21600 HWY 99 STE 150Z1(100 H:*"IJN 177 jr-C16-0 FIRE PREVENTION
Serving Brier, S
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
Mountlake Terraceand
Everett, WA 98208
0 EDMONDS
0 BRIER
the Town of Woodway
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Phone (425) 551-1200
0WOODWAY
0 MOUNTLAKE TERRACE
www.FireDistrict].org
Fax (425) 551-1272
El UNINCORPORATED
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STATION & SHIFT
LOCATION: 21600 Highway 99
150/140
731
16 D
BUSINESS NAME: Dr. Degan/Dr. Kuechle, Orh Surgery
PHONE: 42577426336
SCHEDULED
DATE DUE 1' 1/01113
MAILING 21600 Highway 99 #150
LIFIR � 593 1157
ADDRESS: Edmonds
98026
BUSINESS OWNER: Degan, Thomas
HOME PHONE: 4257420146
AC-71VE
EMERGENCY-1: Kuechle, Dr.
HOME PHONE:
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
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LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE
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HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE -INSPECTION
FINAL RE -INSPECTION
EXTENSION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTED TO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
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INSPECTOR:
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VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
1 5
1 15
LETTER SENT
NUMBER:
4
CODE
5
6
DATE:
SECTION:
RETURN RECEIPT
7
3
7
RECEIVED
6
DISPOSITION:
7
4 8
4
8
DATE:
LETTER NEEDED F] YES NO
LETTER NEEDED C] YES NO
8
FIRE DEPARTMENT COPY
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
t . I S I-) z
LOCATION: 21600 Highway 99
lr(A -4 CA 16
BUSINESS NAME: Dr- DegatilDr. KwooMe.. Orh Surgery
MAILING 21600 Highway 99 #150
ADDRESS: Edmonds
BUSINESS OWNER: Degan.Thomas J. D�7vtcklf_
EMERGENCY-1:
KEY ACCESS-2:
FIRE PREVENTION
SAFETY SURVEY
150 + I 1-i (,-)
PHONE: 4257742636
98026
HOMEPHONE: 4257420146
HOME PHONE:
HOME PHONE:
FREQUENCY
STATION & SHIFT
731
16 6
SCHEDULED
1!011111
DATE DUE 01
LIFIR Ilo 593
1 157
ACTVE
PERSON CONTACTED: a�AQ(l^ LA)00� INITIAL INSPECTION DATE
NAME OF INSPECTOR: tl— I �
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LETTER SENT
NUMBER:
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CODE
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LETTER NEEDED YES NO
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FIRE DEPARTMENT COPY
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