22727 HWY 99 STE 109T - � 4
SNOHOMISH CO.
FIRE
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"67 109 FIRE PREVENTION
Serving Brier, P-amonds, and 12425 Meridian Ave S INSPECTION REPORT
0 EDMONDS
Mountlake Terrace Everett, WA 98208 0 BRIER
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
[I UNINCORPORATED
"ACY A JMJL%.# A www.FireDistrict].org Fax (425) 551-1272
FREQUENCY
STATION & SHIFr_`S
22727 Highway 99 Suite 109 98026
2016
20-D
LOCATION:
Aurora Chiropractic Clinic
4257741090
SCHEDULED Oct 2016
BUSINESS NAME:
PHONE:
DATE DUE 0
593
MAILING
LIFIR �
22727 Highway 99, Suite 109, Edmonds, WA 98026
ADDRESS:
BUSINESS OWNER:
HOME PHONE:
Treadway, Jeffery
4258239332 e-CURRENT
-N
EMERGENCY-1:
HOME PHONE:
KEY ACCESS-2:
HOME PHONE:
CITY
YES NO
BUSINESS
EMAIL:
LICENSE
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR: WIrvsTblo
/104744
1411-1010-
e10^47"&11e&
Date Last Serviced:
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1
2
3
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5
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7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1
2
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7
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 Cities
covered by Snohomish County Fire District 1.
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 above jurisdictions.
Any overlooked hazards or violations of the fire regulations does not imply approval of such conditions or violation.
If you require additional information or to schedule a re -inspection for Edmonds, call (425) 775-7720; for
Mountlake Terrace or Brier, call (425) 744-6231.
LOCATION:
BUSINESS NAME:
MAILING
ADDRESS:
BUSINESS OWNER:
EMERGENCY-1:
KEY ACCESS-2:
EMAIL:
PERSON CONTACTE
NAME OF INSPECTO
FIRE SYSTEMS
ZZ727 1-1r614tjtjy qq /09 FIRE PREVENTION
Serving Brier, Edmonds, a* d 12425 Meridian Ave S INSPECTION REPORT
I V�EDMONDS
Mountlake Terrace Everett, WA 98208 0 BRIER
Phone (425) 551-1200. 0 MOUNTLAKE TERRACE
W1001)1TwwwFireDistrict1.org Fax (425) 551-1272 0 UNINCORPORATED
FREQUENCY STATION & SHIFT
22727 Highway 99 Suite 109 98026 1 2 Yearl 13 20-A
SCHEDULED
Aurora Chiropractic Clinic PHONE: 4257741090 DATE DUE 1' Oct 2013
LIFIR � 593
22727 Highway 99, Suite 109, Edmonds, VIA 98026
HOME PHONE:
Treadway, Jeffery
FE
HOME PHONE: 4
HOME PHONE:
CURRENT
CITY YES NO
BUSINESS
LICENSE x 1:1
INITIAL INSPEqTION DATE
J. 11. ,1
f(djoNms
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
'EXT LA k
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2
2
3
3
W'l
4
4
5
6
Ott — r�__
'4 1 M
5
6
"A
7
7
4 1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAY
1 st RE -INSPECTION
2nd RE -INSPECTION
FINAL RE-IN%"PECTION
EXTENSION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
1
IINSPECTOR�
INSPECTOR:
INSPECTOR:
2
DAM
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
1 5
1 5
LETTER SENT
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
RETURN RECEIPT
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7
3
7
RECEIVED _
6
DISPOSITION:
4
8
4
8
DATE:
LETTER NEEDED El YES 0 No
LETTER NEEDED [-] YES NO
8
FIRE DEPARTMENT COPY