23601 HWY 99 STE A-:7,77
01
FIRE PREVENTION
Serving Brier, P-amonds, and
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMIISH CO.
IM EDMONDS
FI
Mountlake Terrace
Everett, WA 98208
0 BRIER
Phone (425) 551-1200
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
DIST
www.FireDistrictl.org
Fax (425) 551-1272
LOCATION: 236bl' Highway 99 98026
BUSINESS NAME: Office Building be--JUAAMHONE:
MAILING 23601 Highway 99, Edmonds, WA 98026
ADDRESS:
BUSINESS OWNER: HOME PHONE:
EMERGENCY-1: HOME PHONE:
KEY ACCESS-2: y HOME PHONE:
EMAIL: &2= Z VA ',, -, :�
PERSON CONTACTED:
NAME OF INSPECTOR:
Date Last Serviced: -7/1 (p
4257781149
WIECIVE CY ST16PO SHIFT
nual
SCHEDULED Jun 2017
DATE DUE
5 1
09
LIFIR
CURRIENT
CITY YES NO
BUSINESS M El
I LICENSE i2xi —
INITIAL INSPECTION DATE
6--L-n
FIRE PREVENTION
SNOHOMISHCO
ServingBrier, Edmonds, and 12425 Meridian Ave S
INSPECTION REPORT
FIR
Mountlake Terrace
Everett, WA 98208
DEDMONDS
0 BRIER
Phone (425) 551-1200
0 MOUNTLAKE TERRACE
S TR
T'www. FireDistrict]. org
Fax (425) 551-1272
[3 UNINCORPORATED
e' FREOUENCY
STATION & SHIF_*�
LOCATION:
.23601 Highway99 SuiteA98026
BUSINESS NAME:
PHONE:
SCHEDULED .
The Charis Clinic
2067144476
DATE DUE 0
h in 901 R
MAILING
UFIR
ADDRESS:
593
23601 Highway 99, Suite A, Edmonds, WA
98026
__j
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
HOME PHONE:
eCURRENT
KEY ACCESS-2:
Benedict,Deonne
HOME PHONE: 2067 . 144476
CITY YES NO
EMAIL:
BUSINESS
FV
F-1
LICENSE
12�j
PERSON CONTACTED: nAl�e-4_ zely) PLe 'It-,f
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE SYSTEMS:, FEI(a /1�
[DA10F.V2ffV&V*tatbCATIONS /COMMUNICATIONS
-JUD
%
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
1 st RE -INSPECTION
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
LNSPE�T
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3\. x
V16LATIO-NS
VIOLATIONS,��."..-.-,-
PRE-CITATION
CITATION ISSUED
5
5
LETTER SENT
NUMBER:
4
2
DATE:
CODE
SECTION:
5
2 6
RETURN RECEIPT
3
7
3
7
RECEIVED
6
DISPOSIMOOM
.18
DATE:
7
QETTER N EEDED YES NO
LETTER NEEDED, * O'.�YES��. NO
8
jv.�,,,,
1 4
SNOHOMISH CO. Serving Brier, Edmonds
FI]ESPJLA Mo ' untlake Terraceand
the Town of Woodway
ST Rl T www.FireDistrictl.org
LOCATION: 23601 Highway 99
BUSINESS NAME: The Charis Clinic
MAILING 23601 Highway 99 #A
ADDRESS: Edmonds
BUSINESS OWNER: 13enedict,Deonne
EMERGENCY-1: Flugstad, Beverly
KEY ACCESS-2:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS:
q11
12425 Meridian Ave S
Everett, WA 98208
Pho�e (425) 551-1200
Faxf (425) 551-12 72
A
PHONE: 206714.,476
98026
HOME PHONE: 2067144476
HOMEPHONE: 2065501724
HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
E]WOODWAY
[I MOUNTLAKE TERRACE
0 UNINCORPORATED
I'- FREQUENCY I STATION & SHIFT"�
366 20 D
SCHEDULED
DATE DUE � 06,101/13
1uFIR 0 593 6 006
ACTIVE
CURRENT
CITY YE NO
BUSINESS
LICENSE 4 1:1
INITIAL INSPECTIONIDATE
FE
ANNUA
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
I—
A10 t6qzvl!�c- I—Z�VAJ6
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
1 st 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
INSPEbTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
D TE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1
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]l YES N
rLETTER NEEDED [] YES NO
8
FIRE DEPARTMENT COPY
1 9
e Town of Woodway
-ving Briet; Edinonds
Set
SNOHOMIS
FIREMountlake Terrace,and
STRT w"ww.FireDistrict].org
LOCATION: 23601 Highway 99
BUSINESS NAME: The Charis Clinic
MAILING 23601 Highway 99 #A
ADDRESS: Edmonds
BUSINESS OWNER: Benediet,Deonne
EMERGENCY-1: Flugsted, Bevedy
KEY ACCESS-2:
PERSON CONTACTED: KA CA421 Lj��4
NAME OF INSPECTOR: np -, z 7,,__
SYSTEMS:
FIRE PREVENTION
dianAve S
-:-,.—INSPECTION REPORT
Everett, WA 98268
0 EDMONDS
0 BRIER
Phone (425) 551-1200
E]WOODWAY
0 MOUNTLAKE TERRACE
Fax (425) 551-1272
0 UNINCORPORATED
A
FRS%LgNCY I STA28N &dHIFT_*'
PHONE: 2067144476
98026
HOME PHONE: 2067144476
2065501724
HOME PHONE:
HOME PHONE:
SCHEDULED 06/01/11
DATE DUE I`
LIFIR 0 593 6006
AC-nVE
CURRENT
CITY YES NO
BUSINESS
LICENSE pd 0
INITIAL INSPECTION DATE
A
A�NUZ
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
i A& 4, A a
2
2
3
3
4
4
5
5
6
6
4F--
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
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
18
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED [] YES NO
LETTER NEEDED C] YES El NO
8
FIRE DEPARTMENT COPY
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
4S' t 1 S9 z
LOCATION: 23601 Highway 99
BUSINESS NAME: The Charis Clinic
MAILING 23601 Highway 99 AA
FIRE PREVENTION
SAFETY SURVEY
A
PHONE: 2067144476
1AL)UNCOO: Edmonds 93026
BUSINESS OWNER: Benedict,Deonne HOMEPHONE: 2067144476
EMERGENCY-1: Flugstad, Beverly HOMEPHONE: 2065501724
KEY ACCESS-2: HOME PHONE:
FREQUENCY
STATION 1, SHIFT-"
366
20 A
�
SCHEDULED
DATE DUE 11- 06/01,110
LIFIR � 593
6006
ACTWE
11 INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR: 7 - 07 - to
FIRE
SYST EMS:
FEOS1 IQ
MiNUZ
HAZARDS FOUND AND LOCATIONS COMMUNICATION.S
ENTER CODE ONLY ONCE 1�
VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
7
8
8
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
E DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED-
PERSON
CONTACTED:
PERSON
CONTACTED:
I
INSPECTOR:
IN PECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
16
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
7
4
8
4
18
DATE-
DISPOSITION:
8
LETTER NEEDED 0 YES N
ETTER NEEDED 0 YES NO
7—
FIRE DEPARTMENT COPY