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„ p WASHINGTON STATE fIRE INCIDENT REPORT <br /> �� CITY OF EVERETT FIRE DEPARTMENT NFIRS 1 <br /> �1 ❑ delete <br /> I2 O chanpe <br /> FDID INCIDENTNO E%P. MO. OAY YEM DAYOFWEEK 5�7��rypay �RIATME �RRNALTtME T1EMbF:ANtE <br /> A 1 l� ,os��er� aot�wa c�raay <br /> t 0 �L1�M10�4 131V IV�yI��i�LON1� _� 9�9 a a Mo�a�v .o wea�w,r �c s.��,aav � ���� .� _11�1�. _ <br /> TVPE OF SITUATION FOUND <br /> g 1. FIFE, EXPL. ' 3. RESCUE � 5. SER. CALL � 7. FALSE <br /> 2. PRESSURE RUPTURE I 4. HAZ. COND. 6. GOOD INTENT � B. OTHER <br /> = MUTUAL �ID <br /> OW I�E�Iinpunnm�nl 5 � Sl�na EY ! .-' Fn m Move rD I 1 � RSG'A <br /> H p _ ROtu� On1Y 6 . SNr�p1 D .- N01 CI�OA�G � / <br /> Ui ] . imr�bp�tim om� ) - Cmvp MeE 0 � UnOtleimine0 Nol rrponeO � 2 G Gi/An ' <br /> <f � :' R�mo.�M�n�a <br /> FIXED PROPERTY USE (Occupency) IGNITION F�CiOR � � <br /> c �����'� ��61 � I L��t_-'��1C..� m <br /> T SS (lip lo m��imum ol ]1 cAu�clen) ZIP CODE LENSUS TR�CT m <br /> T <br /> o � L�5:� � 0 O � F <br /> N (U3T.FnST.Mq fEIEPNONE P Or MT. r <br /> E „ _� � <br /> � �LAST,F MI) ADDiIESS 1ELEPlIOHE � <br /> F , ,z i �� � « <��_�Fr'Z73 41��8�$ ” <br /> � � <br /> MET110D OF ALARM FIREDE�dnNO SMIFT I NO ALA M$ <br /> 1 [". A4Ynm.� O�ncl � � R�am e ' vo��. �v�.�m���c,c.�n.�m vpn�1 20NE � <br /> g 1.� p .' Muni4pU�brm�Y�I1m 5 .. VuD�I 9 Mol tl�uda0 �� � <br /> ] ;- Pbr�U tlum �pNm E Hp �lym MC'p 0� UnOtlermmeG p n01 nDorleE � I <br /> � ) LpLn� (pll) 1 <br /> NO. FIRE SERVICE PERSONNEI NO ENGINES � O. AERI�L APP�RATUS NO. OTMER VEMCLES <br /> N RESPONDED RESPONCED � RESPONDED � RESPONOED <br /> _�ot�z_ !G� �' �c�] �a <br /> NUMBER OF INJURIES ComDbte Form NFNiS 0 COMPLETE FORM NFIRS 2 NUMbER OF FAT�LITIES <br /> ' 20 I � OTNER �— FIRE SERVICE �� OTM.ER ��— <br /> FIRE SERVICE <br /> J �VMp�EX i MOBILE PROPERTV TYPE „ fQomdeu L�n� 51 <br /> I�� � �v��} <br /> AREA OF FIR ONIGIN� EOOIPMENT INVOLVED IN IGNITION IComO�ne lme 11 <br /> K __� 4 � � � � <br /> 6L � I �� <br /> FORM OF HEAT G ITI N TYPE OF MATERIAI GNITED FORM M�TERIAI IGNITED � <br /> / 2 � n <br /> L �� �rLW't_�f� ��.J �l`^\YV / m <br /> T <br /> � METH OF = <br /> E%TINGUISHMENT P G M�we s��ll �iE� S it Pirconne<I Aoaeilank anly 8 �� sur nre�m aarin � <br /> 9 C PoneDls e�UnpvisM� 6 i�rc•wnnecl hose��yOrem Ere11 slenEp�pe 9 .^. Not cl�uiliaE � <br /> ❑ 1 5�11 �ahnpui�n�E � Q'AutomUlc ml. rytlem 7 C M�nO�luO Aosei�YJ��n� Eeall etenEP�pe 0 �: UnEel�rmin�E or nol �ePoneO T <br /> M — n <br /> LEVEL OF FIRE ORIGIN ESTIM�TED DOLLAR 1059 y <br /> � G GraOe �evel l0 9 1�. 6 : Over 70 leat , <br /> 7 O 10 l0 19 leat 7 _ OEiecb in Iliq�l <br /> J�..20 io 29 le�t B � Below 9�ounO level <br /> � �. JO�o �9 laal 9 .. No� clasLlieE e�ove � I O :.1 <br /> S C 50 to 70 lul 0 i.: UndNermineE V <br /> NUMBEN OF STOHIES i CONSTRUCTION TYPE <br /> 1 � 1 �lory. � ❑ le!Norin. 1 i] �S lo�D�torio I .�ine w+Tne !O UnpM�c��a ore�n�n <br /> N S I I�11e�p timp�r ]G V�oU<IM woeE lum� <br /> t G 7�lary. S G ]�o �t Uor�n. !C W�imm o�mn�. J C ProucleE noncompu�LOb !O tMp�d�clW rooE lum� <br /> y, +� �'�UnDrolecleU noncomEu�tiDb Y C Nol eluuLM�Eov� � <br /> ]^]lo� NonU. !� 1]l0 2��1pin. 0 G Nump��ol Slorn�V�Ef�HIm�1E 01�01 l�DOtllE.I L 5�nUcbE orEm�ry 0 O UM�brminM a not <br /> ��J �eponM <br /> E%TENT OF DAM�GE DETECtOR PERPORM�NCF. $PRINKI,ER PFpFCRM�HCf — 9 <br /> Fl�m� Smoaa m <br /> 1 O D�l�n�oan M �O�c�ol Ln onpin�Opn. � <br /> i f.o�bera m m�oenc� m a� n - � m <br /> t ConLnO lo �h ol ropm p ne� ot on � ❑ � e ��% Dsl. not m�m w�pu ol In�orq�mopx. tJ�amomenl oce�alea T <br /> D Y'^ ]3� = I � �❑ D�t m em a �O�u ol arDirtnol ope 7�EamDmemsnouWn��eopermeE—aqnm <br /> 0 CMlm�a lo�oom o1 upM rlJ �i'• I P <br /> � Ca�Ln�C lo tM In��r�pd comp ol oup�n � I_ ///���I � � i I �❑ D�1.nol �n�m. d�V�c� ol oripm.iwt o0er. ]�EampnentD�esenl.lrtelop�main000e� p <br /> 5 CenLma lo aoor ol wi0�^ S C � 5 U 5 G ON. not m rm. a �p�ce ol Lq a�pm B i No epu�Omenl piaent � <br /> O e ee�u�.e m �nacim� ol upm e— e ❑ I 9�Nol cqSs�LeO <br /> r c.u•ew e. o�a.n�n.,.oi o�� em itt. ioo �m,n�e oo.�. I <br /> � Q'" � � �c � E'� No Eelsclm�O�e�ent � i 0 C UnEeie�mineE or r.oi mpone0 I � C <br /> U VnE�Urm�n�0�no1��DOME 0 C 0 C = <br /> � Y u NW clatnlu0 I m <br /> D No O�m�p� ol��u 40�IN�M 9�_ � 0 C UnONrrm�neC a nm vo���d I T <br /> TYPE OF MATERIAL GENERATING MOST SMOKE AVENUE OF SMONE TRAVEI �j <br /> 1 ". Wn�q ccrn�ny w now <br /> IF SMOKE DAMAGE � :' ��r n�nai�np a.n � : Sun.a� e 1( No�.enu� oi �ma� iu.M (l) <br /> QBEVOND ROOM ^��� p� � :- CauEor 5 '_ Oommp m con�oun�m 9 llol cluutu0 X <br /> OF ORIGIN n� 14� � � Eie.uor �MM1 6 �. Ui��n� oD�^�^0�^ •��� 0 �� V�arlermin�d d nol reD�b V <br /> FORM OF MAlERIAL GEN ATING O5T SMOKE <br /> R N�� <br /> ILE PflOPERTY / YE�R MAKE MODEL SERIAI HO. LlCENSE NO. <br /> S I � (M.A. i NOT �PPLICABLE) �1 /^ � <br /> 11 <br /> MENT (N.A. R+XOT MPL�CA8lE) YEM MAKE MODEL SERIM. N0. �� <br /> T i �a iHvav¢o R <br /> �H aHmo« �. a-1 �+K��os /oS30()' �c <br /> �; <br /> OFFICER IN CMARGE (p�E�SEPRINT) rt%�'�:C'+CJ ME+\ ER 1 KI G REPOPT SIG!:ATUNE) ��T�� � <br /> U I f' .�L.1\y11�0��2 x \� i — — `\ —� <br /> fv ;c�HEv �.::, � <br />