23830 EDMONDS WAYFIRE PREVENTION
..'23030 6*01"qA
SNOHOMISH CJ Servihg Brier,'E&AId 12425Merididii-AveS I .'.INSPECTION REPORT
LIE'DMONDS
Mountlake Terrace Everett, WA 98208 OBRIER
F R Phone (425�551-1200 0 MOUNTLAKE TERRACE
0 UNINCORPORATED
DIST www.FireDistrictl.org Fax (425) 551-1272
FREQUENCY STATION & SHIFT
LOCATION: 238M Ednmttds Way 08U6 A 20-D
SCHEDULED
BUSINESS NAME: No Narmi Apb. PHONE: 1) DATEDUE �NDV2013
MAILING U F I R
ADDRESS: 2�930 Edrmrhis \Nay, Edamrmfi., WA 53102b
BUSINESS OWNER: HOME PHONE:
EMERGENCY-1: Jushw HOME PHONE: CURRENT' YES NO
KEY ACCESS-2: HOME PHONE: CITY
BUSINESS
EMAIL: LICENSE
INITIAL INSPECTION DATE
N CONTACTED:
FINSPECTOR: Aff, I- 7-1,Y
FIRE SYSTEMS; FE -1 tf
HAZARPS �OUND AND LOCATIONS / COMMUNICATIONS
2
2
3
3
4
4
5
5
6
6
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
lst RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
D E DUE:
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
I
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
E:
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
8
18
DATE,
DISPOSITION:
7
LETTER NEEDED E] YES F-1 NO
-4
LETTERNEEDED [-] YES El NO
8
FIRE DEPARTMENT COPY
Serving Briet; Edmonds
sH
SNOHOMISH Co.
,,FI
Mountlake Terraceand
5TIM
the Town of Woodway
"T*www. FireDistrict].
.STRi'l
org
I
LOCATION:
23830 Edmonds Way
BUSINESS NAME:
No Name Apts
MAILING
23830 Edmonds Wy
ADDRESS:
Edmonds
BUSINESS OWNER:
Joshua
EMERGENCY-1:
KEY ACCESS-2:
I
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
-SYSTEMS:
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-12 72
PHONE:
98026
HOME PHONE: 2062273778
HOME'PHONE:
HOMIf PHONE:
FIRE PREVENTION
INSPECTION REPORT
EIEDMONDS
Cl BRIER
0 WOODWAY
[I MOUNTLAKE TERRACE
0-UNINCORPORATED
FREQUENCY
STATION & SHF-r-'s
365
20 B
SCHEDULED 11/01/11
DATE DUE
UFIR 1, 422
11105
ACTIVE
CURRENT
CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
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
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:
I
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
2A E:
DATE:
3
VIOLATIONS
1 15
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
4.,
8
4
18
bATE-
DISPOSITION:
7
LETTER NEEDED E] YES El NO
LETTER NEEDED C] YES El NO
r
8
FIRE DEPARTMENT COPY
FIRE PREVENTION
CITY OF EDMONDS ......... 'SAFETY SURVEY
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FIRE DEPARTMENT
S9
FREQUENCY ION & &
LOCATION: 23830 Edmonds Way 365 sTAT20 A
BUSINESS NAME: No Name Apts PHONE: SCHEDULED
DATE DUE 11 11101/10
MAILING 23830 Edmonds Wy LIFIR 11, 422 11105
ADDRESS: Edmonds 98026
f
BUSINESS OWNER: Joshua HOMEPHONE: 2062273778 ACTIVE
EMERGENCY-1: HOME PHONE:
KEY ACCESS-2: HOME PHONE:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS:
INITIAL INSPECTION DATE
12-/Z -T / I C)
FE 011 10.—
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
1 N (3 U wv
ENTER CODE ONLY ONCE I�
VIOLATION CODE
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
lst RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
1
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
3
VIOLATIONS
5
VIOLATIONS
5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
-1
2
6
DATE:
CODE
SECTION:
5
6
3
7
3
7
RETURN RECEIPT
RECEIVED
7
v
4
16
14
8
1 DATE:
DISPOSITION:
8
�IUETTERNEEDED E] YES NO
LETTER NEEDED Ej_ YES _] NO
F
FIRE DEPARTMENT COPY