21616 76TH AVE W STE 212SNOHOMISH CO.
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Serving Brier, Edmonds, and 12425 Meridian Ave S
Mquntlake Terrace Everett, WA 98208
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one' )551-1200
www.FireDistrict].org Fax (425) 551-1272
LOCATION: 2,1616 76 th Avenue W Suite 212 98026
BUSINESS NAME*—.&mdrgq Edmonds Specialty Clinic PHONE: 42567338�O
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ADDRESS: .21616 76th Avenue W, Suite 212, Edmonds, WA 98026
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FIRE PREVENTION
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2015 20-D
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INITIAL INSPECTION DATE
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HAZARDS FOUND AND LOCATIONS CONIMUNICATIONS
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I AGREE To cbRRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
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LETTER NEEDED YES NO
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DISPOSITION:
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SNOHOMISH CO. Serving Brier, Edmonds 12425 Meridian Ave S INSPECTION REPORT
0 EDMONDS
E Mountlake Terrace, and Everett, WA 98208 0 BRIER
the Town of Woodway Phone (425) 551-1200 E]WOODWAY
El MOUNTLAKE TERRACE
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FREQUENCY TION & SHIFf�
LOCATION: 21619, 76th Avenue. W 212 730 16 A
BUSINESS NAME: k4na" SCHEDULED
PHONE: DATE DUE 09/011,12
MAILING 21616 76th Ave W #212 JTJ LIFIR 156
ADDRESS: Edmonds 98026'
BUSINESS OWNER: HOMEPHONE: 2063204981 AC:T�VE
EMERGENCY-1: -gal. e' CUR -RENT
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KEY ACCESS-2: Cates, Shawi HOME PHONE: CITY YES NO
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NAME OF INSPECTOR:
FIRE
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HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2 2
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5____ 5
6 6
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1 st RE -INSPECTION 2nd RE -INSPECTION EXTENSION FINAL RE -INSPECTION VIOLATIONS
DATE DUE: DATE DUE: GRANTED TO: DATE DUE: CITED:
PERSON PERSON PERSON
CONTACTED: CONTACTED: CONTACTED: 1
INSPECTOR: INSPECTOR: INSPECTOR: 2
DATE: VIOLATIONS DATE: VIOLATIONS PRE- DATE: 5TATioNTs-suEb 3
CITATION 4
1 5 1 5 LETTER SENT NUMBER:
CODE 5
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RETURN RECEIPT
3 3 7 RECEIVED 6
DISPOSITION:
4 18 DATE: 7
LETTERNEEDED [] YES NO LETTER NEEDED 0 YES El NO
FIRE DEPARTMENT COPY