145 3RD AVE S STE 20010*1
SNOHONIISH CO.
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e Serving Baer, cam'onds, and
Mountlake Terrace
www.FireDistrict].org
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12425 Meridian Ave S o,IN�PECTIO�V REP RT
Everett, WA 98208 p ❑BEDMORIER s
RIER
Phone (425) 551-1200. ❑ MOUNTLAKE TERRACE
Fax (425) 551-12 %2 ❑UNINCORPORATED
FREQUENCY STATION & SHIFT
LOCATION: 145 3 rd Avenue S Suite 200 98020 2017 17-D
BUSINESS NAME: Beresford, Booth, Tingstad Inc. PHONE: 4257764100 SCHEDULED Jan 2017
DATE DUE
MAILING UFIR / 591 202
ADDRESS: 145 3rd Ave S Suite 200, Edmonds, WA 98020
BUSINESS OWNER: Beresford, Richard HOME PHONE:
S HOME PHONE:2-(X0 - �' CURRENT
EMERGENCY-1: � q �� � `i,' wJ C .�-.r �I KEY ACCESS-2: LLJ (( ` HOME PHONE: 17 CITY YES NO
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PERSON CONTACTED: '� INITIAL INSPECTION DATE
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NAME OF INSPECTOR: e. r C.
FIRE SYSTEMS: FE —5--/-p
Date Last Serviced:
FIRE.TPREVENTION
C%ITY,..OF-EDMONDS "# °SAFETY SURVEY
121 5TM AVENUE N. • EDMONDS, WASHINGTON 98020 • (425) 771-0215 u'
FIRE DEPARTMENT -
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LOCATION: 145 3rd Avenue S 200
BUSINESS NAME: Beresfard, Booth, Tingstad Inc-, PS PHONE: 4257764100
MAILING 145 3rd Ave S # 200
ADDRESS: Edmonds 98020
BUSINESS OWNER: Beresford, Richard HOME PHONE: 42577514.12 ACTIVE
EMERGENCY-1:
KEY ACCESS-2:
HOME PHONE:
HOME PHONE:
STATION & SHIFT
17 B
INITIAL INSPECTION DATE
PERSON CONTACTED: �� � F'� � � %I ✓�,,.j S�J
NAME OF INSPECTOR: 0"� t t� 't 5 Z— Z T — 1 1
FIRE FE _lf_Lb
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
ENTER CODE ONLY ONCE ►
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
1 5
PRE-CRATION
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
8
DATE:
DISPOSITION:
g
LETTER NEEDED ❑ YES NO
LETTER NEEDED [J YES NO
FIRE DEPARTMENT COPY