21616 76TH AVE W STE 201_27&-61 OUC W Xri� Zo
Kevin Zweber
2p 6
From: Anthony Medawar [amedawar@guardiansecurity.com]
Sent: Wednesday, November 02, 2016 4:21 PM
To: Kevin Zweber
J�o h
Cc: ,7ning 4
Subject: : 21616 76th Ave W Bld201 0904
Good Afternoon -
As I review this checklist, and confirmed with my technician that Item's 1 and 2 are complete
completed Item #3 in September. Please advise.
Anthony Medawar
Project Manager & Operations Manager- Bellingham
0: 360.647.0110 ext. 334 M: 360.440.5518
E: amedawarCa)--quardiansecurity.com W: www.guardiansecurity.com
All email, voicemail, and other communications are responded to within 24-48 hours of initial receipt
11111mm— 41 MEOW
GUARDIAN SECURI"
&#Ff, AND 01NQPfft?V P0Q?CCT#0N
From: Kevin Zweber [mailto:kZweber@firedistrictl.org]
Sent: Wednesday, November 2, 2016 IS7 PM
To: Anthony Medawar <amedawar@guardiansecurity.com>
Cc: John J. Dowling <0dowlingWiredistrictLorp
Subject: 21616 76th Ave W Bld20160904
Anthony,
Reference the above permit: Our inspection was conducted on 8/31/16, below is a copy of the correction notice. Your
permit has not been approved. Please complete the work and call for a re -inspection.
1. Remove FACP sign from Suite 102 panel cover (where old 2nd panel use to be).
2. Rename address points indicated NW or SW hallway to N, S, or E hallway.
Provide graphic layout of system in main entry near remote panel.
Kevin Zweber
Deputy Chief - Fire Marshal
Fire Prevention Services
Snohomish County Fire District 1
Proudly serving the Cities of Brier,
Edmonds, and Mountlake Terrace
425-771-0213 Office
425-231-3644 cell
A
FIRE PREVENTION
Ik4WOMISH CO.
�)4
Serving Brier, Edmonds, and
12425 Meridian Ave S
INSPECT PORT
CT
INSP�E I"E
FIR
Mountlake T�rrace
Everett, WA 98208
ONDS
ONDS
n "",
0 BRIER
DISTR T
Phone (425) 551-1200
Fax 551-1272
0 MOUNTLAKE TERRACE
[]UNINCORPORATED
www.FireDistrictl.org
(425)
FREQUENCY
STATION & SHIFT
LOCATION: 21616 76 th
Avenue W Suite 201 98026
20-D
9S2015
BUSINESS NAME.'
d�
6
PHONE: —42-516861895
SCHEDULED
DATEDUE 0 Sep 2015
MAILING
UFIR 0 593 156
ADDRESS: 21616 76th Avenue W, Suite 201, Edmonds, WA 98026
BUSINESS OWNER:
HOMEPHON
EMERGENCY-1:
HOME PHON43�
C RRIENT
KEY ACCESS-2:
HOME PHONE:
NO
CITY YES NO
BUSINESS
EMAIL: LICENSE
el INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
y
FIRE SYSTEMS: FE4Qme--->7'
nntp I nQt Apniirpri-
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
_A OIL,( W
2 �4 �A Yp
2
.7A
_k
4
5
3
4
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 requireattention to bring them into compliance
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.
gm_b
FIRE- PRkV&,"TION
Serving Brierj Edmonds
.12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH,C .
F I Rhf.)
Mountlake Terraceand
Everett, WA 98208
0 EDMONDS
0 BRIER
DISTR T
the Town of Woodway
Phone (425).551-1200
OWOODWAY
0 MOUNTLAKE TERRACE
www.FireDistrictl.org
Fax (425) 551-1272
0 UNINCORPORATED
FREQUENCY
STATION & SHIFT
LOCATION: 216-16 76"'Avenue
W Suite 201 98026
2 Year 13
20-B
BUSINESS NAME: Avena Vascular
PHONE: 3096'T2q1W*"
SCHEDULED Sep
DATE DUE
MAILING
UFIR 593
ADDRESS: 21616 76th Avenue W, Suite 201, Edmonds, W.A 98026
BUSINESS OWNER:
Email:
HOME PHONE:
6- 4�1�_
EMERGENCY-1:
HOME PHONE:
'Cl RRENT
NO
KEY ACCESS-2:
HOME PHONE-
CITY YES
BUSINESS
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
DI - 2_0 31
FIRE SYSTEMS: FE 0
1/127
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
3
3
4
4
5
5
6
6
7
7
1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1 st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
D E 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
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
18
4
18
DATE:
DISPOSITION:
7
LETTER NEEDED [] YES El NO
LETTER NEEDED C] YES NO
FIRE DEPARTMENT COPY
Serving Brier, Edmonds
SNOHOMISH.CO.
FIREMountlake
f�:o Terraceand
ST kffT
I the Town of Woodway
www.FireDistrictl.org
LOCATION:
21616 76th Avenue
BUSINESS NAME:
Avena VasicUlar
MAILING
21616 76th Ave W #201
ADDRESS:
Edm onds
BUSINESS OWNER:
Fujioka, Keith
EMERGEN�CY-1:
KEY ACCE SS-2:
PERSON CONTACTED:
NAME OF INSPECTOR//`,T
FIRE
SYSTEM&
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
W 201
PHONE:�
� t
98026
HOMEPHONE: 2069799181
HOME PHONE: 20696SO67,2
HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
ffWOODWAY
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY STATION & SHIFF"
730 16 A
SCHEDULED
DATE DUE 1` 09/01/12
UFIR 11, 593 9156
ACTIVE
CURRENT
CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
�015_1111 Z�
FL I""!
ANI`�IJAL
HAZARDS FOUND AND LOCATIONS COMMUNICATI
1 A) , F),-
7 �s Z&,r-��
'I
1
1
2 Al�alqcc df/dA4EM
eLliL
2
5'
3
3
\4
4
5
5
6
6
7
7
I I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS".
1st RE -INSPECTION
2nd RE -INSPECTION
RE -INSPECTION
EXTENSIO�,_,ONAL
VIOLATIONS
DATE DUE:
D TE DUE:
GRANTED TO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED: �.��077—
CONTACTED:
CONTACTED:
I
,INSPECTOR:
2
INSPECTOR.
INSPECTOR:
DATE: /Olt
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
1 Q 5
a
1 5
LETTER SENT
NUMBER:
4
co V
CODE
5
2
6
2
6
DATE:
SECTION:
RETURN RECEIPT
3
7
13
7
RECEIVED
6
DISPOSITION:
4
8
4
8
DATE:
7
"I LETTER NEEDED [] YES NO
LETTER NEEDED [] YES NO
8
FIRE DEPARTMENT COPY _41,
C) 0 0
CITY OF EDMONDS
BUSIN`ESS LICENSE APPLICATION— COMMERCIAL elt I
Ff—E: $125.00
CrrY CLERICS OFFICE, BUSINESS- LICENSE DIVISION
121 5�' AVENUE NORTH, EDMONDS, WA 98020 PHONE: 425.775.2525
OFFICE USE ONLY
1 BL#
I customer#
10011-14 1-3,9&--
SIC
1,
Year
'goll
I SHO
Date Paid, �
I (�
TR#
(,),o
[Fee Paidl
0&t .
Mailed
I Delete
I
INSTRUCTIONS: Plea so complete the application In full and attach the required floor plan. Middle Initial or name required of all
parties coincerned. H no middle name, please Indicate by writing NMN. Sign and return application with fee. Please advise of -
any change In status. Now license required If business changes location or ownership. Notification to City of Edmonds required
if business bloses.
BUSINESS NAM Avena Vascular, Inc., P.C.
BUSINEssADDREss 21616 - 76th Avenue West, Suite 201, Edmonds, WA 98026
street Suite No. Ap Code
MAILING ADDREM 11714 North Creek Parkway North, Suite 100, Bothell, WA 98011
Street or PO Box Suits No. City, State and ZJp Code
BUSINESS PHONE NO. 360 352-7856 -WASTATETAXIQNO.(U BI NO.) 603.113888
BUSINESS E4ML BUSINESS WEBSITE
�ROPEiIT`Y OWNER j
Name Phone Number
EMERGENCY NOTIFICATION (For Premise Acoew in Emergemyy
Fujioka Keith ( 206 i, - 979-9181
i It Name First Name MI Phone No.
Olmsted Paul 206 ) 963-0672
L2st Name First Name 114 Phone No.
NATURE OF BUSINESS Practice of mediciA e
NUMBER 6F E MLOYEES FOOTAGE OF BUSINESS SPACE 450
TYPE OF 81.141NEMS - PLEASE CHF-C*,TME -APPROPRIATE CATEGORY.
a CONSTRUCTION 13 FINANIM INSURANCE, REAL 0 NON-PROFIT
ESTATE. a LANDSCAPE. HORTICULTURAL 0 MANUFACTURING
.a.Rerw 0-SECOM*IAN06EALIER d(SERVICES OWHOLESALE GOTHER
AMUSEMENT DEvictg,oN PREmisEs? cj YES CXN 0 IF YES� TOTAL NUMBER
LIQUOR SOLD ON PREMISES?:, 0 YES. 11NO.- GAMBUNG? QYES (XN0 CIGARETTES SOLD ON PREMISES? OYES CXINO
FLAMMABLE OR HAZARDOUS MATEMALS WEDJOR STORED?.- 13YES MW IFYES, PLEASE PROVIDE LIST OF MATERIALS AND ouANrrmEs:
PROPOSED OPENING DAY -OF BUSINESS July Ist,*2011_EUSINESS HOURS
DAYS OPEN Cl SUNDAY IXMONDA�Y LXTUESDAY PIWEONESDAY XTHUR;DAY 19 FRIDAY - 13 SATURDAY
PARKING SPACES ON SM- TOTAL ACCESSIBLE FOR PERSONS WITH DISABILITIES Yes
DOES THE BUSINESS CONTAIN AN ENTRAINIMACCES818LE To PERSONS WITH DISABILITIES?. 1XyES t] NO
PREVIOUS BUSIWM USE AT THIS ADDMSS Vascular ultrasound lab
SOLE PROPRIETORSHIP
Last First mi
sham Apt No., Link No. City, State and 71p Code
HOME PHONE NO. DOL NO. (DRIVERS LICENSE NO.) OR OTHER ID NO.,
DATE OF BIRTH CITY AND STATE OF BIRTH COUNTRY OF BIKML..��
PARTNERSHIP - PARTNER I
NAME
Lao, First MI
ADDRESS
street Apt No.. Unit No. City. State and Zip Code
HOME PHONE Not_ ----POL NO. (DRIVERS LICENSE NO.) OR OTHER ID NO.__
DATE OF BIRTI-LC1TY- AND STATE OF BI OUNTRY OF
PARTNERSHIP - PARTNER 2,
NAME
Last flist
ADDRESS
Street ApL W75�� City. State mid Zip Code
HOME PHQNE NO.( J. —DOLNO.MRFVERSUCENtENO:)OROTfiER*IDNC$.
DATE OF BIRTH__CITY AND STATE OF BIRTH _COUNTRY OF BIRTH
CORPORATION
NAWOFcoRpOpATION Avena Vascular, Inc., P.C.
PEDERAL TAX ID NO
coRP.ADoREss 1.1714 North Creek P6rkway North, Suite *100, Bothell, WA 98011 PHONENQLL6!� 352-7856
street Sufte� Apt- Unit Ncx Cfty� Stats and Zip Code
CORPORATE OFFICERS:
Last Nam firit Nam M Tide DMb-ofBirth DOL Nd PrIvers License No.) or Odw'ID No.
Larson, M.D. Amy I President 08'-02-69 LARSOM . 31ONB
Secretary
Tremmr'
LOCAL CONTACT
Last Name First Narne Phone No. DOL No. (Drivers Lim Nq.) or Obw 11D No.
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5 TERM PROMED SKMOSE
6. WAMT rpviw KMM
PAHLVIVWM
1. FROME SHEET MM FLOORM
A BASE
8. REHM EMT. TILE KOORDW
FROVWE NEW CARPET
THRORSHCUT E?Za-T HIM
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10.Saw FR" ALL KALLS Tras
ROOM I FFZ%PlPE BATT
INS-OLATICH ASM C.EAJNS.
[I. RMTME By TEKW.
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CITY OF EDMONDS HARVE H. HARRISON
MAYOR
C3VIC CENTER - EDMONDS. WASHINGTON 98020 (206) 775-2525
FIRE DEPARTMENT
January 4, 1979
William Drummond, M.D.
21616 - 76th Avenue West
Suite 201
Edmonds! WA 98020
Dear Dr. Drummond:
The City of Edmonds and Fire Department staff thank you for
your efforts and cooperation in fire safety. Our goal is
to maintain a fire prevention program that will keep our
community safe from fire and the loss of life and property
connected with it.
Your continued assistance will be appreciated. If we can
answer any questions, please call our office at 775-2525,
extension 247.
Sincerely,
Jack F. Cocper
Fire Chief
Gary McComas
Fire Marshal
GM/ amm
CITY' OF. EDMONDS HARVE H. HARRISON
MAYOR
CIVIC CENTER'- EDMONDS. WASHINGTON 98020 (206) 775-2525
FIRE DEPARTMENT
December 27, 1978.
William Drummond, Robert Fleming
,and Edwin Severinghaus, M.D.
21616 - 76th Avenue West, Suite 201
Edmonds, Washingtop 98020
RE: DRUMMOND, FLEMING , SEVERINGHAUS, M.D.
FILE CODES 593-000-022, 593-000-122, 593-000-1
23
Gentlemen:
The'Fire Department inspected your offices at 21616 - 76th. Avenue
West�, Suite 201, on December 11, 1978, after which a letter (copy
enclosed) was mailed to you. Your property was reinspected on
December 26, 1978. The reinspection indicates that the violations
remain uncorrected.
Therefore, under authority of Or * dinance 1779 of the City of Edmonds,
you are hereby. required to comply wi.th the following:
�1. Replace combustible waste containers with approved
noncombustible types.' Plastic liners may be used
in approved containers.
The above requirements must be completed prior to January 10, 1979.
Failure to comply will subject you to a fine, not to exceed $250.00
or imprisonment, not to exceed 90 days, or both. Each day of.
violation after January 10, 19'79 may constitute a separate offense.
Please contact this department if additional information is desired.
Sincerely,
EDMONDS-FIRE DEPARTMENT
ack F. Coopperr�,
Fire'Chief
JFC/amm
Enclosure
cc: City Attorney.
Building official
CITY. OF EDMONDS
CIVIC CENTER - EDMONDS. WASHINGTON 98MO (206) 775-2525
FIRE DEPARTMENT
September 21,,.1978
Edwin C.-Severinghaus, M.D.
21616 - 7.6th Avenue West
Suite 201
Edmonds, -WA 98020
HARVE H. HARRISON
MAYOR
RE: SEVERINGHAUS, EDWIN C., M.D. - FILE CODE 593-000-123
. Dear Dr. Severing'hau.s:
On September 5, 1978, your office -was inspected by members
of the Edmonds Fire Prevention Bureau.
We request the following corrections:
1. Replace combustible waste containers with approved
noncombustibl-e types. ' Plastic liners may be used'
in approved containers.
The Fire Department will reinspect your bu.ilding.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.thrbugh fire prevention,
Jack F. Cooper
Fire -Chief
r7i�47�v� . . 6-- —4 �
Gerald Ehtee
Inspector
GE/amm