21600 HWY 99 STE 290SNOHOMISH CO.
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Serving Brier, Edmonds, -and 12425 Meridian Ave S INSPECTION REPORT
OEDMONDS
Mountlake Terrace Everett, WA 98208 0 BRIER
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
0 UNINCORPORATED
www.FireDistrictl.org Fax (425) 551-1272
FREQUENCY STATION & SHIFT
LOCATION:
21600 Highway 99 Suite 290 98026 2016 L 16-C
BUSINESS NAME: PHONE: SCHEDULED
Children's Clinic, S Sno. Co. 4257780191 DATE DUE 0 Jan 2016
MAILING UFIR 0 593
ADDRESS: 21600 Highway 99, Suite 290, Edmonds, WA 98026
BUSINESS OWNER: HOME PHONE:
EMERGENCY-1: Wong, Agnes HOME PHONE: 4 . 2 57420581.., '�CURRENT YES NO
KEY ACCESS-2: HOME PHONE: CITY
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2ATE DUE:
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FIRE PREVENTION
Serving Bri&,. Edmonds'
.12425 Meridian Ave S
INSPECTION REPORT
SN'QH0Y,1SH CO.
Mountlake Terraceand
FIRE
Everett, WA 98208
0 EDMONDS
O�RIER
the Town of Woodway
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Phone (425) 551-1200
El WOODWAY
El MOUNTLAKE TERRACE
www.FireDistrictl.org
Fax (425) 551-1272
0 UNINCORPORATED
FREQUENCY
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LOCATION: 21600 Highway 99
290
731
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BUSINESS NAME: Children's Clinic, S Sno. Co.
PHONE: 4257780191
SCHEDULED
DATE DUE 11' 0 1101 / 13
MAILING 21600 Highway 99 #290
LIFIR � 593 1 157
ADDRESS: Edmonds
98026
BUSINESS OWNER: Wong,Agnes
HOMEPHONE: 4257420581
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EMERGENCY-1: Govaert, Lisa
HOMEPHONE: 4253454168
CURRENT
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EXTENSION
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DATE DUE:
DATE DUE:
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2
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DATE:
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DATE:
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LETTER NEEDED F] YES El NO
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FIRE DEPARTMENT COPY
0
IN
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 -1 (425) T71-0215
FIRE DEPARTMENT
LOCATION: 21600 Highway 99
BUSINESS NAME: ChildrefYs Clinic, S,.Sno. Co.
MAILING 21600 Highway 99 #290
FIRE PREVENTION
SAFETY SURVEY
290
PHONE: 4257780191
ADDRESS: Edmonds 98026
'A HOMEPHON
BUSINESS OWNER: Wong Mgnes E: 4257420531
4253454168
EMERGENCY-1: Govaert, Lisa HOME PHONE:
KEY ACCESS-2: HOME PHONE:
FREQUENCY
STATION & SHIFT
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SCHEDULED
DATE DUE 10
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DATE DUE:
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NUMBER:
4
2
6
2
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DATE:
CODE
SECTION:
5
3
7
3
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RETURN RECEIPT
RECEIVED
6
7
4
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4
18
DATE:
DISPOSITION:
8
LETTER NEEDED E] YES NO
LETTER NEEDED 0 YES NO
FIRE DEPARTMENT COPY