21204 72ND AVE WI Z_ 0
FIRE PREVENTION
Serving Brier, Edmonds, and 12425 Meridian Ave S
SNOHOMISH CO.
�INSPECTION REPORT
Mountlake Terrace Everett, WA 98208
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DATE DUE I, Oct 2015
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INITIAL INSPECTION DATE
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Date Last Serviced:
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FIRE PREVENTION
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FIRE DEPARTMItNT COPY
FIRE PREVENTION
INSPECTION REPORT
Serving Brier, Edmonds, and 1 N2� Meridian Ave S
SNOHOMISH CO. []EDMONDS
0 Mountlake Terrace Everett, WA 98208 0 BRIER
FIRE wwwFireDistrictl. . org Fax (42-5) 551-1272 0 MOUNTLAKE TERRACE
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21204 72nd Avenue W 98026
2 Year 13 16-8
BUSINESS NAME:
Vacant & 21206 PHONE:
111E JLED
4256404870 DUE I Oct 2013
DATE D
MAILING
LIFIR 1, 593
ADDRESS:
21204 72nd Avenue W, Edmonds, WA 98026
BUSINESS OWNER:
Hockman, Elain HOME PHONE:
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DISPOSITION:
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FIRE DEPARTMENT COPY
FIRE PREVENTION
Serving Brier, Edmonds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
Mountlake Terra&eand
Fl E
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Everett, WA 98208
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BUSINESS NA�E: Vacant & 21206
Ip. 4256404870
PHONE.
SCHEDULED
DATE DUE 10101112
MAILING 21204 72nd Ave W
LIFIR 11, 593 1(157
ADDRESS: Edmonds
98026
BUSINESS OWNER: Stevens Health Care
HOME PHONE: 4256404000
ACIIVE
EMERGENCY-1: Muclklanus, Evits
HOME PHONE: 4256404871
CURRENT
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NUMBER:
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CODE
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DISPOSITION:
LETTER NEEDED C] YES 0 No
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FIRE DEPARTMENT COPY
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CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
LOCATION: 21204 72nd Avenue w
BUSINESS NAME: Vacant & 21206
MAILING 21204 72nd Ave W
FIRE PREVENTION
SAFETY SURVEY
PHONE: 4256404870
ADDRESS: Edmonds 98026
BUSINESS OWNER: Stevens Health Care HOME PHONE: 4256404000
EMERGENCY-1: McManus, Evita HOME PHONE: 425M4871
KEY ACCESS-2: HOME PHONE:
FR W6 NCY
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SCHEDULED
DATE DUE I�
10/01/10 -
LIFIR jo 593
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DATE DUE:
EXTENSION
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PERSON
CONTACTED:
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5
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PRE-CIlAnON
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6.
2
6
DATE:
CODE
SECTION:
5
3
7
3
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RECEIVED
6
7
4
18
4
18
DATE:
DISPOSITION:
8
LETTER NEEDED Ej YES E] NO
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LETTER NEEDED I—
FIRE DEPARTMENT COPY
V
2- er�
Murray A Beighton, M.D.
General & Family Medicine
Cameron A. Stewart, M.D.
General & Family Medicine
David Talbleson, M.D.
7mily Care
Board Certified in Family Practice
David 1. Yonkers, M.D.
ofEdmon&
Board Certified in Family Practice
Viviane DeValle, P.A.C.
Board Certified in Family Practice
Women's Healthcare Specialist
EMERGENCY RESPONSE PLAN
In the event of an emergency; the first person to be aware of the emergency is to call 911
and notify the rest of the clinic as to the emergency and start the evacuation process.
The receptionist at the check -in and check-out desks will evacuate the waiting room out
of the waiting room Exit No. 1
Medical Records clerks will evacuate the business office and the bathroom by the check-
out desk and the staff bathroom out of the business office Exit No. 2
Dr. Beighton's M.A. will evacuate exam rooms 1, 2 and 3 out the back right Exit No. 3
Dr. Stewart's M.A. will evacuate exam rooms 4, 5 and 6 and physicians office out the
back right Exit No. 3
Viviane DeValle and her M.A. will evacuate the bathroom to the right of their station
and exam rooms 7, 8, 9, and EKG room out the back middle Exit No. 4
Dr. Taibleson Is M.A. will evacuate exam rooms 14, 15, X-ray room and physicians
office out the back left Exit No. 5
Dr. Yonkers' M.A. will evacuate exam rooms 10, 11, 12, and break room out of the
breakroom Exit No. 6
The Safe Distance Area for the front office Exit No. 1, 2, and 6 will be by the clinic sign
:212th Medical Center". located in the front comer of the parking lot entryway.
The Safe Distance Area for Exit No. 3 and 4 will be by the dumpster located at the end
of the sidewalk by Exit No. 3 in the apartment parking lot behind our office building.
The Safe Distance Area for Exit No. 5 will be by the dumpster located at the end of the
sidewalk outside of Exit No. 5 in the front of the clinic's parking lot.
Fire Extinguishers are labeled FE on the Exit Plan Diagram.
Exits are labeled 1 - 6 on the Exit Plan Diagram
7 607 Tme r69 VA ct uu/cO 5 1-601
A4WVAI-- IVLLJ, 4&W4*101`1 MAC&-f60 SteVenS
fV, 6v4c 4C(Ot5-
21204 72ndAvenue West, Edmonds, WA 98026 Tel: (206)6404870 Far (206)6404881 M
T-
Stevens' Healthcare
Safety/Security Department
FIRE .]nL%--jvL!j SPO N S E
PROCEDURE
R' - A - C - 11, 'd
Remove any persons in immediate danger from the fire or smok-e.
Alert others by putting fire alarm pull station, call 911.
Contain fire by closing fire doors and using a. fire eXtingUisher if
trained.
Evacuate the area. 1f possible, have one person remain near the
scene to answer questions the fire department niay have.
CNU a\wol I'dy A-1 I ��a 1110�-.Iin ic.doc
Exit Plan
GRAPHIC SCALE NORTH
6 so 20
,Y.
M� lei cov�
MEMORANDUM
DATE tlu*�
REPORTED BY OF
SUEUECT
�7
ADDRESS: ZOq
CONCERNS/
HAZARDS:
FOLLOW-UP:
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SIGNED
Lm,
Eli
6 L -
6i; -7
SIGNED
CityofEdmonds * Office of Fire Prevention
N 0 T I C E
TO PERMITTEE AND/OR OWNER
PARTIAL APPROVAL
q 0. 1 q C)Q� ��_VIOLATION
ErCORRECTIONS REQUIRED
Permit Number Owner F414-IL-1
Job Address 2,1 -7 -P:�:e' AV6:
No PERMIT -STOP WORK -REMOVE CONSTRUCTION OR OBTAIN PERMIT AND MAKE WORK COMPLY
WITH ALL APPLICABLE CITY CODES.
F-1 CONSTRUCTION Is NOT IN ACCORDANCE WITH APPROVED PLANS AND PERMIT - STOP WORK.
MAKE WORK COMPLY WITH APPROVED PLANS AND PERMIT OR REMOVE.
F-1 STOP WORK - UNTIL AUTHORIZED To CONTINUE By CITY INSPECTOR.
2�r CORRECTIONS LISTED BELOW MUST BE MADE: BEFORE WORK CAN BE APPROVED AND/OR THE
NEXT PHASE IS STARTED; To AVOID POSTING OF A STOP WORK ORDER, ORDER To
CORRECT, OR ABATEMENT PROCESS.
F-1 JOB CARD MUST BE POSTED ON SITE AND BE VISIBLE FROM STREET.
F-1 APPROVED PLANS MUST BE AVAILABLE To INSPECTOR ON SITE.
LjWORK DESCRIBED BELOW HAS BEEN INSPECTED AND Is APPROVED.
CONTACT INSPECTOR AND ARRANGE FOR APPOINTMENT.
RECALL FOR INSPECTION.
"P_jo F&R- 2-oviii,-i rvtv*�O Ars-re�_6
THE ACTIONS OR CORRECTIONS INDICATED ABOVE ARE REQUIRED WITHIN
DAYS OR PENALTIES MAY BE APPLIED. FOR INSPECTIONS CALL 771-0220.
Building Division Planning Department L] Engineering Department WFire Department
IT_Y__ OF EDMONDS
Inspector -7 f( f f 6
Date
45
21 "T to] O.'Al Z I Bill kyj I
DATE
REPORTED BY OF
SUBJECT
ADDRESS:
CONCERNS/
HAZARDS:
FOLLOW-UP:
ju L, -t (
SIGNED
SIGNED
I.D.
City of Edmonds * Office of Fire Prevention