645 BELL ST (2)U (4 5- 6 C t-1, S T_
Notification Date 09/15/2017
OV ELD40 CITY OF EDMONDS
Department of Fire Prevention
121 5th AVE N
EDMONDS, WA 98020
DEPARI
JUDY LYLE
645 BELL ST
EDMONDS, WA 98020
REMINDER NOTICE
Property Access Code:
0322NOR9033
For the following Property:
NORTH VISTA CONDOS
645 BELL ST
EDMONDS, WA 98020
This is a reminder that you have one or more life safety systems due for inspection as shown in the table below.
PeriddTd- testing -of'these sy§tems- i§"required by state- dfid loc5i oraina6i5e—arfa ii�_tb�be c6ii-dUctW15y a -st6t6'Iide-n-§ed aNdcwtifi6d-in�;pector or�, or
before, the due date shown below.
System
Location
Inspection Due Date
I Frequency
Status
Fire alarm
10/15/2017
lAnnually
Due
Wet sprinkler
riser room in garage
09/12/2018
lAnnually
Instructions:
• Using any resource you have available, hire a State Certified Inspector to perform your system inspections. TEGRIS Fire may be an additional
resource for locating or requesting bids from inspection companies via the "Request a Bid" link under Actions.
• The vendor that you select to inspect your system will be required to fill out a report online and pay any required fees prior to submittal.
• Instruct your inspection company to use your Property Access Code above to enter the inspection report online at www.tegrisfire.com
• The inspection will be complete upon Fire Marshal review.
• It there are any deficiencies, these must be corrected and submitted prior to Fire Marshal approval.
To view information for your property:
• Visit www.tegrisfire.com and sign in with your user name and password. If you do not have a username and password click on the "sign Up
Here" link and enter the requested information.
• Once logged in, enter the address of the property from this letter and click the magnifying glass icon.
• Click on the "Assign As Owner" icon to the right of the address and enter the Property Access Code (PAC) into the pop-up window.
• Provide a valid email address, review your contact, property, and fire life safety equipment information and update if necessary.
For more information please visit www.tegrisinc.com or contact:
City of Edmonds, Department of FirePrevention, Snohomish County -Fire District 1, PH: 425-775-7720
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n)4tf-' Tujo �_e
(Spanish) Para una copia de esta carta en espahol, va por favor a www.tegrisinc.com/letters/`tfs.
(Chinese) MH-4� www. tegrisinc. com/letters/tfs.
(Korean) tF:� C11011 0�11.= 01 A�-_Aj��j C 0 M de-t-t-c �rt f -2- 1101- —Y 4 Ad 111
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Wolfe Fire Protection Inc.
#B
17321 TYE STREET SE5
MONROE, WA 98272
(360)794-7926/FAX: (360)794-3080
INSPECTION & TESTING OF SPRINKLER & STANDPIPE SYSTEMS: AN EXPLANATION OF TERMS
At Wolfe our goal is to keep you informed as to what type(s) and when your next Inspections & tests will
be due. We hooe this, willAelp u w1ith udg tingf the�wimportant and reiq ired p
- _yo___ _b__ e QL --o jeratiQns
Annual: Next Due I/>,o / F
Five -Year (includes Annual): Next Due 12:! E! Z&
Standpipe(s): Next Due
Sprinklers: Next Due E150yr E120yr ER/10yr E15yr Vt�/ F
Annual Inspection and Test: The most common inspection & testing frequency for fire sprinklers is
typically referred to as the "annual test" or "annual inspection" and, as the name suggests it is required
to be done annually. The inspection & test includes a visual inspection of the system to check for items
that might impact the operation of the system during an emergency. The guideline used is NFPA 25. The
system is also "tested" for operation. Actual functionality of certain components that are critical to the
system, but not able to be evaluated by a simple visual assessment are operated. Where water needs to
be flowed it is routed to the outside or a drain and water is not discharged into the building.
Five -Year Inspection: Every five years the system must be inspected internally. This means emptying the
system of water or air and removing caps/plugs so the piping may be visually assessed. This is somewhat
time consuming and costly. To reduce those costs the five-year inspection is typically scheduled at the
same time as the annual inspection. Wolfe Fire Protection will endeavor to let you know a full -year in
advance of when a five-year inspection is due, and the cost so that you may have time to budget the
additional cost. Standpipe inspection & testing is also due on a five-year basis.
Sprinkler Testing: Depending on the type, sprinkler heads must be replaced on frequencies from as short
as 10 years to as long as 50 years. Alternatively, sprinkler heads may be tested by a recognized testing
laboratory such as Underwriter's Labs (UL). A sampling is taken and sent to the lab where they are
tested to a standardized protocol and if the test samples pass the remaining heads can be issued a
certificate extending their useful life an additional ten years.
At 50 years: Standard response sprinklers (and every 10 years thereafter until 75 years old, then
every 5 years).
At 20 years: Quick & fast Response sprinklers (and every 10 years thereafter).
At 10 years: Dry barrel sprinklers (and every 10 years thereafter).
At 5 years: Link style sprinklers exposed to extra -high heat or sprinklers in harsh environments.
p-'
—�—
Remit Backhow Test Report
to: Atln,:
W, Edmonds, WA 98026
MCMuf)hy@oi,edmonds,wa.us
ACCOUNT ID NO
NAME 01- PREMISE
-North Vista CovnlludoMiniums
�
� CONTACT PERwDN
North Vista HOA
PHONE 425-775-0435 FAX
�OCallON0:
�
� .....~..`^,=
NFV� INSTAL,
EXISTING i:-
.'ROPER INSTALLATION?
OF ASSEMBLY
WAT.J-S —.Mc
SERIAL NO, 21164
UPENED AT AIR INLET
FASS
.
DID NOT OPEN
/
' CI.E
RT CLEAN _..^
.
----_
/ ^^''
~''E^"."m�
HELD AT. pS0
/
LEAKED '
CLEANED
HEPA|nED
*;TER
�------------'
REP4|RS �c�
' ^E
LEAKED
/
/
.
-
OPENED8T._____PO/D NR|wLET
. �^Soco
,
,^xF.n
|
p
|
|D Ill CHECK PG(D �M�VALYE
------- ------pJ/o /
~~r'
Required m/nimunluirgap oepumU(
provided? Yes ' No ' Detector Motor
LINE P ncoSuns___
CVNP/NEDGFwCe
('EIRT NO
DATE
TESTER PHONE #
DATE
'�u/n�nowDxTs�'��
--�---------'--
SERV|OERESTDREo Yo^/�� No
Te sting Company:
v#[FP]Wo1f6\Fire
Protec'u.0n, Inc. -
17321 'rye St.- S.E., Ste. "B" - Monroe',WA 982.72
Fax: 36.0.794,3080. Ph..: 36.0.794.8.621-
Ls� RINKLERS . WET-`
(ONE SYSTEM PER REPORT)
.,gertification Given
R E D`6
YELLOW
W H I TIE ;,a,
CONFIDENCE TEST: REPAIRS:
Occupancy Address: j�W; 5CH Sf� F—AMOr4
Occupancy Name: A20C S+c� ('_ot�jn
Building Owner: AW4-ki u�'sf�c, (rijoJr) Wn-jd
Phone Number:
Responsible Person: �,,(A ryvo C-
, �, � �,) e_1
Phone Number: D 2 __3
Building Owner
Address: 13F,11 5f, SAfl-e- Zaa
P_:-J&it-nj,45, u'JCA
Date of Inspection: 7—?>— 14
Inspection Frequency / Type: Annual
Tester's Name (print): 960 62_1'e4l Mcf /1
Certification Number: SCP- C>91C1"5
Central Station monitoring? Yes No
Monitoring Co. Name: 011 ItKI Pl* Q +
Primary Component: Se
System Make: I -_ A)/
System Model:
System Location: Sri Coo 16
Identification Numb
ProblemsFound: (if additional room is required, please add a separate sheet.)
Corrections Made: Date Corrected:
Corrected by:
(If additional room is required, please add a separate sheet.)
Certification Number: SCP-
This certifies that this Fire and Life Safety system has been properly inspected for reliability to cover the items
listed in this report and is consistent with the Authority Having
Jurisdiction's Fire Department Fire Code standards.
All discrepancies are noted and have been reported to the
building Owner/Manager for corrective action.
Signature of Tester:,
Phone #: 360.794.8621
Testing Agency: Wolfe Fire Protection, Inc.
Mailing Address: 17321 Tye St. S.E., Ste. "B" - Monroe, WA 98272
l/ Building Representative (signature):
11
Sprinklers - WET Page: 1 of 2
The b6low items on the check list shall jbe. inspected and tested. This list does not constitute all of the required
inspecting and testing of the Fire and Life Safety system. Rder to the Authority Having Jurisdiction's
Fire Department Fire Code for inspecting and testing requirements.
Genered
1.,, Flow Test conducted? ............................................................................................................
Yes
N o' U)
2. Static Pressure: psi Flow'Pressure: e psi
3. Total number of sprinkler heads on this system? IWA
4. Was 2" Main Drain checked? .........
........... ................. .......... Othe
Yes-, El
No C3
5. Flow Switches, Supervisory Switches and Alarm Bells tested? ......................... N/A 0
Y e s-@-
No Q
6. Pressure regulating valves tested? .............................................................................. N/A Cl
Yes Ej--
No E)
7. Alarm Bel.l.,operates? ...................... ....................................................................... N/A 0
Yes-Q-
No C3
System inspected and lubricated ? ..... ........................................................................ ....
�Yes-a
No 0
9.-V`aI Ve's-se a I,e d or supervised? ..................................... ....................................
No Q
10. Signs provided on all valvesT .......................................................................................................
Yes',El-
No C3
11. Pumper Connections and Clapper valves unobstructed and turn freely ? ................
Yes 0-,
No LI
12. Sprinkler head coverage acceptable? ..........................................................
Yes 9-
No C1
13�-Kgvie the sprinkler heads been replaced or successfully sample tested in the last 50 years?
Yes 2-
No
14. Proper dUmber'spard-S'prihkler ht-ads7aVail'6bl'd'-�vith-eippro-pri�ite wrenches for-,e`ach?-..=.;
Yes�q-
No Q
15rr-Sy§,�em left in service? .................. i ........................................ ......... I ....................................
Y e s-El-
N o 0-
16.System gauges been replaced or calibrated within the last 5 years? .... e,. Q. .....
Yes-,�
No cl
i 71 . Sprink'ler heads free of corrosion, paint, obstructions and/or physical damage? ....
Yes�E�
No (3
18. Was any debris fo,und in1he Fire Department Connection (FDC,)? ........................
Yes-.Ll
No-@-
.19,;Was.--the Fire Department Connection (FDC)- been back flushed. in the last 5 years? ...
Yes-Q-.
No�,- Cj
20. Was an internal pipe and valve inspection performed within the last 5 years? .................
Y e s .210"
No C3
Date Performed: Z C
21. Was a signal rer,-eived at the Central Station monitoring company? .................... N/A [I
Yes L)
No b
Sprinklers - WET, Page: 2 of 2
FIRE PREVENTION
Serving Bria Edinonds, and 12425 Hei-idian Ave S
FIRESNOHOMISff CO.— Moi I intlake Terrace Everett, WA 98208
Phone (425) 551-1200
DIST T 14114114�FireDistrictl.org Fax (425) 551-1272
645 Bell Street 98020
LOCATION:
North Vista Condos 4256701943
BUSINESS NAME: PHONE:
MAILING 645 Bell Street, Edmonds, WA 9 8020
ADDRESS:
BUSINESS OWNER: Lyle, Judy HOME PHONE:
Welsh, Jim 2063902642
EMERGENCY-1: HOME PHONE:
KEY ACCESS-2: HOME PHONE:
EMAIL:
PERSON CONTACTED: Vo ri e-
NAME OF INSPECTOR:
4-5 Id,115-
FIRESYSTEMS: AS10/14FA10/14FE4/14 FDLkBox
INSPECTION REPORT
0 EDMONDS
0 BFIIER
El MOUNTLAKE TERRACE
[]UNINCORPORATED
,' FREQUENCY I STATION & SHIF'*1
Annt I 17-A
SCHEDULEDJul 2015
DATE DUE
422
LIFIR 10
CURRENT
CITY
YES NO
BUS NES
LICE NSE
INITIAL INSPECTION DATE
bWT%WUMrVj1jq4&pATIONS /,COMMUNICATIONS
AA wo' 4,
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
GRANTEDTO:
FINAL RE -INSPECTION.
DATE DUE:
VIOLATIONS
CITED:
PERSON
-CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
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
3
7
RETURN RECEIPT
RECEIVED
6
4-
18
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED E] YES El NO
rLETTER NEEDED F] YES F1 NO
1
8
FIRE DEPARTMENT COPY
Co'nfidence Testing Company:
Fire Department
Wolfe Fire
Protection, Inc.
17321 Tye St. S.E., Ste. "B" - Monroe, WA 98272
Fax: 360.794.3080 0 Ph.: 360.794.8621
Confidence Test Report
1-11
SPRINKLERS - WET
Certification Given
RED 0
YELLOW 0
WHITE a
(ONE SYSTEM PER REPORT)
CONFIDENCETEST: 1,W1 REPAIRS:1 U
Occupancy Address: A/S Et-111 5�, Lffiollc(
OccupancyName: A)0[ V
BuildingOwner: Alnf+k V�-;+-n (,ci4o' 14,o,14.
Phone Number:
Responsible Person: 1,)C-tM jf,5 Wif I �Z V)
Phone Number:
Building Owner ---,-
Address: 01�. S�l SfA'l �-e- 0 r4
Date of Inspection:-!i
Inspection Frequency Type: Annual
Tester's Name (print): J —
Certification Number: SCP-
Central Station monitoring? Yes No
Monitoring Co. Name: Al'wtr
Primary Component: Z", we�-� RLS
System Make:
System Model: 122 C)
System Location: (—or5ni
Identification Number:
ProblemsFound: (if additional room is required, please add a separate sheet.)
Corrections Made: Date Corrected:
Corrected by:
(If additional room is required, please add a separate sheet.)
Certification Number: SCP-
This certifies that this Fire and Life Safety system has been properly inspected for reliability to cover the items
listed in this report and is consistent with the Authority Having
Jurisdiction's Fire Department Fire Code standards.
All discrepancies are note nd have been reported to the
building Owner/Manager for corrective action.
Signature of Tester--
Phone #: 360.794.8621
Testing Agency,-W�lfe Fif—e Protection, inc.
Mailing Address: 17321 Tye St. S.E., Ste. "B" - Monroe, WA 98272
Building Rep rese ntati ve- (signature):
Sprinklers - WET Page: 1 of 2
The below items on the check list shall be inspected and tested. This list does not constitute all of the required
inspecting and testing of thefire and Life Safety system. Refer to the Authority Having Jurisdiction's
Fire Department Fire Code for inspecting and testin�'requirements.
General
1. Flow Test conducted? ............................................................................................................ Yes No
2. Static Pressure: psi Flow Pressbir_e: psi
3. Total number of sprinkler heads on this system?
4. Was 2" Main -Drain checked?. ..................... ......................... .............................. 0 t h e_�M'. Ye s El No. EI.-
5. Flow Switches, Supervisory Switches and Alarm Bells tested? ......................... N/A YesA7 No El
6. Pressure regulating valves tested? .............................................................................. N/A
-'-Ye"'s' El' No.-L)
T. Alarm Bell operates? ............................................................................................. N/A Ll Yes j No C3
8. System inspected and lubricated ? .................................................................................. Yes No
9. Valves sealed or supervised? ................................. ............................................. Yes �P No 0
10. Signs provided on all valves? ................................................................................................... Yes No C1
11. Pumper Connections and C I lapper valves unobstru . cte I d and tu I rn I freely ? ....... Ye 9r No Q
12. Sprinkler head coverage acceptable? .......................................................... Yes,2V N o Q
-T3-ftve the sprinkler heads been replaced or successfully sample tested in the last 50 years? Yes No (3
-1".roper number spare sprinkler heads available with appropriate wrenches for each? ...... YesAl No 0
15. System left in service? ............................................................................................................ Yeso No El
I zoll
16. System gauges been replaced or calibrated within the last 5 years? . . ................ Yes�W No C)
17. Sprinkler heads free of corrosion, paint, obstructions and/or physical damage? .... Yes No El
18..Was any debris found in the Fire Department Connection (FDC)? .......................... Yes- C)
19. Was the Fire Department Connection (FDC) been back flushed in the last 5 years? ... Ye No C)
S?I
20. Was an internal p!pe and valve inspection performed within the last 5 years? ................. Yes No El
Date Performed: - 7o If
21. Was a signal received at the Central Station monitoring company? .................... N/A (3 YesX No El
Sprinklers - WET Page: 2 of 2
.Confidence Testing Company., Fire Department
Confidence Test Report
DIVANCED
'q%,FIRE PROTECTION, !NC. - - Confidence Testing: 206.79,3.0936
P.O. Box 1543 - Woodinville, WA 98072
Ph.: 425.483.5657
SPRINKLERS WIE''T
Certification Given
RED 0
YELLOW U
WHITEQ,
(NOTE. ONE SYSTEM PER REPORT)
CONFIDENCE TEST: REPAIRS:
,5Z -'Occupancy Name: _vl,
Occupancy Address: L
Building Owner: Phone Number:
Responsible Person: Phone Number:
,.-Building Owner
Address:
Date of Inspection: Inspection Frequency/ Type:
_.e�nU-a.1—
Tester's Name (print) ertification Number SCP-
Central Station monitoring? Yego� No 0' Monitoring Co. Name:
Primary Component: zi �11,lerlll System Make:
11 �A
System Model:
System Location: 0 Identification Number:
ProblemsFound: (if additional room is required, please add a separate sheet.)
Corrections Made: Date Corrected: Corrected by:
(if additional room is required, please add a separate sheet.) Certification Number: SCP-
This certifies that this Fire and Life Safety system has been properly inspected for reliability to cover the ittmis-
listed in this report and is co ent with the Aut rit Having Juris4iction's Fire Department,Fire Code standards.
rt I / -�
All discrepancies are no have been-r t h building Owner/Manager for cqrrective action.
Signature of Tester- Phone #: 425.483.5657
Testing Agency: 4(dvanced Fire Protection, Inc.
Mailing Address: P.O. Box,15
:=072.,
Building Representative(signature) ....)
I
Sprinklers * WET Page: 1 of 2
T!Atteow items on the check -list shall be inspected and tested. This list does not constitute all of the required
4P
inspecting and testing of the Fire and Life Safety system. Refer to the A.uthority Having Jurisdiction-'s.
-Fire Department Fire Code for inspecting and testing requirements.
General
co.ndu'ctid,? ............................................................ . .............................................................. Ye�� No. El,-,
i Pressure: -5 Y,
2. Static Pressure: ps psi �j
I Totat,number of sprinkler, heads on this- system?
4. Was 2" Main Drain checked? ......................................................................................................
OtherEl
Yes-tj— No Q.
Alarm Bells tested?
Flow Switches., Supe isor�
Y
5. ry _�UP!s,(And ..................................... NIA
e s_�,
6. Pressure regulatihie4ifv6sAest�d? e V................................................
N 0
�'t iL�14_ -F ."T F7 jY
7. Alarm Bell operate? ................ Or I ............................................ Yes.,
.8. System inspecteidandIul�iicated ? .... :7,� �n ...... ........................................... ......
......
Y e s-G— N o 0
9. Valves-sealdd or.4dp .........................................................................
,qrvised? .......
Yes-s-- No C3
-- ----- ----
10. Provided on allvalves? ............................. I ..................................................... I ............................
Yew::21�- No Q
11. Pumper Connections and Clapper valves unobstructed and turn freely ? .................... Y e sJ�P— No 0
12�SpIAkler coverage acceptable? ............................................................................................. Yes.�M—No El
13. Have the sprinkler heads been replaced or successfully sample tested in the last 50 years? Yes
No El
14. Proper number spare sprinkler heads available with appropriate wrenchs for each? .............. Yes-5' No Q
15. System left in service? ............................................................................................................ Ye�,�' No El
16. System g.4.uges been replaced or calibrated within the past 5 years? .............................. Ye,%
0, No 0
1T.6 Sprinkj1,er+e9ds free of corrosion, paint, obstructions and/or physical damage? ..................... Ye�� No (J
18. Was debris'found in the Fire Department Connection (FDC)? ................................................ Yes 0 No-Q-
al
19. Was theFire Departmedt,,,C onnection (F.DC) b ck,flushed within the last 5 years7 Yes No LI
20. Was an internal pi"pe"an'd valve inspection performed within the last 5 years? ................. Yes-9— No Ll
Date Performed:
21. Was a signal received at the Central tation monitoring/qompany? ....... L) Y es -a— No Q
Sprinklers 9 WET Page: 2 of 2
FIRE ALARM Olympic Security & Communications Systems
CONFIDENCE TEST PO Box 3559 Arlington, WA 98223
(one system per report) 360-652-1088 800-540-7233
RED E] I YELLOW El I WHITE
Address: (01-5 Z>T Occupancy Name: Pe rCn4 Y I S714 C�ytjW ":-
Building Owner: CLI jr) -e- Dv—�
Responsible Person; I JbY L—Yk OAJ,il In 2-
Phone Number: c9 4) 6, -,37 0 - -,aL 16— Phone Number: 6--) /0 & - -3!� * --
Building Owner Address: 'SAftNr Alternate Phone # AJIA
of
Name (Please
KV -7 / /
Inspection Type: AnnualA Quarterly El Acceptance El
Certification # N'41 &Q!� e-7 7('
j rouoie signal wan AL power ott?
Yes
No LJ
System operates properly on battery backup?
Yes
No 0
Battery voltage (no load)21. 37 -volts Battery Voltage (full load)9511�1-T—charge voltage-�2-7
System operates properly on standby power?
Yes
No 11
All signals operate on AC power?
Yes
No 11
Number of initiating circuits: :2 Number of signal circuits:_ Q,'
Does system meet audibility standards?
Yes
No El
All circuits checked for electrical supervision?
Yes
No 0
All auxilliary equipment operates (elevators, fans, dampers)?
N/A 0
Yes I?
No El
Ventilation controls operate?
N/A 14
Yes 0
No 11
Key to panel available?
Yes
No L1
Operating instructions at panel?
Yes
No 0
Pull station restore tools at main panel (rods, keys, etc.)
N/A #V
Yes 0
No 0
Trouble indicators function properly?
N/A 0
Yes )a
No 0
Remote Annunciator Panels function properly?
N/A El
Yes P
No D
Elevator Call Down functions properly?
Yes �il
No 0
Test record posted at panel?
Yes or
No El
General alarm automatic time delay:
N/A
Central station monitoring company received signals?
Yes
No Ll
Was a full walkthrough done?
Yes
No El
System left in service?
Yes 1,9
No 1:1
informed owner of inspection & testing results and all system deficiencies?
Yes �Plv
No 0
Number of stories: '3
Yes EJ
No U
Do all locking devices release upon activation of the fire alarm system?
N/A
Yes 0
NOD
Do all locking devices release upon power failure?
N/A
Yes EJ
No El
Does the door to roof unlock?
N/A 10
Yes 17-1
NOD
Do doors unlock but not unlatch?
N/A 7
Yes 0
No El
Us there an access key at the control panel for doors that fail to unlock?
N/AjM
Yes F�
No 0
SYSTEM DEVICES TOTAL# UNITS IN BUILDING TOTAL # UNITS TESTED
TEST
RESULTS ACCEPTABLE
Bells, Horns� Chimes
Voice Speakers (voice clarity)
N/A
Yes El
No L-1
Smoke Detectors
N/A
Yes
No 0
Heat Detectors
N/A
Yes 0
No 1:1
Duct Detectors 0
N A
Yes El
No 0
Sprinkler Flow Switches
N/A
Yes
No 0
Sprinkler Supervisory Switches
N/A 11
Yes 11
No 0
Visual Alarm Devices
N/A El
Yes X
No EJ
Manual Pull Stations
N/A El
YesM
No 0
Automatic Door Unlocks
N/AjM
Yes El
No 0
Automatic Door Release
N/A n
Yes
No 0
Central Station Monitoring? Yes No onitoring Company Name:
oly
ontrol Panel Man-l-I ...... Model Number:
ProblernsFound:
Corrections Made: Date Corrected: Corrected By:
Signature of Tester: P Date: 1012/1Z
Customer Signature: !0 tr- Date: � 6('7 ft q
FIRE PREVENTION
ServingBI'let;!-Edmonds, and
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
OPEDMONDS
FIR
Mountlake. Terrace
Everett, WA 98208
0 BRIER'
STR
T www.FireDistrictl.org
Phone (425) 551-1200
Fax (425) 551 72�
-12
0 MOUNTLAKE TERRACE
[I UNINCORPORATED
STATION &SHIFT-'*'
FREQUENCY
LOCATION:
6,44 1 Stree+ QM20
Ammal
17-D
BUSINESS NAME:
i��kl ia Ca ridm
PHONE: 425E701942
SCHEDULED
DATE DUE 11' Ju12014
MAILING
UFIR I,
ADDRESS:
SLrcc� F_dmi3n&-,'VVA 08020
BUSINESS OWNER:
HOME PHONE:
EMERINCY-1:
WC , 6h, Jim
HOME PHONE: 213=02E-42
CURRENT'
KEY ACCESS-2:
HOME PHONE:
CITY
'E" -AIL:
BUSINESS
LICENSE
PERSON C00ACTED:
INITIAL IN�PEIC TION DATE
NAME OF INSPECTOR:
I HE Sys i L- Ms:��_l
F 0113 FE4/14.1 V,"'r-D Llk- Baw
Vw, 6� V
h,4
W.,ARDS FOUND AND LOCATIONS 1COMMUMbA,,,,I INZ)
f
V
2
2
3
3
4
4
5 %
5
6
-6
7
7 4
I AGREE TO CORRECT THE ABOVE VIOLATION I-N THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE-IW CTION
EXTENSION
FINAL RE-INS�ECTION
VIOLATIONS
DATE DUE:
i
DATE DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED1
CONTACTED:
INSPECTOR:
INSPECTOR/
INSPECTOR:
2
DATE:
DATE:
DATE:'
3
VIOLATIONS
VIOLATIONS
PAE-CITATION
CITATION ISSUED
1 5
1
LETTER SENT
NUMBER:
4
CODE
5
2
6
2
6
DATE�
SECTION:
RETURN RECEIPT
6
3
7
3
7
RECEIVED
DISPOSITION:
4
18
4
.8
DATE:* -
7
LETTERNEEDED F] YES NO
LETTERNEEDED F] YES NO
r
8
FIRE DEPARTMENT COPY
FIRE PREVENTIOW,
INSPECTION REPORT.
,SNOHOMISH CO. Sei-ving Biler, Edmonds 12425 Met-idian Ave S EDMONDS
Mountlake Terraceand Everett, WA 98208 EBRIER
FIRE I . " 0 WOODWAY
the Town ofrWbodwdy' Phone (425) 551-1200, - 0 MOUNTLAKE TERRACE
T R T www.FireDistrictl.org Fax (425) 551-1272 0 UNINCORPORATED
FREQUENCY I STATION &SHIFT-)
LOCATION: 645 Bell St 365 17 D
SCHEDULED
BUSINESS NAME: North Vista Condos PHONE: DATE DUE 1 07/01/13
MAILING LIFIR � 422 7203
ADDRESS:
BUSINESS OWNER: HOME PHONE:. 4256701943
Lyle, Ju&y
EMERGENCY-1: Welsh, Jim HOME PHONE: 2063902642 CURRENT YES NO
KEY ACCESS-2: HOME PHONE: CITY
BUSINESS
LICENSE El El
INITIAL INSPECTION DATE
PERSON CONTACTED:
-7
NAME OF I NSPECTOR:
FIRE AS 11/12 FA 9/11 FD LkBx FE —1
SYSTEMS: ANNUAL
I L
jua
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
L'eo L �7
,2
2
3
3
4
4
5
5
I� 6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
lst RE-INS�ECTION
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTED TO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
2ATE:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
1 5
1 5
LETTER SENT
NUMBER:
4
CODE
5
12
6
2
6
DATE:
SECTION:
I
RETURN RECEIPT
3
7
7
RECEIVED
6
DISPOSITION:
4
'8
4
'8
I
DATE:
7
LETTERNEEDED [] YES N 0
LETTERNEEDED F] YES NO
1
8
FIRE DEPARTMENT COPY
Confidence Testing Company:
-A0.2jrD VA NCED
FIRE PROTECTION, INC.
P.O. Box 1543 - Woodinville, WA 98072
Ph�.: 425.483.5657
a 71 Jx,>Fire Department
z ,t
Confidence Test Report
206.386.1448 Confidence Testing Officer.
206.615.1068 (fax)
206.233.7219Red Tag H otline
SPRINKLERS -WET
Certification Given
RED
YELLOW Cj
T_
W-HTT E �3—
(ONE SYSTEM PER REPORT)
CONFIDENCE TES�T:_1-43+REPAIRS:j Fj
Occupancy Address: Sz�` _"'�_Occupancy Name: X/ 111(;Z,4
Building Owner: , Phone Number:
Responsible Person:z=M cq(57(�� - ..a ��"O
Phone Number:
Building Owner
Address:
Date o f Inspection: Inspection Frequency/ Type:
T e s t e r's N a m e (p r i n t): 1'12114� fQ21-2 SFID Certification Number: SCP-
Central Station monitoring? Yes 9— No El Monitoring Co. Name: 0t1_jM2;1>6
Primary Component: C�' A-45 R>J'5e� System Make:
System Model:
System Location: Identification Number:
ProblernsFound: (if addifional room is required, please add a separate sheet.)
Corrections Made: Date Corrected: Corrected by:
(If additional room is required, please add a separate sheet.) SFD Certification Number: SCP-
This certifies that this Fire and Life Safety system has been properly inspected for reliability to cover the items
listed in this report and is consistent with the Sepattle Fire Department Fire Code standards, and all discrepancies
n A
are noted and have be , r p"o;rted to the b il in wn�er/Manager for corrective action.
Signature of Tester: Phone #: 425.483.5657
Testing Agency: Advanced Fire Protection, Inc.
' 3
Mailing Address: P.O. Box 119 3 Woodinville, WA 98072
Building Representative (sign Trze
Sprinklers - WET
Page: 1 of 2
,The below items on the check list shall be inspected and tested. This list does not constitute- all of the
regbired inspecting and.testing of the Fire and Life Safety system., Refer to the Seattle Fire Department,
Ire
Code for inspecting and testing requirements.
General
1. Flow Test conducted?..,,,,.,.-. ......................................................................................................................... Y e s-El— N o C)
2. Static Pressure: psi Flow Pressure: psi
3. Total number of sprinkler heads on this system?
4. Was 2" Main Drain ch6CKed?-',.6 .............
Y No El-
...................................................
e.s-.
yff
V�
5. Flow Switches, rg'Switches and Alarm Bells tested? ..................................... N/A LI YeA',U_ No Q
6. Pressure regulating va/lves tested? ..................................... ....................................... Yes E) No Q
T/ N/A__Uj
_7
7. Alarm Bell operate? ................................................................................ ............... YesoU,—,-No-[3-!
8. System inspected and lubricatOd ...... .............................................. -Y e4z@— N o Ll
Az)
9. Valves sealed or supervisdicu . ....... . .... ..................................................................... ....................... Yes -a- No L)
10. Provided on all valve's? ............................................................................................................... YesizQ—No 0
1 I.Rumper Connections and Clapper valves unobstructed and turn freely 7 ............................................... Ye-s--Ej-- No LI
12. Sprinkler coverage acceptable? ............................................................................................. Y e;s--U, N 6 (3
13. Have the sprinkler heads been replaced or successfully sample tested in the last 50 years? Yes E)_.� No El
14. Proper number spare sprinkler heads available with appropriate wrenchs for each? .............. Y es,-ff-_-N o L)
15. System left in service? ............................................................................................................. Yes-B—No LI
16. lystem gauges been replaced or calibrated within the past 5 years? ............................................. Ye-s--Cl' No Ll
17. Sprinkler heads free of corrosion, paint, obstructions and/or physical damage? ..................... Y e s-B--- N o 0
18. Was debris found in"fKe Fire Departme,�ttonnection (FDC)? ................................................ Yes El No'b-
19. Was the Fire Department Connection (FDC) back flushed within the last 5 years? . AITI Yes (3 No El
.20. Was an internal pipe and valve inspection performed within the last 5 years? ................. Y e s-E]-- N o- El
bate Performed:
211as a signal received at the Central Station monitoring company? . ...... ....... N/A El Y eT,-B- N o El
Spfinklers WET Page: 2 of 2
C6nfidence Testin-g Company:
JAB VA NCED
P.O. Box 1543 - Woodinville, WA 98072
Ph.: 425.483.5657
SeTrattft Fire Department
Confidence Test Report
206.386.1448 Confidence Testing Officer
206.615.1068 (fax)
206.233.7219Red Tag Hotline
SPRINKLERS - WET
Cert-ification Given
RED
YELLOW
WHITE
(ONE SYSTEM PER REPORT)
CONFIDENCETEST: REPAIRSF
Occupancy Address:4
Occupancy Name:-L� �1-17-7-A
Building Owner:
Phone Number:
Responsible Person: L SAI
Building Owner
Address: A /t-�
Phone Number:
Date of Inspection: //- 7
Inspection Frequency/ Type: A_gjLu a I
Tester's Name (printy, 7 5 JP V
SFD Certification Number: SCP-,,5 ' 06:?
Central Station monitoring? YesCQ No (3
Monitoring Co. Name: 0)- Yl'l�) FAf
Primary Component: C;2 // lWt� 7— F/ c� ZE-P
System Make:
System Model:
System Location:
Identification Number:
ProblernsFound: (if additional room is required, please add a separate sheet.)
Corrections Made: Date Corrected:
Corrected by:
(If additional room is required, please add a separate sheet.)
SFD Certification Number: SCP-
This certifies that this Fire and Life Safety system has been properly inspected for reliability to cover the items
listed in this report and is consistent with the Seattle VF"re Department Fire Code standards, and all discrepancies
Al .1 Im
are noted and have been -ofted to the bo Ildi 0 e, anager for corrective action.
1 7-
Signature of Tester: � U.
Phone #: 425.483.5657
Testing Agency: Ad'vanced Fire P te tion, Inc.
Mailing Address: P.O. Box 1543 - LbEdEinviClle, WA 98072
Building Rep re se ntati ve (signature):
Sprinklers * WET Page: 1 of 2
The below items on the check list shall be inspected and tested. This list does not constitute all of the
required inspecting and testing of the Fire and, Life Safety system. Refer to the.Seattle Fire Department
Fire Code for inspecting and testing requirements.
General
-1. Flo'w7estc-briducted? ......................................................................................................................................... Ye-%wE�- No (3
2. Static Pressure: psi Flow Pressure: psi
3. Total number of sprinkler heads on this system?
4. Was 2" Main Drain checked? .................... : ................................ ......... ................... Y es -a- No Ej
Other El
5. Flow Switches, Supervisory Switches and Alarm Bells tested? ..................................... N/A C) Yes-d' No El
6. Pressure regulating valves tested? ..............................................................................
N/A
Yes El
No LI
7. Alarm -Bell operate? .......................................................................................................
N/A El
Y Ps.@—
No El
8. System inspected and lubricated ? .................................................................................. Y es -El' N o Q
9. Valves sealed or supervised?
........................................................................................................... Yes-d' No El
10. Provided on all valves? ............................................................................................................. Yea-B, No E)
11. Pumper,Cdnnections and Clapper valves, unobstructed and turn freely ? ............................................... Yeq-El- No EJ
12. Sprinkler coverage acceptable? .............................................................................................. Yes-tj No 0
13. Have the' 'sprinkler heads been replaced or successfully sample tested in the last 50 years? Y e s"t5-. No El
14. Proper number spare sprinkler heads available with appro priate wrenchs for each? .............. Yes-ff No 0
15. System left in service? ............................................................................................................ Yes-O� No Q
.41
16. System gauges been replaced or calibrated within the past 5 years? ......................... / ..................... Y e sOET N o 0
17. Sprinkler heads free of corrosion, pal nt,, obstructions and/or physical damage? ..................... Yes"U- No E)
18. Was debris found in the Fire Department Connection (FDC)? ................................................ Yes El NoOEJ
19. Was the Fire Department Connection (FDC) back flushed within the last 5 years? .... Yes Q No El
20. Was an internal pipe and valve inspection performed within the last 5 years? ................. YesEj' No [I
Date Performed: 0//
21. Was a signal received at the Cerit�al Station monitoring company? .......... .......... N/A L) Y e s-tj— N o (:1
Sprinklers 9 WET
j Page: 2 of 2
Olympic Security & Communications Systems
FIRE ALARM SYSTEMS RO. Box 3559
(One System Per Report) Arlington, WA 98223
800-540-SAFE
360-652-1088
CONFIDENCE TEST
1*1
REPAIRS
I El
CERTIFICATION GIVEN I
RED 0
YELLOW
11 WHITE
1, q.5, L t I -
Occupancy Address: r6lp,%,,Aj Occupancy Name: N% VIji,
_Qocili�
G!Ijsj
Building Owner: CK RM rA.S Responsible Person:
Phone Number: 14 12�--YM Phone Number: i tO
- 2=6� i,&
Building Owner Address: 1Z it k -
Date of Inspection C! Inspection Type: Annu I �L Quarterly El Acceptance
El
Testers Name (Please Print): Zr� "�T A"floe- Certification Number: 9-tDo 6 1 llokfi
Alarm System Functionality
Trouble signal with AC power off?
Yes JL
No 0
System operates properly on battery backup? Yes;K
Battery voltage (no load) volts Battery Voltage (full load) charge voltaqe
No n
System operates properly on standby -power?
Yes N-
No 13
All signals operate on AC power?
Yes
No 11
No. of initiating circuits no. of signal circuits
Does alarm system meet audibility standards?
YesV
No 0
All circuits checked for electrical supervision?
Yes
No El
All auxiliary equipment operates (Elevators, fans, dampers)? N/A 11 Yes-N
No El
Ventilation controls operate? N/AN Yes 0
No 11
Key to panel available?
Yes 29.
No 11
Operating instructions at panel?
Yes 5b
No C1
Trouble indicators function properly?
YeA
No El
Remote Annunciator Panels function properly? N/A 0 Yes R:-
No El
Elevator Call Down functions properly? N/A 0 Yes-M
No 11
Test record posted at panel'?
Yes 9
No El
General alarm automatic time dealy (minutes) WAIN
Other Devices (Specify)
Yes-��
Other Devices (Specify)
Ld§�4
�No[]
Communication Equipment
Total Number of Units in Building
Total Number Units Tested
Test Results Acceptable
Phone Sets
1
.1
N/A El Yes P
No 0
Phone Jacks
0
0
N/A 10 Yes El
No El
Call -in Signal
N/AJ4 Yes 11
No D
System Devices
Total Number of Units in Building
Total Number Units Tested
Test Results Acceptable
Bells, Horns, Chimes
16
N/A El Yes Uk
No 0
Voice Speakers (Voice Clarify)
e)
N/AK_ Yes 0
No C1
Smoke Detectors
&7
N/A 0 Yes
No 0
Heat Detectors
D
N/A K� Yes
No D
Duct Detectors
e)
0
N/A & Yes El
No El
Sprinkler Flow Switches
N/A El Yes K
No 0
Sprinkler Supervisory Switches
N/A 0 Yes K
No 11
Visual Alarm Devices
N/A 0 Yes
No 0
Manual Pull Stations
—3—
N/A El Yes
No 11
Automatic Door Unlocks
I
N/A El Yesj<
No 0
Automatic Door Release
di
I N/A< Yes 0
No El
Central station monitoring'? Yesk�- NoZ Monitoring company name: 0 -J�_ 4 !!�l
St /(!I Model Number: S�1209
Control panel manufacturer:
Problems Found:
Corrections Made: Date Corrected: Corrected By:
ok
Signature of Tester: Date:
Customer Siqnatu — Date:
SNO
T
D
J
Serving Briet; Edition,, S
Mountlake Terraceand
, Tthe Town of Woodway
www.FireDistrictl.org
LOCATION: 645 Bell St
BUSINESS NAME: North Vista Condos
MAILING
ADDRESS:
BUSINESS,OWNER: Lyle, Judy
EMERGENCY-1: Welsh, Jim
KEY ACCESS-2:
PERSON CONTACTED: �/V/(14.
NAME OF INSPECTOR: (!�� - .5-,4 1 —rH
FIRE AS 10 FA 5/, I'D LkBx
SYSTE�
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE:
HOME PHONE: 4256701943
HOME PHONE: 2063902642
HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
0 WOODWAY
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY I STATION & SHIF"'
365 17 6
SCHEDULED
DATE DUE 0 07/01111
LIFIR " 422 7203
CURRENT
CITY YES NO
BUSINESS
LICENSE � 1:1 1:1
INITIAL INSPECTION DATE
FE8 1/0
A�iNUZ
HAZARDS FOUND AND LOCATIONS / COWUNICATIONS
A) bAZ�6/2� 5 UAI
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:
DA E:
DATE:
3
VIOLATIONS
1
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
6
4
8
8
DATE:
DISPOSITION:
\� LETTER NEEDED [-] YES NO
LETTER NEEDED E] YES El NO
r
8
FIRE DEPARTMENT COPY
ED
ANC
DV
$$00P
FIRE PROTECTION, INC.
City ofit-Se-a-Me Fire Department
4
CONFIDENCE TEST REPORT
Seattle Fire Departmelint Confidence Testing Officer: 206.386.1448, Fax:206.615.1068
WET - AUTOMATIC SPRINKLERS I Certification Given
(NOTE: ON�E SYSTEM PER REPORT) I RED El IYELLOW01 WHI E -a
Date of Inspection: TEST.- Annual-EI-QuarterlyLl Acceptance QjREPAIRS:C3.
Tester-'s Name forint): I sFD certirication Number. SCP - S- WO-5-q
Occupancy Name:X
Occupancy Address: /I-,-
,=- 2-A2�i-Aa- 5, zz-g,
Responsible Person: _,��Iwv/ wz- 4��
Phone Number:6?06 - _5_115io - C�� �/C;�7_
Building Owner's Name: A/
Building, Owner's Address:
Contact Person:
Phone Number: o
I
Central Station monitoring?
Yert5� No 0
Control Panel Manufacturer:
N, -,,q
Monitoring Co. Name: QV klW?�
5-
Model Number:
/ V -4,
ProblemsFound: (Ifaddifional room is required, please add a separale sheet)
Corrections Made: (1faddibonal room is required, please add a separale sheet) DateCorrected: Corrected by:
The below items on the check list shall be inspected and tested. This list does not constitute all the required inspecting and testing
of the Fire and Life Safety system. Please refer to the Seattle Fire Department Fire Code for inspecting and testing requirements.
80. Was a Flow Test conducted?
81. Static Pessure: - (7-5 psi Flow Pessure: -psi
82. Was 2" Main Drain checked?
83. Were all Flow Switches, Supervisory Switches and Alarrh Bells tested?
84. Does the Alarm Bell operate ?
85. Were all valves inspected and lubricated ?
86. Were Pressure Regulating valves tested?
87. Were all val ves "sealed" or supervised?
88. Are signs provided on all valves?
89. Are the Pumper Connections and Clapper valves unobstructed ?
90. Are tive�sprinkler heads less than 50 years old?
91. Is the sprinkler head coverage acceptable?
92. Are spare sprinkler heads available?
93. Was the system left in service?
Yes4@-
No C]
Yes-B-
No Q
OtherC] Yes-E�-
No El
N/A El Yesca-
'No C]
NIA El Yes-E�-
No C]
Yes-5-
No L]
Yes El
No-B-
Yes--8—
No E]
Yes-=�
No C3
Yes -El-.
No L)
Yes-&-
No C]
Yes-2-
No Q
Yes--@—
No Q
Yes-@—
No 0
This certifies that this Fire and Life Safet ' y system has been properly inspected for
reliability to cover the items listed in this report and is consistent with the Seattle
Fire Department Fire Code stan rdards and discrepancies are noted and 'have been
reported to -the building Owner/Manager'for corrective action.,
I
,§ignature of Tester' / UE'LL I/ 2:f-�
Testing Agency: Advanced Fire Protection., Inc. Phon e: 425.483.5657
Mailing Address: P.O. Box 1543 , Woodinville, WA 98072
M
FIRE ALARM SYSTEMS
(One System Per Report)
Olympic Security & Communications Systems
P.O. Box 3559
Arlington, WA 98223
800-540-SAFE
360-652-1088
CONFIDENCE TEST
REPAIRS
10
CERTIFICATION GIVEN I
RED 0
1 YELLOW 0
1 WHITE
N.
Occupancy Address: 64!9 &--ZL C010W% Occupancy Name:
QW94 169-rA C4 60-S
Building Owner: A)D)en-j- III-ST)4 atibol; Responsible Person:
L;L-61-i &2w -//)
Phone Number: q 2- 9- 7 *7 5 -6, It 3:2 Phone Number:
VOL.-6 8� 3-469 --)-
Building Owner Address: klelScin Q0tP-39ba(,,qa
Date of Inspection Inspection Type: Annual N Quarjerly El Acceptance
El
Testers Name (Please Print): Certification Number:_5_4_�
�0 I %A11 I
Alarm System Functionality
Trouble signal with AC power off?
YesS
No El
System operates properly on battery backup?
Yes&
No 11
Battery voltage (n o load) volts Battery Vo Ita ge (full load)
charge vol tage
System operates properly on standb powpr?
_y_
Yes
No
All signals operate on AC power?
No. of initiating circuits no. of signal circuits
Yes'R
No 0
Does alarm system meet audibility standards?
Yes
No El
All circuits checked for electrical supervision?
Yes NL
No El
All auxiliary equipment operates (Elevators, fans, dampers)?
N/A D Yes)�.
No El
Ventilation controls operate?
N/A& Yes 0
No 0
Key to panel available?
Yes N,
No 0
Operating insti&uctions at panel?
Yes
No 0
Trouble indicators function properly?
Ye s
No 0
Remote Annunciator Panels function properly?,
N/A Yes.'S,
No 0
Elevator Call Down functions properly?
N/A Yes Ik
No El
Test record posted at panel?
YesX
No
General alarm automatic time dealy - (minutes)
N/A
Other Devices (Specify)
Yes 0
No 0
Other Devices (Specify)
Yes 0
No 0
Communication Equipment
Total Number of Units in Building
Total Number Units Tested
Test Results Acceptable
Phone Sets
aku"�V- 'TA'4-18V.C3
Yes�3,
NoD
Phone Jacks
N/A.7N Yes 0
No El
Call -in Signal
N/A\� Yes 0
No 0
System Devices
Total Number of Units in Building
Total Number Units Tested
Test Results Acceptable
Bells, Horns, Chimes
__A1_
N/A El YesN
No 0
Voice Speakers (Voice Clarify)
'04
N/AN Yes D
No El
Smoke Detectors
151
N/A El Yes N,
No El
Heat Detectors
N/A\ Yes 0
No 0
Duct Detectors
N/A'& Yes 0
No 0
Sprinkler Flow Switches
N/A 0 Yes
No 0
Sprinkler Supervisory Switches
N/A 0 Yes 0
No 0
Visual Alarm Devices
N/A 0 Yesls�'
No El
Manual Pull Stations
N/A El YesX,
No El
Automatic Door Unlocks
N/A El Yes us,
No
Automatic Door Release
N/A El Yes 0
No El
Central station monitoring? YeSN No El Monitoring company name:
V Model Number:
Control panel manufacturer: -Sl- �Qjl)r V.X%t 1�jk
Problems Found:
Corrections Made: Date Corrected: Corrected By:
Signature of Tester:
Customer Signature:
Date: M VA � �3
Date:
AD-
�TE RECEIVED
PERMIT r5XPI!,F:S
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
IOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRES;,,,:2,K
FOWNER 7NAME/NAME OF BUSINESS
PLAT i4A-m-C/6iu-BbIVISION NO. LOT NO. LID NO.
LID FEE $
Ix MAILING ADDRESS I
LU TESCP Approved 0
z PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
3: RIN Pamit Required [3
0 Street Use Penrift Req'd 0
CITY ZIP TELEPHONE EXISTING — PROPOSED Inspection Required 0
Sidewalk Requited 0
REOUI RED DEDICATION — FT 1 Underground
y iring required
NAME METER SIZE LINE SIZE NO. OF FIX PRV REQUIRED
YES 0 NO 0
W
z
ADDRESS dull 0 U, REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
0
z
EDAAr)NnS QRS DEP;ft�
CITY ZIP TELEPHONE
NAME
REVIEWED/DATE
ENGINEERING
A6DRE!fS
FIRE REVIEWED BY DATE
'ITY ZIP TELEPHONE
z I
0
VARIANCE OR CU SHORELINE OR ADB# INSPECITION BOND
STATE LICENSE�hfUMB EXPIRATION�Q4TE CH, YCED . BY REG D POSTED
61 1 0 YES 0 NO
SEPA REVIEW SIGN AREA HEIGHT
PROPERTN� TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
NEW. RE SIDENTIAL PLUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
ADDITION COMMERCIAL COMPLIANCE OR z
CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL 0 APARTMENT E] SIGN DED
REPAIR GRADING FENCE
CYDS ( X FT) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL
2 CARPORT ROCKRy RENEWAL
(TYPE �INESS OR ACTIVITY) EXPLAIN:
C -,M!
L Fu CHECKEDBY JTYP��N DE OCCUPANT
GROUP
w NUMBER NUMBER OF CRITICAL
a OF DWELLING AREAS SPECIAL INSPECTOR JAREA OCCUPANT
o' STORIES UNITS NUMBER 121 REQUIRED 0 YES LOAD
DESCRIBE WORK TO BE DON.5-7
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTIO!�VEQ'D,
VALUATION FEE
PLAN CHECK FEE
HEAT SOURCE GLAZING % LOT SLOPE % BUILDING
PLAN CHECK NO: VESTED DATE PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADING/FILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
SURCHARGE
w PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT- I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
con ;APPLICANT. ON 13EHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS ENG. INSPECTION FEE
LU N INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
_j LANDSCAPING
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND INSPECTION FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANYCITY ORDINANCE
0 NOR LIMIT IN ANY WAYTHE CITY'S ABILITYTO ENFORCE ANY ORDINANCE PROVISION.'
I X. TOTAL AMOUNT DUE RECEIPT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECTAND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL B ilding Offf * a] or histher Deputy: and Fees are paid, and
u r17t
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION race is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AN3NW Y.27.
OFFICIAL NATURd ATE
SIGNATUR AGENT) SIG ED 425
771-0220 REL�ASED BY DAJIE
NTION EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE - YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK -,OWNER - GOLD -ASSESSOR
5198