145 3RD AVE S (2)HOlVIISH Co.
IRE
1111 III s Sys °3�0 YC)c
Serving Brier Edatu,,.., id 12425 Meridian Ave S
Mountlake Terrace Everett, WA 98208
T Phone (425) 551-1200www.FireDistrictl.org Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
,&EDMONDS
❑ BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
FREQUENCY
STATION & SHIFT
LOCATION: 145 3 rd Avenue S 98020
Annual
17-D
BUSINESS NAME: Edmonds Business Center BldgPHONE:
4256727777
SCHEDULED
DATE DUE ►Jan 2017
MAILING
UFIR ► 509 202
ADDRESS: 145 3rd Avenue S, Edmonds, WA 98020
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1: Beresford Investments
HOME PHONE: 4256727777 CURRENT
KEY ACCESS-2:
EMAIL: 1 ���-''•
HOME PHONE: 17
CITY YES NO
BUSINESSr/f- ❑
LICENSE UU
qj
PERSON CONTACTED: F ' rn ,.,t +'Cu •.�
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE SYSTEMS: FE
Date Last Serviced:
FIRE PREVENTION
P
Serving Brier, 'Edmonds, and
Mountlake Terrace
www.FireDistrictl.org
12425 Meridian Ave S
Everett, WA 98208.
Phone (425) 5514200
Fax (425) 551-1272
LOCATION: 145 3 rd Avenue S 98020
BUSINESS NAME: Edmonds Business Center Bldg PHONE: 4256727777
MAILING
ADDRESS: 145 3rd Avenue S, Edmonds, WA 98020
BUSINESS OWNER: HOME PHONE:
EMERGENCY-1: geresford Investments HOME PHONE: 4256727777
KEY ACCESS-2: HOME PHONE:
EMAIL:
PERSON CONTACTED: N
NAME OF INSPECTOR: }
FIRE SYSTEMS: FE /
INSPECTION REPORT
❑ EDMONDS
❑ BRIER
❑ MOUNTLAKE TERRACE
❑ UNINCORPORATED
00 FREQUENCY [STATION & SHIFT
Annual C
SCHEDULED
DATE DUE ► Jan 2016
UFIR ► 509 202
CURRENT
CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
HAZARDS, FOUND AND LOCATIONS / COMMUNICATIONS
1 PJ �i L_
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
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE,
DATE DUE- -
_..__...
GRANTED TO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
INSPECTOR:
CONTACTED:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS-•
PRE -CITATION
CITATION ISSUED—
_
115
1 6
LETTER SENT
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
S
RETURN RECEIPT
3
7
3
7
RECEIVED
6�
DISPOSITION,
,
4
8
DATE:
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑' NO
-"`: ` a FIRE PREVENTION
CITY OF EDMONDS SAFETY SURVEY
121 5T" AVENUE N. • EDMONDS, WASHINGTON 98020 • (425) 771-0215
FIRE DEPARTMENT
t. 1
LOCATION:
145 3rd Avenue
BUSINESS NAME:
Edmonds Business Center Bldg
MAILING
145 3rd Ave S
ADDRESS:
Edmonds
BUSINESS OWNER:
Beresfurd Investments
EMERGENCY-1:
Beresford, Dick
KEY ACCESS-2:
S
PHONE: 4256727777
08020
HOME PHONE: 4256727777
HOMEPHONE: 4257751412
HOME PHONE:
' FREQUENCY
STATION & SHIFT
2
.17 A
DATE DUES ►
01/01/10
UFIR ► 509
1202
A.CT{VE
PERSON CONTACTED: Toe e Ile -
NAME INITIAL INSPECTION DATE
OF INSPECTOR:
FIRE LOkIAd fe ,� s FE I
SYSTEMS: AicF9)�' 10, �� AI�dNUAL 1
�'?f
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1
ENTER CODE ONLY ONCE ►
VIOLATION CODE
1
2
2,
3
3
4
4
5
5
6
6
7
7
8
8
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE
1
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
t-
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
8
4
8
DATE:
DISPOSITION:
8
LETTER NEEDED ❑ YES ❑ NO
LETTER NEEDED ❑ YES ❑ NO
FIRE DEPARTMENT COPY