21616 76TH AVE W STE 202 (2)F6
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FIRE PREVENTIdN,
Serving Brier, Edmonds, and 12425 Meridian Ave S INSREGTie"EPORT
Mountlake Terrace ----[]EDMONDS
Everett, WA 98208 0 BRIER
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
www.FireDistrictl.org Fax (425) 551-1272 [1 UNINCORPORATED
LOCATION: 211616 76 th Avenue W Suite 202 98026 2015 20-D
PHONE: ULED
BUSINESS NAME: Edmonds Family Care 425775206e DATE DUE o Sep 2015
MAILING LIFIR 11, 593 156
ADDRESS: 21616 76th Avenue W, Suite 202, Edmonds, WA 9aO26
BUSINESS OWNER: HOME PHONE:
EMERGENCY": Bryant, Tanya MID HOME PHONE: 4258202492 CURRENT
'KEY ACCESS-�: HOME PHONE: CITY YES ",,NO
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PERSON CONTACTED: ktj A- INITIAL INSPECTION DATE
NAME OF INSPECTOR: 690'%A N IV Ll 0`6 4-
FIRE SYSTEMS: F E-14� �7/
Date,Last Serviced:
HAZA S FOUND AND. LOCATIONS/ COMMUNICATIONS
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I AGREE TO CORRECT THE. ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
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FINAL RE -INSPECTION
VIOLATIONS
.2ATE Dy�:,
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DATE:
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VIOLATIONS
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LETTER SENT
NUMBER:
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DATE:
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NEEDED [] YES NO
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SNOHOMISH CO. Serving Brier,',tdmonds 12425 Meridian Ave S
0 E0440*-T
Mountlake Terraceand Everett,' WA 98208
FIRE
theTbwn,�f Woodway Phone (425) 551-1200
ST w , ww.FireDistrictl.org Fax (425) 551-1272
LOCATION: 21616 76" Avenue W Suite 202 98026
BUSINESS NAME: Edmonds Famw6are PH NE: �-�-5-2066
MAILING
ADDRESS: 21616 76th Avenue W, Suite 202, Edmonds, INA 98026
BUSINESS[OWNaR: HOME PHONE- "P
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EMERGLNUY-1: HOME ONE:
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FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
0 WOODWAY
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY STATION & SHIFT_'�
2 Year 13 4
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SCHEDULED Sep
DATE DUE 1'
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CURRENT
CITY YES NO
BUSINESS
LICENSE El El
INITIAL INSPECTION DATE
I - 0 10 1
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
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2
2
3
3
4
4
5
5
6
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:
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2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
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INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
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VIOLATIONS
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PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTIOM
5
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RETURN RECEIPT
RECEIVED
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DATE:
DISPOSITION:
\1 LETTER NEEDED E] YES El NO
LETTER NEEDED [] YES NO
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FIRE DEPARTMENT COPY
SNOHOMISH CO. Serving Brier, Edmonds
Mountlake Terraceand
lf*4�00)1
.17 the Town of Woodway
DISTR, '64 www.FireDistrictl.org
LOCATION: 21616 76th Avenue
BUSINESS NAME: Edmonds Family Care
MAILING 21616 76th Ave W #202
ADDRESS: Edmonds
BUSINESS OWNER: .13ryand, Tonya
EMERGENCY-1: QFQp@A~
KEYACCESS-2:4..,,,,,
PERSON CONTACTED:
NAME OF INSPECTOR
, 44140
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FIRE
SYSTEMS.:
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
W 202 .
PHONE: 4257752066
98026
HOME PHONE:
HOME PHONE: 4*56413M0
HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
t(EDMONDS
0 BRIER
E]WOODWAY
[:1 MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY STATION & SHIFT")
730 16 A
SCHEDULED
DATE DUE 1' 09,101/12
UFIR � 593 9156
ACTIVE
CURRENT
CITY YES NO
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INITIAL INSPECTION DATE
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ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
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3
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4
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1 st RE -INSPECTION
DATE DUE.
1
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:
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VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
DATE:
CODE
SECTION:
5
3
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RETURN RECEIPT
RECEIVED
4
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4
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DATE:
DISPOSITION:
"I LETTER NEEDED [-] YES El NO
LETTER NEEDED E] YES NO
FIRE DEPARTMENT COPY
660 C) C(
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CITY OF EDMONDS -----------
COMM15RCIAL
=111sim PUSINESS LICENSE APPUCATION
I . FEE: $125-00
CITY CLERICS OFFICE. BUSINESSIICENSE DIVISION
121 e AVENUE NORTH, EDMONDS. WA 98020 PHONE: 425.775.2525
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OFFICE USE ONLY
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INSTMJCTIONS: Please complete the application In full and attach *a required floor plan. Middle Initial or name required of all
parties concerned. If no middle name, please Indicate by wrl" NMK Sign and return application wIth fbe. Pismo advise of -
any change In status. Now license required It business changes location or ownership. Notffication to City of Edmondi required
111"business tioses.
BUSINESS NAME
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BUSINESSADDRESS 4 16 16 76 Yf"A W '72,
Street suite NO. ZID Code
MAILINGADDRESS
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BUSINESS PHONE NO. 1 WASTATETAXIDNO.(UBINO.) f�00�
BUSINESS E-MAIL ausimsswmsim h4VA). &
PROPERWOWNER
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EMERGENCYNOTIFICATION (ForPrernise A in
Last NanteV First NamV. . MI Phone No.
Last Nam First Narne MI Phone No.
NATURE OF BUSINESS e2lWr
NUMWR&EM'P�OYEES —WW;E FOOTAGE OF BUSINESS SPACE
TYPE OF BUSINM - PLEASE CHFC�(,THE APPROPRIATE CATEGORY-
ocotismiandk' dFikANdEjwsUR*A* a LANDSCAPE. HoR . TicuLTuRAL a MANUFACTUMNG 0 NON-PROFIT
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AMIJOBA64T DEVICiEVON`fkEMWES? -Cl Y9S XNO YES. TOTAL NUMBER
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RAK04ABLE OR HAZARDOUS WkTERI)WS USED STORED?: DYES NO IF;`YESj PLEASE PROVIDE LIST OF MATERMS AND QUANTITIES:
PROPOSED OPENING DAY -OF BUSINESS 0 / �691 911 BUSINESS HOURS
IDAYSOPEN 0SUNDAY DMOND�Y PMESDAY XWEDNESDAY )ITHUR§DAY WFRJOAY -CISATURDAY
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DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES? $YES DNO'
PREVIOUS BUSINESS USE AT THIS ADDRESS
SOLE PROPRIETORSHIP
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Apt No., Urd Nm City. State and Zip Code
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CITY OP- EomaNDS HARVE H. HARRISON
MAYOR
CIVIC CENTER - EDMONDS. WASHINGTON 98020 (206) 775-2525
FIRE DEPARTMENT
September-21, 1978
John Churchill, D.M..D.
21616 - 76th-Avenue West
Suite 202..
Edmonds, WA 98020
RE: CHURCHILL, JOHN, D.M.D. FILE CODE 593-000-078
Dear Dr..Churchill:
On September 5, 1978, your office was inspected by members
of the Edmonds Fire.Prevention'Bu;reau.
We request the following corrections:
1. Replace combustible waste'containers with approved
noncombustible.types. -Plastic liners may be used
in approved 'containers..
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 Chi.ef
Gerald Ehtee
Inspector
GE/amm