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untlake Terrace Everett, WA 98208
0 BRIER
FIRE P Phone (425) 551-1200 [3 MOUNTLAKE TERRACE
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LOCATIqN:
211701-7-6 th Avenue W Suite 205 98026
BUSINESS NAME: Vacant,' PHONE:
MAILING
ADDRESS: 21701 76th Avenue W, Suite 205, Edmonds, WA 98026
BUSINESS OWNER: Standlee, Pam HOME PHONE:
FREQUENOY STATION 1, SHIFT'
2015 20-C
SCHEDULED
4257441777 DATE DUE i Oct 2015
LIFIR o 593 157
EMERGENCY-1: Stevens Cardiology
HOME PHONE: 4257441777.
CURRENT:
KEY ACCESS-2:
HOME PHONE:
CITY
YES NO
EMAIL:
BUSINESS
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LICENSE
PERSON CONTACTED:
INITIAL I,NSPEPTI N DATE
NAME OF INSPECTOR:
FOE SYSTEMS: . FE
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HAZARDS FOUND AND LOCATIONS /COMMUNICATIONS
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE -INSPECTION
FINAL RE
EXTENSION
-INSPECTION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
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CONTACTED:
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
3
DATE:
DATE:
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VIOLATIONS
VIOLATIONS:-
PRE -CITATION
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NUMBER:.
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2 6
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3
7
3
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RECEIVED
6
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LETTER NEEDED [] YES NO
LETTER NEEDED [I YES NO
OIRE.PREVIfNTION
SNOHOMISH CO.
Set-ving Bi-ier, Edmonds
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INSPECTION REPORT
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Mountlake Terraceand
P�ier'e'tt, WA 98208
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the Town of Woodway
Phone (425) 551-1200
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0 MOUNTLAKE TERRACE
www.FireDistrict].org
Fax (425) 551-1272
0 UNINCORPORATED
LOCATION:
21701 76th Avenue
W 205
FREQUENCY
730
STATION & SHIFT�
16 'C
BUSINES�NAME:
PHONE: 4257441777
SCHEDULED
DATE DUE 11' 10/01/1-1
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MAILING
21701 76th Ave W #100
LIFIR 11, 593 1(157
ADDRESS:
Edmonds
98026
BUSINESS OWNER:
Stevens Cardiology
HOME PHONE: 4257441777
ACTIVE
EMERGENCY-1:
Standlee, Pam
HOME PHONE:
�CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
El 1:1
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF. INSPECTOR:..
FIRE
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SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
0 Ole
.2
2
3
3
4
4
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7
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I AGREE TO CORRECT THE ABOVE VICLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE -INSPECTION
FINAL RE -INSPECTION
EXTENSION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTED TO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
1 5
1 5
LETTER SENT
NUMBER:
4
CODE
5
2
6
2
6-
DATE:
SECTION:
RETURN RECEIPT
3
7
3
7
RECEIVED
6
DISPOSITION:
4
8
4
18
DATE:
LETTER NEEDED [:] YES NO
I LETTER NEEDED E] YES El NO
8
FIRE DEPARTMENT COPY