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LOCATION: 21616 76 th Avenue W Suite 207 98026
BUSINESS NAME: Laboratory Corp of America
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BUSINESS OWNER:
12425 Meridian Ave S
INSPECTION REPORT
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Everett, WA 98208
0 BRIER
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INITIAL INSPECTION DATE
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BUSINESS NAME: Laboratory Coro of America PHONE: 3364364264
MAILING
ADDRESS: 231 Maple Ave, Tax Dept, Burlington, NC 27215
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FREQUENCY STATION & SHIFT
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2015 720-D
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CIVIr-NUM110IT-1: Haven, Erika HOME PHONE: 4254509065 CURRENT
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DATE DUE:
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DATE DUE.
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VIOLATIONS
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LETTER SENT
CITATION ISSUED
NUMBER:
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5
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6
2
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DATE:
CODE
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RETURN RECEIPT
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DISPOSITION:
7
\"LETTER NEEDED [] YES 0 NO
LETTER NEEDED [] YES NO
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CITi(OF EDMONDS
BUSIN'ESS LICENSE APPLICATION— COMMERCIAL
. FEE: $125-00
CITY CLERICS OFOCE, BUSINESS'LICENSE DIVISIdREgjfWD%q,'%0
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Ed—d. WA 90024
21616 76th Ave West, Edmonds, WA 98026 tr 426.778.1$30
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12425 Meridian Ave S
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Mountlake Terraceand
Everett, WA 98208.
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th'e'Town of Woodway
Phone (425) 551-1200
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LOCATION: 21616 76"'Avenue W Suite 207 98026
BUSINESS NAME: Ise B f-w-A+we - e44 4 e PHONE: 4257745005
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ADDRESS: 21616 7Cth Avenue W, Suite 207, Edmonds, WA 98026
BUSINESSF0
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EMERGENCY-1: Chin, Jonah
KEY ACCESS-2:
PERSON CONTACTED:
NAME OF INSPECTOR:
HOME PHONE:
HOME PHONE: 425aQ87171
HOME PHONE:
FREQUENCY STATION & SHIFT"'�
2 Year 13 1 20-B
SCHEDULED Sep
DATE DUE
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INITIAL INSPECTION DATE
1,9. 0/
- ),01-2,
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
3
4
4
5
5
6
6
7
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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:
I
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
7
RETURN RECEIPT
RECEIVED
6
4
18
18
DATE:
DISPOSITION:
7
\1 LETTER NEEDED [-] YES NO
LETTER NEEDED C] YES [__1 NO
8
FIRE DEPARTMENT COPY
SN0HOM,1SkC0. Serving Briet; Edinonds
Mountlake Terraceand
TIRE' the Town of Woodway
DISTRT www.FireDistrictl.org
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LOCATION: 21616 76th Avenue
BUSINESS NAME: Go Bang Acupuncture Clinic
MAILING 21616 76th Ave W #207
ADDRESS: Edmonds
BUSINESS OWNER: Chin, Jonah
EMERGENCY-1: Kim, Lucas
KEY ACCESS-2:
M
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS
12425 Meridian Ave S
Everett, WA 98208
Phone (425)7�51-1200
Fax (425) 551-1272
W 207
PHONE: 4257745005
98026
HOMEPHONE: 4253037171
HOMEPHONE: 2062357778
HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
JrEDMONDS
0 BRIER
OWOODWAY
[:1 MOUNTS�E TERRACE
[I UNINCORPORATED
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730 16 A
SCHEDULED
DATE DUE 11' 09/01112
LIFIR � 593 9156
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CURRENT
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INITIAL INSPECTION DATE
FE I
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
2 a^ 7r
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:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
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
14
18
4
18
DATE:
DISPOSITION:
LETTER NEEDED F] YES E],'�O
LETTER NEEDED E] YES C] NO
8
FIRE DEPARTMENT COPY