642 MAPLE STServing Briet; Edino rlu') 12425 Meridian Ave S
S140HOMISH Co.
? Mountlake Terraceand Everett, WA 98208
INVIRE
DISTi__� the Town of Woodway Phone (425) 551-1200'
I ; t www.FireDistrictl.org Fax (425) 551-1272
I e- FREQUENCY I STATION 1, SHIFT�
LOCATION: 642 Maple Street 366 17 C
BUSINESS NAME: Maple Apts PHONE: SCHEDULED n 8/01111
DATE DUE � '
MAILING 361 W. Afta Via Dr LIFIR 1,. 422 8203
ADDRESS: Camano Island 98292 1�1
BUSINESS OWNER: Barrett, Don/Becky HOME PHONE: 3603870178
4254899865
FIRE PREVENTION
INSPECTION REPORT
91'ErDIVIONDS
El BRIER
0 WOODWAY
[I MOUNTLAKE TERRACE
OUNINCORPORATED
ACTIVE
EMERGENCY-1: HOME PHONE: URRENT
KEY ACCESS-2: HOME PHONE: CITY YES NO
rBUSINESS -1 El
LICENSE F
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR: A) �`fg fill
_j
FIRE
SYS7EMS: ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
DM:b,� �6 -F�J Kf
2
2
3
4
5
6
6
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
,DPTE DUE:
2nd RE -INSPECTION
DATE DUE:
I
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 15
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
8
4
8
DATE,
DISPOSITION:
, ETTER NEEDED [:] YES N
rLETTER NEEDED [:] YES NO
i
8
FIRE DEPARTMENT COPY
CITY OF EDMONDS
121 AVENUEN. - EDMONDS, WASHINGTON 98020 (425)771-0215
FIR DEPARTMENT
LOCATION: 642 Maple Street
BUSINESS NAME: Maple Apts
MAILING 361 W. Afta Via Dr
PHONE:
FIRE PREVENTION
SAFETY SURVEY
ADDRESS: Camano Island 98292
BUSINESS OWNER: Barrett, Don/Becky HOMEPHONE: 3603870178
EMERGENCY-1: Bodano, Barb/Mgr. HOMEPHONE: 4254899865
KEY ACCESS-2: HOME PHONE:
FREQUENCY
STATION 1, SHIFT-""
2
17 6
�
SCHEDULED
DATE DUE 0- 08101/10
UFIR 0, 422
8203
ACTIVE
PERSON CONTACTED: INITIAL INSPE7N DATE
NAME OF INSPECTOR: 44VA&Ae
FIRE FE ,-4(4
SYSTEMS: ANNUAL
HAZARDS FO�U7N AND LOCATIONS COMMUNIC IONS
ENTER CODE ONLY ONCE 11�
YIOLATION CODE
2
3
3
4
xi
5
6
7
8
ist RE -INSPECTION
DArE DUE
2nd RE -INSPECTION
DATE DUE
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
IN,cPECTOR-
INSPECTOR*
INSPECTOR-
2
DArE:
DATE:
DATE:
3
VIOLATIONS
5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
18
4
18
DATE:
DISPOSITION:
7
8
ETTER NEEDED C] YES E) NO
UETTER NEEDED [] YES NO
FIRE DEPARTMENT COPY