6801 N MEADOWDALE RDIAJ 07CRVOW04ti- RD
CITY OF EDMONDS
FIRE DEPARTMENT
PERMIT
01/01/2017 122-300-11 B-457 12/31/2017
Date of Issue UFIR Number Date of Expiration
I
I This PERMIT is issued to: I COE Meadowdale Community Club
I located at: 16801 N Meadowdale Road --F—Edmonds, WA I
I To engage in the business, occupation or process of: I Community events
And shall constitute permission to maintain, store, use or handle materials or to conduct
process which produce conditions hazardous to life or property or to install equipment used in
connection with such activities as follows:
Places of Assembly — Occupant Load 300
I Allowed Occupant Load: 1 30
Pursuant to the provisions of the International Fire Code, any violation of the Code may be
groundsfor the revocation of this PERMIT.
This permit does not take the place of any
license required by law and is not
transferable. Any change in the use or
occupancy of premises shall require a new
permit.
Fire Marshal
Fire Prevention Division
This Permit Must Be Posted At All Times in The Premises Mentioned
Above
City of Edmonds Community Development Code 19.25.020
I /I /, � Z�l
CITY OF EDMONDS
PERMIT
� 01/01/2018 122-300-11 B-457 12/31/2018
'Date of Issue LIFIR Number Date of Expiration
This PERMIT is issued to: I COE Meadowdale Community Club
located at: 16801 N Meadowdale Road Edmonds, WA
FTo —engage in the business, occupation or process of: I dommunity events
I
And shall constitute permission to maintain, store, use or handle materials or to conduct
process which produce conditions hazardous to life or property or to install equipment used in
connection with such activities as follows:
Places of Assembly — Occupant Load 300
Allowed Occupant Load: 300—]
Pursuant to the provisions of the International Fire Code, any violation of the Code may be
grounds, for the revocation of this PERMIT.
This permit does not take the place of any
license required by law and is not
transferable. Any change in the use or
occupancy of premises shall require a new
permit.
Fire Marshal
Fire Prevention Division
This Permit Must Be Posted At All Times in The Premises Mentioned
Above
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FIRE PREVENTION
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Serving Brier, Edino'nds, and
12425 Meridian Ave IS
INSPECTION'REPORT
SNOHOMISIf
Mountlake Terrace
Everett, WA 98208
%tDMONDS
F1
(0 BRIER
DISTT
Phone (425) 551-1200
0 MOUNTLAKE TERRACE
[1 UN INCORPORATED
www.FireDistrict].org
Fax (425) 551-1272
I
LOCATION: 6801 Meadowdale Road 98026
BUSINESS NAME: Meadowdale Clubhouse PHONE:
MAILING
ADDRESS: 6801 Meadowdale Beach Road, Edmonds, WA 98026
BUSINESS OWNER: City of Edmonds
EMERGENCY-1:
KEY ACCESS-2:
EMAIL:
PERSON CONTACTED: lje^1155�
NAME OF INSPECTOR: ZLt
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,:FIRE SYSTEMS: FA' 9/1� FE 4/1 12:00:00 AM
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Date Last Serviced:
HAZA�R�DFOUND AND LOCATION��/ COMMUNICATIONS
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HOME PHONE:
-HOME PHONE:
HOME PHONE:
4257710230
I" FREQUENCY I STATION& SHIFT*'
Annual 16-A
SCHEDULED Nov 2016
DATE DUE
IU FIR 11, 122
CURRENT
CITY YES
BUSINESS
LICEN
INITIAL INSPECTION DATE
//A V/6
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2
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4
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
I St RE -INSPECTION
2nd RE -INSPECTION
FINAL RE -INSPECTION
EXTENSION VIOLATIONS
DATE DUE
DATE DUE-
GRANTEDTO, DATE DUE: CITED:
PERSON
PERSON
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CONTACTED,
CONTACTED
CONTACTED
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INSPECTOR:
INSPECTOR
INSPECTOR'
DATE;
DATE:
DATE,
VIOLATIONS
VIOLATIONS
CITATION ISSUED
PRE -CITATION
1 5
1 5
LETTER SENT NUMBER
CODE 5
2 6
2 6
DATE SECTION:
RETURN RECEIPT
3
3 7
RECEIVED 6
DISPOSITION:
4 8
4 8
DATE:
LETTER NEEDED YES El NO
LETTER NEEDED F YES NO
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I
FIRE PREVENTION
SNOHO Seriqngprie Edmon i,-and,- 12425 Meridian Ave S
M-1 S H
INSPECTION REPORT
Mountlake Terrace
A
Everett, WA 98208
[3EDMONDS
0 BRIER
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Phone (425) 551-1200
[3 MOUNTLAKE TERRACE
0 UNINCORPORATED
or. www. org
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0' FREQUENCY
STATION & SHIF
LOCATION: 6801 Meadowdale Road 98026
Annual
16-D
I
BUSINESS NAME: Meadowdale Clubho�se
PHONE: 4257710230
SCHEDULED Nov 2015
DATE DUE
MAILING
LIFIR 1'22
ADDRESS: 6801 Meadowdale Beach Road, Edmonds, WA 98026
BUSINESS OWNER�e_ ITY 6 F F- 0/,A Lmj f). s
HOME PHONE:
EMERGENCY-1:'
HOME PHONE:
'CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY 'YES NO -
EMAIL:
BUSINESS
LICENSE 11 11
P . EPSON CONTACTED: F_ A) F P L) 1
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INITIAL INSPECTION DATE�
NAME OF INSPECTOR: vj L i Aj Z
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I AGREE tO CORRECT THE ABOVE VIOLkION(S) IN THE NEXT 30 DAYS X,,-*
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2nd RE -INSPECTION
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FINAL RE -INSPECTION
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NUMBER:
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RETURN RECEIPT
7
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RECEIVED
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DISPOSII ION:
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DATE:
7
LETTERNEEDED YES NO
LETTERNEEDED YES NO
8
FIRE PREVENTION
Serving Brier Edmonds, and
124.,2.5Mei-idiaiiAi,eS,.,,I��,.
INSPECTION REPORT
S110HOM-ISH CO.
FIRE
Mountlake Terrace
Everet'(,' 'W'A' '9'8'208
EDMONDS
b BRIER
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9T
Phone (425) 551-1200
0 MOUNTLAKE TERRACE
[1 UNINCORPORATED
wwwFireDistrictl.org
Fax (425)'551-1272
0' FREQUENCY
STATION& SHIFT—'*-'
LOCATION:
68fil Meadamdafe Road, OM26
y
113_r
I
BUSINESS NAME:
Meadawdalu Clubtiautic
PHONE: 425771023C
SCHEDULED Nav2014
DATE DUE II'
MAILING
UFIR � 1221
ADDRESS:
6801 mcadamdaic Reach Road, EdIT0r%&, \i14A 0902E
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
HOME PHONE:.
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
EMAIL:
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BUSINESS
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LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OFJ N"SPECTOR:
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1st' RE -INSPECTION
DArE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTE"NSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATI(5NS
CITED:
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DATE:
DATE:
3
VIOLATIONS
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1 5
PRE -CITATION
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CITATION ISSUED
NUMBER:
4
2
6
2
6
___LETTER
DATE:
CODE
SECTION:
5
3
7
3
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RETURN RECEIPT
RECEIVED
6
4
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4
DATE:
DISPOSITION:
7
Q ETTER NEEDED C] YES NO
LETTERNEEDED F] YES NO
8
FIRE DEPARTMENT COPY
FIRE PREVENTION
SliIOHOMISh*66� Serving riet; Edmonds, and
12425 Meridian Ave S
INSPECTION REPORT
Mountlake Terrace
FIRE
Everett, WA 98208
OEDMONDS
0 BRIER
DISTR1 4
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Phone (425) 551-1200
El MOUNTLAKE TERRACE
[1 UNINCORPORATED
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Fax (425) 551-1272
0' FREQUENCY
STATION & SHIF*"I
LOCATION: 6801 Meadomdale %ad ON26
Antwal
16-B
BUSINESS NAME-, M-cadmAdalc Clubhousc
PHONE: 4215771022C
SCHEDULED
DATE DUE Nav 2013
MAILING
'ADDRESS: E801 McadaAdalc Rcarh ftad, Edamrids, WA
08021
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
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CURRENT
HOME PHONE:
KEY ACCESS-2:
HOME PHONE:
ITY YES No
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INITIAL INSPECTION DATE
NAME OF INSPECTOR: Dn V-) A) 67-()2
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2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DA-E DUE:
DATE DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
ONTACTED:
CONTACTED:
CONTACTED:
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DATE:
DATE:
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VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
1 5
1 5
LETTER SENT
NUMBER:
4
CODE
5
2
6
2
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DATE:
SECTION:
RETURN RECEIPT
7
3
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RECEIVED
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DISPOSITION:
4
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4 18
DATE:
L =TTER NEEDED [] YES NO
rLETTER NEEDED [:] YES El NO
8
FIRE DEPARTMENT COPY
S'NO
Serving Brier, Edinonds
Mountlake Terraceand
the Town of Woodway
www.FireDistrictl.org
FIRE PREVENTION
INSPECTION REPORT
12425 Meridian Ave S I
t3EDMONDS
Everett, WA 98208 0 BRIER
Phonej(�25) 551-1200 OWOODWAY
-.0 MOUNTLAKE TERRACE
Fax (425) 551-1272 0 UNINCORPORATED
FREQUENCY STATION & SHIFT)
LOCATION: 6801 N. Meadowdale Rd
366 16 A
BUSINESS NAME: Meadowdale Clubhouse
PHONE:
4257710230
SCHEDULED
DATE DUE 1` 11!01112
MAILING 700 Main St
UFIR � -122 - 1'457
ADDRESS: Edmonds
98020
LL—i
BUSINESS OWNER: City Of Edmonds
HOMEPHONE:
4257710230
ACTIVE 01 998
EMERGENCY-1: "Gnacke, Angela'
HOMEPHONE:
4256403470
e CURRENT
KEY ACCESS-2: Stevens, Jim
HOMEPHONE:
4254855781
CITY YES NO
BUSINESS
A
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
L NAME OF INSPECTOR:
/-7
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SYSTEMS:
ANNUAL
F11AZARDSFOU DANDLOC IONS /COMMUNICATIONS
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4
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1�.t RE -INSPECTION
D/kTE DUE:
2nd RE -INSPECTION
DATE DUE:
1
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
IN3PECTOR:
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
4 18
4
18
DATE:
DISPOSITION:
7
,-ETTER NEEDED El YES [:1 NO
LETTER NEEDED [] YES NO
1
8
FIRE DEPARTMENT COPY
CITY OF EDMONDS
DEPARTMENT OF FIRE PREVENTION
PERMIT TO Tl��
January 1, 2011 122-300-11 B-457 December 31, 2011
Date of Issue UFIR Number Date of Expiration
I This PERMIT is issued to: I COE Meadowdale Community Club I
I located at: 16801 N. Meadowdale Rd I Edmonds, WA
To engage in the business, occupation or pr cess of-,
And shall constitute permission to maintain, store, use or handle materials or to conduct
process which produce conditions hazardous to life or property or to install equipment used in
connection with such activities as follows:
Places of Assembly - Occupant Load: 300
I Allowed Occupant Load: 1 30707]
Pursuant to the provisions of the International Fire Code, any violation of the Code may be
grounds for the revocation of this PERMIT.
This permit does not take the place of any
license required by law and is not
transferable. Any change in the use or
occupancy of premises shall require a new
permit.
Firq)MarshaI,j
Debktment of Fire Prevention
This Permit Must Be Posted At All Times in The Premises Identified Above
City of Edmonds Community Development Code 19.25.020
APPLICATION FOR PERMIT
FOR MATERIALS OR PROCESSES
January 3, 2012
Please verify and correct the following information:
Name of Company (DBA):
COE Meadowdale Community Club
Edmonds Location :
6801 N. Meadowdalle Road
In conformity with the
terms of the International
Fire Code, application is
hereby made to store, use
Places of Assembly - Occupant Load: 300
or maintain the following
activity, storage or pro-
cesses:
c/o City Of Edmonds
Mailing Address:
Director of Parks and Rec
Edmonds, WA 98020
EFD LIFIR #:
11223001113457
(for office use)
Your Signature
Your Name (print)
S L__)
Your Title
Please make corrections, attach $40 payable to the City of Edmonds and mail to:
Fire Marshal
Department of Fire Prevention
121-5 th Avenue North
Edmonds, WA 98020
FOR OFFICE USE ONLY
----- - -----
Rec'd
Check#
CITY'OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98620i (425i 771-0215
FIRE DEPARTMENT
41S 0
6801 N. Meadolmdale Rd
LOCATION:
BUSINESS NAME: Meadowdale Clubhouse
MAILING 700 Main St
FIRE PREVENTION
'SAFETY. -SURVEY
PHONE: 4257710230
ADDRESS:� Edmonds 98020
BUSINESS OWNER:, City Of Edmonds HOMEPHONE: 4257710230
EMERGENCY-1: "Gnacke, Angelan HOME PHONE: 4256403470
KEY ACCESS-2: Stevens, Jim HOMEPHONE: 4254855731
FREQUENCY
STATION& SHIFT
366
16 C
SCHEDULED
11/01/10
DATE DUE 10
UFIR 11� 122
1-457
ACTIVE 01L 998
PERSON CONTACTED: N c, N INITIAL INSPECTION DATE
ia-
NAME OF INSPECTOR: ct I 15
FIRE FA 8/07 I'D LkI3x FE 4 /_%0
SYSTEMS:
ANNUAL
fbkZARDS FOUND AND LOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE lo
VIOLATION CODE
2
3
4
5
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6
7
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8
1st RE -INSPECTION
DX'E 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
DK-E:
DATE:
DATE:
3
VIOLATIONS
L_ 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
L
18
4
18
DATE:
DISPOSITION:
7
1 8
� LETTER NEEDED E] YES Ej NO
LETTER NEEDED [] YES E] NO
FIRE DEPARTMENTGOPY