22815 100TH AVE WFIRE PREVENTION -
A L)
INSPECTION- REPORT
sNotibMISH. I ('�O. k..' , Serving Nie'r, Eamon s, and 12425 Meridian.Ave S DEDIVIONDS
Mountlake Terrace Everett, WA 98208 0 BRIER
FIRM- Phone (425) 551-1200 0 MOUNTLAKE TERRACE
DISTRwww.FireDistrict].org Fax (425) 551-12 72 [1 UNINCORPORATED
LOCATION: 22815100th AvenueW 98026
BUSINESS NAME: Ann D. Liou, DDS/MSD
MAILING
ADDRESS: 22815 100th Avenue W, Edmonds, WA 98026
BUSINESS OWNER:
EMERGENCY-1: Liou, Ann D.
KEY ACCESS-2:
EMAIL: ULA,484-0 1013,11w2e h0w - Av�4
PERSON CONTACTED: &6Z694
NAME OF INSPECTOR: 14 / )A/
FIRE SYSTEMS: FIE 11 /11#
Date Last Serviced:
PHONE: 4257763166
HOME PHONE:
HOME PHONE: 2064193546
HOME PHONE: 20
FREQUENCY STATION & SHIFT
2015 20-D
SCHEDULED
DATE DUE I, Jan 2017.
LIFIR o 593 154
CURRENT
CITY YES NO
BUSINESS
LICENSE Z 1:1 . ..
INITIAL INSPECTION bATE —
Serving Brier, Edinonds-, and
mou`nilake'rer�ace
DISTRICTwww.FireDistrictl.org
LOCATION: 22815 100 th Avenue W 98026
BUSINESS NAME: Ann D. Liou, DDS/MSD
MAILING 22815 1 00th Avenue W, Edmonds, WA 98026
ADDRESS:
BUSINESS OWNER:
EMERGENCY-1: Liou, Ann D.
K
,EY ACCESS-2:
EMAIL: )Orq�k'40'R j)'cc6y'yl n kA 01-`,
PERSON CONTACTED: ti"(-tA�Lo' "N
NAME OF INSPECTOR:
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fdx (425) 551-1272
PHONE: 4257763166
HOME PHONE:
HOME PHONE: 2064193546
HOME PHONE:
FIRE PREVENTION
INSPECTION. REPORT
0 EDMONDS
0 BRIER
[I MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY STATION & SHIFT
2015 1 20-B
SCHEDULED Jan 2015
DATE DUE l'
UFIR 0 593154
CURRENT
CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
1151 � —s
HAZARDS F LIND AND LOCATIONS COMMUNICATIONS
2 LNU
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 -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
I
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 15
VIOLATIONS
1 15
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:
11 LETTER NEEDED F] YES NO
LETTER NEEDED F] YES NO
8
FIRE DEPARTMENT COPY
SNOHOMISH CO. Serving Brier, Edt�onds 12425 Meridian Ave S
FIREMountlake Terraceand Everett, WA 98208 -
the Town of Woodway Phone (425) 551-1200
ST Rf*�"`�:hT www.FireDistrictl.org Fax (425) 551-1272
LOCATION: 22815 1 00th Avenue W
BUSINESS NAME: Ann D. Liou, DDS/MSD
MAILING 22815 1 OOTh Ave W
PHONE: 4257763166
Auuncoo: Edmonds 98020
BUSINESS OWNER: Liou, Ann D. HOMEPHONE: 2064193546
EMERGENCY-1: HOME PHONE:
KEY ACCESS-2: HOME PHONE:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS:
FIRE PREVENTION
INSPECTION REPORT
DEDMONDS
El BRIER
El WOODWAY
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
I'- FREQUENCY I STATION & SHIFF"I
731 20 D
SCHEDULED
DATE DUE 0 01/01/13
UFIR � _593 154
A(_T1VE
CURRENT
CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
FEL I fL2_
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
rZ,,? UAJ
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:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
I
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
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
DATE:
DISPOSITION:
7
LETTER NEEDED . [] YES NO
LETTERNEEDED YES NIO
8
FIRE DEPARTMENT COPY
FIRE PREVENTION
CITY, 0F'E&\M0NDS' SAFETY SURVEY
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-021.5,o.
FIRE DEPARTMENT
41 t
FREQUENCY ION& SHIFT
r LOCATION: 22w5 I GMh t #enue w 731 sTAT2.
y BUSINESS NAME: Ann D. Liou, DDS/t"SD PHONE: 4257763166 SCHEDULED 01/01/11
DATE DUE ll�
MAILING 22815100Thi'k-'veW LIFIR 1, 593 15 4
ADDRESS: Edmonds 98020
BUSINESS OWNER: Liou, Ann D. HOME PHONE: 2064193546 ACTIVE
EMERGENCY-1: HOMIt PHONE:
KEY ACCESS-2: 1, HOME PHONE:
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE lo
VIOLATION CODE
2
2
3
3
4
4
5
6
6
7
7
8
A
8
Ist 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:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
5
VIOLATIONS
5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6"
4 �18
1
4
18
DATE:
DISPOSITION:
8"!;
LETTER NEEDEq E] YES E] NO
LETTER NEEtDD El YES NO
FIRE DEPARTMENT COPY