23700 EDMONDS WAYFIRE PREVENTION
SNOkOMISH CO..
Serving Brier, -Edmonds, and
12425 Meridian Ave S
INSPECTION REPORT
FIR
Mountlake Terrace
Everett, WA 98208
0 BRIER
DISTT
Phone (425) 551-1200
0 MOUNTLAKE TERRACE
[3 UNINCORPORATED
www.FireD.istrict].org
Fax (425) 551-1272
FREQUENCY STATION & SHIFT
LOCATION: 23700 Edmonds Way 98020" 2015 20-B
BUSINESS NAME: New Health Med Center PHONE: 4257756001/ "61HEILILID Nov 2015
DATE DUE
MAILING LIFIR � 593
ADDRESS: 23700 EdmondsWay, Edmonds, WA 98020
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BUSINESS OWNER: Kitaeff, Richar/d�—�--rHOME PHONE:7
EMERGENCY-1: Soiset, Alsia, HOME PHONE: .2962eeSO5t— CURRENT
KEY ACCESS-2: OME PHONE:;) CITY YES
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EMAIL:Fi, at ;L 0( 2"' F
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PERSON CONTACTED: INITIAL INSPECTION DATE
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NAME OF INSPECTOR: xp A'
FIRE SYSTEMS: FE 4/14
Date Last Serviced:,
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
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5
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I AGREE TO.CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION 2nd RE -INSPECTION
EXTENSION FINAL RE -INSPECTION VIOLATIONS
DATE DUE: DAT DUE: GRANTEDTO: DATE DUE: CITED:
PERSON PERSON PERSON
CONTACTED: CONTACTED: CONTACTED: 1
------------ —
I.NSPECTOR.- INSPECTOR: 2
INSPECTOR:
DATE: DATE: \3
VIOLATIONS; CITATION ISSUED 7
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CODE
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RETURN RECEIPT
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DISPOSITION:
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k_LETTER NEEQ�Q. YE 0 NO. LETTER NEEDED C] YES 0 NO
SNOHOMISH CO.'
FIRE
Serving Briei; Edmonds-, and
Mountlake Terrace
JMJL%.O.A wwwFireDistrictl.org
LOCATION: 2370D Ednmn& Way 2W20
BUSINESS NAME: Ncw I IcalLh Mcd Ccn[Lr
MAILING
ADDRESS: 23700 EdrTmImIsi Way, EdrivInds, WA OS020
BUSINESS OWNER: K_ trAEFF
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE: Qq9&76R_2ff 2�
HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
El BRIER
0 MOUNTLAKE TERRACE
[I UNINCORPORATED
FREQUENCY STATION & SHIFT"-'
2 Yew 13 20-D_
SCHEDULED
DATEDUE
LIFIR
EMERGENCY-11: K+t0Cff- I
, HOME PHONE: 4-�16776bb'*4 ' CURRENT
KEY ACCESS-2: HOME PHONE- 97-/ t1,60 CITY YES NO
501 < SS
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EMAIL: LICENSE Ef El
PERSON CONTACTED: INITIAL INSPECTION DATE
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NAME OF INSPECTOR: q11j
FIRE SYSTEMS; FE _L� 1.2--
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
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2 MA c.,_7s,
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
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
1
INSPECTOR:-----
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
4
1 5
1 15
LETTER SENT
NUMBER:
CODE
5
2
6
2
6
DATE:
SECTION:
RETURN RECEIPT
6
3
7
3
7
RECEIVED
DISPOSITION:
4
8
I
4
8
DATE:
7
\I LETTER NEEDED [I YES NO
LETTER NEEDED F] YES NO
8
FIRE DEPARTMENT COPY