21600 HWY 99 STE 120 (2)SNOHOMISH CO.
FIRE
DIST'.'
2 0 () Nzr�&"tJ Iq SrO 12-0
FIRE PREVENTION
Serving Briet; Edmonds, and 12425 Meridian Ave S INSPECTION REPORT
0 EDMONDS
Mountlake Terrace Everett, WA 98208 0 BRIER
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
[I UNINCORPORATED
www.FireDistrictl.org Fax (425) 551-1272
LOCATION: 21600 Highway 99 Suite 120 98026
BUSINESS NAME: KRi&w Glipig honaedics PHONE:
MAILING
ADDRESS: 21600 Highway 99, Suite 120, Edmonds, WA 98026
BUSINESS OWNER: HOME PHONE:
4257742636
FREQUENCY I STATION& SHIFT
2016 16-C
SCHEDULED
DATE DUE � Jan 2016
UFIR � 593
EMERGENCY-1: Degan, Thomas HOME PHONE: 4257420146 CURRENT YES NO .
KEY ACCESS-2: HOME PHONE: CITY
BUSINESS
EMAIL: LICENSE El 1:1
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR: C)\1
FIRE SYSTEMS: FE
n�f_ I f C—A-4.
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
3
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
In our continuing effort to promote fire safety and prevention within the community, your fire department conducts
regularly scheduled "Fire Safety Survey Inspections" of all businesses and multi -family occupancies in the Cities
covered by Snohomish County Fire District 1.
You are to be congratulated on the relative good condition of your occupancy in regards to fire safety. Above you
will find the item(s) that were noted during. our inspection which require attention to bring them into corn *ance
w ith the minimum standards adopted by the above jurisdictions.
C
Any overlooked hazards or violations of the fire regulations does not imply approval of such conditions violation.
If you require additional information or to schedule a re -inspection for Edmonds, call (425) 775-7720; for
Mountlake Terrace or Brier, call (425) 744-6231.
SNO)
F
2 HrO-ftJ "')l 9T ST_flqP- �REVENTION
Serving Brier Ednionds 425 Meridian Ave S INSPECTION REPORT
0 EDMONDS
Mountlake Terraceand Everett, WA 98208 0 BRIER
the Town of Woodway Phone (425) 551-1200 E]WOODWAY
[3 MOUNTLAKE TERRACE
www.FireDistrictl.org Fax (425) 551-1272 0 UNINCORPORATED
LOCATION: 21600 Highway 99
BUSINESS NAME: Kruger Clinic Orthopaedics
MAILING 21600 Hwy 99 #120
ADDRESS: Edmonds
BUSINESS OWNER: Degan, Thomas
EMERGENCY-1:
KEY ACCESS-2:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS:
-1920
PHONE: 4257742636
98026
HOMEPHONE: 4257420146
HOME PHONE:
HOME PHONE:
FREQUENCY
STATION & SHIFF**'
731
I
16 D
SCHEDULED
DATE DUE � 01/01/13
LIFIR � 593
1157
ao"Tc.
CURRENT
CITY
YES NO
BUSINESS
1:1 1:1
LICENSE
INITIAL INSPECTION DATE
FE
f
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
3
4
4
5
5
6
6
7
7
1 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:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 15
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
4
18
DATE:
DISPOSITION:
7
LETTER NEEDED YES El NO
LETTER NEEDED [] YES NO
8
FIRE DEPARTMENT COPY
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
4�' t
LOCATION: 21600 Highway 99
i
BUSINESS NAME: Kruger Clinic Orthopaedics
MAILING 21600 Hwy 99 #120
FIRE PREVENTION
SAFETY SURVEY
120
PHONE: 4257742636
ADDRESS: Edmonds 98026
BUSINESS OWNER: Degan, Thomas HOMEPHONE: 4257420146
EMERGENCY-1: HOME PHONE:
KEY ACCESS-2: HOME PHONE:
FRE=,qUENCY
STATION& SHIFT
1 16 6
SCHEDULED
01/0/11
DATE DUE 11
LIFIR o, 593
1157
ACTIVE
PERSON CONTACTED: 3-v\ �� 7�d I INITIAL I INSPECTION DATE
NAME OF INSPECTOR: ' brf t1vt ),f-;( , V-� C__ I ( �_ I � — I I I '
FIRE FE '!
�( 11-0
SYSTEMS:
ANNUAL
HAZrQS FOUND AND LOCATIONS / COMMUNICATIONS
1 , \ ��\ fti- -� , � �P�U('c
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ENTER CODE ONLY ONCE 11�
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VIOLATION CODE
1
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2
2.
3
3
4
4
5
5
6
6
7
7
8
8
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTEjC)q
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
PRE -CITATION
LETTER SENT
DATE:
3
OL IONS
5
VIOLATIONS
1 5
CITATION ISSUED
NUMBER:
4
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
18
4
8
DATE:
DISPOSITION:
7
8
V, LETTER NEEDED .E] YES NO
LETTER NEEDED L7 YES Lj NO
FIRE DEPARTMENT COPY