21701 76TH AVE W STE 201 (2)1-7 Of
Serving Brier, Edmonds, and
-Mountlake Terrace
www.FireDistrictl.org
LOCATION: 21701 76 th Avenue W Suite 201 98026
BUSINESS NAME: UW Medicine/Heart Center
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'�ORE PREVENTION
12425 M
eridian Ave S
I NSPECTION REPORT
Everett, WA 98208
0 EDMONDS
0 13RIER
Phone (425) 551-1100
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
Fax (425) 551-1272
FREQUENCY _FTATION & SHIFT
2015 20-C
SCHEDULED
DATE DUE k-Oct 2015
MAILING LIFIR 11, 593 157
ADDRESS: 21701 76th Avenue W, Suite 201, Edmonds, WA 98026
BUSINESS OWNER: HOME PHONE:
HOME PHONE: "CURRENT
EMERGENC, &C'.4
KEY ACCESS-2: YES NO
HOME PHONE: CITY
EMAIL: 14 a wo, iedu BUSINESS
oo LICENSE
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR: Le I
FIRE SYSTEMS: FE 7
Date Last Serviced:.
PHONE: 4257748251
HAZARDS FOLIND AND LOCATIONS COMMUNICATIONS
,2
2
3
3
4
4
5
6
5-
6
7
7
I AGREE TO cbRRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
lst RE -INSPECTION
_R,ATE DUE:
PERSON---
CONTACTED:
2nd RE -INS PECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECTOR:
DATE:
INSPECTOR:
INSPECTOR:
DATE:
2
3
DATE:
VIOLATIONS
VIOLATIONS-*
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
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8
4
8
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DATE:
DISPOSITION:
7
8
LETTER NEEDED C] YES NO
11
LETTER NEEDED ] YES. 0 NO
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1_2/0�hO'12 1' 1: 11 2065985334 LIWIVIC LIVER TX PAGE 02/05
A�.
CIT� OF EDMONDS
ddS�IN*E ICCENSE APPLICATION- COMMERCIAL
F.EE: $125.00
CITY CLERICS OFFIliM, BUSINESS'LICENSE DIVISION
C.16
121 5' AVENUE NORTH, EDMONDS, WA 98020 PHONE: 425.775.2525
INSTRUCnONS: Plea�e complete the application In full and attach the required floor plan. Middl4i initial or name required of all
parties adncernatL If no middle name, plane Indicate by writing NMN. Sign and return application with fee. Please advise of
Any changa In status. New license required If businass changes location or ownership. Notification to City of Edmond6 required
ff'business tioses,
BUSINESS NAME
BUSI�SSS ADDRESS - ZI Y A / 76S
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'Suite No �jn Code
MAILINGADDRESS 11-W 4.,e- W S�w,-A 2,01 Z.6
Sbvet or PO Box Sulto No. r4ty,_ State and 7jp Code
BUSINESS PHONE NO. I J-r 7 -7 f( -F-Z JT WA STATE TAX ID No. Nei No.) / 7 rZ5
SUSIM6S E-MAIL BUMNESSWEBSITE 4WAt<Aj,',re_
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�PLast Name 47 Fimt Name
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INATVKE OF BUSINESS Y.1 X. -
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NUMBER CiF EMPLOYEES' —SQUARE F00-TAGI:_! OF BUSINESS SF�ACE
TYPE OF RUSINESS - PLEASE CHECK,THEAPPROPRIATE CAIr!GORY-
DOONMUCTION' 6FINANdE,lf4SUk�INCE,-Rr=A�EVATE 01LAN05CAPE.1-10,
RTICULTURAL 0 MANUFACTURING 0 NON-PROFIT
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FLAMMABLE OR KA7ARDOUS MATERiALS USED"OR STOREDT WYES (3. NO IF -YES.' PLEASE PROVIDE LIST OF MATERIALS AND QIJANMTIES:
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#
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k0FOSED OPEN'NG 6AY OF BUSINESS
—BUSINESS HOuRS
DAYS OPIEEN D SUNDAY
PARKINQ SPACES . ON SITE: UTUESDAY NWEDNESDAY JCTHUR�;DAY XFRIDAY M SATURDAY
TOTAL -ZL.9�...ACCESSMLE FOR PERSONS WITH DISABIU*TIE4
DOES THE BUSINESS CONTAIN
AN FNTRANCEACCE'ft8LE To PERSONS WITH DISABILITIES? kyEs r3 NO
PREVIOUS gusINESS -USE AT THIS ADDRESS
I
12/03/2012 11:11 2065985334 UWMC LIVER TX PAGE 83/05
SOLE PROPRIETORSHIP
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12/03/2012 11:11
2065ge5334
UWlAC LIVER TX
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