21701 76TH AVE W STE 20370-h PVC Lj
SNOHOM'ISH CO Serving Brier, Edmonds, and .12425 Meridian Ave S
Mountlake Terrace Everett, WA 98208
FIRE Phone (425) 551-1200
DISTR T ww:"w'. FireDistrict.l. org' Fax (425) 551-1272
LOCATION: 21701 76 th Avenue W Suite 203 98026
BUSINESS NAME: Chronic Pain Management PHONE: 4257745163
MAILING V"
ADDRESS: 21701 76th Avenue W, Suite 203, Edmonds, WA 98026
BUSINESS OWNER: HOME PHONE:
EMERGENCY-1: Olson, Jon HOME PHONE: 2063659667.
KEY ACCESS-2: HOME PHONE:
EMAIL:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE SYSTEMS: FE
Date Last Serviced'
-F 01ON
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!R REVE
:INSPECTION REPORT
OEDMONDS
0 BRIER
0 MOUNTLAKE TERRACE
[3 UNINCORPORATED
0' FREOUENCY T-STATION & SHIFT
2015
SCHEDULED
DATE DUE o Oct 2015
UFIR o 593 157
CURRENT
CITY YES NO
BUSINESS
LICENSE
ITIAL IqSPECTI N DATE
rz I—Z,
HAZARDS'FOUND AND LOCATIONS COMMUNICATIONS
7-
2
2
3_
3
.1. 4
4
5
6
6
7
7
I AGREE To cbRRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE -INSPECTION
FINAL RE
EXTENS16N
-INSPECTION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
.EONTA�CTED:
CONTACTED:
CONTACTED:
INSPECTOR:
INSPECTOR:
2
INSPECTOR:
DATE:
. .. . .... --- ------
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS:,
PRE -CITATION
-CITATION ISSUED
5
1 5
SENT
NUMBER:
4
-----LETTER
CODE
5
6
2
6
DATE:
SECTION:
RETURN RECEIPT
3
7
3
7
RECEIVED
DISPOSITION:
4
8
DATE:
7
ETTER NE EDED [] YES NO
LETTER NEEDED. [:] YES NO
8
SNOHOMISH CO. Serving Brier, Edinonds
:�,`FIR Mountlake Terraceand
the Town of Woodway
.'DIST R T www.FireDistricti.org
LOCATION: '1101 1611 Avenue
BUSINESS NAME: Chronic Pain Management
MAILING 21701 76th Ave W =3
ADDRESS: Edmonds
BUSINESS OWNER: Olson, Jon
EMERGENCY-1: Withey,Peggy
KEY ACCESS-2:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIREE
SYSTEMS:
Mvr,
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
W 203
PHONE: 4257745163
98026
HOME PHONE: 2063659667
HOME PHONE: 4253571263
HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
El BRIER
E]WOODWAY
[I MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY I STATION & SHIFF"'
730 16 C
SCHEDULED
DATE DUE 11' 10/01/11
UFIR � 593 11157
ACTIVE
CURRENT
CITY YES NO
BUSINESS
LICENSE
INITIAL I SPECT�IN DATE
FE 11 1 11
ANNUAL
HAZARDS FOUND AND LOCATIONS �/OMMUNICATIONS
4
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
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 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
8
DATE:
DISPOSITION:
7
LETTER NEEDED E] YES El NO
LETTER NEEDED C] YES NO
8
FIRE DEPARTMENT COPY
ki
CITY OF EDMONDS BARBARA'FAHEY
MAYOR
CIVIC CENTER - EDMONDS, WA 98020 (206) 771-0215 - FAX (206) 771-0208
FIRE DEPARTMENT
-cs t . 18 9"3
December 6, 1996
Dr. R. Alexander ,
21701 76th Avenue W. #203.
Edmonds, WA 98020
Dear Dr. Alexander:
This letter will provide you with the determination in regards to portable fire extinguisher
coverage at Stevens Health Center.
Fire extinguishers must be within 75' travel distance from all spaces in a building such as
Stevens Health Center. Fire extinguishers must be conspicuously mounted and
accessible. Your building and management have provided common fire extinguishers in
the corridors for common use by all.
Your tenant space does not require a portable fire extinguisher. The fire extinguisher next
to the elevator is within 75' travel. distance to all areas of your tenant space.
Typically fire extinguishers are located in common areas near the primary exits. An
oversight occurred in identifying the extinguisher cabinet next to the elevator, which is not a
means of emergency exiting. Mr. Hadfield will provide a sign to conspicuously identify this
fire extinguisher location. I apologize for any confusion which has been generated for you
and your office staff.
Should you choose to provide and maintain a fire extinguisher within your suite, the fire
department requires that this additional fire extinguisher be serviced and tagged on an
annual basis by a qualified technician. Responding staff and personnel can then be
assured that this fire extinguisher, like the common extinguishers, will operate as designed
to put a fire out.
* Incorporated August 11, 1890 0
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