23805 HWY 99 STE 10023665- "-r644cjiqy 7 � J7-,Z- MO
FIRE PREVENTION
Serving Brier, Edmonds, and
12425 Meridian Ave S
INSPECTION REPORT
SNOHONIISH CO.
Mozintlake Terrace
Everett, WA 98208
0 EDMONDS
0 BRIER
Phone (425) 551-1200
0 MOUNTLAKE TERRACE'
[I UNINCORPORATED
www.FireDistrict].org
Fax (425) 551-1272
LOCATION: 23805 Highway 99 Suite 100 98026
Avenue Dental Care 4257786333
BUSINESS NAME: PHONE:
MAILING 23805 Highway 99, Suite 100, Edmonds, WA 98026
ADDRESS:
BUSINESS OWNER:
EMERGENCY-1: Bains, Rattanjit
KEY ACCESS-2:
EMAIL:
PERSON CONTACTED:
NAME OF INSPECTOR:
bate Last Serviced:
HOME PHONE:
4252489957
HOME PHONE: 20
HOME PHONE:
FM?fNCY ST161f SHIFT
—7
SCHEDULED Jun
DATE DUE 0
1
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CURRENT
CITY YES, NO
BUSINESS 171
LICENSE 'Isi 1:1
INITIAL INSPECTION DATE
FIRE PREVENTION
Serving Brier, Edmonds
12425 Meridian Ave S
INSPECTION REPORT
SNOHQMISH CO.
Mountlake Terraceand
FIRE
f"T
Everett, WA 98208
DEDMONDS
0 BRIER
MI off the Town of Woodway
ST R
Phone (425) 551-1200
E]WOODWAY
[I MOUNTLAKE TERRACE
www.FireDistrictl.org
Fax (425) 551-1272
0 UNINCORPORATED
e FREQUENCY STATION & SHIFT'N
LOCATION: 23805 Highway 99
100
730 20 D
BUSINESS NAME: Avenue Dental Care
PHONE: 4257786333
SCHEDULED
DATE DUE � 06/01,113
MAILING 23805 Hwy 99 # 100
UFIR 10 593 6006
ADDRESS:
Edmonds
98026
BUSINESS OWNER: Sains, Rattanjit
HOMEPHONE: 4252489957
ACTIVE
EMERGENCY-1:
HOME PHONE:
e—CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY Y S 0
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HA�MDS FOUND AND LOCATIONS COMMUNICATIONS
2
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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-INSPECTIO;E!��
DATE DUE:
VIOLATIONS
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2
DATE:
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3
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LETTER SENT
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NUMBER:
4
2
6
2
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DATE:
CODE
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3
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6
4
18
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18
DATE:
DISPOSITION:
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LETTER NEEDED E:] YES [:1 NO
LETTER NEEDED El' YES NO
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FIRE DEPARTMENT COPY
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Serving Brier, Ednionds
Mountlake Terraceand
Tthe Town of Woodway
. www.FireDistrictl.org
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
__ FIREERR—EVENTION -
INSPECTION REPORT
0 EDMONDS
0 BRIER
-E]WOODWAY
[I MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY
STATION & SHIFT-)
LOCATION:
23805 Highway 99
100
730
20 C
BUSINESS NAME:
Avenue Dental Care
PHONE: 4257786333
SCHEDULED
DATE DUE 1' 06/01/12
MAILING
23805 Hwy 99 # 100
LIFIR � 593 6006
ADDRESS:
Edmonds
98026
BUSINESS OWNER:
Sains, Rattanjit
HOME PHONE: 4252489957
ACTIVE
EMERGENCY-1:
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1-41
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HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
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2
2
3
3
4
4
5
5
6
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7
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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:
DA E:
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
3
7
RETURN RECEIPT
RECEIVED
6
4
.8
4
.8
DATE:
DISPOSITION:
LETTER NEEDED [] YES NO
LETTER NEEDED [] YES NO
FIRE DEPARTMENT COPY
C1W OF EDMONbS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
4j' t
LOCATION: 23805 Highway 99
BUSINESS NAME: Avenue Dental Care
MAILING 23805 Hwy 99 # IGO
FIRE PREVENTION
SAFETY SURVEY
FRE816NCY STAT�W&gIIFT
SCHEDULED
DATE DUE
LIFIR"Ilo 593 6006
ADDRESS: Edmonds 9BD26
BUSINESS OWNER: tbff,_QM V1 vy'4 HOME PHONE: ACTIVE
EMERGENCY-1: HOME PHONE:
KEY ACCESS-2: HOME PHONE:
100
PHONE: 4257786333
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PERSON CONTACTED: INITIAL INSPECTIOr
NAME OF INSPECTOR: 40 �R - & L_� 11%.1 �j ( ('
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2
2
3
3
4
4
5
5
6
6
7
7
8
8
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
3
7
RETURN RECEIPT
RECEIVED
6
7
4---
18
4
18
DATE:
DISPOSITION:
13
I�UETTERNEEDED 0 YES NO
LE-17ER NEEDED [-] YES NO
FIRE DEPARTMENT COPY
I.