22617 76TH AVE W STE 107MISH Co.
FIRE
DIST:
J'�-g /0 7 FIRE PREVENTION
Serving Zztorl lqcli- INSPECTION REPORT
#ric .. .... -ads, and 12425 Meridian Ave S 0 EDMONDS
Mountlak,g.,T 0 BRIER
errace , Everett, WA 98208
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
ww-wFireDistrictl.org Fax (425) �51-1272 0 U.NINCORPORATED
e- FREQUENCY
STATION & SHIF'*'�
LOCATION: -
22617 76th Avenue W Suites I G4 & 107
98026
2 Year
1 13
20-D
BUSINESS NAME:
Vacant
PHONE: 4257780617
SCHEDULED
DATE DUE � Oct 2013
MAILING
LIFIR 1, 591
ADDRESS:
22617 76th Avenue W. Suites 104 & 107,
Edmonds, WA .98026
BUSINESS OWNER:
LaAigiie, Hap
HOME PHONE:
EMERGENCY-1:
RENT
Langlie, Hap
HOME PHONE: 4 �7 —13-80—Dr—CUR
KEY ACCESS-2:
HOME PHONE:
YES
CITY
NO
BUSINESS
EMAIL:
LICENSE
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE SYSTEMS:
FE
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
3
4
4
5'
5
6
6
7
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
GRANTEDTO:
FINAL RE-INSPECTI(ON
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
D E:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
8
4
18
DATE:
DISPOSITION:
\� LETTER NEEDED [-] YES NO
LETTER NEEDED [-] YES El NO
8
FIRE DEPARTMENT COPY
Sei-ving Briei: Edmonds, and 12425 Mei-idian Ave S
SNOHOMISH CO.
Mountla4-
,e Terrace Evei-ett, WA 98208
:FIR Phone (425) 551-1200
DIS T141141A�FireDistrietl.org Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
El BRIER
El MOUNTLAKE TERRACE
[I UNINCORPORATED
FREQUENCY
STATION& SHIFT_"�
LOCATION:
22617 76th Avenue W Suite 106 98026
2 Year
13
I
20-D
BUSINESS NAME:
Lotus Health Clinic
PHONE:
42-57768050
SCHEDULED
DATE DUE � Oct 2013
MAILING
UFIR � 593
ADDRESS:,
22617 76th Avenue W, Suite 106, Edm onds, WA 98026
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
Pace, Rashmi
HOME PHONE:
4257788050
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES
NO
BUSINESS
1:1
1:1
EMAIL:
LICENSE
INITIAL INSPECTION DATE
PERSON CONTACTED:
INSPECTOR:
NAME OF
FIRE SYSTEMS:
FE I
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
3
4
4
5
5
.6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
PERSON
CONTACTED:
VIOLATIONS
CITED:
1
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
DATE:
2
3
DATE:
DATE:
VIOLATIONS
1 5
VIOLATIONS
1 5
2
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
18
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED F] YES El NO
LETTER NEEDED E] YES [__1 NO
8
FIRE DEPARTMENT COPY
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HOMISH Co. ',SelTing Briet; Edinonds
Motintlake Teri-aceand
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the'Town of T6odway
is www.FireDistrictl.org
LOCATION: '22 17 ,`�61:h filu' e W 10 6
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BUSINESS NAME: tlh Clinic
MAILING 2261 iN76th Ave W #106
ADDRESS: Edmonds
BUSINESS OWNER: Pace, Rashm'i-
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EMERGENCY-1: Alibh6l�".''
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KEY ACCESS-2:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS:
12425 Meridian Ave S
Everett, WA 98208
Phone (4-95) 551-1-900
Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
[]EDMONDS
[I BRIER
E]WOODWAY
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730 20. C
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PHONE: 425718 DATE DUE � 10/01112
UFIR � 593 11107
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HOMEPHONE: 4257738050 'A.CTIVE
HOME PHONE: 4257745131 CURRENT YES NO
HOME PHONE: CITY
BUSINESS
LICENSE 1:1 El
INITIAL INSPECTION DATE
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ANNUAL
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/ I
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
A _7
2
2
3
3
4
4
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATIONS) IN THE NEXT—:k DAYS X
1st RE -INSPECTION
DATE DUE:
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2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
'CO69
SECTION:
5
3
7
3
7
RETURN RECEIPT'
RECEIVED
6
4
18
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED C] YES F-1 NO
LETTER NEEDED YES NO
8
FIRE DEPARTMENT OOPY
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FIRE PREVENTION
Brier, Edmonds 12425 Meridian Ave S INSPECTION REPORT
OEDMONDS
Mountlake Terraceand Everett, WA 98208 0 BRIER
the Town of Woodway Phone (425) 551-1200 OWOODWAY
0 MOUNTLAKE TERRACE
www.FireDistrictl.org Fax (425) 551-1272 OUNINCORPORATED -
r FREQUENCY STATION & SHIFT-)
LOCATION: 22617 76th Avenue W 107/104 730 20 C
BUSINESS NAME: Vacant
MAILING 2261776th Ave W #107
ADDRESS: Edmonds
BUSINESS OWNER: Langlie, Hap
EMERGENCY-1:
KEY ACCESS-2:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS:
PHONE: 4257780617
98026
HOMEPHONE: 4257713800
SCHEDULED
DATE DUE � 10101112
UFIR 0 591 11107
ACTIVE
HOME PHONE: CURRENT
HOME PHONE: CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
�j
FE I
A14�UZ
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
2 N / A
2
V
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
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
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
7
RETURN RECEIPT
RECEIVED
6
4
18
4
18
DATE:
DISPOSITION:
7
LETTERNEEDED [] YES El NO
LETTER NEEDED C] YES E3 NO
8
FIRE DEPARTMENT
COPY
FIRE PREVENTION
ClW OF EDMONDS ......... . . SAFETY,SURVEY
-(425)771
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 -0215
FIRE DEPARTMENT
LOCATION: 22617 76th Avenue W 107/104
BUSINESS NAME: Vacant 4257780617
PHONE:
MAILING 22617 76th Ave W #107
ADDRESS: Edmonds 98026
FIR T-Sd NCY I STATJ8&X4IFT
SCHEDULED
DATE DUE
LIFIR 111, 591 1(107
BUSINESS OWNER: Langlie, Hap HOMEPHONE: 4257713800 ACTIVE
EMERGENCY-1: HOME PHONE:
KEY ACCESS-2: HOME PHONE:
PERSON'CONTACTED: INSPECTION DATE
NAME OF INSPECTOR:
FIRE FE
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE ll�
VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
7
8
8
lst RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
DATE:
CODE
SECTION:
5
3
7
7
RETURN RECEIPT
RECEIVED
6
4
.8 _..
4
8
DATE:
DISPOSITION:
7
8
\,LETTER NEEDED ID YES E] NO
LETTER NEEDED E] YES E] NO
FIRE DEPARTMENT COPY