21600 HWY 99 STE 100 (2)SNOliOMISH CO.
FIRE
DIST
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FIRE PREVENTION
Serving Brier, Edmonds, and 12425 Meridian Ave S INSPECTION REPORT
Mountlake Terrace Everett, WA 98208 EDMONDS
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Phone (425) 551-1200 0 MOUNTLAKE TERRACE
Twww.FireDistrictl.org Fax (425) 551-1272 [1 UNINCORPORATED
FREQUENCY
T" & SHIFT
LOCATION:
21600 Highway 99 Suite 100 98026
2016
7STATION
16-C
BUSINESS NAME
PHONE:
Raymond Liu, DDS 4257712100
SCHEDULED
DATE DUE � Jan 2016
MAILING
-
LIFIR 593
ADDRESS:
21600 Highway 99, Suite 19 100, Edmonds, WA 98026
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BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
HOME PHONE
Liu, Raymond : 4254441995
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY
YES NO
EMAIL:
BUSINESS
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LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
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I AGREE TO CbRRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
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PERSON
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INSPECTOR:
DATE:
2nd RE -INSPECTION
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EXTENSION
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VIOLATIONS
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DISPOSITION:
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Serving Brier, Edmonds
YIRSNOHOMISH CO. Mountlake Terraceand
the Town of Woodway
DIST www.FireDistrictl.org
LOCATION: 21600 Highway 99
BUSINESS NAME: Raymond Liu, DDS
MAILING 21600 Highway 99 #100
.124.25 Meridian Ave'S.'.
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
FREQUENCY STATION & SHIFF"'
100 731 16 D
PHONE: 4257712100 SCHEDULED
1, 01/01/13
AIJUNCOO: Edmonds 98026
BUSINESS OWNER: Liu, Raymond HOME PHONE: 425444199Y5
EMERGENCY-1: HOME PHONE:
KEY ACCESS-2: HOME PHONE:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS:
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FIRE PREVENTION
INSPECTION REPORT
[]EDMONDS
0 BRIER
0 WOODWAY
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
Lim I r_ Liu r_
UFIR � 593 1 157
ACTIVE
CURRENT
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LICENSE 1:1 1:1
INITIAL INSPECTION DATE
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ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2 A) 0 V
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2
3
3
4
4
5
6
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
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DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
ONTACTED:
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
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RETURN RECEIPT
RECEIVED
6
4
'8
4
'8
DATE:
DISPOSITION:
\� LETTER NEEDED [] YES N
rLETTER NEEDED [] YES NO
8
FIRE DEPARTMENT COPY
FIRE PREVENTION
CITY OF EDMONDS SAFETY SURVEY
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
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LOCATION: 21600 Highway 99 100
BUSINESS NAME: V.IQ=l fAYM%6 Ilit r)D5 R>,�CPHONE: 4257440161
MAILING 21600 Highway 99 #130
ADDRESS: Edmonds 98026
FREQUENCY
STATION& SHIFT
731
16 13
SCHEDULED
DATE DUE 11
UFIR 1. 593
1157
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BUSINESS OWNER: HOME PHONEA-,�?�,. E.'X/OaC
EMERGENCY-1: HOME PHONE:
KEY ACCESS-2: HOME PHONE:
PERSON CONTACTED: li t^ " INITIAL INSPECTION DATE
NAME OF INSPECTOR:+yl ilk.
FIRE FE _(u '
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DATE DUE: DUE: GRANTED TO: J DATE DUE: CITED:
PERSON PERSON
PERSON
CONTACTED: gL4,-tf CONTACTED: CONTACTED:
. .... .. .. . .... .. ... ...
INSPECTOR: INSPECTOR: INSPECTOR: 2
DATE: DATE: DATE:
VIOLATIONS VIOLATIONS PRE-CrIA11ON CITATION ISSUED
5 1 5 LETTER SENT NUMBER,
DATE, CODE
SECTION-
2 6 2 6 5
RETURN RECEIPT
2_ 7 3 7 RECEIVED
4 18 .DATE: SITION: 7
LETTER NEEDED 7
_I YES NO JUETTERNEEDED i--. �IES NO
8
FIRE DEPARTMENT COPY