21616 76TH AVE W STE 2081�f LP rh M U41-
.Serving Brier, Edmonds, and 12425 Meridian Ave S
Mountlake Terrace Zverett, WA 98208
Phone (425) 551-1200
www.Fi�eDistrictl.org Fax (425) 551-1272
LOCATION: 21616 76 th Avenue W Suite 208 98026
BUSINESS NAME: Edmonds Internal Medicine PHONE: 4257782499
MAILING
ADDRESS: 21616 76th Avenue W, Suite 208, Edmonds, WA 98026
BUSINESS OWNER: HOME PHONE:
FIRE PREVENTION
2ECTION REPORT
EDMONDS
DBRIER
0 MOUNTLAKE TERRACE
[3 UNINCORPORATED
FREQUENCY STATION & SHIF"�
2015 20-D
SCHEDULED
DATE DUE o Sep 2015
LIFIR 0 593 156
EMERGENCY-1: _7!!_PC HOME PHONE
Williams, Brucee : 4257782499 CURRENT
KEY ACCESS-2: OME PHONI(:70LO CITY YE NO
n c[S n4er n &1 10 C 1.4 Ce. 1. Z_7 2 BUSINESS
EMAIL: I- - 41 � I _0 LICENSE
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NAME OF INSPECTOR:
FIRE SYSTEMS: FE 10/
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HAZARDS FOUND AND LOCATIONS/ COMMUNICATIONS
2
2
3
3
4
4
5
6
6
7
7
I AGREE To.cbRRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1 st. RE -INSPECTION
2nd RE -INSPECTION
FINAL RE
EXTENSION
-INSPECTION
VIOLATIONS
DATE DUE: ----
DATE DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTAC ED:
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS:�
PRE -CITATION
CITATION ISSUED
5
5
LETTER SENT
NUMBER:
4
CODE
5
6
DATE:
SECTION:
-2
RETURN RECEIPT
3
7
3
7
RECEIVED
6
DISPOSITION:
4
18
4
18
DATE:
7
LETTER NEEDED 0 YES [I NO
LETTER NEEDED [] YES 0 NO
SNO'HONIISH CO.
,-,.FIRE PREVENTION
JNSPECTION REPORT-.
Serviizg Brier, Edmoi?ds, and 12425 Meridian Ave S EDMONDS
Mountlake Terrace Everett, WA 98208 BRIER
DL 41 ccl 11f)n MOUNTLAKE- TERRACE
one ( -),/ - 0 UNINCORPORATED
DISTR."*L—�uTwww.FireDistrictl.org- Fax (425) 551-1272
FREQUENCY
STATION & SHIFT
LOCATION: 21616 76 th Avenue W Suite 208 98026
20-B
'4
BUSINESS NAME,. Edmonds Interna.I.Medicine PHONE:
4257782499
SCHEDULED Seo,2'0117
DATE DUE
MAILING
593156
LIFIR
ADDRESS: 21616 76th Avenue W, Suite 208, Edmonds, WA 98026
BUSINESS OWNER: Williams, Bruce, Dr. HOMEPH ONE:
EMERGENCY-1: Williams, Bruce HOME PHONE:
4257782499 CURRENT
KEY ACCESS-2: HOME PHONE:
20
CITY
'YES NO
EMAIL:
BUSINESS
LICENSE
f7l
OL,3�,j 1:1
PERSON CONTACTED: Liiwlpp(
INITIAL INSPECTION DATE
NAME OF INSPECTOR: UJ I IV cs
9—,6 —/7
FIRE SYSTEMS.- Common
Date Last Serviced: F6 �/l
HOMISH CO.
FIRE
DIST
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
E]WOODWAY
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY STATION & S
2 Year 13 2G-B
SCHEDULED
DATE DUE II' Sep
MAILING UFIR 0 593
ADDRESS: 216-16 76th Avenue W, Suite 208, Edmonds, WA 98026
BUSINESS OWNER: Phillips, Sue HOME PHONE:
Email.-
EMERGENCY-1: \AAlliams, Bruce* HOME PHONE: 4257782409 CURRENT
KEY ACCESS-2: HOME PHONE: CITY YES NO
BUSINESS A71
LICENSE 1_�
INITIAL INSPECTION DATE
PERSON CONTACTED: VIA 4,y(,L
NAME OF INSPECTOR:
FIRE SYSTEMS: FE
Serving Brier,,Edt�bnds
Mountlake Terra":c'eand
the Town -of Woodway
www.FireDistrictl.org
LOCATION: 21616 76"' Avenue W Suite 208 98026
BUSINESS NAME: O'Brien &VAIIiams. MD'
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE: 42.57745197
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
2
2
3
3
4
4
5
5
6
6
7
7
I A, GREE 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:
D TE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 15
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
8
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED F] YES El No
rLETTER NEEDED [I YES NO
FIRE DEPARTMENT COPY
W
Serving Briet; Edmonds
SNOHOMISH CO.
Mountlake Terraceand
FIRE the Town of Woodway
Ir
DIST, ' h'4rTwww.FireDistrict1.org
—LOCATION: 21616 76th Avenue
BUSINESS NAME: eftiivn &Wlliams, MD
.- MAILING 21616 76th Ave W #208
ADDRESS: Edmonds
BUSINESS OWNER: Williams, Bruce
EMERGENCY-1:
KEY ACCESS-2:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS:
1' 2425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
W 208
PHONE: 4257745197
98026
HOMEPHONE: 4257782499
HOMEPHONE: 3604225075
HOME PHONE: —
FIRE PREVENTION
INSPECTION REPORT
gfEDMONDS
0 BRIER
0 WCOD�,VAY
[I MOUNTLAKE TERRACE
[I UNINdORPORATED
I'- FREQUENCY STATION & SHIFT-"
730 16 A
SCHEDULED
DATE DUE � 09 1/12
UFIR � 593 9156
ACTIVE
CURRENT
CITY YES NO
BUSINESS
LICENSE 5Z 1:1
INITIAL INSPECTION DATE
FE f
ANNUAL
HAZA RDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
3
4
4
5 ov
5
Y
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:
0 E:
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
4
8
4
18
DATE:
DISPOSITION:
LETTER NEEDED [] YES No
LETTER NEEDED [3 YES C3 NO
8
FIRE DEPARTMENT COPY
Serving Brier, Edmonds
/'SNOHOMISH CO. Mountlake Terraceand
FIRE'(W-1 1 -'54 the Town of Woodway
0
DISTR IT www.FireDistrictl.org
LOCATION: 21616 76th Avenue
BUSINESS NAME: alftim &Wlliams, MD
MAILING 21616 76th Ave W #208
ADDRESS: Edmonds
BUSINESS OWNER: Williams, Bruce
EMERGENCY-1:
KEY ACCESS-2:
PERSON CONTACTED: /
�_IAIbP j4 /I I /c _4-(C4__r
NAME OF INSPECTOR: Z
FIRE
SYSTEMS:
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
W 208
PHONE: 4257745197
98026
HOME PHONE: 4257782499
HOME PHONE: *"RR5095,
HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
OWOODWAY
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY I STATION & SHIF')
730 16 A
SCHEDULED
DATE DUE 0 09/01/12
UFIR o 593 9156
ACTIVE
CURRENT
CITY YES NO
BUSINESS
LICENSE �( 1:1
INITIAL INSPECTION DATE
FE I
ANNUAL
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
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 or the Town of Woodway, call (425)
775-7720; for Mountlake Terrace or Brier, call (425) 754-0434.
BUSINESS COPY
CITY OF En. [VOITINDS
CIVIC CENTER - EDMONDS. WASHINGTON 98020 (206) 775-2525
FIRE DEPARTMENT
September 25, 1978
Northwest Urologists Inc. P.S.
21616��6th Avenue West
Suit 08
' '�A 98020
E d m o nX.: s�—,
HARVE H. HARRISON
MAYOR
I . r 11111"
RE: NORTHWEST UROLOGISTS INC. P.S. - FILE CODE 593-000-075
Gentlemen:
On September 5, ' .1978, ycur office was inspected by members
of the Edmonds Fire Prevention Bureau.
We request the following corrections:
1. Replace combustible waste -container's with approved
,01 noncombustible types. ..Plastic liners may be used
i-n approved containers.
The Fire Department will reinspect your building after fifteen
days-.
If we may be of further assistance, please contact this office
(175-252.5, 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