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21616 76TH AVE W STE 112�21(pj(p 76A, POC L-i I-rc, li2- Serving Briei; Edmonds, and 12425 Meridian Ave S Mountlake Terrace Everett, WA 98208 Phone (425) 551-1200 www.FireDistrict].org Fax (425) 551-1272 FIRE PREVENTION INSPECTION REPORT gEDMONDS RIER 0 MOUNTLAKE TERRACE [I UNINCORPORATED FREQUENCY STATION & SHIFT LOCATION: 21616 76 th Avenue W Suite 112 98026 2015 20-D BUSINESS NAME: Puget Sound Ear, Nose & Throat PHONE: SCHEDULED 4257756651 DATE DUE Sep 2015 MAILING UFIR 0 593 156 ADDRESS: 21616 76th Avenue W, Suite 112, Edmonds, WA 98026 BUSINESS OWNER: HOME PHONE: EMER.GENCY-1: Riddell, Duncan HOME PHONE: CURRENT YES NO KEY ACCESS-2: HOME PHONE: CITY BUSINESS EMAIL: [LICENSE g El INITIAL INSPECTION DATE PERSON CONTACTED: NAME OF INSPECTOR: _j FIRE SYSTEMS: FE1 Date Last Serviced: 1r, HAZARDS FOUND AND LOCATIONS /COMMUNICATIONS 1 - 1 !:> - I /V 2 2 3 4 4 .. ..... ... 5 6 6 7- 7 I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X��Z AAAj-4-,l 4Je"A_LY 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 compliance with 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. oj(� iq el C,4j 41 FIRE PREVENTION .112 *rving Brier,,Edthonds . 1 j 12425 Meridian Ave S INSPECTION REPORT SNOHOMISH CO. Mountlake Terrace, and Everett, WA 98208 0 EDMONDS 0 BRIER - I e Town of Woodway www.FireDistrictl.org 0 WOODWAY Phone (425) 551-1200 - 0 MOUNTLAKE TERRACE Fax (425) 551-1272 0 UNINCORPORATED FREQUENCY STATION & SHIFT �OCATION:_ 21616 76ul Avenue W Suite '112 98026 2 Yea'r 13 2c)-e BUSI ESS NAME: Puget Sound Ear, Nose &Throat ....... PHONE: 4257756651 SCHEDULED DATE DUE Si MAiLING FIR 0 593 IU I ADDRESS: 21616 76th A� enue W. Suite 112, Edmonds, _WA 98026 _7p�j_ Fllkln�tSpMj )p R: OME-PHO EM'ERGENCY-1: HOME PHONE: CURRENT KEY ACCE S-2: HOME PHONE: CITY YES . NO BUSINESS F-1 F-1 LICENSE 1 4—) INITIAL INSPECTION DATE PERSON CONTACTED: NAME OF INSPECTOR: k ki HAZARDS FOUND AND LOCATIONS COMK4UNICATIONS 12-J 2 J-15 2 &1AA 4 3 3 4 01 4 5 5 'U. 6 6 I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXt, 3,0-D 1, AYS X; 1 St RE -INSPECTION 2nd RE -INSPECTION EXTENSION FINAL RE -INSPECTION VIOLATIONS DATE DUE: DATE DUE: GRANTED TO: DATE DUE: CITED: PERSOIN� PERSON PERSON CONTACTED: CONTACTED: CONTACTED: 1 INSPECTOR: INSPECTOR: INSPECTOR: 2 DATE: DATE: DATE: 3 VIOLATIONS VIOLATIONS PRE -CITATION CITATION ISSUED 1 5 1 5 LETTER SENT NUMBER: 4 CODE 5 2 6 2 6 DATE: SECTION: RETURN RECEIPT 13 7 3 7 RECEIVED 6 _ DISPOSITION: 14 '8 4 8 DATE: 7 LETTER NEEDED F ] YES NO LETTER NEEDED [] YES El NO 8 FIRE DEPARTMENT COPY Serving Brier, Edmonds SNOHOMRSH CO. TIRE Mountlake Terraceand *­TI ST R., the Town -of Woodway www.FireDistrictl.org LOCATION: 21616 76th Avenue BUSINESS NAME: Puget Sound Ear, Nose & Throat MAILING 21616 76th Ave W #112 ADDRESS: Edinonds BUSINESS OWNER: Riddell, Duncan EMERGENCY-1: GhElfig, em D�V)rN KEY ACCESS-2: W PERSON CONTACTED: NAME OF INSPECTOR: FIRE SYSTEMS: 12425 Meridian Ave S Everett, WA 98208 Phone (425) 551-1200 Fax (425) 551-1272 W 112 PHONE: 4257756651 98026 HOMEPHONE: 4256702957 HOME PHONE: C,:ZX� _WGME­PHONE�� FIRE PREVENTION INSPECTION REPORT Nf EDMONDS 0 BRIER E]WOODWAY [I MOUNTLAKE TERRACE C1 UNINCORPORATED e- FREOUENCY STATION & SHIF`� 731 16 A SCHEDULED DATE DUE 09/01,112 [ U 9156 FIR � 593 ACTIVE CURRENT CITY YES NO BUSINESS LICENSE -2 1:1 INITIAL INSPECTION DATE FE I ANNUAL HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 1 VC3 1,4_d,� -��dzt 6 7- 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: DATE: DATE: 3 VIOLATIONS 1 5 VIOLATIONS 'I. 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 14 LIETTERNEEDED .8 DATE: DISPOSITION: 7 LETTER NEEDED YES NO E] YES El NO 8 FIRE DEPARTMENT COPY a APPLICATION ROUTING FORM FILE: ADR-02-193 / V-02-196 AND CHECKLIST FROM: PLANNING ROUTE[) TO: Engineering 10/08/02 Fire 10/08/02 PW 10/08/02 Parks A Rec. 10/08/02 Building— N/A Community Svcs NIA RETURNED Engineering Fire Public Works Parks & Rec. Building Community Svcs Staff Comments: 62 R-.L— IV E-k/r- 5- hGjV C- ox 4R+11" AArD Fu&L xyl-� ir,�-"LAmaj /96kni i 7-r *PER WHAT SECTION OF THE CODE? *Additional Information Required for Complete Application • Owner: PUGET SOUND EAR, NOSE THROAT GROUP • Property Address. 21616 #112 • Date of Application: 10/04/02 764 s4ysikk • Type:_ Install generator / Variance to reduce street setback • Meeting Required: Yes X No Date of Meeting • Planning Contact. Star Campbell X Application __K_Fee --2�—APO List Recording Fee X Critical Areas Determination X Vicinity Map X Colored Pictures Landscaping Plan Petition (Official Street Map) Site Plan for Short Subdivision/LLA (8.5 x 11) X Site Plan/Floor Plan Legals (Existing & Proposed) Title Report Covenant X Criteria Drainage Plan/6rading X Elevations —SEPA Checklist city of edmonds land use application 0 aa 11N ARCHITECTURAL DESIGN REVIEW 11,0122 to] F.11 ItINImelel Q COMPREI IENSIVE PLAN AMENDMENT C3 CONDITIONAL USE PERMIT FILE# .� ZONE LA C3 HOME OCCUPATION ') DAJ lo-14- o- 2- REC'DBY-,:�-)c,) 13 FORMAL SUBDIVISION C3 S1 IORT SUBDIVISION FE Lo!b� RECEIPT # �Qc) & -7 c, Q LOT LINE ADJUSTMENT 0 0 - ND3 HEARING DATE 11 PLANNED RESIDENTIAL DAV9,0?MhNT 0 OFFICIAL STREET MAP AMENDMENT Q HE Q STAFF EI P'B 0 ADB 11 CC Q STREET VACATION 15. e, C;),.- Ll REZONE C> Q SHORELINE PERMIT Pa VARIANCE / REASONABL ASE EXCEPT ION Q OTHER: PROPERTY ADDRESS OR LOCATION 21616 76th Ave. SW Suite 112 Edmonds, WA PROJECT NAmE. (IF APPLICABLE) Puget Sound Ear. Nose & Throat Group PROPERTY OWNER Stpvens Medical T.LQ PI-IONE# (425)643- s400 ADDRESS P.O. Box 53290 Bellevue, WA 98105-3290 E-MAIL ADDRESS FAX # (.425)643-9139 1* -1610-001-001-01 TAX ACCOUNT# 2* �295-000-006-00 SEC. TwP. RNG. Dr--SCRIPTION OFPROJECTOR PROPOSED USE The installation of a propane powered electricity generator for use as backup provider of electricity to an existing ambulatory surgical center. The practice currently uses battery power for emergency backup.The state of Washington no long er allows -battery backup. APPLICANT Puatt Sound Ear, Nose'& Throat PHONE # (425)775�6651 ADDRESS 21616 76th- Ave, W. #112 Edmonda, WA E-MAIL ADDRESS FAX # (4251670�6718 CONTACT PERSON/AG ENT -Jeff Ekstrom/Wilcox Construction PI-IONE# (425)774�4185 ADDRESS 234 5th- Ave. -S. Edmonds, WA 9-8020 E-MAIL ADDRESS jekstr6m@wilcoxcons-truction.coTa FAX #— (-425)174-,4187 'I'lie undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees to release, indemnify, defend and hold the City of Edmonds harmless from any and all darnages, including reasonable attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or incomplete information furnished by the applicant, his/her/its agents or employees. By my signature, I certify that the information and exhibits herewith submitted are true and correct to tile best of my knowledge and that I am authorized to fil this application on the behalf of the owner as liste elow. K I SIGNATUREOFAPPLICANT/AGEN� DATE 19cs —Z-- /VL Property Owner's Authorization By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application, and grant my permission for the public officials and the staff of the City of. * Edn-ionds to enter tile subject property forthe purposes of!PT-6f10 and posting attendant to this application. S IGNATURE OF This application form was revised on 1/27/00. To verify wlieflier it is still current, call (425) 77170220. 1,:\LIBIZAItY\PLANNIN(;\Foi-iiis & liundouls\llublic I landoutAl-and Use Application.doc WILCOX CONSTRUCTION INC. Jeff Ekstrom Project Manager Phone (425) 774-4165 - FAX (425) 774-4167 Cell (206) 817-1255 234 - 5th Avenue South - Edr-6onds. WA 98020 Email: iekstrom@)witcoxconstruction.com REG. #WILCOC*1940C Y,7 oo"- V .1 & ILA-pr� �,0(1- T 0 !(f It.( �3o tw v -fA-o-, N DS r,, -'f i+aO A-:-T & (Wof 'A �(o Ito -1 (or-- 112, ItIN IL --------- --- — — --------- ................ s w I a P-� WILCOX CONSTRUCTION INC. 234 5th Avenue South - Edmonds, WA 9BO20 Rhone (425) 774-41B5 - FAX (425) 774-41B7 July 16, 2002 City of Edmonds Development Services. Department 1215 1h Ave. North Edmonds, WA. 98020 Attn: Robert Chave, AICP Dear Mr. Chave, We have been asked by the Puget Sound Ear, Nose and Throat Group to provide and install for them an updated emergency power transmission system for their Ambulatory Surgery Center. The Puget Sound Ear, Nose & Throat Group is a well established medical practice located at 21616 76t" Avenue West, Suite 112, in the Edmonds Professional Center. The PSENT Group provides among their other services, outpatient surgical procedures in their offices. These practices and procedures are regulated by the State of Washington Department of Labor & Industries who certify the facilities compliance with the Medicare system. As a part of the regulatioris, an ASC (Ambulatory Surgery Center) must have a backup emergency power system so that in the event of a general power outage sufficient power is available to allow any surgeries in progress to be completed or the patient stabilized and any recovering patient have enough recovery time to safely discharge them. When this ASC was established several years ago, the State allowed use of battery backup systems for this purpose. This year the regulations have been changed so that battery backup is no longer acceptable and fuel fired generators are now required. The PSENT Group has to perform this upgrade this year. One of the requirements of placing a generator and propane fuel tank is that the generator must be a minimum of 10 feet away from any wall opening (window or door) and the fuel tank must be 10 feet from any source of ignition. This generator system would be in operation only in an emergency and the generator itself will be programmed to run once a week for about twenty minutes for testing purposes. The property on which this facility is located has very few acceptable locations for the system to be placed. I am enclosing a plot plan I have made showing the location of landscaping and how it relates to where I have located the generator and propane tank. Both pieces of equipment will be screened with a chain link fence with cedar or vinyl inserts. My desire is for direction allowing me to submit for a building permit so that this work can proceed. Respectfully yours, Jeff Ekstrom Manager r 7 e I ? WILCOX CONSTRUCTION INC. 234 5th Avenue South - Edmonds, WA 9BO20 Rhone (425) 774-41B5 - FAX (425) 774-41B7 September 26, 2002 City of Edmonds Development Services Department 1215 1h Ave. North Edmonds, WA. 98020 Criteria For Variance Request Please refer to the attached letter addressed to Mr. Robert Chaves and dated July 16, 2002 for an explanation of the need for this requested variance. 2 LI How does the proposal meet the Special Circumstance Criteria? Because this medical practice is required to upgrade it's Emergency Power source, the installation of a propane fueled electrical generator is required. The required 15' setback from the property line when coupled with the required location of the generator and fuel tank 10' away from the building are at odds with each other. If the Emergency generator cannot be placed within the 15' setback, this medical practice will not be in compliance with the regulatory conditions placed upon it by the medicare system. Explain why the proposal is not a grant of Special Privilege. This Ambulatory Surgical Center is already in practice for several years. Denial of this process will cause this practice to be violating the law it is required to adhere to. How is the proposal consistant with the Comprehensive Plan I don't believe the Comprehensive Plan applies to this request. Explain how the proposal is constant with the Zoning Ordinance. This use is allowed by zoning. 5. Explain how this proposal meets the criteria of Not Detrimental This variance will not deter property values or use of adjoining areas as the adjoining areas is a street. In addition, the generator and fuel tank will be screened by fences. 6. Explain how the proposed variance is the Minimum Variance needed. There is no other location to put this equipment. The medical clinic is required to have 248 parking stalls and there are 248 parking stalls provided. This planter is the only large enough space on site. MEMORANDUM DATE 7 I.D. REPORTEDBY OF SUBJECT ADDRESS: 7/,,,A 4v u) 4fl CONCERNS/ E74P- m3ac C HAZARDS: FOLLOW-UP: SIGNED v-Ael&rY Oc c oc E7xerr e/Al D15c(13;rc-V or-r- SIGNED City of Edmonds * Office of Fire Prevention Ar 99-198 HEALTH CARE FACILITIES 1-6.2 Action of Administrator. Based on this assessment, the Health Care Disaster Plan will be activated in part or in its entirety by the administrator or his/her designated alter- nate. Degree of structural damage will often be the major decision factor. 1-6.3 Disaster Control Center. The disaster control cen- ter will be activated to coordinate and direct all further activities under the Health Care Disaster Plan, as described under the external disaster plan. (See 1-5.4.) The first func- tion of the control center will be to determine whether patients and personnel should be removed from actual or threatened danger 'by partial or total evacuation of the facility, under an evacuation plan described herein. In localized disasters, the fire chief, upon arrival, will usually assume responsibility for evacuation decisions. In other cases, evacuation may be ordered by outside authorities. 1-6.4 Fire and/or Explosion ' Protocol (Including Arson Attempts). In the event that the health care facility need not be completely evacuated immediately, the following actions need to be accomplished as applicable, with the order of implementation dependent on circumstances. (a) Notify. emergency, services (e.g., fire department, 911 " ); (b);Alert, any facility emergency responders; (c) . Contain and/or extinguish fire according to the facil- ity's policies and procedures; (d) Rescue all persons,in immediate danger; (e) Meet-jesponding emergency services personnel and direct ifi�e'm to scene; (O.Secure the affected area; (g) Control movement of all patients and visitors; and (h) Evacuate facility of portions thereof, as directed. 1-6.5 Severe Storm Protocol. The warning system oper- ated by the National Oceanic and Atmospheric Administra- tion will, in most cases, provide adequate time to permit the health care facility to take certain precautions, and if disaster appears inevitable, to activate the Health Care Disaster Plan in advance of the disaster event. Precautions include the following: (a) Draw all shades and close all drapes as protection against shattering glass; (b) Lowi5� all patient beds to the low position, wherever possible A (c). Place blankets on patients; (d) Close all doors and windows. 1-6.6 Fallout Shelter Protocol. It is expected that a crisis period of variable duration will precede nuclear warfare and that the degree of crisis will progressively worsen. During this increasing crisis period the following actions will be taken: (a) Discharge all inpatients who can safely be dis- charged. 1993 Edition (b) Admit only critically ill or injured patients for whom medical treatment -is mandatory, and obstetric cases. (c) Prepare those areas of the facility designated as fall- out shelter areas, to ensure that space and habitability is adequate, and that these areas are stocked with or have ready access to potable water and survival rations. (d) Upon warning of imminent nuclear explosion threat or imminent fallout, evacuate patients and facility person- nel to these fallout shelters. In the case of patients who cannot be moved at the required time to evacuate to shel- ter, e.g., certain patients in intensive care units, certain orthopedic patients, etc., provide them with the best avail- able shelter on the si.te (i.e., position patient's bed so as to take advantage of whatever radiation shielding is available in the room). (e) Wartime plans should not assume availability of util- ities or refuse collection. 1-6.7 Evacuation Protocol. Evacuation may be partial or total. It may involve moving from one story to another, one lateral section or wing to another, or moving out of the structure. Even partial evacuations may involve all catego- ries of patients; where these are people who would not routinely be moved, extraordinary measures rray be required to support life. It. is also necessary to ensure movement of supplies in conjunction with any evacuation. Decisions to evacuate may be made as a result of internal problems or under menace of engulfing external threats. In all cases, the following considerations govern: (a) Move to predesignated areas, whether in the facility, nearby, or in remote zones. Evacuation directives will nor- mally indicate destinations. (b) Ensure movement of equipment and supplies to accompany or meet patients and staff in the new location. (c) Execute predetermined staffing plans. Some'staff will accompany patients; others will rendezvous in the new location. Maintenance of shifts is more complex than nor- mal, especially when (1) some hard -to -move patients stay behind in the threatened location, and (2) staff -may be separated from their own relocated families. (d) Protection of patients and staff (during and after movement) against the threatening environment must be provided. (e) Provisions of the fallout shelter protocol will be rele- vant in wartime or nuclear contamination situations. Planning must consider transportation arrangements. 1-6.8 VIP Admission Protocol. Admission of a VIP to a health care facility in an emergency creates two sets of problems, which may require partial activation of the Health Care Disaster Plan. These problems are: 1-6.8.1 Security. Provision of security forces in this situ- ation will normally be a responsibility of the U.S. . Sec . ret Service or other governmental agency. However, activation of facility security forces may be required to prevent hordes of curious onlookers from entering facility work areas and interfering with routine facility functioning. Rou- tine visiting privileges and routine visiting hours may need to be suspended in parts of the facility. 1--vu et -*,3ounci otolaryngology, Inc., P.S. 9 John T Todd, I�LD., EA.C.S. Surgery of Lte Head & Ner-1c Disea,w of the Ear, Nose & Throat FAX TRJ4-NZSMITTAL NOTIFICATION DATE : Y— �3 --,? —7 zo. RE: RECEIVING FAX MMER:1 NU!,MER OF PAGES. (Including cover sheet) FAX NUMBER: 670-6718 John T. Parker, M-D. Surgery of the Head & Neck Fadal Plastic Surgery Diseases of Erie EarMose & Throat Ben Thal,,%LD. Diseases of Erte Ear,,Nos,- & Throat Alan L. Keaton, M.D., F.A.C.S. Surgery of the Kead & Neck Diseases of Uhtt Ear, Nose & Throat If there are any questions or concerns, please call our office at (206) 775-6651. Thank You. "This facsimile transmission (and/or the documents accompanying it) May contain confidential information belonging to the sender which is protected by the physician/patient privilege- The information is intended for the use of the iadividual or entity named above. if you are not the intended recipient, you are� hereby notifted that any disclosure, coping, distribution or the taking of any action in reliance of the contents of this information is strictly prohibited by law. If you have recieved this transmission in error, please immediately notify us by telephone and arrange for return of the document-" 57 Jh" . 1121 el A Wd102T L66T 2T cl-774t— - y, Ice 4 n �7 /1 40 ,6nd 6TL90L9SFV 'ON 3NOHd Stevens Professional Center 21616 - 76th A%-enue West, Suite 112 Edmonds, Washin&rton 98026 (206) 775-66K Fax (206) 670-6-718 A90-10ONANHIOiO GNnos 139nd : WOaJ MEMORANDUM DATE REPORTED BY OF I.D. SUBJECT ADDRESS: CONCERNS/ A/Z7 j2f;&4rV7f7--X A./fl HAZARDS: co" 6 Iff? 7 FOLLOW-UP: 1,(^47t LAVIA.� Alc)A'4-, Fe4--t R 'I PF' Irl I /V 'Ovej— SIGNED Ae. LA/ 7- -x> SIGNED City of Edmonds * Office of Fire Prevention �,lf 3 �cj-7 C) CITY OF EDIMUNDS HARVE H. HARRISON CIVIC CENTER - EDMONDS. WASHINGTON 98020 (206) 775-2525 MAYOR FIRE DEPARTMENT September 20, 1978 Mark T. Hanson, M.D. 21616 - 76th Avenue West Edmonds, WA 98020 RE: EDMONDS FAMILY MEDICINE CLINIC, P.S. - FILE CODE 593-000-118 Dear Dr. Hanson: On August 30, 1978, your bu,ilding was inspected by members of the Edmonds Fire -Prevention Bureau. We request the following corrections: Replace combustible waste containers throughout occupancy'with approved noncombustible types. Plas- tic liners may be used in approved containers. 2. Service fire extinguisher. 3. Provide a permanent mounting bracket for the fire extinguisher so that the.top of the extinguisher is not more than five feet above the floor and the bot- tom not less than 18 inches above grade. 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 Gerald Ehtee Inspector GE/ amm