21807 76TH AVE W STE A (4)111111111-!;219 0-7 76 A 'A :R FIRE PREVENTION
A02 k14 INSPECTION REPORT
$erving Brie�, qds, and 12425 Meridian Ave S
HOMISH CO. * I - - , I .... 1—. 0 EDMONDS
)) - Mountlake Terrace Evei-ett, WA 98208 0 BRIER
FIRECQA,.�) I Ph ) 551-4200 El MOUNTLAKE TERRACE
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LOCATION: 21807 76 th-;46nue W Suite A 98026 2 Year 14 16-C
BUSINESS NAME: Song DentaL..., PHONE: 4257752002 SCHEDULED Feb,2014
DATE DUE
MAILING FIR493 157
ADDRESS: 21807 76thAvenue W, Suite A, Edmonds, WA 98026 [U j
BUSINESS OWNER: HOME PHONE:
EMERGENCY-1:
Sonq, Hyun
HOME PHONE:
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2062500299
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1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
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VIOLATIONS
DATE DUE:
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FIRE DEPARTMENT COPY
IRS%
FIRE PREVENTION
SNOHOMISH CO. Serving Brier, Edmonds 12425 Meridian Ave S INSPECTION REPORT
0 EDMONDS
Mountlake Terrace, and Everett, WA 98208 0 BRIER
F1 E E]WOODWAY
r the Town of Woodway Phone (425) 551-1200 0 MOUNTLAKE TERRACE
R Fax (4,,25) 551-1272
DI T T www. FireD is tric t]. o rg 0 UNINCORPORATED
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LOCATION: 21807 76th Avenue W A 731 6 6
BUSINESS NAME: Song Dental PHONE: 4257752002 SCHEDULED
DATE DUE 1' 02/0 1 /1
MAILING 21307 76th Ave W #A LIFIR 0 593 2 157
ADDRESS: Edmonds 93026
BUSINESS OWNER: Song, Hyun HOME PHONE: 2062500299 AC71\1E
EMERGENCY-1: McLeod,Bob HOME PHONE: 2066898978 e-CURRENT
KEY ACCESS-2: HOME PHONE: CITY YES NO
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DATE DUE:
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FIRE DEPARTMENT COPY
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FIRE DEPARTMENT
LOCATION: 21807 76th Avenue W A
BUSINESS NAME: Song Dental
MAILING 21807 76th Ave W #A
FIRE PREVENTION
SAFETY SURVEY
PHONE: 4257752002
ADDRESS: Edmonds 98026
BUSINESS OWNER: Song, Hyun HOME PHONE: 2062500299
EMERGENCY- 1: McLeod, Bob HOME PHONE: 2066898973
KEY ACCESS-2: HOME PHONE:
FREQUENCY—T—STATION
1, SHIFT
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SCHEDULED
DATE DUE 11
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FIRE DEPARTMENT COPY
V-3-60o -01*-?q
R E C E I V E " Do EDMONDS POLICE DEPARTMENT Es-9--0303
JAN INVESTIGATION REPORT DATE - TIME REPORTED
1-26-79 0900
T Y P E 5 F 0 Ffft,!W�,D S ` 1 s-� !:- Lj r- - 1 TYPE OF OFFENSE WITH ARREST
Arson Attempt -
DATE - TIME OF OFFENSE AND/OR ARREST
FILE No.
Sometime between 1800 yesterday and 0750 this date
----
LOCATION OF OFFENSE AND/OR ARREST
EVIDENCE No.
21807-76th West ..Edmonds.
TIM No.'l iLAST - FIRST . MIDDLE-..)-Fikm NAME -IF BUS,INESS -_[D,O.B.- OCCUPATION
RACE - SEX AGE
76TH AVE DENTAL CLINIC
BUS. PHONE
ADDRESS OF VICTIM RES.PHONE
PERSON REPORTING (LAST - FIRST - MIDDLE I D. 0. B. ADDRESS
RES.PHONE
Receptionist
WITNESS No. 1 tLAST. FIRST. MIDDLEi AooiiEss
IRES. PHONE
/AuuHLbb
ING OR WARRANT No. CHARGE, AND/OR ,O�OINANCE
bCHOOL ATTENDS
RACE - SEX - AGE D-O-B HEIGHT WEIGHT BUILD COMPL. HAIR EYES OCCUPATION
CLOTHING TATTOOS, SCARS. MARKS. PECULIARITIES
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11
(1) Identify additional victims.
(2) Identify and/or describe additional witnesses.
(3) Identify and/or describe additional suspects,
(4) Describe property taken, showing serial numbers, identifying marks
T and value of each.
(5) Describe vehicle used by suspect and disposition.
E (6) Describe physical evidence. where found, by whom and disposition.
(7) Describe victim's injuries and where medical exam occurred.
M (8) Report all property damage — describe damage and indicate amount
of loss.
19) Describe premises —or vehicle of victim and where parked.
El O.K. TO DISCLOSE
L] Do NOT DISCLOSE
(10) For burglary and torceny (car prowl) reports describe entry whefe and how,
and tools used..
(11) Reconstruct incident (offense and/or arrest).
(12) Indicate time and location where victims and witnesses may be contacted
later by follow-up investigators.
(13) For ivvenile(s) placed in detention, indicate name, address and phone of
parents or guardian and how notified.
(14) List persons you require to be subpoenaed to court.
(15) Indicate if you need a CCDR or ADR and on whom.
(16) Indicate arraignment recommendations If any.
(17) Officer opinion. (NOTE: 00 NOT PUT OPINION WITHIN ITEM 11).
U DISCLOSURE NOT MENTIONED
Partial package of Winston cigarettes, some small ieces of paper,
Pj lined. Small
appear to come from a�standard type notebook paper,
pieces of wood, apparently -picked up from the area, All these items
were burnt and were turned. -,over to -the -arson inspector of the fire
Department.
Damage was minimul since it was not set close enough to door. Small
scorched area on the right side of the door ledge where you lay a
book of matches after they igfii�6d*the TEain'fire.
The PR states that last Monday, that the's'a'me area had been set for a
fire and she had found the debris, approximately this same type of thing
was.done. This morning after she came to work at 0750 she found anothEr
pile which had already been,mentioned., contents stacked in front of the
door which had al-r. , e�Ldy 156eii'ig�aited burned out: Also
there was a smear of what appeared to on the window
glass of the door. Reque-st a'.'copy of this report be sent to the Fire
Department Arson Inspector, station 1.
INVESTIGATING OFFICER SERIAL
R, 421
35
UNIT ASSISTING 'OFFICER APPROVED IGNEO DISPOSITION STAFF CARDED
EPD-101
.; . -rl
TO#
May 9, 1983
IIEMIO TO: Hal Reeves
Building Official
FROM: Gary L. McComas
Fire Marshal
SUBJECT: 76TH AVENUE PROFESSIONAL CENTER, 21821-76TH AVENUE W.,
EDMONDS, WA
After review, the fire department has the following requirements:
1. Nonflammable Medical Gas Systems must comply with
N.F.P.A. 56F
2. Portable fire extinguishers must be located as in-
dicated on approved print. One in basement area
and two on main level. Minimum rating 2,A-10,B:C.
GLM: be
Attachment