529 WALNUT ST5zq a.41 A.lur j
12425 Meridian Ave S
Serving 'Brier, Edmonds, and
SNOHOMISH CO
Mountlake Terrace Everett, WA 98208
FIRE Phone (425) 551-1200
DISTR' T www.Fire'-'Districtl.org Fax (425) 551-1272
LOCATION
529 Walnut Street- 98020
BUSINESS NAME: 529 Walnut Condos PHONE: 4257762765
MAILING
ADDRESS:
529 Walnut Street, Edmonds, WA 98020
BUSINESS OWNER: HOME PHONE:
q
FIRE PREVENT16N
INSPECTION REPORT
DEDMONDS
0 BRIER
[3 MOUNTLAKE TERRACE
[3 UNINCORPORATED
0' FREQUENCY I STATION& SHIF_r
Annual 17-C
SCHEDULED
DATE DUE I,. Aug 2015
UFIR o 423
EMERGENCY-1: 529 Walnut HOA HOME PHONE: CURRENT
KEY ACCESS-2: YES NO
HOME PHONE: CITY
EMAIL: BUSINESS
LICENSE
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
Date Last Serviced:
115
�-6 �IS
HAZARDS FOUND AND LOCATIONS/ COMMUNICATIONS
_A_
2
N
2
3
4
4
6
7
5
6
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:
PERSON O'�
CONTACTED: QVI
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
L NLPECTOR:
INSPECTOR:
INSPECTOR:
2
3
4
5
6
DATE: 31e2_0116
1VO'
IOLATIOWS
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VIOLATIONS,,
DAT
PRE -CITATION
SENT
DATE:
CITATION ISSUED
NUMBER:
2
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CODE
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17
3
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RETURN RECEIPT
RECEIVED
�4
18 _.. 'L'�i
4
8
.
DATE:
DISPOSITION:
7
LETTER NEEDED [] YES [I NO
LETTER NEEDED [] YES NO
8
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CONFIDENCE TESTING
FIRE ALARM SYSTEM
TEST REPORT
lot
NAME OF FACILITY
WPINU7 '5'EUF_')
PHONE NO.
41-�- q-+ (e - '2 4 (- �-
DATE INSPECTION
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ADDRESS
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TYPE OF TEST
MONTHLY QUARTERLY EMIANNUALEI
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BATTERY VOLTAGE
(a
BATTERY UNDER VOLTS,
FULLILOAD
CHARGE CIRCU fr -:� VOLTS
I I
ITEM
YES�
NO
N/A
ITEM
YES
NO
N/A
ITEM
YES
NO
N/A
TROUBLE AC OFF
CIRCUITS CHECKED
FOR SUPERVISION
SYSTEM WIRING CONFORMS
TO NFPA STANDARDS
SYSTEM OPERATES
ON STANDBY POWER
CONTRbLPANELCHECKED
PER NFPA & MFG INST.
KEY TO PANEL
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ONACIPOWER
AUXILIARY EQUIP.
OPERATES
OTHER
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STANDBY POWER
OPERATING INSTRUCTIONS
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EQUIPMENTTESTED
NO. OF UNITS
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NO. OF UNITS
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TYPE OF EQUIPMENT
IN BLDG.
TESTED
YES
NO
N/A
TYPE OF EQUIPMENT
IN BLDG.
TESTED
YES
NO
I N/A
BELLS, HORNS, CHIMES,
VOICE ALARM, SPEAKERS
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ELEVATOR CALL DOWN
HEAT DETECTORS
DOOR RELEASE
SMOKE DETECTORS
111110100"
FIRE & SMOKE DAMPERS
MANUAL PULL STATIONS
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AUTO DOOR UNLOCKS
(FAIL-SAFE)
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><
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OPERATE
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SERVICE TECHNICIAN NOTES Fire Watch required, threat level 1 2 (see reverse for a threat level explaination)
THIS IS TO CERTIFY THAT THIS FIRE ALARM HAS BEEN PROPERLY TESTED AND INSPECTED FOR RELIABILITY
TO COVER ITEMS LISTED IN THIS REPORT, IS CONSISTENT WITH FIRE ALARM MAINTENANCE STANDARDS
OWNER WAS INFORMED ABOUT ANY NEEDED REPAIRS OR DISCREPANCIES. NONEN� YE:�]
OWNER OR FACILITY REPRESENTATIVE
. 1
DATE
7.. 1 L
TECHNICI N
IN
LICENSE No.
'j V� V
SIGNATURE,
SNOHOMISH CO.
FIRE
_-ST]
Serving Brier, Edmonds, and
Mountlake Terrace
www.FireDistrictl.org
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
SMDMONDS
/0 BRIER
0 MOUNTLAKE TERRACE
[3 UNINCORPORATED
FREQUENCY
STATION & SHIFT
LOCATION:
529 Walnut Street 98020
I r-L)
,BUSINESS NAME:
PHONE:
SCMU6
DATE DUE
529 Walnut Condos
4257762765
Aug 2616
MAILING
UFIR 0
ADDRESS:
423
529 Walnut Street, Edmonds, WA 98020
BUSINESS OWNER:
HOME PHONE:
.EMERGENCY-1:
k1l /*ak
HOME PHONE: �26_ 776- 7,1T
.
CURRENT
KEY ACCESS-2:
529 Walnut HOA
HOME PHONE:
YES NO
CITY
BUSINESS
r-1
EMAIL:
LICENSE
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
-746
FIRE SYSTEMS:
FA 7/15 FE 7/15
Dahadangt8w\AisedocATiONS
/ COMMUNICATIONS
2
776- g-S-
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. Above you
will find the item(s) that were noted during. our inspection which require attention to bring them into compliance
w ith 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.
�V_9_0_ff_
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'JUN 2 3 2014
CONFIDENCE TESTING
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OCCUPIEDAS
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PRO-COMM LICENCE
BATTERY VOLTAGE VOLTS
BATTERY UNDER VOLTS
FULL LOAD
CHARGE CIRCUIT VOLTS
ITEM
YES�
NO
N/A
ITEM
YES
NO
N/A
ITEM
YES
NO
N/A
TROIIBLE.AC,OFF
CIRCUITS CHECKED
FOR.SURERVISION
---.-.IQNFP
SYSTEM WIRING CONFORMS
STANDARDS
SYSTEM OP ERATES
ON STANDBY POWER
CONTROL PANEL CHECKED
PER NFPA & MFG INST.
KEY TO PANEL
AVAILABLE
SIGNALS OPERATE
ON AC POWER
'10
AUXILIARY EQUIP.
PERATES
OTHER
SIGNALS OPERATE
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OPERATING INSTRUCTIONS
AT PANEL
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EQUIPMENTTESTED
NO. OF UNITS
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NO. OF UNITS
SATISFACTORY I
TYPE OF EQUIPMENT
IN BLDG.
TESTED
Yff__
NO
N/A-;
TYPEOFEOUIPMENT
IN BLDG.
TESTED
YES
NO
N/A
BELLS, HORNS, CHIMES,
VOICE ALARM, SPEAKERS
ANNUNCIATORS
VISUALALARM DEVICES
ELEVATOR CALL DOWN
HEAT DETECTORS
T
ILI
DOOR RELEASE
SMOKE DETECTORS
FIRE & SMOKE DAMPERS
MANUAL PULL STATIONS
PHONEJACKS
SPRINKLER
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(FAIL-SAFE)
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OTHER
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OPERATE
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;?,=)O
OTHER
SERVICE TECHNICIAN NOTES Fire Watch required, threat level 1 2 3 (see reverse for a threat level explaination)
4
THIS IS TO CERTIFY THAT THIS FIRE ALARM HAS BEEN PROPERLY TESTED AND INSPECTED FOR RELIABILITY
TO COVER ITEMS LISTED IN THIS REPORT, IS CONSISTENT WITH FIRE ALARM MAINTENANCE STANDARDS.
OWNER WAS INFORMED ABOUT ANY NEEDED REPAIRS OR DISCREPANCIES. NONE Ej YES [I
OWNER OR FACILITY REPRESENTATIVE
DATE
TECHNICIAN
LICSSE NO..
SIGNATURE
4
SNOHOMI13H CO. , . Serving Brier, Edmonds
FIRE'N Mountlake Terraceand
the Town of Woodway
S I jM.1y1T www.FireDistrictl.org
LOCATION:
5207 T Edmonds
BUSINESS NAME: 529 Walnut Condo's
MAILING
ADDRESS: 529 Walnut Street_
12425 Mo�lrididn,Aves
f-1, .,* , '�;
Everett�,._WA *9,,��08
v'�'Phone (425)'551-1200
Fax (425) 551-1272
PHONE: 0
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
0 WOODWAY
[I MOUNTLAKE TERRACE
[I UNINCORPORATED
FREQUENCY STATION & SHIFF"I
I 17-A
SCHEDULED
DATE DUE � Auo
1UFIR 1, 423
BUSINESS OWNER: HOME PHONE:
Email:
EMERGENCY-1 : 55 Walnut HOA ___HU9E_PMNr=: CURRENT
KEY ACCESS-2: HOME PHONE: CITY YES NO
BUSINESS
LICENSE
PERSON CONTACTED: INITIAL INSPECTION DATE
,PECTOR: /6
NAME OF INS A Z
rl'RE SYSTEMS: FE57 /
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
/J!2
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
0 Ist RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
D E DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
I
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
14
8
4
8
DATE:
-4
POSITION:
7
LETTER NEEDED E] YES NO
LETTER NEEDED []]:E:S NO
8
FIRE DEPARTMENT COPY
CO ' NFIDENCE TESTING
Protection Communications,. Inc. FIRE ALARM SYSTEM..
(800) 774-9099 -fax (425) 774-6317 TEST REPORT
www. pl07(30mm-onfine.com
NAME OF FACILITY
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PHONE NO.
DATE INSY.E�TION
ADDRESS
'CITY STATE
40m tw4
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8
OCCUPIED AS
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MONTHLY 0 QUARTERLYE] SEMI ANNUALEI o4,�-,,'�ANNUALJZ ACCEP
PRO-COMM LICENCE
BATTERY VOLTAGE VOLTS
BATTERY UNDER VOLTS,
FULL LOAD
CHARGE CIRCUIT VOLTS
�2 7.5
ITEM
YES
NO
N/A
ITEM
YES
NO
N/A
ITEM
YES
NO
N/A
TROUBLE AC OFF,
CIRCUITS CHECKED
FOR SUPERVISION
SYSTEM WIRING CONFORMF
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SYSTEM OPERATES-
ON STANDBY POWER
-CONTROL-PANEL-CHECKED--
PER NFPA & MFG INST.�
KEY TO PANEL -
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ON AC POWER
AUXILIARY EQUIP.
OPERATES
'OTHER
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ATP"ANEL
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EQUIPMENTTESTED
NO. OF UNITS
SATISFACTORY
NO. OF UNITS
SATISFACTORY.
TYPE OF EQUIPMENT
IN BLDG..-
-TESTED
YES
NO
N/A
TYPE OF EQUIPMENT
IN BLDG.
TESTED
YES
NO
N/A
BELLS, HORNS, CHIMES,
VOICE ALARM, SPEAKERS
If
ANNUNCIATORS
VISUAL ALARM DEVICES
ELEVATOR C ALL DOWN
HEAT DETECTORS .
r
DOOR RELEASE
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MANUAL PULL STATIONS
-
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OTHER
VENTILATION CONTROLS
OPERATE
OTHER
PANEL AND MODEL'
OTHER
SERVICE TECHNICIAN NOTES Fire Watch required, threat level 1 2 �3 (see reverse.for a threat level explaination)
fHIS,IST9,C . ERTIFYTH�kT THIS FIRE ALARM HAS BEEN FiRPIDERLYTESTED AND INSPECTED FOR RELIABILITY'
TO COVER ITEMS LISTED, IN THIS REPORT, 1S CONSISTENTWITH FIRE ALARM MAINTENANCE STANDARDS..�
OWNER WAS INFORMED ABOUT ANY NEEDED REPAIRS OODISCREPANCIES. NONE-E].: YES El.l.'
OWNER OR'FACILITY REPRESENTATIVE
t_�z zc—u"
DATE
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Set -Ong Biler Edmonds
12425 Mei-idia'n Ave S
INSPECTION REPORT
SNOHOMISH CO. '
4 Mountlake Terraceand
FIRE
Everett, WA 98208
.0 EPMONDS
the Town of Woodway
DIST Rift
Phone (425) 551-1200
WOODWAY
MOUNTLAKE TERRACE
wwwFireDistrictl.org
Fax (425) 551-1272
UNINCOROORATED
r FREQUENCY
STATION & SKFC�
LOCATION: 529 Walnut Street
366
17 D
BUSINESS NAME: 529 Walnut Condos
PHONE:
SCHEDULED
DATE DUE 1' 08/01/12
MAILING 529 Walnut St #201
UFIR 11, 423 8203
ADDRESS: Edmonds
98020
BUSINESS OWNER: 529 Walnut HOA
HOME PHONE:
AcTiVE
EMERGENCY-1: Roumonada, Jim-#201
HOME PHONE: 4257762765
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
El
F1
LICENSE
PERSON CONTACTED: N,�^(_
0
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
j
4�&A
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FE�E2,a
SYSTEMS:
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HAZARDS FOUND AND -LOCATIONS / COMMUNICATIONS
xya 111aL- A/�,Os
2
2
3
3
4
4
5
5
6
6
V
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S)
IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE -INSPECTION
FINAL RE -INSPECTION
EXTE NSION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTED TO:
DATE DUE:
CIfED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLAPONS
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:
4
8
4
18
DATE:
7
LETTER NEEDED [I—]] YES N
rLETTER NEEDED [-] YES NO
8
FIRE DEPARTMENT COPY
. . . . . . . . . .
. �WIVI-1-1
ITIT-M 7-IM117717,4,
CONFIDENCE. TESTING
Pro'tection Comimunications, Inc. FIRE ALARM SYSTEM
JTEST -REPORT
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(800) 71479.099.
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OCCUPIED.AS
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4�
BATTERY VOLTAGE VOLTS
BATTERY UNDER VOLTS
FULLLOAD
CHARGE CIRCUIT VOLTS
7A,
ITEM
YES
NO
N/A
ITEM
YES
NO
N/A
ITEM
YES
NO
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TROUBLE AC OFF
CIRCUITS CHECKED 7
FOR SUPERVISION
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YES
NO
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TYPE OF EQUIPMENT
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TESTED
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BELLS, HORNS, CHIMES,
VOICE ALARM, SPEAKERS
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ELEVATOR CALL DOWN
HEAT'DETECTORS
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v 7- AOL)
OTH . E R
SERVICE TECHNICIAN NOTES Fire Watch required, threat level �1 2 3 (see reverse for a threat level explaination)
THIS IS TO CERTIFY THATTHIS FIRE ALARM HAS BEEN PROPERLY TESTED AND INSPECTED FOR RELIABILITY
TO COVER ITEMS'LISTED IN THIS REPORT, IS CONSISTENTWITHFIRE ALARM MAINTENANCE STANDARDS..,*
OWNER WAS'INFORMED ABOUT ANY NEEDED REPAIRS OR DISCR E I PANCIES. NONE YES
OWNER OR FACILITY REPRESENTATIVE
11A�
DATE
TECHNICIAN
LICENSE,NO.
IvSIGNATURE-
FIRE PREVENTION'
Serving Briet; Edmonds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
8rEDMONDS
Mountlake Terraceand
TIRE
Everett, WA 98208
0 BRIER
the Town of Woodway
STR,WrT.
Phone (425) 551-1200
OWOODWAY
0 MOUNTLAKE TERRACE
www.FireDistrictl.org
Fax (425) 551-1272
0 UNINCORPORATED
LOCATION: 529 Walnut Street
FREQUENCY STATION & SHIFTT�'
366 17 C
"!,
BUSINESS NAME: 529 Walnut Condos
PHONE:
SCHEDULED
DATE DUE
MAILING 529 Walnut St #201
UFIR o 423 8203
ADDRESS: Edmonds
98020
BUSINESS OWNER: 529 Walnut H,0_A f
HOME PHONE:
A, CTIVE
EMERGENCY-1: Roumonada, Jim #201
4257762765
HOME PHONE:
KEY ACCESS-2:
i
HOME PHONE: —
[—�URRENT
Ty YES NO
BUSINESS
1:1 El
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
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HAZARDS FOUND AND LO�ATIONS C�MMUNICATIONS
1 kj AI
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A\,ol
2 eo
2
3
3
4
4
5
5
6
/1 Ti
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:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
D TE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
.4
18
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED [:] YES NO
LETTER NEEDED YES NO
F
8
FIRE DEPARTMENT COPY
CONFIDENCE TESTING
Protection &Communications, Inc. FIRE. ALARM SYSTEM,
-9099 Fax (425) 774�6317, TEST REPORT
(80.0)774.
www: pro-comm.ohhnlp..cb1m�.,
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YES
NO
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TYPE OF EQUIPMENT
IN BLDG.
TESTED
YES
NO
N/A
BELLS, HORNS, CHIMES,
VOICE ALARM, SPEAKERS
ANNUNCIATORS
VISUALALARM.DEVICES
ELEVATOR CALL DOWN
HEAT,DETECTORS,
DOOR RELEASE
SMOKE DETECTORS
FIRE & SMOKE DAMPERS
MANUAL PULL STATIONS
PHONE.JACKS
SPRINKLER'
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UIA -
—2 LA C),25p
IOTHER
SERVICE TECHNICIAN NOTES Fire Watch r uired, threat level 1 2 3 (see reverse for a threat level explaination)
THIS IS TO CERTIFY THAT THIS FIRE ALARM HAS, BEEN PROPERLY TESTED AND INSPECTED FOR RELIABILITY..
TO COVER ITEMS LISTED IN THIS REPORT, IS CONSISTENT WITH FIRE ALARM MAINTENANCE STANDARDS.
OWNER WAS INFORMED ABOUT ANY NEEDED REPAIRS OR DISCREPANCIES. NONEE] YES EJ
OWNER OR FACILITY REPRESENTATIVE
DATE
TECHNICIANV
LICENSE NO.
if
SIGNATURE
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
4S' S t B
LOCATION:
529 Walnut Street
BUSINESS NAME:
529 Walnut Condos
MAILING
529 Walnut St #201
ADDRESS:
Edmonds
BUSINESS OWNER:
529 Walnut HOA
EMERGENCY-1:
Roumonada, Jim #201
KEY ACCESS-2:
PHONE:
98020
HOME PHONE:
FIRE PREVENTION
SAFETY SURVEY
HOMEPHONE: 4257762765
HOME PHONE:
01 FREQUENCY
STATION 1, SHIFT"'
I
17 6
SCHEDULED
DATE DUE 0'
LIFIR � 423
8 20S
ACTIVE
r INITIAL INSP TION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE I -A (j/U I
a I EtM S: ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
1
ENTER CODE ONLY ONCE 110
VIOLATION CODE
2
2
3
3
4
.4
5
5
6
6
7
�7
8
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:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
5
VIOLATIONS
5
PRE-CITAT10N
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
?
6
DATE:
CODE
SECTION:
5
.3
7
RETURN RECEIPT
RECEIVED
6
7
8
4_1
18
DATE
DISPOSITION:
8
YES NO
'LETTER N[EEDEDO YES NO
FIRE DEPARTMENT COPY
1. Ap . . . . . .
G�z' CONFIDENCE TESTING
Protection &,Communications, Inc. FIRE ALARM SYSTEM
TESTREPORT
�800)774-9099,*. Fax, (425) 774-6317,,
Com,
W��W. Pro -on ih'e.'
'�Omm'
7
NA C
ME OF F,
�ON -
Et
DqATE'INSPE-TI N
C b
9,
,ADDRESS
CITY STAT4
ojo_
ZIP
OCCUPIEDAS
MONITORED BY
ACCT#'
TYPE OF TEST QUARTERLY 0 SEMI ANNUAL El ANNUAL
MONTHLY El ACCEPTE]
M,LICENCE
BATTERY VOLTAGE VOLI
"S
j;2- 02- IFULLLOAD
BATTERY UN�tR OLTS
S-139
CHARGE CIRNT,7, VOLTS
I 0/_ -f- 6 7
ITEM
YES
NO
N/A
ITEM
YES
NO
N/A
ITEM
YES
NO
N/A
TROUBLE AC OFF
X
.
CIRCUITS CHECKED
FOR SUPERVISION
/X
SYSTEM WIRING CONFORMS
TO NFPA STANDARDS
SYSTEM OPERATES
ON STANDBY POWER
JC
CPNTROLPANELCHECKED
PER NFPA & MFG INST
KEY TO PANEL
AVAILABLE
SIGNALS OPERATE
ONACPOWER
AUXILIARY EQUIP.
OPERATES
OTHER
SIGNALS OPERATE
STANDBY POWER
OPER ING INSTRUCTIONS
AT PANEL
OTHER
EQUIPMENTTESTED
NO. OF UNITS
SATISFACTORY
NO. OF UNITS
SATISFACTORY
TYPE OF EQUIPMENT
IN BLDG.
TESTED
Yff-
NO
N/A
TYPE OF EQUIPMENT
IN BLDG.
TESTED
YES
NO
N/A
BELLS, HORNS, CHIMES,
VOICE.ALARM, SPEAKERS
ANNUNCIATORS
VISUALALARM DEVICES
ELEVATOR CALL DOWN
HEAT DETECTORS
/s
DOOR RELEASE
SMOKE DETECTORS
FIRE & SMOKE DAMPERS
MANUAL PULL STATIONS
PHONEJACKS
SPRINKLER
SUPERVISORY SWITCHES
AUTO DOOR UNLOCKS
(FAIL-SAFE)
SPRINKLER
FLOW SWITCHES
OTHER
CENTRAL STATION
OTHER
VENTILATION CONTROLS
OPERATE
OTHER
PANEL AND MODEL
7 1-44e.,
JOTHER
SERVICE TECHNICIAN NOTES Fire Watchyeq jired, threat level 1 2 3 (see reverse for a threat level explaination)
I ) 7
L\-j
IC7
THIS IS TO CERTIFYTHAT THIS FIRE ALARM HAS BEEN PROPERLY TESTED AND INSPECTED FOR RELIABILITY
TO COVER ITEMS LISTED IN THIS REPORT, IS CONSISTENT WITH FIRE ALARM MAINTENANCE STANDARDS.
OWNER WAS INFORMED ABOUT ANY NEEDED REPAIRS OR DISCREPANCIES. NONE YES
OWNER OR FACILITY EPRESENTATIVE
DATE
TECHNICIAN <W
LICENSE NO
, _-_5 z V F
SIGNATURE
I