
4
5
5
Al
6
6
7
7
1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
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
1 0(tAIOLATIONS
5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2 D �V
6
2
6
DATE:
CODE
SECTION:
5
3 U �V
7
3
7
RETURN RECEIPT
RECEIVED
6
4
.8
4
.8
DATE:
DISPOSITION:
7
"I LETTER NEEDED E] YES I-] NO
LETTER NEEDED [:] YES NO
I'll,
1
8
FIRE DEPARTMENT COPY
FIRE PREVENTION,',,,�
Serving Beier, INSPECTION REPORT
SNOHOMISH CO. onds 1?.M�MiridianA�
ve S
MEDMONDS
e;l erraceand re
E�6ti,`WA 98208
0 BRIER
the Town of WoodKW Phone(425)55171200 0 WOODWAY
0 MOUNTLAKE TERRACE
www.FireDistrictl.org Xx (425) 551-1272 0 UNINCORPORATED
LOCATION: 23825 Highway 99 FREQUEN TATION & SHIF�
36 20 B
-57
BUSINESS NAME: SCHEDULED
Travelodge PHONE: 4257718008
DATE DUE 06/01/12
MAILING
23825 Highway 99 UFIR 0 443 6006
,ADDRESS: Edmonds 98026
BUSINESS OWNER:
Kim, John HOMEPHONE: 2062357577 ACnVE
EMERGENCY-1: HOME PHONE: "CURRENT
KEY ACCESS-2: YES NO
HOME PHONE: CITY
BUSINESS
LICENSE
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE AS3/08FA11/11
FE
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
3
4
4
5
5
6
6
7
7
I AGREJ TO CORRECT THE ABOVE VICLATION(S) IN THE NEXT 30 DAYS X
,Ist RE -IN ECTION 2nd RE -INSPECTION
EXTENSION'
FINAL RE -INSPECTION
VIOLATIONS
okEPUE: DATE DUE: GRANTED TO:
DATE DUE:
CITED:
PERS6R .1 PERSON
co": CONTACTED:
PERSON
CONTACTED:
INSPECTOR: INSPECTOR:
2
INSPECTO R:
DATE: DATE:
L
3
VIOLATIONS VIOLATIONS PRE -CITATION
i Lvi't-6t 5
DATE:
61TAT-ION ISSUED
1 5 LETTER SENT
NUMBER:
4
2 6 2 6 DATE:
CODE
SECTION,
5
RETURN RECEIPT
3 7 3 7 RECEIVED
DISPOSITION:
4 8 4 18 DATE:
7
�,�TER NEEDED [I YES NO LE17ER NEEDED 0 YES 0 NO
11,
FIRE DEPARTMENT
COPY
'.00-M I OR =6
I
12/07/2011 11:50 FAX 4253538934 Evergreen Security 10002
FIRE PROTECTION BUREAU — FIRE AND LIFE SAFETY INSPECTIONS
EVER6REE111 PO aox 42600 Olympia. WA 98604-2600 iw-
ilfffrc,�V�rilfx f it - oetil .3900 FAX; (3so)596-3934
(360)696
FIRE ALARM SYSTEM INSPECTION REPORT
RETAIN COPY ON PREMISES
FACILITY NAME
Travelodge
DATE
11125/11
BUILDING NAME OR NUMBER
OCCUPANCY CLASSIFICATION
Commercial
ADDRESS
23825 Highway 99, Edmonds
LOCAL FIRE AUTHORITY
Edmonds Fire Department
TEST
DE CRIPYION
MONTHLY
JE]OUARYeALY ANNUALLY CONSTIAIJ IONACCEPTANCE
EQUIPMENT
TEST
EQUIPMENT TYPE
NUMBER OF
UNITS TESTED
TEST DATE
SATISFACTOkY CHECK
IYES. NO. NIAI
TYPE AND MANUFACTURER
CONTROL PANELS
0�0
MANUAL STATIONS
e5 I
HEAT DETECTORS
SMOKE DETECTORS
AUDIBLE ALARMS
SMOKE DETECTOR SENSITIVITY
VISUAL ALARMS
AUTO DOOR RELEASES
TROUBLE INDICATORS
MASTER ALARM BOX
Abo
BATTERIES DATE INSTALLED
CHARGER
GENERATOR
VENTILATION CONTROLS
FIRE DEPARMTENT INTERCONNECTION
EXTERIOR SPRINKL�R ELECTRIC ALARM
BELL
SPRINKLER WATERFLOW SWITCH
SPRINKLER GATE VALVE TAMPER
SWITCH
ANNUNCIATORS
ELEVATOR RECALL
DUCT DETECTORS
SMOKE)FIRE DAMPERS
SPECIAL EGRESS CONTROL DEVICES
47
PHONFJACKS
TIME TEST TRANSMISSION RECEIVED BY CENTRAL STATION (TIME AM PM
FIRE ALARM SYSTEM LEFT IN SERVICE AT THE COMPLETION OF INSPECTION YES NO
TIME FIRE ALARM RESET (Til AM PM
TEST OF ALARM SYSTEM ON GMERGENCY POWER 15 SATISFACTORY YES NO
COMMENTS
EXPLAINATION OF UNSATISFACTORY RESULTS AND CORRECTIVE ACTIONS TAKEN,
TM IS ISTO CERTIFY THAT TFIS AUTOMATIC FIRE ALARM SYSTEM HAS BEEN INSPECTED IN ACCORDANCE WITH THE INTERNATIONAL FIRE CODE. AS ADOPTED
By THE WA314INGTON STATE FIRE MARSHAL
FIRST NAME PHONE
Adam_Stryker, Evergreen Security Systems, Inc.— 425-348-3850
ADDRESS
8115 Broadway Suite 101, Everett WA 98203
SIGNATURE
ELECTRICAL CONTRACTOR'S LICENSE NO.
EVERGS11121-2 A
ELFCTRICIANS, LICENSE NO.
1h" ?
:OFFILCAL SIGNATURE (OF F�IRM
�.N.A
VW-NER/AEPPA N T U R �1
RTY 'W� Sr IS S I
i
12/07/2011 11:50 FAX 4253538934 Evergreen Security lao0i
ANWEVERGREEN
57ecurity Systems
A 01V(SION OF EVERGREEN sEcupiry itsic FAX
:'.`:W.e ar�4 company.'' VOICE: (425) 344-3850,6r 1-80 FAX, �(42�)'Ili$;3-86�4;
UL 0- 6039,50
TO: Edmonds Fire Department Fax: 425-775-7721
From' Lisa Sleloff, Service Coordinator Date:
Re: Confidence Testing Reports Pages:
CC:
0 Urgent 0 For Review Q Please Comment 13 PlBa Reply 0 Please Recycie
Attached Please find oompleted confidence testing reports, If you have any questions, or N this
report should be forwarded to another department, please contact me.
Lisa L. Sieloff, Service Coordinator
Evergreen Security Systems
LisaS@evergreensecurity.com
(425) 348-3850, (800) 466-3850
_,.OTICE: Tihis is a CONFIDENTIAL facsimile transmission and is intended for the addressee only, Dissemination of the contents herein and of the
accompanying page(s) to any other person or persons Is strictly prohibited. If you have received this transmission and are not the addrassaa, return
all pages to EVERGREEN SECURITY, Inc., 8115 Broadway Suite 101, Everett. WA 98203. Your cost of postage will be reimbursed. Evergreen
O�QU(ijy, ljj�. io tile jawftll Ovyllfir Of this facsimile and Me accompanying page(s) and by transmitting same dooz not r0inquish that right of
ownership.
0
CITY OF-- EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FIRE DEPARTMENT
LOCATION: 23825 Highway 99
BUSINESS NAME: Travelodge
MAILING 23825 Highway 99
FIRE PREVENTION
SAFETY SURVEY
PHONE: (4:2_�7�7180&
Auurlroo: Edmonds 98026
BUSINESS OWNER: Kim, John HOMEPHONE: 2062357577
EMERGENCY-1: HOME PHONE:
KEY ACCESS-2: HOME PHONE:
FREQUENCY
STATION& SHIFT
365
20 D
SCHEDULED
DATE DUE I�
06,"01/10
UFIR I� 443
6006
ACTIVE
e- INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE AS (18 FA 3,107 FEB Q_!�
SYSTEMS: 0 — ANNUAL
1410 1 0 /(),?
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
c' f c� C�_
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ENTER CODE ONLY ONCE I�
VIOLATION CODE
2
2
3
4
5
3
4
5
6
6
7
7
8
8
lst RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
2ATE DUE
E DUE:
PERSON
CONTACTED:
INSPECTOR,
DATE:
VIOLATIONS
15
6
3 7
4 98
�TTER NEEDED E] YES NO
EXTENSION
GRANTED TO:
PRE -CITATION
LETTER SENT
DATE:
RETURN RECEIPT
RECEIVED
1 1 DATE:
I
FINAL RE -INSPECTION
DATE DUE:
PERSON
CONTACTED:
INSPECTOR,
DATE: 2�_� 70
6-ITATkISSUED
NUMBER: -
CODE
SECTION: -
VIOLATIONS
CITED:
PERSON
CONTACTED: -
1
INSPECTOR '�4 v"j 4'�
DATE:
\AOLATIONS
1 *dt' 5
2
3
4
2
3
6
7
5
6
4
18
8
T
LETTER NEEDED 0 YES 0 NO
FIRE DEPARTMENT COPY