21600 HWY 99 STE 235C. - I .
SNOHOMISH CO.
Zl(,po6 Hz&lvaay �7 S7140 Z315__
FIRE PREVENTION
Serving Brier, Edmonds, and 12425 Meridian Ave S INSPECTION REPORT
0 EDMONDS
Mountlake Terrace Everett, WA 98208 OBRIER
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
[]UNINCORPORATED
www.FireDistrictl.org Fax (425) 551-1272
LOCATION: 2 00 Hi way 99 Suite 235 98026
PHONE:
BUSINESS NA : Vacant
MAILI
ADDRESS: 21600 Highway 99, Suite 235, Edmonds, WA 98026
BUSINESS OWNER: HOME PHONE:
4256404642
FREQUENCY I STATION & SHIFT
2016 16-C
SCHEDULED
DATE DUE - 0 Jan 2016
LIFIR 0
EMERGENCY-1: HOME PHONE:
CURRENT
KEY ACCESS-2: HOME PHONE:
CITY
YES NO
BUSINESS
M
EMAIL:
LICENSE
L—J
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE SYSTEMS: FE
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
__4
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 co
w ith the minimum standards adopted by the above jurisdictions.
Any overlooked hazards or violations. of the fire regulations does not imply approval of such conditions or 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.
SNOHOMISH CC
"FIRE
ST
Serv,ing Briet; Edmonds
Mountlake Terraceand
the Town of Woodway
www.FireDistrictl.org
LOCATION: 21600 Highway 99
BUSINESS NAME: Vacant
MAILING 21600 Highway 99
ADDRESS: Edmonds
BUSINESS OWNER:
io
P-AVa—N T 10 N
.12 425 Meridian Ave S INSPECTION REPORT
0 EDMONDS
Everett, WA 98208 016RIER
Phone (425) 551-1200 E]WOODWAY
[I MOUNTLAKE TERRACE
Fax (425) 551-1272 El UNINCORPORATED
I` FREQUENCY I STATION & SHIFT'*�
235 731 16 D
PHONE: 4256404642
98026
HOME PHONE:
SCHEDULED
DATE DUE � 01/01/13
UFIR � 593 1157
ACTIVE
EMERGENCY-1: Stevens Hospital HOME PHONE: 'CURRENT
KEY ACCESS-2: HOME PHONE: CITY YES NO
BUSINESS
LICENSE E] 1:1
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE FE f
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2 A
2
3
3
4
4
5
5
6
6
7
7
I 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:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
54
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
4
8
4
18
DATE:
DISPOSITION:
7
LETTER NEEDED [:] YES NO
LETTER NEEDED [] YES NO
8
FIRE DEPARTMENT COPY
1""
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
LOCATION: 21600 Highway 99
BUSINESS NAME: Kruger Clinic
MAILING 21600 Highway 99 #235
FIRE PREVENTION
SAFETY SURVEY
235
PHONE: 4256404642
ADDRESS: Edmonds 98026
BUSINESS OWNER: HOMEPHONE: 4258821680
EMERGENCY-1: Stevens Hospital HOME PHONE: 4256404000
KEY ACCESS-2: HOME PHONE:
FREQUENCY
STATION 1, SHIFT
731
1 16 B
SCHEDULED
011101/11
DATE DUE 11'
LIFIR o, 593
1 157
ACTIVE
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR: 6r!��
Cimr_ FE I
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE ll�
VIOLATION CODE
a v-, F
2
2
3
3
4
4
5
5
6
6
7
7
8
8
lst 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:
DATE:
DATE:
DATE:
3
VIOLATIONS
5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SE ON:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
7 .
4
18
4
18
DATE:
DISPOSITION:
t::�j
V., LETTER NEEDED [] YES 71 No
LETTER NEEDED [-, YES F] NO
FIRE DEPARTMENT COPY