23805 HWY 99 STE 101W 0
inipir. 2 0 5 H_3�644W Al S7 - / If
FIRE PREVENTION
SNOHOMISH CO. Serving Brier, Edinonds, and 12425 Meridian Ave INSPECTION REPORT
OEDMCNDS
Mountlake Terrace Everett, WA 98208 0 BRIER
FIRE Phone (425) 551-1200 0 MOUNTLAKE TERRACE
DISTT www.FireDistrictl.org Fax (425) 551-1272 [3 UNINCORPORATED
r-FREQUENCY STATION & SHIF"*'
LOCATION: 23805 . Highway 99 Suite 101 98026 28q Is
BUSINESS NAME: PHONE: SCHEDULED
Vacant DATE DUE juR 2016
MAILING LIFIR
ADDRESS: 0
23805 Highway 99, Suite 101, Edmonds, WA 98026
BUSINESS OWNER: HOME PHONE:
EMERGENCY-1: HOME PHONE: "CURRENT
KEY ACCESS-2: HOME PHONE: CITY YES NO
EMAIL: BUSINESS
LICENSE
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:--eVx.4rnr\ XU r', I
FIRE SYSTEMS: FE
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
In our continuing effort to promote fire safety and prevention within the community, your fire departrkIent conducts
regularly scheduled "Fire Safety Survey Inspections" of all businesses and multi -family occupancies'n th ities
covered by Snohomish County Fire District 1.
f
You are to be congratulated on the relative good condition of your occupancy in regards to fire safe . Ab ve you
r
I
will find the item(s) that were noted during, our inspection which require attention to bring them in Xcompli ce
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.
SNO
F
D
J-7-C / SIPE PREVENTION-
r i4wA-1
INSPECTION REPO RT'
Serving Brier, Edmondi 12425 Meridian Ave S
El EDMONDS
Mountlake Terraceand Everett, WA 98208 0 BRIER
OWOODWAY
the Town of Woodway Phone (425) 551-1200 [1 MOUNTLAKE TERRACE
www.FireDistrictl.org Fax (425) 551-1272 0 UNINCORPORATED
LOCATION: 23805 Hwy 99
BUSINESS NAME: New Wave Dental Lab
MAILING
23805 Hwy 99 4101
ADDRESS:
Edmonds
BUSINESS OWNER:
Kim, Hea In
EMERGENCY-1:
Kim, Eun Sun
KEY ACCESS-2:
Virk, Mahadeep
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE Yvf—
SYSTEMS:
101
PHONE: 4257761234
98026
HOMEPHONE: 4085317393
HOMEPHONE: 4259570829
HOMEPHONE: 2067865351
FREQUENCY
STATION & SHIFT**'
731
20 D
SCHEDULED
DATE DUE 1' 06/01113
LIFIR � 593
6006
CURRENT. YES NO
CITY
BUSINESS
LICENSE
INITIAL INSPECTION DATE
FE I
ANNUAL,_
I
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
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:
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
6
DATE:
CODE
SECTION:
5
f3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
I
8
L4
18
DATE:
DISPOSITION:
7
LETTER NEEDED E] YES El No
LETTER NEEDED 0 YES 0 NO
a
FIRE DEPARTMENT COPY
U �Wfl
s.,
Serving Brier, Edmonds
Mountlake Terrace, and
m 7"
p� the Town of Woodway
.0 1 www.FireDistrictl.org
LOCATION: 23805 Hwy 99
BUSINESS NAME: New Wave Dental Lab
MAILING
23805 Hwy 99 #101
ADDRESS:
Edmonds
BUSINES9 OWNER:
Kim, Hea In
EMERGENCY-,1:
Kim, Eun Sun
KEY ACCESS-2:
Virk, Mahadeep
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
101
PHONE: 4257761234
98026
HOMEPHONE: 4085317393
HOMEPHONE: 4259570829
HOMEPHONE: 2067865351
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
E]WOODWAY
[I MOUNTLAKE TERRACE
0 UNINCORPORATED
e FREQUENCY STATION & SHIFT)
731 20 C
SCHEDULED
DATE DUE 1' 06/01/12
FIR 10 593 �6
U 6 00 _j
CURRENT
CITY YES NO
BUSINESS
LICENSE 1:1 1:1
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE FE
SYSTEMS: APiNUTL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
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:
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
4
18
4
18
DATE:
DISPOSITION:
LETTER NEEDED [] YES No
LETTER NEEDED [:] YES NO
8
N
FIRE DEPARTMENT COPY j
Aillml i"V
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
LocATiom 23805 Hwy 99
BUSINESS NAME: New Wave Dental Lab
FIRE PREVENTION
SAFETY SURVEY
1011
PHONE: 4257761284
MAILING
23805 Hwy 99 #101
ADDRESS:
Edmonds
98026
BUSINESS OWNER:
Kim, Hea In
HOME PHONE:
4065317393
EMERGENCY-1:
Kim, Eun Sun
HOME PHONE:
4259570829
KEY ACCESS-2:
Virk, Mahadeep
HOME PHONE:
2067865351
FREQUENCY
STATION& SHIFT
`731
20 A
SCHEDULED
DATE DUE 0-
06/101/10
UFIR 11- 593
6006
I INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE FE
A
SYSTEMS: ;_%NINUA!�
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE I�
'VIOLATION CODE
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
5
PRE-CITAT10N
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
7
RETURN RECEIPT
RECEIVED
6
4
18
4
8
DATE:
DISPOSITION:
7
8
�, LETTER NEEDED [] YES NO
LETTERNEEDED 1:] YES E] NO
. ;.. . . f;" ' �1.
FIRE DEPARTMENT COPY