540 MAPLE ST5-q 0 J-7-
FIRE PREVENTION
rving Brier, Edmonds, and 12425 Meridian Ave S INSPECTION REPORT
EDMONDS
Mountlake Terrade Everett, WA 98208 9BRIER
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
www.FireDistrictl.org Fax (425) 551-1272 [3 UNINCORPORATED
FREQUENCY
STATION& SHIFT I
LOCATION:
523 Maple Street
98020
A[ II lucil
117-5
BUSINESS NAME:
PHONE:
SCHEDULED
0
Laurintine Condos
4257747214
DATE DUE
A
20465
, ...q
MAILING
UFIR 0
ADDRESS:
424202
523 Maple Street,.Edmonds, WA 98020
BUSINESS OWNER:
HOME PHONE:
Victor,Scoft
EMERGENCY-1:
HOME PHONE:
"'CURRENT
KEY ACCESS-2: Kelly, Bob #102
HOME PHONE: 4257747214
CITY YES NO
EMAIL:
BUSINESS
En
EJ
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
IN
NAME OF INSPECTOR:
FIRE SYSTEMS:. ( FA_6�r6(qE 9/15 YaCk B
2
2
3
3
4
5
6
4
6
7
7
I AGREE TO CO RRECT 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
VIOLATIONS
6
VIOLATIONS�,
1
2
-5
6
7
F] YES NO
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
DATE:
CODE
SECTION:
DISPOSITION:
6
7
3
4
LETTERNEEDED
RETURN RECEIPT
RECEIVED
4
8
DATE:
7
8
LETTER NEEDED C] YES NO
"N
SNOHOMISH CO. Serving Brier, Edmonds
FIREMountlake Terraceand
the Town of Woodway
rl
DISTh r www.FireDistrictl.org
M�, 5-f-.
LOCATION: 54o)?sfr , Edmonds 98020
BUSINESS NAME: Jacobsen Apts
MAILING
ADDRESS: 540 Maple Street, Edmonds, WA 98020
BUSINESS OWNER:
Email:
EMERGENCY-1: Jacobsen, Jack B/Chadene
KEY ACCESS-2:
PERSON CONTACTED: A-14,0t., y,
NAME OF INSPECTOR:
FIRE SYSTEMS: FE
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE:
HOME PHONE:
HOME PHONE: 4257764659
HOME PHONE: Li Z&14 �
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
0 WOODWAY
[I MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY STATION & SHIFT
Annual 17—A
SCHEDULED
LAE DUE' Aug
T
U
FIR 422
CURRENT
CITY YES NO
BUSINESS
LICENSE 0 1:1
INITIAL INSPECTION DATE
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
A �PV6,., 614 ;e e-
2
2
3
3
4
qLq11!2 WW
4
0
L51M/
h S 0i C A6
A WCV_QMfiJ,
5
'Flu U
6
1
N
6
7
7
1 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
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 or the Town of Woodway, call (425)
775-7720; for Mountlake Terrace or Brier, call (425) 754-0434.
BUSINESS COPY
f7-
FIRE PREVENTION
Senwing Brier, Edmonds
12425'Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
FIRE
I Mountlake Terraceand
Ev'erett, WA 98208
[]EDMONDS
0 BRIER'
DISFM RiFT
llw� the Town of Woodway
Phone (425) 551-1200
0 WOODWAY
[I MOUNTLAKE TERRACE
wwiw.FireDis�riboti,org
Fa)c (4�5)651-1272
[I UNINCORPORATED
LOCATION:
540 Maple Street
FREQUENCY I STATION & SHIFT`�
366 17 D
BUSINESS NAME:
Jacobsen Apts
PHONE:
SCHEDULED n3/01/12
DATE DUE I` W
MAILING
128 Sunset Av
UFIR 422 8203
ADDRESS:
Edmonds
98020
BUSINESS OWNER:
"Jacobsen, Jack BfCharlene"
HOME PHONE: 4257764659
ACTIVE
EMERGENCY-1:
HOME PHONE:
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
El 1-1
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
d
/0//
FIRE
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
3
4
4
5
0
6
"
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
&TE 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:
2
[N,3PECTOR:
D TE:
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
'41,
18
4
8
-DATE:
DISPOSITION:
7
.ETTER NEEDED [] YES NO
rL��ER NEEDED [] YES C3 NO
1
1
8
FIRE DEPARTMENT COPY
FIRE PREVENTION
Serving Brier, Edmonds
12425 Meridian Ave S
INSPECTION REPORT
S:L%40HOMISH CO.
-0� fDM 0 N D S
Mountlake Terrace, and
JFIRE MOVE/
Everett, WA 98208
0 BRIER
131STI . the Town of Woodway
R IT
Phone (425) 551-1200
0WOODWAY
0 MOUNTLAKE TERRACE
www.FireDistrictl.org
Fax (425) 551-1272
El UNINCORPORATED
0' FREQUENCY
STATION & SHIF`�
LOCATION: 540 Maple Street
366
I
17 C
BUSINESS NAME: Jacobsen Apts
PHONE:
SCHEDULED 08101/11
DATE DUE II'
MAILING 128 Sunset Av
LIFIR 1,, 422 8203
ADDRESS: Edmonds
98020
BUSINESS OWNER: nJacobsen, Jack B/Charlene"
HOME PHONE: 4257764659
ACTIVE;.,
EMERGENCY-1:
HOME PHONE:
CURRENT 7,
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
1:1
1:1
LICENSE
PERSON CONTACTED: &144) 1 1-j M
INITIAL INSPECTION DATE
NAME OF INSPECTOR: 44
ILI, 11
FIRE
FE 1.2-110
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
3
4
5
6
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
I Et RE -INSPECTION
D1,TE DUE:
I
2nd RE -INSPECTION
DATE DUE:
I
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VICLATIONJ
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
IN13PECTOR:
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
-3
4
18
DATE:
DISPOSITION:
7
LETTER NEEDED C] YES NO
N__
LETTER NEEDED E] YES NO
I
1
8
FIRE DEPARTMENT COPY
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
t
LOCATION: 540 Maple Street
BUSINESS NAME: Jacobsen Apts
MAILING 128 Sunset Av
PHONE:
FIRE PREVENTION
SAFETY SURVEY
ADDRESS: Edmonds 98020
BUSINESS OWNER: nJacobsen, Jack B/Charlene" HOMEPHONE: 4257764659
EMERGENCY-1: HOME PHONE:
KEY ACCESS-2: HOME PHONE:
FREQUENCY
STATION 1, SHIFT
366
17 B
I
SCHEDULED
DATE DUE 11'
08/01/10
UFIR P� 422
8203
ACTIVE
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE
SYSTEMS: ANNUAL
HAZARDS FOUND ANP
�4
LOCATIO.NS COMMUNICATIONS
/
ENTER CODE ONLY ONCE 10
VIOLATION CODE
2
2
3
4
5
5
6
7
8
1st RE -INSPECTION
DArE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PE ISON
CC NTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
IWIPECTOR:
INSPECTOR:
INSPECTOR:
2
DArE:
DATE:
DATE:
3
VIOLATIONS
5
VIOLATIONS
5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
18
4
18
DATE:
DISPOSITION:
7
8
LETTER NEEDED [] YES NO
LETTER NEEDED 0 YES NO
FIRE DEPARTMENT COPY