21911 76TH AVE W STE 2007 (P-M PJO Lj jr�r Z-00 FIRE PREVENTION
SNOHOMISH CO. Serving Brie., ...._!ds 12425 Meridian Ave S INSPECTION REPORT
OEDMONDS
Mountlake Terrace, and Everett, WA 98208 0 BRIER
FIRE the Town of Woodway Phone (425) 551-1200 El WOODWAY
[I MOUNTLAKE TERRACE
ST6 T www.FireDistrictl.org Fax (425) 551-1272 0 UNINCORPORATED
e- FREQUENCY I STAJION & SHIFT`�
LOCATION: 21911 76th Ave W 201 730 6 A
BUSINESS NAME: Custom Dental Care PHONE: 4257440598 SCHEDULED 02/01/12
DATE DUE 0
MAILING 21911 76th Ave W #201 UFIR 1, 593 2157
ADDRESS: Edmonds 98026
BUSINESS OWNER: Youg, Jane HOME PHONE: 4252388307
EMERGENCY-1: Lee, David HOME PHONE: 4252388307 CURRENT
CITY YES NO
KEY ACCESS-2: HOME PHONE:
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INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR: rP
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
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2nd RE -INSPECTION
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EXTENSION
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FIRE DEPARTMENT COPY
CITY OF EDMONDS
121 51H AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
li�s t 89Z
LOCATION: 21911 76th Ave W
BUSINESS NAME: Custom Dental Care
MAILING 21911 76th Ave W #201
ADDRESS: Edmonds
BUSINES,1 ne
EMERGENCY-1: Lee, David
KEY ACCESS-2:
FIRE PREVENTION
SAFETY SURVEY
201
PHONE: 4257440598
FREQUENCY
STATION& SHIFT
730
16 C
SCHEDULED
02/01110
DATE DUE 01
UFIR i� 593
98026 �1_
HOMEPHONE: 4252388307
HOME PHONE(qt'� �507
HOME PHONE:
A
10 INITIAL INSPECTION VATE
PERSON CONTACTED: .. /�L, _( 0 05,0
NAME OF INSPECTOR: Z1 — 10 I's<
FIRE FE
aLLV
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS ENTER CODE ONLY ONCE
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VIOLATION CODE
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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 City of
Edmonds.
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
with the minimum standards adopted by the City of Edmonds.
Please call (425) 775-7720 within 30 days to schedule a reinspection.
Any overlooked hazards or violations of the fire regulations does not imply approval of such condition or violation.
If you require additional information or assistance, please contact this off ice by calling (425) 775-7720 between
the hours of 8 a.m. and 5 p.m., Monday through Friday.
BUSINESS COPY