21616 76TH AVE W STE 101_2/0/
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12425 Meridian Ave S
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Everett, WA 98208
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[1 UNINCORPORATED
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Washington Center for Pain Management
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BUSINESS NAME: PHONE:
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BUSINESS OWNER: Bundy, Sarah HOME PHONE:
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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
1st RE -INSPECTION
2nd RE -INSPECTION
DATE DUE.
DAT DUE:
PERSON
PERSON
CONTACTED-
CONTACTED -
INSPECTOR.
INSPECTOR.
DATE,
DATE -
VIOLATIONS
VIOLATIONS
1 5
1 5
2 6
2 6
3 7
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4 8
4 8.
LETTER NEEDED YES NO
LETTER NEEDED YES NO
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EXTENSION V
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3
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CITATION ISSUED
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NUMBER,
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DATE
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RETURN RECEIPT
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6
DISPOSITION
DATE*
8
Sri Co.
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Serving Brier, Edmoi nds
Mountlake Terraceand
12425 Meridian Ave S
Everett, WA 98208
FIRE PREVENTION
INSPECTION REPORT
EIEDMONDS
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the Town of Woodway
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Phone (425) 551-1200
Fax (425) 551-1272
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LOCATION: 21616 76"'
Avenue W Suite 102 98026
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BUSINESS OWNER: /0 HOME PHONE:
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1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
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2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
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NUMBER:
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DATE:
CODE
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DATE:
DISPOSITION:
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LETTER NEEDED [0] YES [__31 N
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FIRE DEPARTMENT COPY
Serving Brier, Edmqvds 12425 Meridian Ave S
--Mountlake Terrace, and Everett, WA 98208
.,.the Town of Woodway Phone (425) 551-1200
www.FireDistrictl.orz Fax (425) 551-1272
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LOCATION: 21616 76 Avenue Vl= 8026 t7bj�
BUSINESS NAME: Evergreen Healthcare PHONE: 425775344f
MAILING
ADDRESS:
21616 76th Avenue W, Suite 101, Edmonds, WA 08026
BUSINESS OWNER:
HOME PHONE:
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EMERGENCY-1:
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HOME PHONE:
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DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
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LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
14
18
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED YES No
LE;TER NEEDED [I YES NO
8
FIRE DEPARTMENT COPY
FIRE PREVENTION
Serving Brier, Edmonds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
'FIR
)aEDMONDS
Mountlake Terrace,and
Everett, WA 98208
[3,BRIER
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the Town of Woodway
Phone (425) 551-1200
0WOODWAY
[I MOUNTLAKE TERRACE
www.FireDistrictLorg
Fax (425) 551-1272
0 UNINCORPORATED
"' FREQUENCY
STATION & SHIF"I
LOCATION: 21616 76th Avenue
W
730
16 A
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BUSINESS NAME: Evergreen Healthcare
PHONE: 4257753446
SCHEDULED
DATE DUE 1` 09/01/12
MAILING
21616 76th Ave W #10 1
UFIR 1,, 593 9156
ADDRESS:
Edmonds
98026
BUSINESS OWNER:
HOME PHONE:
AC 11VE
EMERGENCY-1:
HOME PHONE:
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS El
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE
FE
SYSTEMS:
ANNUAL
T
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
2
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:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
D E:
DATE:
3
VIOLA IONSJ
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
18
4
18
DATE:
DISPOSITION:
7
LETTERNEEDED E] YES F-1 N
rLETTERNEEDED [] YES NO
8
FIRE DEPARTMENT COPY
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HARVE H
61-IT Y. OF EDM=DB H RRISON
CIVIC CENTER - EDMONDS. WASHINGTON 98WO (206) 775-2525 MAYOR
FIRE DEPARTMENT ( _
�eptember 19, 1978
Stephen F. Mackey, M.D. '74-2
21616 - 76th Street. S.W.
Edmonds, WA 98020
RE: STEPHEN F. MACKEY, M.D.— FILE CODE 593-0007056
Dear Dr..Mackey:
On August.30, 1978, your office was i,nspected by members of
the Edmonds.Fire Prevention Bureau.
We request the following corrections:
Replace combustible waste containers with approved
noncombustible types. Plastic liners may be used
in approved containers.
Provide restraining chains or devices for the free-
standing compressed air cylinders to'protect against
physical damage or upset..
pr3. Move extinguisher out from gas storage closet to
a more accessible area.
The Fire Department will reinspect your building after fifteen
days.
If we may be of further assistance, please contact*this office
(775-2525, Ext. 247) during business hours, 9:00 A.M. to 5:00
P.M.
Yours for a safer community'through fire prevention,
Jack F. Cooper
Fire Chief .
6�11V_to .
Gerald Ehtee
Inspector
GE/ amm