21810 76TH AVE W STE 201�4
s-,SNOHON11SH CO.
Serving Brier, Eamohds, and
Mountlake Terrace
sre— FIRIE-PREVENTION
12425 Meridian Ave S INSPECTION REPORT
0 EDMONDS
Everett, WA 98208 0 BRIER
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
UNINCORPORATED
www.FireDistrictl.org . Fax (425) 551-1272
LOCATION: 21810 76 th Avenue W Suite 201 98026
BUSINESS NAME:-PaGift--Nutr#km-T-hera-py PHONE:
MAILING
ADDRESS: 21810 76th Avenue W, Suite 201, Edmonds, WA 98026
BUSINESS OWNER: HOME PHONE:
EMERGENCY-1: Machado, Melanie
KEY ACCESS-2:
EMAIL:
PERSON CONTACTED:
NAM E OF INSPECTOR:
b'-FIRE FA5/11FE
4257767333
HOME PHONE: 4257753461
HOME PHONE:
FREQUENCY T-STATION & SHIFT
2016 20-D
SCHEDULE D
DATE DUE � Nov 2016
UFIR � 593 156
CURRENT
CITY YES NO
BUSINESS E] 1:1
LICENSE
INITIAL INSPECTION DATE
11, A. - �C/j e
W
SNOHOMISH CO.
FIRE
DIST".
Serving Briet: Edinonds
Mountlake Terraceand
the Town of Woodway
T www.FireDistrictl.org
LOCATION: 21810 76th Ave W
BUSINESS NAME: Pacific Nuffidion Therapy
MAILING 21610 76th Ave W #201
ADDRESS: Edmonds
BUSINESS OWNER: Machado, Melanie
t
EMERGENCY-1: Gant, Tom
KEY ACCESS-2:
PERSON CONTACTED:
NAME OF INSPECTOR:
SYSTEMS:
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
201
4257767333
PHONE:
98026
HOMEPHONE: 4257753461
2069990293
HOME PHONE:
HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
EIEDMONDS
0 BRIER
E]WOODWAY
[I MOUNTLAKE TERRACE
0 UNINCORPORATED
FRT3U
6NCY I STATIV4 86HIFT
SCHEDULED .141101112
DATE DUE II'
LIFIR 0 593 1'156
CURRENT
CITY YES NO
BUSINESS
LICENSE El 1:1
INITIAL INSPECTION DATE
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2 A-)
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
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
D TE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
,INSPECTOR:
INSPECTOR:
INSPECTOR:
2
1.
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
.8
4
.8
DATE:
DISPOSITION:
7
`( LETTER NEEDED E] YES F1 NO
LETTER NEEDED [] :Y:ES C3 NO
8
FIRE DEPARTMENT COPY