21701 76TH AVE W STE 301 (2)SNOHOMISH CO.
;?17ol 7(PA Aacw S�rtr-_'301
FIRE PREVENTION
Serving Brier, Edmonds, and 12425 Meridian Ave S INSPECTION REPORT
0 EDMONDS
Mountlake T�rrace Everett, WA 98208 0 BRIER
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
[3 UNINCORPORATED
www.FireDistrictl.org Fax (425) 551-1272
LOCATION: 2170176th Avenue W Suite 302 98026
,BUSINESSNAME: 1iV@-P4yQhoIegiealam449eia�ms PHONE: 4256780463
MAILING
ADDRESS: 21701 76th Avenue W, Suite 302, Edmonds, WA 98026
BUSINESS OWNER: York, James. HOME PHONE:
FREQUENCY STATION & SHIFT
2015 20-C
SCHEDULED
DATE DUE � Oct 2015
UFIR 0 591 157
CURRENT
.EMERGENCY-1: Winters, Nicole HOME PHONE: 4253872113 E
KEY ACCESS-2: HOME PHONE: CITY YES NO
EMAIL: BUSINESS M
LICENSE L-J 1:1
PERSON CONTACTED: INITIALI PECTONDATE
1Z )T�
NAME OF INSPECTOR:
FIRE 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
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
w . ith 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 viola ion.
If you require additional information or to schedule a re -inspection for Edmonds, call (425) 775-7720; for
Mountlake Terrace or Brier, call (425) 744-6231.
SNOHOMIS11 CO.
FIRE
'.p
FIRE PREVENTION
Servin . g Brier, Edmonds, and 12425 Meridian Ave S INSPECTION REPORT
OEDMONDS
Mpuntlake Terrace Everett, WA 98208 El BRIER
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
www�,FireDistrictl.org Fax'(425) 551-1272 UNINCORPORATED
LOCATION: 21701 76 th AvenueW Suite 301 98026
BUSINESS NAME: -Vota-Mpt 5WC-D j_5e4 PHONE: 4257751865
0' FREQUENCY I STATION &SHIFT,).
2015 20-C
SCHEDULED
DATE DUE o Oct 2015
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: GRANTEDTO: CITED:
...... DATE DUE.
PERSON PERSON PERSON:
CONTACTED: CONTACTED: CONTACTED:
INSPECTOR: INSPECTOR: INSPECTOR: 2
DATE: DATE: DATE:
VIOLATIONS VIOLATIONS;,, --df4TF6N i§s6Ef6--
15 15 PRE -CITATION 4
LETTER SENT NUMBER:
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_6 2 DATE: SEqT!�N:
RETURN RECEIPT
17 RECEIVED
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LETTER NEEDED YES El NO LETTERNEEDED YES 0.No 8
Serving Brier, Edmonds, and
Mountlake Terrace
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 5514200
www.FireDistrictl.orz Fax (425) 551-1272
LOCATION
21701 76 th -Avenue W Suite 300 98026
BUSINESS NAME: QemnTaffft7-mtrjfttrQarg -7 RHONE: 257893700
5toezI, 1 SO4
MAILING
ADDRESS: 21701 76th Avenue W, Suite 300, Edmonds, WA 98026
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
D MOUNTLAKE TERRACE
D UNINCORPORATED
FREQUENCY -STATION & SHIFT
2015 20-C
SCHEDULED
DATE DUE o Oct 2015
LIFIR 11, 593 157 -
BUSINESS OWNER: HOME PHONE:
EMERGENCY-1: HOME PHONE: "'CURRENT
KEY ACCESS-2: HOME PHONE: CITY YES _./NO
EMAIL: BUSINESS
LICENSE
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE SYSTEMS: FE
Date Last Serviced:.
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
30-0 A 94--3LD
3
3
4
5
6
4
6
7
7
I AGREE TO cbRRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
I st RE -INSPECTION
DATE DUE:
2nd RE-INSPECTIOR
DATE DUE:
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
'DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
6
VIOLATIONS:'.,
1
2
5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
7
DATE:
CODE
SECTION:
5
6
.7
8
7
3
RETURN RECEIPT
RECEIVED
DATE:
DISPOSITION:
4
8
LETTER NEEDED [:] YES NO
LETTER NEEDED YE'S NO
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SNOHO
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j�tj Serving Briet: Edinonds
py
, / Mountlake Terraceand
\;4 the Town of Woodway
T-wwwFireDistrictLorg
LOCATION: 21701 - 76th Avenue
BUSINESS NAM
MAILING 21701 76th Ave W #301
ADDRESS: Edmonds
BUSINESS OWNER:
Proliance Surgeons, Inc.
EMERGENCY-1: Surgical Assoc.
KEY ACCESS-2: Fitzgerald, David
PERSON CONTACTED
NAME OF INSPECTOR
I FIRE
SYSTEMS:
In
d? II f '6
12425 Meridian Ave S
Everett, WA 98208
Phone(425)55171200
Fax (425) 551-1272
W 301
PHONE: 4257751865
98026
HOMEPHONE: 2062MIDO
HOME PHONE: 4257788116
HOME PHONE: 2068382599
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
E]WOODWAY
[I MOUNTLAKE TERRACE
0 UNINCORPORATED
FR EQUENCY I STATION&SHIFF)
16 C
SCHEDULED
DATEDUE � 10/01/11
UFIR � 593 1057
ACTIVE
CURRENT -
CITY YES NO
BUSINESS
LICENSE El El
INITIAL INSPECTION DATE
FE I
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
1
1
-
2
2
3
3
4
4
5
5
6
6
7
7
1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
I st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
_RATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
_DATE:
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 18
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED F-1 YES El No
LETTER NEEDED [] YES NO
8
FIRE DEPARTMENT COPY