520 HEMLOCK WAYFIRE PREVENTION
;16
INSP ',CTION REPORT
.3en,ing Briei; Ed. nd 12425 Meridian Ave S
SNOHOMISH 0 EDMONDS
IR 0 BRIE�
ountlake Teri -ace Everett, WA 982-0f,' v
E 4200 0 MOUNTLAKE TERRACE
DISTRI Plione (425) 551 [1 UNINCORPORATED
T 4,.,,FireDistriet1. A� Fax (42-5) 551-1272
FREQUENCY STATION & SHIF__*'
LOCATION: 520 Hemlo6k Way 98020 Annual 17-A
SCHEDULED
BUSINESS NAME: Kincaid's Apartment Bldn PHONEI 4287787111 DATE DUE 0 Oct 2013
J MAILING LIFIR o 422
ADDRESS: 520 Hemlock Way, Edmonds, INA 98020
BU SINESS OWNER: Brooks, Kay HOME PHONE:
CURRENT
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EMERGENCY-1: B HOME PHONE: .4257787-111 IT
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YES
KEY ACCESS-2: HOME PHONE: CITY
Y
B USI
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EMAIL: LIC S
LICENSE
INITIAL INSPECTION DATE
PERSON CONTACTED: A )o pie
NAME OF INSPECTOR:
FIRE SYSTEMS: FE
7V-
HAZARDS AFUND AND L70CC TIONS COMMUNICATIONS
2
2
3
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5
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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
CONTACTED:f'
CONTACTED:
CONTACTED:
1
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUE15
.1' 5
1 5
LETTER SENT
NUMBER:
4
CODE
5
2
6
2 6
DATE:
SECTION:
RETURN RECEIPT
6
3
7
3 7
RECEIVED
DISPOSITION:
18
4
DATE:
18
LETTERNEEDED E] YES El NO
F7_
8
YES No
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FIRE DEPARTMENT COPY
CITY OF EDMONDS
121 5- AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FIRE DEPARTMENT
r.7n 1-4amint-le Wnv
FIRE PREVENTION
SAFETY SURVEYi
LOCATION:
Kincaids Apartment Bldg
4257787111
BUSINESS NAME:
PHONE:
MAILING
402 9th Av S
ADDRESS:
Edmonds
98020
BUSINESS OWNER:
Curtis, Chester B
HOME PHONE: 4257787111
Brooks, Kay
EMERGENCY-1:
HOME PHONE:
KEY ACCESS-2:
HOME PHONE:
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NAMI�CF INSPECTOR:
FRE fWail Notice to. Owner
SYSTEMS:
ACTIVE I
INITIAL INSPECTION DATE
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ANUA71
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
ENTER CODE ONLY ONCE 1�
VIOLATION CODE
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2
2
3
3
4
4
5
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5
6
6
7
7
8
8
1st RE -INSPECTION
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTED TO:
DATE DUE:
PERSON
CITED:
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
---IDATE.
DATE:
DATE:
VIOLATIONS
L
CITATION ISSUED
3
VIOLATIONS
PRE -CITATION
5
5
LETTER SENT
NUMBER:
CODE
4
2
6
DATE,
RETURN RECEIPT
SECTION:
5
3
7
3
7
RECEIVED
DISPOSITION:
4 8
�4
18
DATE:
LETTER NEEDED D YES
NO
NO
I
TTER
—NEEDED I' YES NO
FIRE DEPARTMENT COPY