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617 VIEW PLFIRE PREVENTION mlbv .0 ,, . jj[jjjjjj__(A/7'10-_t&j D, - INSPECTION REPORT SNOHOMISH CO. Seri��,'��ng Brier, Edmi . 12425 Meridanz Ave S Pinunminq Mo�ntlake Yerraceand 'IRE, 4 Everett, WA 98208 0 BRIER the Town of Woodway Phone (425) 551-1200 E]WOODWAY )ISTI,tt"Y,Twww.FireDistrictl.org [1 MOUNTLAKE TERRACE Fax (425) 551-1272 0 UNINCORPORATED . � e- FREQUENCY STATION 1, SHIFT_� LOCATION: 617 View Place S 365 HO FP I BUSINESS NAME: Sarausad Homes AFH PHONE: 4256407369 SCHEDULED DATE DUE 06/01/13 MAILING 617 View Place S LIFIR 1' 411 3116157 ADDRESS: Edmonds 98020 BUSINESS OWNER: Sarausad, Semardita HOMEPHONE: 2067060755 ACTIVE EMERGENCY-1: Cell # 206-926-3740 HOME PHONE: CURRENT KEY ACCESS-2: HOME PHONE: CITY YES NO BUSINESS Lj Lj LICENSE INITIAL INSPECTION DATE ER N CONTACTED: P M S ' I LNA EOOF INSPECTOR: FIRE FE —I— SYSTEMS: A P I-1 ANNUAL HAZARDS FOUND AND LOCATIONS COMMUNIcAfl-ONS q\J c) c, r\ 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 14 00� 4 9 18 DATE, DISPOSITION: 7 LETTER NEEDE��'[] YES No LETTER NEEDED YES NO 8 FIRE DEPARTMENT COPY Westfall, John From: Westfall, John Sent: Thursday, November 29, 2007 9:37 AM To: Petrella, Marc Cc: Tomberg, Thomas Subject: RE: 931 12 Ave N - Meryl Hrdlicka Thanks, Marc, only the legal owner of house is Ms. Sarasaud that also owns Sarasaud AFH @ 617 View Pl. And I agree with not very good job. John ----- Original Message ----- 7, From: Petrella, Marc Sent: Thursday, November 29, 2007 8:43 AM To: Westfall, John Subject: RE: 931 12 Ave N - Meryl Hrdlicka It is not an AFH. Former Mayor Hrdlicka is supposedly being cared for in his own home but they're not doing a good job. MP ----- Original Message ----- From: Westfall, John Sent: Tuesd ay, November 27, 2007 2:05 PM To: Petrella, Marc; Hunter, David; Krugmire, David; Boyle, Dean Cc: Chief Tomberg Subject: 931 12 Ave N - Meryl Hrdlicka Fellows: I'm assisting with factfinding on a DSHS investigation. Were more than one adults cared for at the address when you were on scene? Property is not a licensed AFH. I ncidents were on 11/26/07 and 11 /17/07. Thanks, John F�— J9*1r, 6cg 09;6 Soo 4 9 7 DA ( (o 6) K q-,� i ,jv /,,,vAj (e)44 7 �- 73 3 3 8 3 z It-CC,0,,,tPt�J I C---D I -J -7-,z A---rP-L�, 17 o s-T;, G Y- 1 WebFIRS Data Tools Patient Search Results - Page 1 of I ,Admin Journal Training Main Password Incident Incident Type Fi rst Last Address Number Name Name EMS call, excluding vehicle accident with 205 PL EF05000977 Meryl Hrdlicka C injury EMS call, excluding vehicle accident with injury EMS call, excluding vehicle accident with injury Meryl Hrdlicka 12 AVE N Meryl Hrdlicka 610TARRE'"N"O http://webfirs/dataoutput/dsp_PatientSearchResults.cfm 11/27/2007 Fire Incident Report Edmonds Fire Department Incident # EF07004165 Case $: $EF07004682 Incident Date: g2,—'64 t' - 2111 VA6 Exposure: Ju ' ct)ional Station: 17 Location Type: Street ad�'rd§s Address: 99,,-,3TIVMFlr2lMFA.7VE-WWN—��— City: EdMo�ndsSitate: WA Zip: 98020 Incident Type: EMS call, excluding vehicle accident with injury Shift: C Alarms: 1 Grid: EF254 Aid Type: None Alarm Time: (21:28:55) 11/26/2007 Arrival Time: (21:34:22) 11/26/2007 Last Unit Cleared Time: (22:20:35) 11/26/2007 Actions Taken: Provide basic life support (BLS) 1p�KmVerson HazMat Released: None Property Value: 0 Contents Value: 0 Property Loss: 0 Contents Loss: 0 Fire Service Deaths: 0 Civilian Deaths: 0 Fire Service Injuries: 0 Civilian Injuries: 0 Detector: Officer In Charge: MARC PETRELLA Assignment: Medical Mixed Property Use: Not mixed use Property Use: 1 or 2 family dwelling we"I'ARS Fire Incident Report Edmonds Fire Department Incident Number: EF07004165 Exposure: 0 Incident Date: 11/26/2007 Person('s) Involved Role: Patient Name:—m----',"V�,imr-,*-d*ri.c.—k,,a�Phone Number: Addre 1 12 AVE N Edmonds, WA 98020 Apparatus and Personnel Apparatus ID Personnel ID('s) A17 EF0326 EF1035 EF1532 Fire Incident Report Edmonds Fire Department Incident EF07004052 Case $: $EF07004552 Incident Date: - cti. Exposure: onal Station: 17 Location Type: Street address Address:&931 W, City: EdVmW6nWdWs—WWStw-z-dfi`e: WA Zip: 98020 Incident Type: EMS call, excluding vehicle accident with injury Shift: C Alarms: 1 Grid: EF254 Aid Type: None Alarm Time: (22:23:15) 11/17/2007 Arrival Time: (22:29:20) 11/17/2007 Last Unit Cleared Time: (22:57:09) 11/17/2007 Actions Taken: Provide basic life support (BLS) HazMat Released: None Property Value: 0 Contents Value: 0 Property Loss: 0 Contents Loss: 0 Fire Service Deaths: 0 Civilian Deaths: 0 Fire Service Injuries: 0 Civilian Injuries: 0 Detector: Officer In Charge: DAVID HUNTER Assignment: Medical Mixed Property Use: Not mixed use Property Use: 1 or 2 family dwelling gi Fire Incident Report Edmonds Fire Department Incident Number: EF07004052 Exposure: 0 Incident Date: 11/17/2007 Person('s) Involved Role: Patient Name: IM. W-jM 11H. Wli-c-ES—a jW Phone Number: 4257765073 A. j5y Address�-931 12 AVE N Edmonds, WA 98020 Apparatus and Personnel Apparatus ID Personnel ID('s) A17 EF0326 EF1532 EF1785 Advanced Adult Family Home Locator Results Page I of I Priv -acy I Find a Local Office I Contact ADSA I Contact DSHS I Help I Search DSHS 0 AGING AND DISABILITY SERVICES ADMINISTRATION Adult Family Home Locator Adult Family Homes in the following zip cod ff. , Note: Sorted by City PROVIDER NAME ADDRESS PHONE FACILITY NAr4E TOTAL BEDS EDMONDS . .. ........ . BRUJBAN, CORNELIA 9810 234TH ST SW, EDMONDS, 98020 (206) 533-0316 BETTER LIVING RESORT 6 Specialities: Dementia BRUJBAN, CORNELIA 415 9TH AVE S, EDMONDS, 98020 (425) 778-8649 BETTER LIVING RETREAT 6 Specialities: Dementia VARTOLOMEU, JENICA 431 12TH PL N, EDMONDS, 98020 (425) 775-0381 EMERALD HILLS AITH 6 Specialities: Mental Health, Dementia, Developmental Disabilities FEDOREAN, MARIA 9609 CHERRY ST, EDMONDS, 98020 (425) 712-8555 HELLEN'S AITH 6 Specialities: Mental Health, Dementia KITSAK, LARISA A. 21301 95TH AVE W, EDMONDS, 98020 (425) 771-5337 HOPE 6 Specialities: Dementia BULACLAC, EDGARDO A. 202 S 9TH AVE, EDMONDS, 98020 (425) 672-2080 MORNING GLORY AITH 6 Specialities: Mental Health, Dementia BULACLAC, EDGARDO A. 537 PARADISE LANE, EDMONDS, 98020 (425) 697-3459 MORNING GLORY AITH 6 Specialities: Mental Health, Dementia, Developmental Disabilities ORATE, ANTONIA P. 434 12TH PLACE N, EDMONDS, 98020 (425) 673-5876 ORATE HOME CARE CORPORATION 6 MONZON, JOHN D. 23326 97TH PLACE W, EDMONDS, 98020 PLEASANT LIVING AFH 4 Specialities: Mental Health, Dementia RADU, RODICA 1327 9TH AVE N, EDMONDS, 98020 RODICAS AITH 5 Specialities: Mental Health, Dementia (206) 801-7016 (425) 774-6957 WEAVER, SHARON 832 PINE STREET, EDMONDS, 98020 (425) 776-5115 ROSE MANOR INC 5 Specialities: Dementia SARAUSAD, BERNARDITA F. 617 VIEW PLACE S, EDMONMS-2aQLO (425) 640-7369 SARAUSAD HOUSE Specialities: Mental Health, Demenna r Ne. Search Al Contact the ADSA Webmaster for more information about programs on the Aging and Disability Services Web Site. For more ways to get in touch with the Department of Social and Health Services go to the DSHS Contact Information Web page. For technical questions or comments please contact the DSHS Webmastcr. For information about privacy, please read the DSHS Privacy Notice Before following any advice, suggestions, or recommendations on this website, please read our Disclaimer. http://www.aasa.dshs.wa.gov/Lookup/AFHDisplayv2. asp 11/27/2007 Snohomish County, WA Assessor Parcel Data Page I of 2 SnohomishOnillne Government information & Services County4* Washington * R E A L * Property Information County Home Assessor Home Treasurer Home Information on which Department to contact Please view Disclaimer If you have questions, comments or suggestions, please Contact Us. Date/Time:11/27/200712:19:36PM Answers to Erequently Asked Questions about Parcel Data (opens as new window) Retum to Prope ty e Parcel Number 00507000001800 Prev Parcel Reference 50700000180004 4ap of this parcel (opens as new window)11 General Information Taxpayer Name 11 Address (contact the Treasurer if you have questions) SARAUSAD CESAR & BERNARDITA 11 93112TH AVE N --- EDMONDS, WA 98020 If the above mailing address is incorrect and you want to make a change, see the information on Narneand Address Changes Owner Name 11 Address (contact the Assessor if you have questions) SARAUSAD CESAR & BERNARDITA 11 93112TH AVE N --- EDMONDS, WA 98020 If the above name and address is incorrect due to a recent sale, please see the information on Name and Address Changes After a Sale Street (Situs) Address (contact the Assessor if you have questions) 931 12TH AVE N --- EDMONDS, WA 98020 Parcel Legal Description MAPLEWOOD VILLAGE NO I BLK 000 D-00 - LOT 18 Go to top-gf-page Treasurer's Tax Information Taxes For answers to questions about Taxes, please contact the Treasurers office (opens as new window) 2007 Taxes for this parcel $8,808.53 (Taxes may include Surface Water Management and/or State Forest Fire Patrol fees. LID charges, if any, are not included.) To obtain a duplicate tax statement, either download our Tax Statement Request fon-n or call 425-388-3366 to request it by phone. Go to top of page Assessor's Property Data Characteristics and Value Data below are for 2007 tax year. Please contact the Treasurer's office for answers to questions about Taxes (opens as new window) For questions ONLY about property characteristics orproperty values (NOT taxes), please contact the Assessor's Office Property Values do not reflect adjustments made due to an exemption, such as a senior or disabled persons Values exemption. Reductions for exemptions are made on the property tax bill. http://web5.co.snohomish.wa.us/propsys/asr-tr-propinq/PrpInqO2-ParcelData.asp?PN=00... 11/27/2007 Snohomish County, WA Assessor Parcel Data Page 2 of �. Tax.Year 2007 Market Land $481,000 Market Improvement $501,1001 Market Total $982,1001 Tax Ye ar 2008 Market Land $555,000 Market Improvement $582,7001 Market Total $1,137,7001 Go to top of page Valuation and Property Tax History View KI—Story (opens as new window) Go to top —Of page Property Characteristics Tax Code Area (TCA) 00210 View Taxing Districts for this Parcel (opens as new window) Use Code 111 Single Family Residence - Detached Size Basis ACRE Size 0.28 (Size may include undivided interest in common tracts and road parcels) Go to top of page Property Structures Type Yr.Built Structure Description Dwelling 1979 1 1/2 Story w/Basement Go to top of page Property Sales since 7/31/1999 View Structure Data (opens as new window) Explanation of Sales Information (opens as new window) Sales data is based solely upon excise affidavits processed by the Assessor. No sales for this parcel have been recorded since 7/31/1999 Go to top-Qf page Property Maps Township/Range/Section/Quarter, links to maps Neighborhood 1605001 Explanation of Neighborhood Code (opens as new window) Townshi 27 Range 03 Section 24 Quarter NE Find parcel rhaps for this Township Range/Section p L— FELap of this parcel (opens as new window)II http://web5.co.snohomish.wa.uslpropsyslasr-tr-propinqlPrpinqO2-ParcelData.asp?PN=00... 11/27/2007 Snohomish County, WA Assessor Pa�icel Data: Page 2 of 2 Tax Year 2007 Market Land $481,000 Market Improvement $501,1001 Market Total $982,1001 Tax . Ye . ar 2008 Market Land $555,0001 Market improvement $582,7001 Market Total $1,1137,7�0] Go-tq top otpage Valuation and Property Tax History View KistM (opens as new window) Go to toD of r)a —99 Property Characteristics Tax Code Area (TCA) 00210 View Taxing Districts for this Parcel (opens as new window) Use Code I 11 Single Family Residence - Detached Size Basis ACRE Size 0.28 (Size may include undivided interest in common tracts and road parcels) Go to top-Qf pPge Property Structures Type Yr.Built Structure Description Dwelling 1979 1 1/2 Story w/Basement View Structure Data (opens as new window) Go to top gf page Property Sales since 7/31/1999 Explanation of Sales Information (opens as.new window) Sales data is based solely upon excise affidavits processed by the Assessor. No sales for this parcel have been recorded since 7/31/1999 Go to top-Qf page Property Maps Township/Range/Section/Quarter, links to maps Neighborhood 1605001 Explanation of Neighborhood Code (opens as new window) Township 27 Range 03 Section 24 Quarter NE Find parcel rnaps=-fQr-t—h:UTaw--n!jh g ion Nipffian et$gct View Map of this parcel (opens as new window)] htti):Ilweb5.co.snohomish.wa.uslpropsyslasr-tr-propinqlPrpinqO2-ParcelData.asp?PN=00... 11/27/2007 E City of Edmonds Fire Department A Fax Cover Sheet 9 10 Date: It f-17/0 7 Number of pages (including cover): 2 To: A k From: 0 Leis Edmonds Fire Department F-74,5 A—se<- 121 - 5th Avenue North Edmonds, WA 98020 - Phone: (4 2 5) 7 7 1 -eZT5'- 0 7- Fax Number: 5 60 -11 740 1 Fax: (425) 775-7721 --.2 � / i 1�r— A IV Al Af:�Y 12 tr CL,44.LM� &f-PAIC. S- 6-,l &A/ p4,j5� q�iZIStjo 071= L_ J'C-6 E? 0 vv-v The information contained in this fax transmission may be privileged, e6ficlential, and protecte&om disclosure. If you are nol the intended recipient, any dissemination, distribution, or copying of th-r-Ontents of this message is strictly prohibited. If you think that you received this transmission in error, pleas!shred the pages and notify the sender at 425-771-0215 or by fax at 425-775-7721. U:FireAdm in: Forms:AdrninFa Co%erSheet.doc 1Y2O!04j%%S TRANSMISSION VERIFICATION REPORT TIME 11/27/2007 14:26 NAME FAX TEL DATEJIME 11/27 14:23 FAX NO./NAME 83604167401 DURATION 00:03:31 PAGE(S) 09 RESULT OK MODE STANDARD ECM Wesffall, John From: Westfall, John Sent: Thursday, December 06, 2007 1:16 PM To: Petrella, Marc Cc: Correira, Mark Subject: Hrdlicka DSHS Investigation Marc: At your next on -duty opportunity, please call Mary Ann at DSHS w 425 339-3832 / c 360 929-0552. She has further questions regarding care for Mr. Hrdlicka: Was caregiver present upon arrival? Did you enter through window? Did caregiver accompany transport (#EF07-4165 11/26/07)? Previous incident is #EF07-4052 11/17/2007. Thank you, John