611 DALEY ST(0
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SNOHOMISH CO. 1 12425 Me
Mountlake Tei-i-aceand Evetett, WA 98208
')FIRE Ile Town of Woodway Phone (425) 551-1200
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�'DISTRI T www.F,,ireDistrictl.org Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
El BRIER
0WOODWAY
[I MOUNTLAKE TERRACE
0 UNINCORPORATED
"_ FREQUENCY
STATION& SHIFT"
LOCATION:
611 Daley Street
365
17 6
BUSINESS NAME:
Daley St Apts
PHONE: 4257716651
SCHEDULED
DATE DUE �
MAILING
611 Daley St #1
LIFIR � 422 8203
ADDRESS:
Edmonds
98020
BUSINESS OWNER:
"Ellingson, Sharon S. #I
HOME PHONE: 4257716651
ACTIVE
EMERGENCY-1:
"Cubbin, JoefTerrin
HOME PHONE: 4257711783
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
LICENSE
rl_
PERSON CONTACTED: oa2d,
INITIAL INSPECTION DATE
—1
I NAME OF INSPECTOR:
/0 AV//
FIRE
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SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
4 b ZA
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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.
1
EXTENSION
GRANTED TO*
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DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:.
2
DATE:
D E:
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
.4
.8
4
.8
DATE:
DISPOSITION:
7
LETTER NEEDED !E] YES F-1 No
LETTER NEEDED [] YES El NO
8
FIRE DEPARTMENT COPY
CITY OF EDMONDS
1215THAVENUEN. - EDMONDS, WASHINGTON 98020 - (425)771-0215
FIRE DEPARTMENT
LOCATION: 611 Daley Street
BUSINESS NAME: Daley St Apts
MAILING 611 Daley St #1
FIRE PREVENTION
SAFETY SURVEY
PHONE: 4257716651
ADDRES,z): Edmonds 98020
BUSINESS OWNER: "Ellingson, Sharon S. #1 HOMEPHONE: 4257716651
EMERGENCY- 1: "Cubbin, JoefTerri" HOME PHONE: 4257711783
KEY ACCESS-2: H OME PHONE:
FREQUENCY
STATION & SHIFT'
365
17 A
SCHEDULED
DATE DUE 10 08/0-1/10
LIFIR i� 422
8203
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11 INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE FE
SYSTEMS: ANNUAL
HAZARDS FOUN AND LOCATIONS / COMMUNICATIONS
1-7,
ENTER CODE ONLY ONCE I�
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 DIJE-
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
E:
DATE:
3
VIOLATIONS
5
VIOLATIONS
15
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER: -
2
6
2
6
DATE:
CODE
SECTION: -
5
3
7
3-
7
RETURN RECEIPT
RECEIVED.,
6
4
18
4
8
DATE:
DISPOSITION: _
7
8
\ LETTER NEEDED [] YES NO
ILETTERNEEDED 0 YES NO
FIRE DEPARTMENT COPY .1