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"_ FREQUENCY STATION & SHIFT
LOCATION: 21810 76 th Avenue W Suite 101 98026
2016 20-D
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BUSINESS NAME: NW Dental Center
PHONE: 4257743710
SCHEDULED Nov 2016
DATE DUE 1'
MAILING
UFIR � 593 156
ADDRESS: 21810 76th Avenue W, Suite 10 1, Edmonds, WA 98026
BUSINESS OWNER: Re za
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DATE DUE;
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FIRE PREVENTION
SNOHOIMISH
Set -ving Brier, Edinbnds, atid
12425 Meridiati Ave S
INSPECTION REPORT
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Everett, WA 98208
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0 MOUNTLAKE TERRACE
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LOCATION: 21810 76 th AvenVe W Suite 102 98026
BUSINESS NAME: Edmonds Woodway Dental Care PHONE: 4257753446
MAILING
ADDRESS: 21810 76th Avenue W, Suite 102, Edmonds, WA 98026
BUSINESS OWNER:
EMERGENCY-1: Hrankowski, Michael
KEY ACCESS-2:
EMAIL:
PERSON CONTACTED:
f�NAIVIE OF INSPECTOR:
FIRE SYSTEMS: FE
HOME PHONE:
HOMEPHONE: 2067787456
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FREQUENCY STATION & SHIFT
2016 20-D
SCHEDULED Nov 2016
DATE DUE �
UFIR � 593 156
.CURRENT
CITY YES NO
BUSINESS F--j
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INITIAL INSPECTION DATE
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BUSINESS OWNER: Hrankowski, Michael
EMERGENCY-1: Gant, Thomas, MD
KEY ACCESS-2:
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
i n,2
PHONE: 4257753446
98026
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
0 WOODWAY
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
FR5% NCY I STATjWq &6HIFT
SCHEDULED 111101/12
DATE DUE �
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HOMEPHONE: 2067787456
4258218755�
HOME PHONE: URRENT
HOME PHONE: ITY YES NO,
BUSINESS
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INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
3
4
4
5
5
6
6
7
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1 AGREE TO COR.RECT, THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE.,
2nd RE -INSPECTION
DATE DUE.
EXTENSION
GRANTED TO-
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DATE DUE:
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INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
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1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
13
7
RETURN RECEIPT
RECEIVED
6
4
18
4
18
DATE:
DISPOSITION:
7
11 LETTER NEEDED [) YES NO
LETTER NEEDED F] YES NO
8
FIRE DEPARTMENT COPY
CITY, OF EDMONDS
121 5TH AVENUE N. EDMONDS, WASHINGTON 98020 - (425) 771-0215
Fik'66PARTMENT
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LOCATION: 21810 76t Ave Vv.
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BUSINESS NAME: Edmonds Woodwa Dental Care
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I�AILING 21810 76th Ave W #102
FIRE PREVENTION
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PHONE: 4257753446
ADDRESS: Edmonds 98026
BUSINESS OWNER: Hrankowski, Michael HOMEPHONE: 2067787456
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GRANTED TO:
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DATE �UE:
DATE DUE:
DATE DUE:
PERSON
PERSON
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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
2
6
2
6
DATE:
SECTION:
5
RETURN RECEIPT
6
3
7
3
7
RECEIVED
DISPOSITION:
4
8
4 18
DATE:
8
LETTER NEEDED E] YES E] NO
LETTER NEEDED E, YES F1 NO
FIRE DEPARTMENT COPY