267 4TH AVE S (2)00
FX
Serving Brier, Edmonas, �nd
ANOHA11SH CO.
1WTIR 1W- Mountlake Terrace
-DIST www. . FireDistrictl.org
LOCATION: 267 4 th Avenue S 98020
BUSINESS NAME: Edmonds Condos
MAILING
ADDRESS:
q BUSINESS OWNER:
EMERGENCY-1:
kEY ACCESS-2:
EMAIL:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE SYSTEMS: FA 6/15 FIE 2/17 12:00:00 AM
# — I
'FIRE
PREVENTION
12425 Meridian Ave S
INSPECTION REPORT
Everett, WA 982081'-;
\J�(EDMONDS
0 BRIER
Phone (42�) 551-1200
0 MOUNTLAKE TERRACE
[I UNINCORPORATED
Fax (425) 551-1272
PHONE: 4256403411
HOME PHONE:
IiT-� 79
HOME PHONE:
HOME PHONE: 17
FREQUENCY
Annual 17-B
.1 STATION& SHIFT"'
SCHEDULED Apr 2017
DATE DUE
423202
UFIR 0
CURRENT
CITY YES 0
BUSINESS
LICENSE 1:1 M
INITIAL INSPECTION DATE
t*- :3- 1-7-
SNO
F
D
Serving Brier, Edmonds, and 12425 Meridian Ave S
Mountlake Terrace Everett, WA 98208
Phone (425) 551-1200
www.FireDistrictl.org Fax (425) 551-1272
LOCATION:
267 4 th Avenue S 98020
BUSINESS NAME:
Edmonds Condos
MAILING
ADDRESS:
BUSINESS OWNER:
lz� . .
,
.EMERGENCY-1:
KEY ACCESS-2:
EMAIL:
01
PERSON CONTACTED:
FIRE PREVENTION
INSPECTION REPORT
OeDMONDS
0 BRIER
0 MOUNTLAKE TERRACE
[I UNINCORPORATED
UENCY I STATION &SHIFT
PHONE:
��25640341�) Apr 2016
LIFIR 423202
HOME PHONE:
U/0V
HOME PHONE: CURRENT YES NO .
HOME PHONE: CITY
BUSINESS
00 LICENSE 1:1 0
INITIAL INSPECTION DATE
NAME OF INSPECTOR: T �_ S_ —
Z- 4
FIRE SYSTEMS: FA 6/15 FE 3/1 . 4. 1A -e / led L4
r.7A. t �_ f__
-UM!MPZ',9TO)�TiMb"Ailflqg&ATIONS / COMMUNICATIONS
2 A/0 CIA11F �V47 446 6- �IAI_SW�V�J?e�
2
J�
3
-CAU, m6riLk-
4
4
5 "Z
5
6
6
Q�
7
7�
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN T
In our continuing effort to promote fire safety and prevention within the community, you4�rtment conducts
regularly scheduled "Fire Safety Survey Inspections" of all businesses and multi -family occupancies in the Cities
covered by Snohomish County Fire District 1.
You are to be congratulated on the relative good condition of your occupancy in regards to fire safety. Above you
will find the item(s) that were noted during, our inspection which require attention to bring them into compliance
with the minimum standards adopted by the above jurisdictions.
Any overlooked hazards or violations of the fire regulations does not imply approval of such conditions or vio tion.
If you require additional information or to schedule a re -inspection for Edmonds, call (425) 775-7720, for
Mountlake Terrace or Brier, call (425 )744-6231.
SNOHOMISH COUNTY FIRE DISTRICT ONE
CITY'S OF BRIER, EDMONDS & MOUNTLAKE TERRACE FIRE
WATCH
Snohomish County Fire District One and the Snohomish County Fire Marshals office have
prepared the following information to assist in clarifying the requirements and responsibilities of
maintaining a continuous and systematic surveillance of a building.
FIRE WATCH REQUIREMENTS
A fire watch will be required to be maintained whenever a fire alarm system and/or sprinkler
system has been identified as in either in "trouble" status or the system has been shut down.
The fire code specifically requires that fire alarms and sprinkler systems be maintained as they
were installed for protection of human lives and to minimize property damage in the event of a
fire (NFPA 72 and NFPA 13).
OWNER RESPONSIBILITY
— Immediately contact the alarm company to have the alarm repaired. The name and phone
number of the alarm company is on the annual inspection report or it can usually be located on
the service tag on the alarm panel and sprinkler riser.
— Notify the tenants in the building that the fire alarm and/or sprinkler system is being repaired
and in the event of a fire to call 911. If tenants are not at home place, notices need to be placed
on the doors explaining what the situation is and what to do while the alarm and/or sprinkler
system is being re-established.
— Immediately start a fire watch. The frequency of the fire watch shall be based on the type of
occupancy:
* Institutional, assembly, or education occupancy shall be conducted on a continuous
schedule and not to exceed more than 15 minutes between inspections.
* Hotel, motel, apartment and condominium occupancies shall be conducted no less than
every 60 minutes.
— A written log needs to be maintained of the fire watch activities. This log should include the
date, time and names of the person or persons conducting the fire watch.
Once the alarm and/or sprinkler system has been restored call (425) 551-1980 and leave a
voicemail message. Include contact information and the Deputy Fire Marshal will make contact
as soon as possible.
Obtain the report from the person that repaired the alarm system and/or sprinkler system,
stating that the alarm and/or sprinkler system has been fully restored.
Serving Briet: Edmonds, and
SNOHOMISH CU.
FIRE, Mountlake �errqce
DISTR-T ww,,wFireDistrict].org
LOCATION: 267 4 th Aven ue S 98020
BUSINESS NAME:
MAILING
ADDRESS: wa �) I)TI) t'� Co �j \f� 0
BUSINESS OWNER: J\j 1,
EMERGENCY-1:
KEY ACCESS-2:
EMAIL:
PERSON CONTACTED: All b�
NAME OF INSPECTOR: IdA A (� ., i
NV
FIRE PREVENTION.-
)i46PECTION REPORT
12425 Meridian Ave S EIEDMONIJS
Everett, WA 98208 0 BRIER
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
El UNINCORPORATED
Fax (425) 551-1272
PHONE: 4256403411
HOME PHONE:
HOME PHONE:
HOME PHONE:
FREQUENCY ION & SHIFT"
Annual 17-D
SCHEDULED Apr 2015
DATE DUE
U F19 0 423202
CURRENT
CITY
YESAII*I�NO
BUSINESS
El El
LICENSE
INITIAL INSPEqTION Q�TE
._AA
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
1
41 �.A. A Se P-OLC
(5-A-aNG E
C>(
14
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
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED,
PERSON
CONTACTED:
PERSON
CONTACTED:
77
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
D 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
4
'8
DATE:
DISPOSITION:
7
LETTER NEEDED [] YES NO
I LETTER NEEDED E] YES El NO
8
FIRE DEPARTMENT COPY
SNOHOMISH CO.
d 7 / q
Serving Brier, Edmonds, and
Mountlake T�rrace
www.FireDistrictl.org
LOCATION: 271 4 th Avenue S 98020
BUSINESS NAME: Seaside Aptartments
MAILING
AD . DRESS: 271 4th Avenue S, Edmonds, WA 98020
BUSINESS OWNER:
.EMERGENCY-1:
Nute, Tom/Anita
KEY ACCESS-2:
EMAIL:
PERSON CONTACTED:
NAME OF INSPECTOR: 7_1
FIRE SYSTEMS: FE 4/14 FD Lk �ox
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE: 3602936224
HOME PHONE:
HOME PHONE: 3602936224
HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
OEDMONDS
[3 BRIER
0 MOUNTLAKE TERRACE
[3 UNINCORPORATED
FREQUENCY - [STATION &SHIFT
17_
Annual 17-A
SCHEDULED
DATE DUE ' Apr 2016
UFIR 0 422202
A/- '005.0y_j,
CURRENT YES NO .
CITY t.
BUSINESS
LICENSE
INITIAL INSPECTION DATE
02191
1_26t S@PAdGQd' == 's I I
HAZARDS FOUND AND LOCATIONS/ C MMUNICATIONS
6' Y
2
2
3
_4
5
3
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
In our continuing effort to promote fire safety and prevention within the community, your fire department conducts
regularly scheduled "Fire Safety Survey Inspections" of all.businesses and multi -family occupancies in the Cities
covered by Snohomish County Fire District 1.
You are to be congratulated on the relative good condition of your occupancy in regards to fire safety. Above you
will find the item(s) that were noted during. our inspection which require attention to bring them into c H
with the minimum standards adopted by the above jurisdictions.
Any overlooked hazards or violations. of the fire regulations does not imply approval of such conditio::ion.
If you require additional information or to schedule a re -inspection for Edmonds, call (425) 775-7720; for
Mountlake Terrace or Brier, call (425) 744-6231.
2030 Airport Way S, Seattle WA 98144 Certification Given:
NA PH: 206-328-3288 FAX: 206-322-7214
WASHINGMNALARM N"vw.washingtonalarm.com White7Yello-f7l RedF
WASHIA12820
Fire Alarm Confidence Test Report
Central Station Transmitter Test Report
SWF Test Report
Lj
Jurisdiction: Edmonds
Name of Facility: Seaside Apt
Central Station Acct #: 1010008
Address: 271 4th Ave S.
UL Cert #:
Type of Test:
Monthly
F-1
I
Bi-Monthly
Qua rlyF]
I
Semi Annual
F-1
Annuall
7
AcceptanceF]
Voltage:
Battery 13.0 volts
Charge Circuit 13.3 Volts
Battery Voltage under Full Load 12.9 Volts
Item
Yes
0
em
es
0
em
es
0
Loss ofAC Results in
Trouble Signal @keypad
W]
I
L1
Circuits Checked for
I Electrical Supervision
F-1
Key to Panel Available
I
V/
11
_11-1
System Operates on AC
Power
Control Panel Tested per
NFPA & Mgfs Specs
7
F-1
Operating Instructions at
Panel
v/
F-1
System Operates on
Standby Powe
7
1
F-1
F-1
Auxiliary Equip Operates
(Elev/Fans/etc)
F-1
F-1
F71
Test Record Posted at Panel
VE.
Signals Operate on AC
Power
V
-1
FT
F-1
" Alarm Silence" Results in
Trouble Signal
F�
Signals Received at
Monitoring Station
Z
F
Signals Operate on Standby
Power
W]
11-11
[1
Ground Fault Exists on
1 System
I
I I
W1
F]
# Smokes Cleaned
0
Fire Alarm Control Panel Mfg: Model:
Radionics
8012
# of Initiating Circuits: #
7 11
of Signaling Circuits:
Central Station Transmitter Mfg: (if Model:
different)
# of Initiating Circuits: #
of Signaling Circuits:
TYPE OF EQUIPMENT
4 of Units
S tisfactory
TYPE OF EQUIPMENT
# of Units
Satisfactory
In Bldg T
—Tested
Yes
I No
I NIA '
In Bldg
Tested
Yes
No
N/A
Bells
F]
I F1
—
I
Sprinkler Waterflow
Switches Electronically
1
11
Homs
5
5
�]f
—1
F
Sprinkler Supervisory
Switches Electronically
H
F] I
Strobes
I-J
U
Ventilation Controls
ODerate
F1
I I
L
Horn / Strobes
E
Annunciators Facp
V/
1:11F
1
Trouble Indicators
1
1
17
F-1
I
F I
Elevator Recall
7
F-1 I
Heat Detectors
3
3
Fire & Smoke Dampers
—1
F I
Smoke Detectors
5
5
PhoneJacks
A
E I
F I
Smoke Beams
Auto Door Release
Manual Pull Stations
Other
-HE
This is to certify that this Fire Alarm System / Central Station Transmitter has been properly tested and inspected for reliability to cover the items listed in this report, is
consistent with Fire Alarm Maintenance Standards / Manufacturers Reauirements. and all corrections have / have not been made.
Testing Agent - Printe-d- Robert Huynh
Test . ing Agent - Signature:
Robert Huynh
SFD Exam Cert #:
H-08647
Date:
12/29/16
Problems Found:
Corrections Made:
Date Made:
Additional Notes:
System on 1 phone line, maybe grandfathered in or non required
Panel Location:
Between storage units 3-4
uia noi receive AC; iroUDie signal
Horn circuit not supervised
F4
D,
Servin'g� Brier, Edmonds, 'and
Mouptl.ake Terrace
www.FireDistrictl.6rg
FIRE PREVENTION
12425 Meridian Ave S
INSPECTION REPORT
Everett, WA 98208
EDMONDS
9 BRIER
Phone (425) 551-1200'
[3 MOUNTLAKE TERRACE
[3 UNINCORPORATED
Fax (425) 5514272
STATION& SHIFT-\
FREQUENCY
LOCATION:
.315 5 th Avenue S Suites A-D 98020 4:7 9
,11,r r
BUSINESS NAME: PHONE: SCHEDULED
5'DATE DUE 11'
Paktia Pharmacy LLC 4254t9Ttm Aw-DU:16
MAILING LIFIR 0
ADDRESS: 543203
315 5th Avenue S, Suite C, Edmonds, WA 98020
BUSINESS OWNER: HOME PHONE: //z
Jamali, Rashid
HOME PHONE: "'CURRENT
EMERGENCY-1: %
KEY ACCESS-2: HOME PHONE: 4252523626. CITy YES NO
EMAIL: BUSINESS M, D
LICENSE ?!L\i
INITIAL INSPECTION DATE
PERSON CONTACTED: A LX
NAME OF INSPECTOR: MCI b.),q,,J --At JZ4 /1 -7 r\ I i
FIRE SYSTEMS:. FEOJa—"
I)eJBtxL9Wwvm-sbcbcATiONlS
2
COMMUNICATIONS
2
3
-2-
3
4
4
6
5
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
#4
lst RE -INSPECTION
2ATE DUE
2nd RE -INSPECTION
DATE DUE:
,
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
.SCNTAC�ED
INSPECTOR:
PERSON
CONTACTED:
PERSON
CONTACTED -
2
INSPECTOR:
INSPECTOR:
DATE:
DATE:
DATE:
VIOLATIONS
2 6
VIOLATIONS'
PRE -CITATION
LETTER SENT-
CITATION ISSUED
NUMBER:
/4
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
8
4
18
DATE:
DISPOSITION:
7
\1 LETTER NEEDED [] YES NO
LETTER NEEDED E] YES [I NO
1
8
®rom�t
ti Serving Briei; EdWonds, and 12425 Meridian Ave S
SW0HQMI&H-�G0.'
Mountlake Terrace Everett, WA 98208
RE t,
Phone (425) 551-1200
DISTRnILU 'www.FireDistrict].org Fqx (425�,'
i551-12 72
271 4 th Avenue S 98020
LOCATION: 4
Seaside Aptartments 3602936224
BUSINESS NAME: PHONE'
%111 ,,"MAILING j
271 4th Avenue S, Edmonds, WA 98020
ADDRESS:
BUSINESS OWNER: HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
RIER
0 MOUNTLAKE TERRACE
[I UNINCORPORATED
FREQUENCY I STATION 1, SHIFT
Ann 17-D
I SCHEDULEDApr 2015
DATE DUE ktN�
1,422 20:2\-,,,
I WF1 �_; _ j
EMERGENCY-1: Nute, Tom/Anita HOME PHONE: 3602936224 '-CURRENT
KEY ACCESS-2: HOME PHONE: CITY YES NO
BUSINESS
EMAIL: LICENSE
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPEcToR:14A*�
--A&,,, T _�f _� -1 1 1 1 1 Q FD Lk box
To A,, tm VA- 1110
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
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS -
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
I VIOLATIONS
15
1 VIOLATIONS
5
PRE -CITATION
LETTER SENT
NUMBER: CITATION ISSUED
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
4
18
INO
DATE,
DISPOSITION:
7
LETTER NEEDED E] YES El NO
LETTER NEEDED 0 YES
r
8
FIRE DEPARTMENT COPY
NA
WASHINGMNALARM
2030 Airport Way S, Seattle WA 98144
PH: 206-328-3288 FAX: 206-322-7214
www.washingtonalarm.coill
WASHIA12820
Certification Given:
White)�—Yellow 0 Red E]
Fire Alarm Confidence Test Repo�5�
Central Station Transmitter Test R epor��
SWF Test Report El
Jurisdiction: 5� A&D A
Name of Facility: AP6
Central Station Acct /6/000
Address: 141 - -
7
UL Cert #:
Type of Test:
Monthly
Bi-Monthly
Quarterly
Semi Annual ;0
Annuali,,��
Acceptance
Voltage:
Battery-L't, Volts
Charge Circuit volts
Battery Voltage under Full Load Volts
Item
Yes
No
N/A
Item
Yes
No
N/A
Item
Yes
No
N/A
Loss of AC Results in
Trouble Signal'i�
Circuits Checked for
Electrical Supervision e
Key to Panel Available
>
System Operates on AC
Power
Control Panel Tested per
NFPA & Mgfs Specs
Operating Instructions at
Panel
System Operates on
Standby Power
Auxiliary Equip Operates
(Elev/Fans/etc)
z�-Test
Record Posted at Panel
>
Signals Operate on AC
Power
"Alarm Silence" Results in
Trouble Signal
Signals Received at
Monitoring Station
Signals Operate on Standby<
Power
Ground Fault Exists on
System
# Smokes Cleaned
Fire Alarm Cyntrol Panel Mfg:
RA-, 1\> Ai C-45
Model:
1 i5c>t
# of Initiating Circuits: -7
# of Signaling Circuits:
I
Central Station TrInprititter Mfg: ff
d�fferent)
Mode 1 1:
# of Initiating Circuits: f tl
# of Signaling Circuits:
TYPE OF EQUIPMENT
# of Units
S tisfactory
TYPE OF EQUIPMENT
# of Units
Satisfacto y
In Bldg
Tested
Yes
No
N/A
In Bldg
Tested
Yes
No
N/A
Bells
Sprinkler Waterflow
Switches
Horns
Sprinkler Supervisory
Switches
Strobes
Ventilation Controls
Operate
Hom / Strobes
Annunciators
Trouble Ind* t
Alcoars
Elevator RecAll
Heat Detectors
Fire & Smoke Dampers
Smoke Detectors
Phone Jacks
Smoke Beams
Auto Door Release
r!�� Pull Stations
Other
This is to certify that this Fire Alarm System / Central Station Transmitter has been properly tested and inspected for reliability to cover the items listed in this report, is
consioent with Fire Alarm Maintenance Standards I Manufacturers Reouirements- and all corrections have / have not been. made.
Testing Agent — Printed:
Testing Agent — Signat
SFD Exam Cert
0
Date:
Problems Found:
Corrections Made:
M-41
Date Made-
IV, iv( y
nu
Additional Notes:
0 ktl 6e
Panel Location:
h2y( LAI
llo-�
Cu�rlus
ha_� �ALYQ Ay01V11'S%Aj 1A (M&4 Z�,6
FIRE PREVENTION
Serving Brier, Edmonds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
DEDIVIONDS
Mountlake Terraceand
FIRE
'RhIll
Everett, WA 98208
0 BRIER
the Town of Woodway
DISr""Rit
Phone (425) 551-1200
El WOODWAY
0 MOUNTLAKE TERRACE
www.FireDistrictl.org
Fax (425) 551-1272
0 UNINCORPORATED
FREQUENCY STATION & SHIF"
LOCATION: 271 4th Avenue
S
366 17 6
I
BUSINESS NAME: Seaside Aptartments
PHONE: 3602936224
SCHEDULED
DATE DUE 11' 04/01113
MAILING ill 8 Doon Way
LIFIR 0 422 4202
ADDRESS: Anacortes
98221
BUSINESS OWNER: Nute, Tofn/Anita
HOME PHONE: 3602936224
EMER GENCY-1: Staats, Ken/Olive
HOME PHONE: 4257741516
—'s
" CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
LICENSE
PERSON CONTACTED: pi r) Q a-i -\ ",-C T
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
/ -7
FIRE FA 9/12 FD CkBx-Access off Alley
FE
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
"j (3
2
2
3
r
31
4
4
L
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE -INSPECTION
FINAL RE
EXTENSION
-INSPECTION
VIOLATIONS
DATE DUE:
DATE 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:
7
4
18
4
18
DATE:
LETTER NEEDED [] YES NO
LETTER NEEDED F] YES NO
8
FIRE DEPARTMENT COPY
__4 0 ��_
Serving Briet: Edmonds
12425 Meridian Ave S
SNOHOMISH CO.
Mountlake Terraceand
FIRE
Everett, WA 98208
the Town of Woodway
S T R, T
Phone (425) 551-1200
Fax
www.FireDistrictl.org
(425) 551-1272
LOCATION: 271 4th Avenue
BUSINESS NAME: Seaside Aplartments
3602936224
PHONE.
MAILING 5118 Doon Way
ADDRESS: Anacorles
9'8221
BUSINESS OWNER: Nute, Tom/Anda
HOME PHONE. 3602936224
EMERGENCY-1: Slaals, Ken/Olive
4257741516
HOME PHONE:
KEY ACCESS-2:
HOME PHONE:
PERSON CONTACTED
NAME OF INSPECTOR
FIRE FA 9/
SYSTEMS:
(�, 1, �. f- A, � 7 C).
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
0 WOODWAY
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY STATION & SH1FT_*'
366 1 -17 A
SCHEDULED 04/01/12
DATE DUE �
UFIR 1, 422 4202
ACTIVE
CURRENT
CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
ANNUAL
HAZARDS FOUND AND L IONS/COMMUNICAT
1 07i o
NS
1
2
2
3
3
4
4
5
5
6
6
7
7
1 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:
I
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:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
8
4 18
DATE:
DISPOSITION:
7
\� LETTER NEEDED C] YES C3 NO
I LETTERNEEDED [] YES NO
8
FIRE DEPARTMENT COPY
WASHINGTON ALARM, INC. FOR THE CITY OF
1253 South Jackson Street
Seattle, WA 98144
Ph. (206) 328-1800 - FAX (206) 328-6755
Electrical Contractor's License No. WASHIA1282C3
SFD Examination Certificate No. :� __151 I/ UL Certificate N
J6K FIRE ALARM SYSTEM CONFIDENCE TEST REPORT
A CENTRAL STATION TRANSMITTER TEST REPORT
Central Station Account No.
Occupied as (major tenanA) E'Oce _)t C(C in!;eZ LA
Address 27 zip Cd.
Phone No.
Fire Department representative present r-L" �,F_
No. of initiating circuits No. —grialing circuits
Type of test Monthly ID Quarterly Semi -Annual Annual Accept
Fire control panel manufacturer
. enLra Station transrrdr�tr, manufacturer —
Battery voltage — I - 4� - C volts' *
Model No. Z.
Model No. If
Battery charger voltage volts
Battery voltage under alarm load (with horns/bells sour
Transmitter tripped by which initiating circuit
Smoke detectors cleaned?
System operates on AC power
"Alarm Silence" results in tbl. sig.
Loss of AC results in trouble signal
volts
1_�
CENTRAL STATION
FIRE CONTROL PANEL TRANSMITTER
Alyes ID No El. NA aYes
C3 Yes D No W-NA 0 Yes
Yes 0 No ID NA ii�"Yes
System operates on battery
Yes
No
ID
NA
Ja Yes
All circuits checked for elec. supv.
Yes
No
C3
NA
Z�k Yes
Test meets manufacturer's specs.
oO Yes
C3 No
ID
NA
0--Yes
All auxiliary equipment operates
Yes
C3 No
NA
Key to fire control panel available
Yes
El No
NA
Operating instructions posted
Yes
IJ No
NA
Test record posted at control panel
Yes
ID No
NA
Yes
Automatic time delay of general alarm
minutes
Time initiated /3
Time received by Central Station
-Ile
EQUIPMENT TESTED
No
No
No
No
C3 No
E) No
0 No
TYPE OF EQUIPMENT
NO. OF UNITS
TESTED
SATISFACTORY
YES NO NA
NO. OF UNITS
IN BUILDING
Be]IZH.mTChimes, Voice Alarms, Speakers, Water Gongs
Visual Alarm Devices
Trouble Indicators
Heat Detectors
Smoke Detectors. -
Smoke Beams
Sprinkler Waterflow Alarms
Sprinkler Supervisory Switches
Manual Pull Stations
Ventilation Controls Operate
Annunciators
Elevator Recall
Fire Dampers/Smoke Dampers
Phone Jacks
Automatic Door Release
Other
THIS IS TO CERTIFY THAT THIS FIRE ALARM SYSTEM/CENTRAL STATION TRANSMITTER H AS BEEN PROPERLY TESTED AND INSPECTED FOR
RELIABILITY TO COVER THE ITEMS LISTED IN THIS REPORT, IS CONSISTENT WITH FIRE ALARM MAINTENANCE STANDARDS/MANUFACTURER'S
REQUIREMENTS, AND ALL CORRECTIONS HAVE/HAVE NOT BEEN MADE.
Signature of Inspector Date
Signature of Owner's Representative
Problems Found
Corrections Made
Date Corrected By
WASHINGTON ALARM, INC. FORTHECITYOF EDY0045
1253 South Jackson Street
Seattle, WA 98144
Ph. (206) 328-1800 * FAX (206) 328-6755
Electrical Contractor's License No. WASHIAI282C3
SFD Examination Certificate No. a- -6� T�, ( UL Certificate No.
0 FIRE ALARM SYSTEM CONFIDENCE TEST REPORT
Eff CENTRAL STATION TRANSMITTER TEST REPORT
Central Station Account No. 101dQ10 I&'
Occupied as (major tenant) _SCA516C AMAPICAJS
2-// 4
Address /7-41 A JIZ5' __ZipCd._0J9102() —Phone No.(�;60� 2,q
Fire Department representative present
No. of initiating circuits No. of signaling circuits
Type of test Monthly Quarterly ID Semi -Annual ji;i Annual 0 Accept
Firp-contro.1 panelmanufacturer Model No.
Central Station transmitter manufacturer Model No.
Battery voltage volts Battery charger voltage volts
Bat— volta - und— Marm I f -4-1, 1, /11 11 A.—
.7 5 - — -- - . soun g/
Transmitter tripped by which initiating circuit— 5",%QLy_S
Smoke detectors cleaned? A'
System operates on AC power
"Alarm Silence" results in tbl. sig.
Loss of AC results in trouble signal
System operates on battery
All circuits checked for elec. supv.
Test meets manufacturer's specs.
FIRE CONTROL PANEL
Yes
No
Yes
No
Yes
No
Yes
No
91 Yes No
49 Yes No
All auxiliary equipment operates
Yes
No
Key to fire control panel available
Yes
No
Operating instructions posted
OF Yes
No
Test record posted at control panel
C5 Yes
No
Automatic time delay of general alarm
minutes
zio " ? —
Time initiated 5 —
Time received by Central Station
EQUIPMENT TESTED
vo ES
NA
NA
NA
NA
NA
NA
C2F NA
NA
NA
NA
_3S7
CENTRAL STATION
TRANSMITTER
8 Yes
0 Yes
0 Yes
(a Yes
12r Yes
12 Yes
0 Yes
0 No
No
No
No
No
No
1:1 No
TYPE OF EQUIPMENT
NO. OF UNITS
TESTED
SATISFACTORY
YES NO NA
NO. OF UNITS
IN BUILDING
Bells, ld2�j�, Chimes, Voice Alarms, Speakers, Water Gongs
Visual Alarm Devices
Trouble Indicators
Heat Detectors
Smoke Detectors
Smoke Beams
Sprinkler Waterflow Alarms
Sprinkler Supervisory Switches
Manual Pull Stations
Ventilation Controls Operate
Annunciators
Elevator Recall
Fire Dampers/Smoke Dampers
Phone jacks
Automatic Door Release
Other
STATION TRANSMITTER HAS BEEN PROPERLY TESTED'AND INSPECTED FOR
RELIABILITY TO COVER THE ITEMS LISTED IN THIS REPORT, IS CONSISTENT WITH FIRE ALARM MAINTENANCE STANDARDS/MANUFACTURER'S
REQUIREMENTS, AND ALL CORRECTIONS HAVE/HAVE NOT BEEN MADE.
Signature of Inspector
Signature of Owner's Representative
Problems Found
Corrections Made
Date 9- 7- //
Date Corrected By
"'7)
CITY OF EDMONDS
121-5TH AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FIRE DEPARTMENT
LOCATION: 27 1 4th Avenue S
BUSINESS NAME: Seaside Aptartments
MAILING 5118 Doon Way
FIRE PREVENTION
SAFETY SURVEY
PHONE: 3602936224
ADDRESS: Anacorles 98221
BUSINESS OWNER: Nute, Tom/Anita HOMEPHONE: 3602936224
EMERGENCY- 1: Staats, Ken/Olive HOMEPHONE: 4257741516
KEY ACCESS-2: HOME PHONE:
FREQUENCY
STATION & SHIFT
366
17 D
SCHEDULED
DATE DUE 10
04/01/11
UFIR 0, 422
4202
ACTIVE
I kL INSP 'k
ECTIONPATE
NITIj
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE FA 3/05 FE _C11-0
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE 11�
VIOLATION CODE
2
2
3
3
4
4
6
6
7
7
8
8
'Ist 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:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE-CRATION
LETTER SENT
CITATION ISSUED
NdMBER:
2
6
2
6
DATE:
CODE
SECTION:
5
3.
7
3
7
RETURN RECEIPT
RECEIVED
6
7
4
18
4
18
DATE:
DISPOSITION:
11 LETTER NEEDED EI YES NO
LETTER NEEDED E-1 YES E] NO
FIRE DEPARTMENT COPY
WASHINGTON ALARM, INC. FORTHECITYOF
1253 South Jackson Street
Seattle, WA 98144
Ph. (206) 328-1800 FAX (206) 328-6755
Electrical Contractor's License No. WASHIAI282C3
SFD Examination Certificate No. 6�_061921( UL Certificate No.
FIRE ALARM SYSTEM CONFIDENCE TEST REPORT
CENTRAL STATION TRANSMITTER TEST REPORT
Central Station Account No. /6 1A /,) 40 ITS,'
Occupied as (major tenant) 5105-C6br_
Addres.% 2_Z/_ 4/7// 414!�� 5 ZipCd._!99-02-0 —PhoneNo. 36
Fire Department representative present IF-,-, f !M
No. of initiating circuits No. of signaling circuits Avi
Type of test Monthlv Quarterly ID Semi -Annual 12 Annual ID Accevt
Fire control panel manufacturer rJ
Central Station transmitter manufacturer
Battery voltage 12 6, volts Battery charger voltage
Battery voltage under alarm load (with horns/bells soun(
Transmitter tripped by which initiating circuit A;
Model No.
Model No.
volts
volts
CENTRAL STATION
A-
FIRE
CONTROL PANEL
TRANSMITTER
Smoke detectors cleaned? /J
System operates on AC power
Yes
U No
NA
[a Yes
0
No
"Alarm Silence" results in tbl. sig.
Yes
No
NA
Yes
(2
No
Loss of AC results in trouble signal
Yes
No
NA
Yes
0
No
System operates on battery
Yes
No
NA
Yes
U
No
All circuits checked for elec. supv.
1�5 Yes
D No
Ll
NA
�9 Yes
0
No
Test meets manufacturer's specs.
Yes
No
ID
NA
Yes
No
All auxiliary equipment operates
Yes
No
NA
Key to fire control panel available
Yes
No
NA
Operating instructions posted
Yes
No
NA
Test record posted at control panel
Yes
No
NA
Yes
No
Automatic time delay of general alarm
minutes
Time initiated Time received by Central Station
EQUIPMENT TESTED
TYPE OF EQUIPMENT
NO. OF UNITS
TED
SATISFACTORY
YES NO NA
NO. OF UNITS
IN BUILDING
Chimes, Voice Alarms, Speakers, Water Gongs
Visual Alarm Devices
ek—
Trouble Indicators
Heat Detectors
Smoke Detectors
Smoke Beams
Sprinkler Waterflow Alarms
Sprinkler Supervisory Switches
Manual Pull Stations
Ventilation Controls Operate
Annunciators 1p� ce
Elevator Recall
Fire Dampers/Smoke Dampers
Phone Jacks
Automatic Door Release
Other
THIS IS TO CERT71FY THAT THIS FIRE ALARM SYSTEWCENTRAL STATION TRANSMITTER HAS BEEN PROPERLY TESTED AND INSPECTED FOR
RELIABILITY TO COVER THE ITEMS LISTED IN THIS REPORT, IS CONSISTENT WITH FIRE ALARM MAINTENANCE STANDARDS/MANUFACTURER'S
REQUIREMENTS, AND ALL CORRECTIONS HAVE/HAVE NOT BEEN MADE.
Signature of Inspectort;p�, �1_ oe
Signature of Owner's Representative
Problems Found
Corrections Made
Date q-3-ld
Date Corrected
By
SNOHOMISH CO. 1'�
Servino, the cities ofBrier, Edmonds, Mountlake Terrace,
FIR
DISTR and town of Woodway
MEMORANDUM
DATE d 1 (5 1 ��t .
I.D.
L"4.� ItL'A ? k
REPORTED BY OF rX _'A'1
SUBJECT
ADDRESS:
CONCERNS/ A'6� t,45 rv—
HAZARDS:
VtS (T_ -170 '575T6- n.,V cL'-'r
&.e_ I p9i ctT,_&-J cF F;j- �� c-75:�L� A
INITIALS
FOLLOW-UP:
7
"�7-1 LL_ I,<-
6::�Z V I
C'+-t-L"D 57-u1'L'-1 7c,> -4 1 �eu SS-.
HOLirs Expended:
SIGNED
Er&T,,,4A,
14
Fire Marshal, 121 5"' Ave N, Edmonds, WA 98020 / 425-771-0213 / (0 425-775-7721. �lilttp://www..firedistTictl.orL,
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
S
LOCATION: 271 4th Avenue
BUSINESS NAME: Seaside Aptartments
MAILING 5 118 Doon Way
FIRE PREVENTION
SAFETY SURVEY
PHONE: 3602936224
ADDRESS: Anacorles 98221
BUSINESS OWNER: Nute, TomlAnda HOMEPHONE: 3602936224
EMERGENCY-11: Staats, Ken/Olive HOMEPHONE: 4257741516
KEY/,ACCESS-2: HOME PHONE:
FREQUENCY
STATION& SHIFT
366
17 C
SCHEDULED
DATE DUE 1�
W01110
UFIR � 422
4202
ACTIVE
01 PE I RSON CONTACTED: cv INITIAL INSPECTION DATE
NAML,OF INSPECTOR:
FIRE FA 3105 FE
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
3
ENTER CODE ONLY ONCE
VIOLATION CODE
2
3
4
4
5
5
6
6
7
8
7
8
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE.
PERSON
CONTACTED:
IN PECTOR:
DATE:
VIOLATIONS
5
1 2 6
3 7
14
ILETTERNEEDED C] YES 0 NO
EXTENSION
GRANTED TO:
PRE -CITATION
LETTER SENT
DATE:
RETURN RECEIPT
RECEIVED
DATE:
FINAL RE -INSPECTION
DATE DUE:
PERSON
CONTACTED:
INSPECTOR:
E:
CITATION ISSUED
NUMBER:
CODE
SECTION:
DISPOSITION:
I
VIOLATIONS
CITED:
PERSON
CONTACTED:
1
-2
INSPECTOR:
DATE:
3
VIOLATIONS
5
4
6
5
3
7
6
7
4
18
8
LETTERNEEDED [] YES NO
FIRE DEPARTMENT COPY