318 3RD AVE S-vi . ng Briet; EOnont_ I) �5 s
9NOHOMISH CO. Meridian Ave
-Mountlake Terrcic�� veiidt,'WA 98208
FIRE- Phone (425) 551-1200
wwit�FireDistrictl.org Fax (425) 5�1-1272
DImrrR T
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
0 MOUNTLAKE TERRACE
El UNINCORPORATED
LOCATION: FREQUENCY I STATION& SHIFT-'
3 IS.3 rd Awtue.S GM21) Ant I 17-A
BUSINESS NAME: 3rdSLraeL Dcvclapmcnl,
MAILING
ADDRESS:
BUSINESS OWNER:
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EMERGENCY-1:
Burdcl.� Scall
KEY ACCESS-2:
EMAIL:
PERSON CONTACTED:
NAME OF INSPE CTOR:
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, PHONE: 42GW7.",S
HOME PHONE:
HOME PHONE: 42GE40731S
HOME PHONE:
SCHEDULED
DATE DUE *r 2014
UFIkj�, I
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CURRENT
CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
HAZARDS FOUND AND LOCATIONS/ C MMUNICATIONS
2
2
3
3
4
4
5
51
6
6
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:
DATE DUE:
GRANTEDTO:
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
1
3
7
RECEIVED
6
DISPOSITION:
4
J8
4
18
DATE:
7
LETTER NE . EDED F] YES NO
LETTERNEEDED [:] YES El NO
8
FIRE DEPARTMENT COPY
4W,
CITY OF EDMONDS
121 5- AVENUE N., . EDMONDS, WASHINGTON 98020 (425) 771-0215
FIRE DEPARTMENT
LOCATION:
318 3rd Avenue s
BUSINESS NAME:
3rd Street Development
MAILING
ADDRESS:
BUSINESS OWNER:
Burdett, Scott
EMERGENCY- 1:
Surdeft, Jerry
KEY ACCESS-2:
FIRE PREVENTION
SAFETY SURVEY
PHONE: 4256407818
HOMEPHONE: 4256407818
HOMEPHONE: 4257120538
HOME PHONE:
FREQUENCY
STATION 1, SHIFT
366
17 6
I
SCHEDULED
DATE DUE 0'
04/01/11
UFIR I� 422
4202
ACTIVE
�NITIAL NSPECTION DATE
PERSON CONTACTED: AVCA: I , A .
NAME OF INSPECTOR: C)
FIRE FE I
SYSTEMS: ANNUAL
HAZARDS FOUID AND LOCATIONS( COMMUNICATIONS
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ENTER CODE ONLY ONCE to
VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
7
8
8
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:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
5
VIOLATIONS
5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
6
6
DATE:----
CODE
SECTION:
5
3
7
-2
7
RETURN RECEIPT
RECEIVED
6
7
4
18
4
18
DATE:
DISPOSITION:
8
1,, LETTER NEEDED E] YES NO
LETTER NEEDED E] YES NO
FIRE DEPARTMENT COPY
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FIRE DEPARTMENT
4t� t
LOCATION:
318 3rd Avenue S
BUSINESS NAME:
3rd Street Development
MAILING
ADDRESS:
BUSINESS OWNER:
Burdett, Scott
EMERGENCY-1:
Burdett, Jerry
KEY ACCESS-2:
FIRE PREVENTION
SAFETY SURVEY
PHONE: 4256407818
HOMEPHONE: 4256407818
HOMEPHONE: 4257120538
HOME PHONE:
FREQUENCY
STATION& SHIFT
17 A
SCHEDULED
DATE DUE I�
94,101,110
UFIR � 422
4202
ACTWE
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PERSON CONTACTED: Ncv-�C. kvo(
NAME OF INSPECTOR: St'��ocL 0
FIRP FE -S-1 0
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS COM
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CA
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ENTER CODE ONLY ONCE I�
VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
7
8
8
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
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
7
4
18
4
8
DATE:
DISPOSITION:
8
� LETTER NEEDED I-] YES NO
JUETTERNEEDED [] YES NO
FIRE DEPARTMENT COPY
3�cl 3eo 0 El I
FIRE PREVENTION
SAFETY SURVEY
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 9802d, - (425) 771-0215
FIRE DEPARTMENT
t sl� i) , .
11 FREQUENCY
STATION & SHIFT
LOCATION:
324 3rd Avenue
366
17 6
I
BUSINESS NAME:
Burdeff Apts
PHONE: 4256407813
SCHEDULED
DATE DUE 11-
(34/01/11
MAILING
22014 98th PI W
LIFIR 0 422'
4202
ADDRESS:
Fd nwilz
QRn7n
BUSINESS OWNER: Burdeff, Jerry HOMEPHONE: 4257120538 ACtIVE
EMERGENCY-1: Third Ave Prop. Dev LLC HOME PHONE: 4256407818
KEY ACCESS-2: HOME PHONE:
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR: CT30V I '-- - I � -) 4 -
FIRE FE7 //(,) .
SYSTEMS: A14NU�11_
HAZARDS FOUND AND LPCATIONS / COMMUNICATIONS
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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
DATE 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 -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
RETURN RECEIPT
RECEIVED
6
4
18
4
18
DATE:
DISPOSITION:
_I
8
( LETTER NEEDED E] YES NO
LETTER NEEDED E] YES NO
FIRE DEPARTMENT COPY
0
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
S
LOCATION: 324 3rd Avenue
BUSINESS NAME: Burdett Apts
MAILING 22014 98th PI W
FIRE PREVENTION
SAFETY SURVEY
PHONE: 4256407818
ADDRESS: Edmonds 98020
BUSINESS OWNER: Burdett, Jerry HOMEPHONE: 4257120538
EMERGENCY-1: Third Ave Prop. Dev LLC HOMEPHONE: 4256407818
KEY ACCESS-2: HOME PHONE:
FREQUENCY
STATION & SHIF-""
366
17 A
SCHEDULED
DATE DUE 01 04/01/10
UFIR ll� 422
4202
ACTIVE
INITIAL INSPECTION DATE
PERSON CONTACTED: r '0
NAME OF INSPECTOR:
FIRE FE/J
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONI/ COMMUNICATIONS 4
1 Fo o &L
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,
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
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
7
8
4
8
DATE:
DIsposiTON:
8
LETTER NEEDED E] YES [3 NO
LETTERNEEDED [] YES NO
FIRE DEPARTMENT COPY