21701 76TH AVE W STE 3037 01
7 (p+h A d6
36
3
FIRt:00EVENTION
Serving Brier, Edmonds, and
12425 Meridian Ave S
-INSPECTION REPORT
SNOHOMISH CO.
FIRE
Moupitlak . e Terrace
Everett, WA 98208
DEDMONDS
13 BRIER
DISTICLUT
Phone (425) 551-1200
0 MOUNTLAKE TERRACE
[3 UNINCORPORATED
ww,w.FireDistrictL org
Fax (425) 551-1272
FREQUENCY STATION & SHIFT
LOCATION: 21701 76 th
Avenue W Suite 303 98026
2015 20-C
BUSINESS NAME: Va cant
PHONE:' 4257441730
SCHEDULED
DATE DUE i Oct 2015
MAILING
FUFIR �591 157
ADDRESS: 21701 76th Avenue W, Suite 303, Edmonds, WA 98026
BILISINESS OWNER: HOME PHONE:
EMERGENCY-1:
MAI,6id j 6e- I HOME PHONE: 4257441730 CURRENT
KEY ACCESS-2: HOME PHONE- CITY 'YES NO
BUSINESS [71.
EMAIL:
LICENSE
PERSON CONTACTED: INITIAL INsFEQTIOV DATE
7w J,
NAME OF INSPECTOR:
FIRE SYSTEMS: FE
n;;tp I nst Sprvirpfi-
HAZARDS FOUNDAND LOCATIONS/ COMMUNICATIONS
2
2
3
.3
4
..5
6
7
6
7
I AGREE -TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
lst RE -INSPECTION
DATE DUE:
. 2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED . T 0:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR.,
2.
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS:-
1
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBE R:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
RETURN RECEIPT
RECEIVED
4
.4� 8:
�'L&TgR NE bED [] YES El NO
DATE:
DISPOSITION:
7
\,,LETTERNEEDED YES [I NO
OMISH CO. ServingM-iei; Edinonds 12425 Meridian Ave S
Mountlake Terraceand Everett, WA 98208
'FIRE the Town of Woodway Phone (425) 551-1200
r
..-DISThWT. www.FireDistrictl.org i Fax (425) 551-1272
LOCATION: 2112t 76th Avenue W 303
Vacant
BUSINESS N Vacant PHONE: 4257441730
MAIL71N 01 76th Ave W #303
ADDRESS: Edmonds 98026
BUSINESS OWNER: Hadfield, Joel HOME PHONE: 4257441730
EMERGENCY-1: HOME PHONE:
KEY ACCESS-2: HOME PHONE:
PERSON CONTACTED
NAME OF INSPECTOR
FIRE
SYSTEMS:
C's, � `--I It
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
0WOODWAY
[I MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY STATION & SHIFT
730 16 C
SCHEDULED
DATE DUE 1` 10/01/11
UFIR 0 591 1(157
ACTIVE
CURRENT
CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
FE i
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
3
4
4
4
j
—5-
6
6
7
7
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:
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:
7
4
8
4 18
DATE:
LETTER NEEDED [:] YES NO
ETTERNEEDED [] YES El NO
8
FIRE DEPARTMENT COPY
a
Stevens Health Clinic
R27CZIVED
JAN 2
January 16, 1998
0
ul(
. FL
City of Edmonds
121 5th Ave N
Edmonds, WA 98020
ATTN: Business Licensing Dept.
RECEIVED
RE: License #850
Dear Sirs, JAN 20,1998
Per your request, this letter is to notify the City of F.DMONDS FIRE DEPT.
Edmonds that Stevens Health Clinic has opened an additional
suite (#303) within Stevens Health Center where we currently
conduct our medical practice (suite #302) effective 1-1-98.
Business operations don't officially start in suite #303
until 1-22-98.
The business will be conducted under our current federal tax
ID # (91-1002339) and UBI # (600-250-488). The business
operations remain the same: professional/retail.
The address for the new suite is: 21701 76th Ave W #303,
Edmonds, WA 98026. Enclosed, per your request, is a copy of
the floor plan for this suite.
We request the addition of the name: dba "Stevens Wellness
Center" to our current business license, if possible.
Please feel free to contact me at (4�5) 744-1780 with any
questions you may have.
Thank you for your assistance.
Best regards,
SFY,ENS HEALTH CLINIC
Chris Brooks
Practice'Manager
Enclosure
CC: Stephen Yarnall, MD
21701 76th Ave. W. #302 Edmonds, WA 98026 (425) 744-1780 Fax (425) 744-1727
Web Site: www.BIZNW.com/swmc Wall: syarnall@homer.u.washington.edu
STAIR
mij
ED
PHYSCIANS
DOWN FFICE
Eo
EXISTING
SINK -
DOOR
NG Ili I \1EXISTING
NEW COUNTER
FAX
I I N
P.
I
-uA
PRINTER
ON STAND
NEW I
DOOR I
J
ED
MODIFIE
COUNTER
r
MA STATION
3'-8.
01
k
NEW EIGHT (8) SHELF
C
EXISTING
S
SUITE ENTRY
PATIENT CHARTS
REMOVE
EXISTING
CLOSET EXISTI
DOOR
'EX�IOSTING
R
OR
EXISTING EXISTING PROCEDURE/
EXAM EXAM EXAM
I
PRELIMINARY FLOOR PLAN FOR
'-c:%/ENS HEALTH CENTER SCHEME "A"
0OR AUGUST 29,1997 / MMY NORTH
6 L-5., n -)� ��
C