456 ADMIRAL WAY STE 100 (2)SNO
F
D
too
FIRE PREVENTION
S . erving Brier, Edmonds, and 12425 Meridian Ave S INSPECTION REPORT
0 EDMONDS
Mountlake Terrace Everett, WA 98208 OBRIER
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
[3 UNINCORPORATED
www.FireDistrictl.org Fax (425) 551-1272
LOCATION:
456 Admiral Way Suite 100 98020
BUSINESS NAME: PHONE:
Anthony's Beach Room
MAILING
ADDRESS:
456 Admiral Way, Suite'l 00, Edmonds, WA 98020
BUSINESS OWNER: HOME PHONE:
4257785...
FREQUENCY STATION & SHIPT`�
SCHEDULED
DATE DUE 0
Atig 2616
UFIR 0
233 -
.EMERGENCY-1: HOME PHONE: CURRENT
KEY ACCESS-2: Burns, Stev HOMEPHON . E: 2067930549 CITY YES NO
_J�a O'k BUSINESS
EMAIL: LICENSE
INITIAL WPEFno�`DATE
PERSON CONTACTED:
NAME OF INSPECTOR: 1A hV)49 Y111 1A4_,PP— fl IA, A
FIRE SYSTEMS: FE 11/13
D@A%Aam91c1Bi9DAsedocATI0NS
COMMUNicxnONS
c n
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
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. `AOv ou
will find the item(s) that were noted during. our inspection which require attention to bring them into corn ance
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 violation.
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.
45 (P
f); ._0L_ WA�
FIRE PREVENTION',;..
IN$P
Serving Brier, Edmonds, and 12425 Meridian Ave S
SNOHOMISH -ECTION REPORT
Mountlake Terrace Everett, WA 98208 ZEDMONDS
.,.,.[3BRIER
FIR
425) 551-1200 0 MOUNTLAKE TERRACE
Phone 0 UNINCORPORATED
DISTRIUT www.FireDis"t�ii"61:'4i].org Fax (425) 551-1272
FREQUENCY 7A N & SH71FT
T'O
LOCATION: 456, Admiral Way Suite �iffl 98020 U I
Ann al 17-D
BUSINESS NAME: Anthony's Beach Room PHONE: 4257785499 SCHEDULED Aug 2Q1 5
DATE DUE
MAILING UFIR o 233
ADDRESS: 456 Admiral Way, Suite 100, Edmonds, WA 98020
BUSINESS OWNER: HOME PHONE:
EMERGENCY-1: Burns, Steve HOME PHONE: 2067930549 CURRENT
KEY ACCESS-2: HOME PHONE: CITY . . . YES NO
EMAIL: !S4C,je- &fAt AIALVA\45, BUSINESS Ea,," E]
- - , I LICENSE
PERSON CONTACTED: 6WA V INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE SYSTEM S: - FE-11/13
Date Last Serviced:
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
13
2
3- -
...... ....
-------
---
4
5
51
6
7
6
7
7
I AGiREE TO cbRRECT,THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1 st RE -INSPECTION
2nd RE -INSPECTION
FINAL RE PECTION
EXTENS16
-IN
VIOLATIONS
DATE DUE:
��PUE:
GRANTEDTO:
DATE DUE.
CITED:
PERSON
PERSON
'��RSO
- -
CONTACTED:
CONTACTED:
CONTAI
INSPECTOR:
NSPECTOR:
jNSPECTOR:
2
DATE:
DATE:
DATE:
3
Viiolfifio_N6
VIOLATIONS;-
PRE -CITATION
CITATION ISSUED
15
15
SENT
NUMBER
4
CODE
DATE:
SECTION:
RETURN RECEIPT
7.
3 17
RECEIVED
DISPOSITION:
4 18
18
DATE:
7
LETTER NEEDED YES NO
LETTER NEEDED
YES NO
8
Serving Brier, Edmonds, and
12425 Meridian Ave S
SNOHOMISH Co.
Mounflake Terrace
FIR,
Everett, WA 98208
DIS R T
Phone (425) 551-1200
www'.FireDistrictl.org.
Fax (425) 551-1272
LOCATION: 456 Admiral Way"Suite 101 98020
BUSINESS NAME: Anthony's Beach Cafe
PHONE: 4257714400
-MAILING
ADDRESS: 456 Admiral Way, Suite 101, Edmonds, WA 98020
BUSINESS OWNER: Bergau, Dawn
HOME PHONE:
EMERGENCY-1: Burns,,Steve,,,.,
HOME PHONE: 2067930649
KEY ACCESS-2:
HOME PHONE:
EMAIL: !-S�euf
PERSON CONTACTED:
NAME OF INSPECTOR: re
FIRE SYSTEMS: FE11/13 'HDUL3004/15
Date Last Serviced:
FIRE PREVENTION
ItPPECTION REPORT
,15 EDMONDS
0 BRIER
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY —FTA—TION&SHIFF-'s
Annual 17-D
SCHEDULED
DATE DUE o Aug 2015
E161201
CURRENT.
CITY YES
NO
BUSINESS
P71
[:]
LICENSE
L__j
INITIAL INSPECTION DATE
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
4
4
6
6
7
7
A I
I AGREE TO.CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:
2nd RE -INS PECTION
DATE DUE: . . .........
EXTENSION
GRANTEDTO:
VIOLATIONS
T CITED:
PERSON
�O TACTED:
..... ..... . .....
INSPECTOR:
PERSON
CONTACTED:
INSPECTOR:
PERSON
CONTACTED:
NSPECTOR:
1
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 15
VIOLATIONIS;�
1 5
PRE-C TATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
DATE:
RETURN RECEIPT
RECEIVED
CODE
SECTION:
5
6
3
7
3
7
4
8
4
18
RAT�:
DISPOSITION:
LETTER NEEDED [] YES 0 NO
LETTER NEEDED [] YES 0 NO
8
_7
FIRE PREV NTION
$PECTION, REPORT
HOMISH Co. Serving Brier, Edmonds, and 12425 Meridian Ave S
Mqyntlake Terrace Everett, WA 98208 �MEDMONDS
RE 0 , B , RIER
-1200 OMOUNTLAKE TERRACE
'STR, T [3 UNINCORPORATED
Phone(425)551
www.FireDistib Lorg Fax (425) 551-1272
e FREQUENCY _FT_ATIO
N & SHIFT
LOCATION: 456 AdmiralWay '98020 Annual .1 7-D
SCHEDULED
BUSINESS NAME: Anthony's Restaurant PHONE: 4257714400 DATEDUE �Aug2015
MAILING
ADDRESS: 456 Admiral Way, Edmonds, WA 98020
BUSINESS OWNER: Bergau, Dawn HOME PHONE:
EMERGENCY-1: Burns, Steve.,,,-o HOME PHONE: 2067930649
KEY ACCESS-2: HOME PHONE:
EMAIL: kA1 0 PA
PERSON CONTACTED:
NAME OF INSPECTOR: C,
FIRE SYSTEMS:. AS 4114 FA 6114 FE 4114' FD Lk Box HD UL300 4/15
Date Last Serviced: rF — Ini Id . �.. / L/ 411(— P, tg A- lf%,A
E 161
CURRENT
CITY
YES NO
BUS NES
el 1:1
LICE NSE
INITIAL INSPECTION DATE
-7 - -31 -,..1
r
I-M � _�-. � : i A'� /) 44 /1 r'
HAZARDS FOUND AND LOCATIONS/ coKwONICATIONS
- ----------
2
2
3
3
4
6
4
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
V, Wr
`FhAL
1st RE -INSPECTION
DATE DUE:
2nd RE-JNSPECTION
I
4
DATE DUE:
EXZSf6N
GRANTEDTO:
RE'INSP� sTI 11
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
I
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
E:
DATE:
3
VIOLATIONS
1
2
2�_
4
5
VIOLATIONS:,`
1
2
3
5
6
7
PRE -CITATION
LETTER SENT
CITAMON ISSUED
NUMBER:
4
6
7
8
DATE:
CODE
SECTION
DISPOSITION:
5
RETURN RECEIPT
__fELEI�ED
SE
DATE:
6
4
8
7
LETTER NEEDED [-] YES NO
LETTER NEEDED [] Y
SNOHOMISH CO.
FIRE
'DIST]
I pv LOCATION: 456
Serving Briei; Edinonds
Mountlake Terraceand
- the Town of Woodway
Twww.FireDistrictl.org
Admiral Way
BUSINESS NAME:
Vacant
MAILING
ADDRESS:
BUSINESS OWNER:
Shreve, Harold
EMERGENCY-1:
l3entzen, Audree
KEY ACCESS-2:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE HU-1-
SYSTEMS:
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
,Fax (425) 551-1272
100
1, 4257785499
PHONE.
HOMEPHONE: 4254830495
HOMEPHONE: 4257441014
HOME PHONE: —
FIRE PREVENTION
ANSPECTION REPORT
0 EbM ONDS
0 BRIE4.
0 WOODWXY-
0 MOUNTLAKE TER�ACE
0 UNINCORPORATED
FREQUENCY STATION & SHIFT�
365 17 A
SCHEDULED
DATE DUE 0 08101112
�UFIR � 143 11201
L
ACTIVE 175
CURRENT
CITY YES NO
BUSINESS
LICENSE 1:1 El
INITIAL INSPECTION DATE
ANNUZ
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
1
1
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
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
7
RETURN RECEIPT
RECEIVED
6
4
18
8
DATE:
DISPOSITION:
7
LETTER NEEDED [] YES NO
LETTER NEEDED E] YES [I NO
1
8
FIRE DEPARTMENT COPY
I i" Serving Brier fdmonds,,,,�-
SNOHOMISH CO.
FIRE
Mountlake Terraceand
'
IDISTI
, I the Town of Woodway
T
www.FireDistrictl.org
LOCATION:
456 Admiral Way
1,j I BUSINESS NAME:
Yacht Club /Vacant
MAILING
ADDRESS:
BUSINESS OWNER:
Shreve, Harold
.j EMERGENCY-1:
Bentzen, Audree
KEY ACCESS-2:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE HD 10/06 UL300
SYSTEMS:
12425 MeridianAve S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
100
PHONE: 4257785499
HOME PHONE: 4254830495
HOME PHONE: 4257441014
HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
0EDMONDS
0 BRIER
OWOODWAY
0 MOUNTLAKE TERRACE
OUNINCORPORATED .-
FREQUENCY I STATION& SHIFT"'
365 17 D
SCHEDULED ()8/01/11
DATE DUE 1'
UFIR 0 143 8201
ACTIVE 175
CURRENT
CITY
YES
NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
FE
ANNUAL
HAZARDS FOUND AND LOC TIONS 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:
1
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
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
4
'8
4
8
DATE:
DISPOSITION:
LETTER NEEDED F] YES NO
LETTER NEEDED [I YES NO
8
FIRE DEPARTMENT COPY
FIRE PREVENTION
7
C1W OF EDMONDt SAFETY SURVEY
121 5TH ENUE N - EDMONDS WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
.0s's t
LOCATION: 456 Ad iral Wa
-11
BUSINESS NAME: Yacht C b /Vacant
MAILING
ADDRESS:
BUSINESS OWNER: Shreve, Harold K"
EMERGENCY- 1: Bentzen, Audree
KEY ACCESS-2:
i
FREQUENCY STATION & SHIF)
log 365 17 C
SCHEDULED
PHONE: 4257785499 DATEDUE 08/01/10
LIFIR P, 143 8201
HOME PHdN :) 4?5744�U
E
HOME PHONE
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE HD 10,106 UL300 FE f
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE 10
VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
7
8
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:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
5
VIOLATIONS
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 [] YES NT
LETTER NEEDED [] YES NO
FIRE DEPARTMENT COPY
77,777, 77.7-777--
RIVOICE
THOMPSON"S F.IRE EQUIPMENT N!-: 1040-0
P.O. BOX 2=
PJRCrOK WA SOM -
(4251271-M
WREET & Nft
c" zd~,.xds
sun
(i
erry SOM
rm
a m. r-luz
9 MW
, VIOY�
mmm
mom
mom
mom
mmm
11/25/2002.,0.9.:49 4257437747
Evergreen Fire and SafetYx Inc
5116 196th SW # 104
Lynnwood, WA 98036
425/778-8155
TED MAYER
PAGE 03
'0
(V3 1 / 0.-)
invoice
Date
8/2312002
30266
Ship To
Bill To
SAME
i EDMONDS YACHT CLUB KATHY ARM5fROl,,'(; 425,743-7747
p,o. BOX 356 425-776-7447 JIM
EDMONDS, WA. 98020 206-910-1057 BILL,
Ship Via FOB Work Order 0
P.O. No. Terms Due Dats Rap
. ..... . ......
:.— I .... .1 1 78533
t. RYAN OUR TRUCK
1 NET 20 9/1212002
VFRBAL
Rate AmoUnt
Qty Description
Rom Ship i
4 1 . RUCK & . T . RA�'v Pl'us 25.00'r
1,-M,-,I,N- S"ERVICE STOP. INCLUDES T
MSS
ANNUAL CERTIFICAT)CIN 01� PORTABLEFIRI,
EVINGUISHERS.
ORDEXICON4PLETE."'T8ANK YOM'
A 1.5% per month late chuge will be billed on all past
due accounts. Please pay from this invOice.
Subtotal $25,00
Sales Tax (8,91%) $2.23
Total S27.23
Balance Due $27.23
11/25/2002 09:49 4257437747 TED MAYER PAGE 02
OF EDMOND*
V $W^WxK 0 EX04A %WWWONOW 0 MOM=
In owww"n"T
LOCAncft 454 AdMk* Way
Edmanft Yom C30
WAM
A01010010
SUliWW 0040t Shm", t*W
aiwanuamCv-v SotMAUdimee
K9Y *=Wt
no"
MIMI
FIRE PREVEMN
UnTy WJMY
100 us 1 17 A
PHW: MFW'o =41111012
um 0143 0 201
mWE P40m: 42%5'W95
HOOMPWONE: 4257441("4
NOW pfl"�
ACTIVE 175
ya No
Cl 0
In OW OWWWng ~ tO WOM040 ON 40%*Y end ISMINGntlan witIvIn Ow rornmunfly, your fire delpartmnt canducts
"MOV 8011*01194 *Pkv 841104Y $Urft IMSIMftnev of all buelnovw and FAU111111-110mily *oaw In ft Clty of
gdmorW&
Iftu we to be cwqpatuWftd On thW f*Wkf good condition of your acucuipency in "rds to fire eafety. Aft" Vou
will OW the lomfe) that w011 nQW Wing out Inspection which "Ire ~bon to bling them Into compliefte
"Ith 00 mininitim ebmWrd$ 8dQPW bY *4 CHY of 501mands,
A ff-IM100600" will be 60r4uc" in 80 dWP 110 GGRI'lirm that the NOW hern(s) hoe OW co"oeted,
AM WarkPOW hamOrds of V11011stlons of the " agul tions does not Imply spowaval of sush gondmon or vloisdon.
It Vft f9WAM @ddMMI I"ftMWJ9n W 1111111411111111ING, Oun G~ this office Oy calling (424) 771-02 15 betwo.an
the houm of a am. WW I pm., mondly WOU0 pfkw.
SU&INESS COPY
11/25/2002 09:49 4257437747 TED MAYER PAGE 01
V-,