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10119 EDMONDS WAY (2)7 IIII�lIII Serving Brier, Edmonds, and Mountlake Terrace www.FireDistrict].org i o nq CIvh owof w RY 12425 Meridian Ave S Everett, WA 98208 Phone (425) 551-1200 Fax (425) 551-1272 r LOCATION: 10119 Edmonds Way 98020 BUSINESS NAME: Taco Bell #20855 PHONE: 4257748309 MAILING ADDRESS:10119 Edmonds Way, Edmonds, WA 98020 BUSINESS OWNER: Brian HOME PHONE: EMERGENCY-1:AlP Ventures HOME PHONE: 2065262710 KEY ACCESS-2: HOME PHONE: EMAIL: PERSON CONTACTED: NAME OF INSPECTOR:— FIRE SYSTEM` FE 8/15 HD 7/1$ .00)Date Last Serviced:``t�!J ///7 HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 1 3 4 5 6 7 I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X FIRE PREVENTION INSPECTION REPORT DMONDS ,eft ER ❑ MOUNTLAKE TERRACE ❑ UNINCORPORATED FREQUENCY ST110te SHIFT Annual0-- SCHEDULED Feb 2017 DATE DUE � UFIR CURRENT CITY YES NO BUSINESS LICENSE INITIAL INSPECTION DATE �'LG�- t I 1 2 3 4 5 6 7 In our continuing effort to promote fire safety and prevention within the community, your fire department conducts regularly scheduled "Fire Safety Survey Inspections" of all businesses and multi -family occupancies in the Cities covered by Snohomish County Fire District 1. You are to be congratulated on the relative good condition of your occupancy in regards to fire safety. Above you will find the item(s) that were noted during our inspection which require attention to bring them into compliance with the minimum standards adopted by the above jurisdictions. A Any overlooked hazards or violations of the fire regulations does not imply approval of such conditions or If you require additional information or to schedule a re -inspection for Edmonds, call (425) 775= Mountlake Terrace or Brier, call (425) 744-6231. ._i o; {_ Semi -Annual Systern S9FV1c9 Report 320 West Valley Hwy N, Suite D111, Auburn, WA 98001 Phone: 253-852-1962 Fax:253-852-2049 estaurant Q. industrial, ( (� Gb Ir / INSPECTION CATEE / AOCR-SS l ✓/ l l/ 2—> NCNITCRED 0 YES 3LC I AUDI BLE 0 YES rtA�fUFAv"T5REUR: 'viCf t A L�,� 'USIBLE LINKS IUANTm Dnf/S G1_.(1 YNo MONITORED BY No COVERAGE HOOD QUAWITY L Is5^ 212° Zi3o^ -1 YES Cylinder Pressure Gauge or weight is at acceptable Level System is free of any prior, Discharge/Damage or Tampering . All piping and conduit is immobil!zPrf CITY STATE I ZIP 69tw_u, ❑ ANNUAL -4-I'E,M[-ANNEAL TITLE PHONE NO. PHONE NC. ACCT. N0. FRYER BROILER WOK 3URNER HOT TOP GRILL f G i ( I 360" 4500 s00° RRE EXTINGUISHER ABC BC FUEL 0 GAS QUANTITY SOURCE p ELEC. NUN with proper hangers and bgackets v Q ❑ All Nozz!es are in proper position [ C2 All Nozzles are covered by blowoff caps Date Fusible Links last changed System operated properly from Terminal Link System operated properly from Manual Actuators l;hNir,1; N MOTES: {?iiCl?.4 L I C rt 9. automatic shutdown of Fuel/ Power operated propeiy 10. Exhaust Fan operated propery 11. All cooking surfaces properly protected 12. Grease accumulation in hoed and duct 13. Hood has full bank of filters 14. Last date Pressurized Dry Systems had Chemical Checked 15. Date of last Hydrostatic Test of Cylinder 16. Inspection Tag on System Cylinder and remote pull AP9 T. T11ME AM 9 YES 14O N/A Ij IFQ Llf" r I1 I'D Q a' Q o CUSTOMER'S AIUTHORIZED AG=IUT FIRE PPRESSiON SYSTEM INSPECTION REP )= JAN 3 0 2016 FIRE 0EPARTLIE4 T COPY - wHI i t FILE: COPY - Y=.LLow CUSTONIER COPY - PtW N 4 _ a .s y _; SNOHOMISH CO. FIRE DISTR Serving Brier, Edmonds, and 12425 Meridian Ave S Mountlake Terrace"" Everett, WA 98208 Phone (425) 551-1200 www.FireDistrictl.org Fax (425) 551-1272 FIRE PREVENTION INSPECTION REPORT ❑ EDMONDS ❑ BRIER ❑ MOUNTLAKE TERRACE []UNINCORPORATED FREQUENCY STATION & SHIFT LOCATION: Y 10119 Edmonds Way 98020 . Annual 20-C BUSINESS NAME: Taco Bell #2085.5 PHONE: 4257748309 SCHEDULED DATE DUE ► Feb 2016 MAILING UFIR ► 161 54 ADDRESS: 10119 Edmonds Way, Edmonds, WA 98020 BUSINESS OWNER: Brian HOME PHONE: EMERGENCY-1: AIP Ventures HOME PHONE: 2065262710 CURRENT. KEY ACCESS-2: Z� HOME PHONE: ' Co CITY YES NO BUSINESS EMAIL: rS Q Z ` rM • . LICENSE PERSON CONTACTED: 04, INITIAL NSPEC IONPATE 11 NAME OF INSPECTOR: b FIRE SYSTEMS: FE 9/15.HD 8/ 5 HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 1 2 2 3 4 4 ;. 5 6 6 . ,. 7 . c I AGREE TO CORRECT TWE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X 1st RE -INSPECTION 2nd RE -INSPECTION FINAL RE -INSPECTION EXTENSION VIOLATIONS DATE DUE: DATE DUE: GRANTED TO: DATE DUE: CITED: PERSON PERSON PERSON CONTACTED: CONTACTED: CONTACTED: INSPECTOR: 2 INSPECTOR: INSPECTOR: DATE: DATE: DATE: 3 VIOLATIONS VIOLATIONS �; PRE -CITATION CITATION ISSUED LETTER SENT NUMBER: 4 CODE - 5 2 6 2 6 DATE: SECTION: RETURN RECEIPT 3 7 3 7 RECEIVED 5 ' DISPOSITION: 4 $ 4 $ DATE: J.7 LETTER NEEDED ❑ YES ❑ NO LETTER NEEDED ❑ YES ❑ NO FIRE PREVENTION 17, y1 f ' �, INSPi6TION REPORT SNOHOMISH CO. ? Ser-vlrT& Bider', Edmonds,'and 1.:425 Meridian Ave S Motlritlake Terrace Everett, WA 98208 BRIER FIRE El Phone (425) 551-1200 ❑ MOUNTLAKE TERRACE i DISTR a ❑ UNINCORPORATED wwwFireDistrictl.org Fax SSI-1272 FREQUENCY STATION & SHIFT LOCATION: 10119 Edmonds Way 98020 Annual 20-B BuslNEss NAME: Taco Bell #20855 PHONE: 4257748309 SCHEDULECFeb 2015 DATE DUE ► MAILING UFIR ► 161 54 ADDRESS: 10119 Edmonds Way, Edmonds, WA 98020 BUSINESS OWNER: HOME PHONE: �c-lt� ►JIoE of- DIaI m-2 EMERGENCY-1: AIP Ventures HOME PHONE: 2065262710 CURRENT KEY ACCESS-2: HOME PHONE: CITY YES BUSINESS EMAIL: LICENSE PERSON CONTACTED: INITIAL INSPECTION DATE NAME OF INSPECTOR: u X70 1 I 2.z' 5 FE 3/13 HD 7/1 HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 2 2 y 3 3 i 4 4 5 5 6 6 7 7 r- I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X _w 1st RE -INSPECTION DATE DUE: , 2nd RE -INSPECTION DATE DUE: EXTENSION GRANTEDTO: INAL RE -INSPECTION DATE DUE: VIOLATIONS CITED: PERSON CONTACTED: PERSON CONTACTED: PERSON CONTACTED: I INSPECTOR: INSPECTOR: INSPECTOR: 2 DATE: DATE: DATE: 3 VIOLATIONS 1 5 VIOLATIONS 1 5 PRE -CITATION LETTER SENT CITATION ISSUED NUMBER: 4 2 t" 6 2 6 DATE: CODE SECTION: 5 3 7 3 7 RETURN RECEIPT RECEIVED s 4 8 4 8 DATE: DISPOSITION: LETTER NEEDED ❑ YES ❑ NO LETTER NEEDED ❑ YES ❑ NO 8 FIRE DEPARTMENT COPY CIN&I Sem. System Service Repon 3320 West Valley Hwy N, Suite D111, Auburn, WA 98001 Phone: 253-852-1962 Fax: 253-852-2049 Restaurant Q Industrial CUSTOMER i C bGr� INSPECTION DATE ADDRESS j �% I O II �V Off% �� /t/� CITY -) c i..', C15 STATE iv°l ZIP r� �� I g'D/^O O ANNUAL SEMI-ANNUAL CONTACT TITLE PHONE NO. MONITORED ❑ YES 0 NO MONITORED BY PHONE NO. ACCT. N0. BLDG. AUDIBLE 0 YES ❑ NO MANUFACTURER:, -,YI )�C'v% l/ l�V �'v MODEL & U COVERAGE HOOD FRYER BROILER WOK BURNER HOTTOP I GRILL QUANTITY FUSIBLE LINKS 165' 212' 280' 360' 450' 500- FIRE EXTINGUISHER ABC BC FUEL GAS SOURCE---ekELEC: QUANTITY y QUANTITY - YES NO N/A YES NO N/A 1. Cylinder Pressure Gauge or is 9. Automatic shutdown of Fuel/ weight at acceptable Level Power operated properly 2. System is free of any prior 10. Exhaust Fan operated properly ❑ [� Discharge/Damage or Tampering 3. All piping and conduit is immobilized 11. All cooking surfaces properly protected with proper hangers and brackets 4. All Nozzles are in proper position 12. Grease accumulation in hood and duct 5 �' 5. All Nozzles are covered by 13. Hood has full bank of filters (� blowoff caps 6. Date Fusible Links last changed 14. Last date Pressurized Dry Systems had Chemical Checked �L �l/0 7. System operated properly from 15. Date of last Hydrostatic Test of 26�p Terminal Link Cylinder 8. System operated properly from 16. Inspection Tag on System Manual Actuators Cylinder and remote pull OWNER WAS INFORMED ABOUT ANY DISCREPANCIES OR NEEDED REPAIRS —U-NONE- -YES-- TECHNICLU ;COTES: G APFT. TIME Ail PM TECHNICIAN LIC# CUSTOMER'S AUTHORIZED AGENT FIRE SUPPRESSION SYSTEM INSPECTION REPORT AUG 2 6 2015 FIRE DEPARTMENT COPY - WHITE: FILE COPY - YELLOW CUSTOMER COPY - PINK AUG 012014 Semi -Annual System Service Report 3320 West Valley Hwy N, Suite D111, Auburn, WA 98001 Phone: 253-852-196 2 Fax:253-852-2049 Restaurant 0 Industrial CUSTOMER p p / ✓ l INSPEC DATEr ( 1f ADDRESS (O CITY ij STATE 7IR� ( O ANNUAL (SEMI-ANNUAL CONTACT TITLE PHONE N0. 7 ( MONITORED O YES 0 MONITORED BY PHONE . ACCT. NO. BLDG. AUDIBLE 0 YES 0 MANUFACTURER ' M E . 0 COVERAGE HOOD FRYER BROILER WOK BURNER HOTTOP GRILL QUANTITY FUSIB INKS 165' 212' 280' 360' 450' 500- ORE EXTINGUISHER ABC Bc FUEL GAS SOURCE VELEC. QUANTITY I'?— QUANTITY 1. Cylinder Pressure Gauge or weight is at acceptable Level 2. System Is free of any prior Discharge/Damage or Tampering 3. All piping and conduit is immobilized with proper hangers and brackets 4. All Nozzles are in proper position 5. All Nozzles are covered by blowoff caps 6. Date Fusible Links last changed 7. System operated properly from Terminal Link YES NO N/A YES NO N/A 9. Automatic shutdown of Fuel ❑ ❑ Power operated properly 10. Exhaust Fan operated properly' ❑ 11. All cooking surfaces properly protected 12. Grease accumulation in hood and j ❑ ❑ duct � ❑ 13. Hood has full bank of filters ❑ ❑ �O 1� 14. Last date Pressurized Dry Systems had Chemical Checked 15. Date of last Hydrostatic Test of Cylinder 8. System operated properly from 16. Inspection Tag on System Manual Actuators Cylinder and remote pull OWNER WAS INFORMED ABOUT ANY DISCREPANCIES OR NEEDED REPAIRS NONE ❑ YES TECHNICIAN NOTES: �KC�V�O`..4�1 �jV�c.�57�¢�.P.,r•� APPT.TI4VIE AM PICA9 TECHNICIAN v L�� LIC f w jC CUSTOMER'S AUTHORIZED AGENT FIRE DEPARTMENT COPY - WHITE FILE COPY - YELLOW CUSTOMER COPY - PINK � i �. , { .� j 4ti�Yo )•� Pam; I� c � "z' '4°n E IJ a P mull t'I ` • A- F: `�i T !� �n.FR'j ;... ) 1 a �'"� �;e�j ly, . � � Ol, j Y f 4 ?.fi3 Central Ave. North, Kent, WA 98032 _ �e: 253-852-1962 Fax: 253-852-2049 P Restaurant 0 Industrial INSPECTION DATE MER CITY STATE ZIP :SS ❑ ANNUAL Je SEMI-ANNUAL V� CT TITLE PHONE NO ( �Z5 - -77t1' U J0� ORED 0 YES NO MONITORED BY PHONE N0. ACCT. N0. AUDIBLE 0 YES NO =ACTU ER: MODEL: COVERAGE HOOD FRYER BROILER WOK BURNER HOT TOP GRILL QUANTITY 2 C -E KS 165' 212' 280° 36V 450° 500° FlREEXTINGUISHER ABC BC FUEL SOURCE �( GAS ELEC. QUANTITY ,ITM JA YES NO N/A YES NO N/A Minder Pressure Gauge or 9. Automatic shutdown of Fuel/ Power operated properly -fight is at acceptable Level sstem is free of any prior ❑ 10. Exhaust Fan operated properly ❑ ❑ scharge/Damage or Tampering 11. All cooking surfaces properly I piping and conduit is immobilized protected ith proper hangers and brackets 12. Grease accumulation in hood and I Nozzles are in proper position duct I Nozzles are covered by 13. Hood has full bank of filters ❑ ❑ owoff caps 14. Last date Pressurized Dry ite Fusible Links last changed 2O12 Systems had Chemical Checked (stem operated properly from 15. Date of last Hydrostatic Test of Cylinder Za�� Irminal Link /stem operated properly from 16. Inspection Tag on System Cylinder and remote pull ❑ anual Actuators ❑ NONE 0 YES IER WAS INFORMED ABOUT ANY DISCREPANCIES OR NEEDED REPAIRS iNICIAN MOTES: APPT. TIME AM PM o I oD CUSTOMER'S AUTHORIZED AGENT iPJICIAN LIC x FIREE SUPPRESSION SYSTEM INSPEEC a ION REPORT FIRE DEPARTMENT COPY - kAHIT'E FILE COPY - YELLOW CUSTWER COPY - PINK G FIRE PREVENTION Serving Brier, Edmonds 12435 Meridian Ave S INSPECTION REPORT SNOHOMISH CO. Mountlake Terrace, FIRE Everett, WA 98208.. ❑ EDMONDS ❑BRIER ' ` tlie'Town of Woodway DISTR T Phone (425) SS1-1200� ❑WOODWAY AKE TERRACE, 1 ❑ www FireDistrictl.org a Fax 425 SSI -1272 UNINCOMOUNTRPORATED ❑UNINCORPORATED FREQUENCY STATION & SHIFT o LOCATION: 10119 Edmonds Way 365 20 C BUSINESS NAME: Taco Bell ##20855 4 !` PHONE: 206526271P SCHEDULED DATE DUE ► 02/01f13 MAILING 9703 3rd Ave NE #550 �� j \ UFIR ► 161 2053 ADDRESS: Seattle 93115 BUSINESS OWNER: AIIP Ventures � � �/ HOME PHONE: 2065262710 EMERGENCY-1: Holmes, Kurtiv � �� 11 �� 2067308460 , HOME PHONE: ..-; ., T ....0 . CURRENT ' KEY ACCESS-2: BC81Cfl, Rc�ylifi I� " HOME PHONE: 42524'9090 Q CITY. YES NO BUSINESS LICENSE , PERSON CONTACTED: J INITIAL INSPECTION DATE NAME OF INSPECTOR: FIRE I-ICs 9f 2 r SYSTEMS. _2 ' J - �Ni4U? HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 2 r /�}� Cif �J �L. L=/ll C�� / ( r L.l i4% 2 n J t 4 Gi�.� I �- b 4 5 .' , 5 6 1 �� 6 7 7 I AGREE TO CORRECT THE ABOVE IOLATION(S) IN THE NEXT 30 DAYS X 1st RE -INSPECTION DATE DUE: J 4-v- 11 Ild RE -INSPECTION DATE DUE: - 1 12 Q EXTENSION GRANTED TO: FINAL RE -INSPECTION DATE DUE: VIOLATIONS CITED: PERSON 'CONTACTED: PERSON CONTACTED: PERSON CONTACTED: �, 1 INSPECTOR: INSPECTOR: INSPECTOR ' 2 DATE 5. I r DATE � l� � jJ � `may G DATE: V 3 VI LATI 1 NS 5 .- 1 VIOLATIONS 5 PRE -CITATION LETTER SENT CITATIONISSUE NUMBER: 4 2 6 / 2 � 6 DATE: CODE SECTION: 3 7 / j 3 V 7 RETURN RECEIPT RECEIVED 6x 0* ' 4 -� 8 4 19 .' 8 DATE: DISPOSITION: v� 71 LETTER NEEDED ❑ YES ❑ NO LETTER NEEDED ❑ YES O FIRE DEPARTMENT COPY "I� Y�ve'. LIAR 2 2 2013 C1 el -Annual Ste Service Report MIRE . )02 Central Ave. North, Kent, WA 98032 industrial hone: 253-852-1962 Fax: 253-852-2049 ❑ Restaurant INSPECTION DATE CUSTOMER ( 3 -Detz' ADCITY STATE ZIP DRESS O ANNUAL 12-IMI-ANNUAL „ TITLE PHONE NO. CONTACT MONITORED ❑ YES 0 NO SLOG. AUDIBLE 0 YES 0 NO MANUFACTURER: MODEL' FUSIBLE LINKS QUANTITY MONITORED BY PHONE NO. ACC'T. NO. COVERAGE HOOD FRYER BROILER WOK BURNER HOT TOP GRILL I K QUANTTYFUEL ,a -GAS 165° 212° 280° 3601 450° 500° FlRE EXTINGUISHER ABC OURCE 0 ELEC. QUANTITY YES NO N/A Pressure Gauge or YES NO N/A 9. Automatic shutdown of Fuel/ r ❑ ❑ 1. Cylinder ❑ ❑ Power operated properly weight is at acceptable Level ❑ ❑ 2. System is free of any prior ❑ ❑ 10. Exhaust Fan operated properly Discharge/Damage or Tampering 11. All cooking surfaces properly ❑ ❑ 3. All piping and conduit is immobilized brackets 7°` protected with proper hangers and 12. Grease accumulation in hood and L iA/ ❑ 4. All Nozzles are in proper position ❑ ❑ duct by 13. Hood has full bank of filters ❑ ❑ 5. All Nozzles are covered ❑ ❑ blowoff caps 14. Last date Pressurized Dry i I Ch ked 6. Date Fusible Links last changed dO L aZ Systems had Chem ea ec 7. System operated properly from �/ ❑ ❑ 15. Date of last Hydrostatic Test of Terminal Link. Cylinder 8. System operated properly from ❑ ❑ 16. Inspection Tag on System ❑ Cylinder and remote pull Manual Actuators I OWNER WAS INFORMED ABOUT ANY DISCREPANCIES OR NEEDED REPAIRS TECHNICIAN NOTES: �/�� lfD t Gt/ M i 1 J TECHNICIAN LIC I J ' NONE APPT. TIME AM PM /� • a .211r< CUSTOMER'S AUTHORIZED AGENT FIRE SUPPRESSION SYSTEM INSPECTION REPORT FIRE DEPARTMENT COPY - WHITE FILE COPY - YELLOW CUSTOMER COPY - PINK ReportCINTAse., Semi -Annual 002 Central Ave. North, Kent, WA 98032 1:1 Industrial PR'�Qx,T`E'.�trT�tsOt`.M Service •62 ax:0. • 5L. Restaurant ADDRESS MONITORED O YES LOG. AUDIBLE O YES FUSIBL LINKS 165' QUANTITY 1. Cylinder Pressure Gauge or weight is at acceptable Level 2. System Is free of any prior Discharge/Damage or Tampering 3. All piping and conduit is immobilized with proper hangers and brackets 4. All Nozzles are in proper position 5. All Nozzles are covered by biowoff caps 6. Date Fusible Links last changed 7. System operated properly from Terminal Link 8. System operated properly from Manual Actuators TY STATE ZIP O ANNUAL SEMI-ANNUA TITLE PHONE NO. MONITORED BY PHONE NO. ACCT. NO. COVERAGE OOD FRYER BROILER WOK BURNER HOTTOP GRILL ` QUANTITY 2121 0° 7, 860' 450° 500, ARE EXTINGUISHER ABC BC FUEL OURCE GAS LEC. QUANTITY -YES NO- N/A YES NO N/A 9. Automatic shutdown of Fuel/ Ok ❑ ❑ ❑ Power operated property 10. Exhaust Fan operated properly 11. All cooking surfaces properly protected 12. Grease accumulation In hood and duct 13. Hood has full bank of filters ❑ 14. Last date Pressurized Dry �^ Systems had Chemical Checked 15. Date of last Hydrostatic Test of �— ❑ Cylinder 16. Inspection Tag on System OL ❑ ❑ Cylinder and remote pull OWNER WAS INFORMED ABOUT ANY DISCREPANCIES OR NEEDED REPAIRS NONE ❑YES TECHNICIAN NOTES: 0 APPT. TIME AM PM Qvz\�^` � S'-� yP CUSTOMER'SAUTHORIZED AGENT II` TECHNICIAN LIC FIRE SUPPRESSION SYSTEM INSPECTION REPORT FIRE DEPARTMENT COPY - WHITE FILE COPY - YELLOW CUSTOMER COPY - PINK ' � _.... ,- .-.,'r`"�`"E't:Y,M;,t+�,�..i!�X`�':'Z..�...:.yd R�'�"•c.N•d'ia.,. �i.t'+.:C-(n�y�a .its 1•Sti,.,1•'..._�q� i��.�p'.�Y�, .. �.,::.::,".-i. ....tia; �,. A•r: .. ',�.*..;.�'. ;,J. :r ."' 4`' h� 11 12249 8th AVE. SO. SEATTLE, WASH. 98168 PHONE (206) 241-5909 FAX (206) 241-6323 Semi -Annual System Service Report ; Restaurant ❑ Industrial CU% IN WE 40 �Z. ��U� �• �\ W �M� � gO� O ANNUAL �sEMI•ANNUAL CONTACT TITLE PHONE NO. MONITORED U YES 0 MONITORED BY PHONE NO. ACCT. NO. BLDG. AUDIBLE O YES 0 UFA RE M COVERAGE HOQD FRYER BROILER WOK BURNER HqTTOP GRILL QUANTITY FUSIBLE LINKS 165• 212• 280' 3W 4W 5W FIRE EXTINGUISHER ABC BC FUEL SOURCE O ELEC. QUANTITY - QUANTITY YES NO N/A YES NO N/A 1. Cylinder Pressure Gauge or ❑ ❑ 9. Automatic shutdown of Fuel/ ❑ ❑ weight is at acceptable Level Power operated properly 2. System is free of any prior ❑ ❑ 10. Exhaust Fan operated properly (21- ❑ ❑ Discharge/Damage or Tampering 11. All cooking surfaces properly ❑ ❑ 3. All piping and conduit is immobilized � ❑ ❑ protected with proper hangers and brackets 12. Grease accumulation In hood and L uw ❑ 4. All Nozzles are in proper position duct 5. All Nozzles are covered by ❑ ❑ 13. Hood has full bank of filters Q�' ❑ ❑ blowoff caps �� 14. Last date Pressurized Dry 6. Date Fusible Links last changed 1 Systems had Chemical Checked 7. System operated properly from ❑ ❑ 15. Date of last Hydrostatic Test of Terminal Link Cylinder B. System operated properly from ❑ ❑ 16. Inspection Tag on System ❑ Manual Actuators Cylinder and remote pull OWNER WAS INFORMED ABOUT ANY DISCREPANCIES OR NEEDED REPAIRS NONE ❑ YES TECHNICIAN NOTES: `.� �D APPT. TIME AM PM TECHNICIAN LIC It` CUSTOMER'S AUTHORIZED AGENT FIRE SUPPRESSION SYSTEM INSPECTION REPORT FIRE DEPARTMENT COPY - WHITE FILE COPY - YELLOW CUSTOMER COPY - PINK �� t a • , • o. � ti ,, .a •' ti, are3"d.`P�.��ti•`I'�r �., .A rJx;��t`. �/�c-'� t'Y"'t.'•."l„'.T �i�.:•�'�r�,S..��.>�.� .;�. �s : •;'4'•'".'a2�C'i-•�_�ro ... •...,..... Est= a9• . ;i.. ;;,' , .. .. ..V'`L„.. � 12249 8th AVE. SO. SEATTLE, WASH. 98168 PHONE (206) 241-5909 FAX (206) 241-6323 Semi -Annual System Service Report dRestaurant ❑ Industrial CUSTOMER .�^-�Ca INSPECj10N,pr►�SQ ( 1 ADDRESS \ �\\nA `\ r� q7Y\� STA ZIPry �/NUL O SEMI-ANNUAL COr�TAgT TITLE PHEBO. � (C ----I b MONITORED O YES WNO MONITORED BY PHONE N0. ACCT. NO. BLDG. AU018LE O YES rfi NO NUFACTURER: jkv- ODEL: DZ COVERAGE H D FRYER BROILER WOK BURNER HOTTOP GRILL QUANTITY FUSIBLE LINKS 165• 212• 280• 38& 450' 5W FIRE EXTINGUISHER ABC BC FUEL GAS SOURCE O ELEC. QUANTITY QUANTITY -- --- — __—..__.�.---_------ --- —YES NO --'N/A �YES ------NO-__.-N/A 1. Cylinder Pressure Gauge or a ❑ 9. Automatic shutdown of Fuel/ ❑ ❑ weight is at acceptable Level Power operated properly 2. System is free of any prior ❑ ❑ 10. Exhaust Fan operated properly] ❑ ❑ Discharge/Damage or Tampering 11. All cooking surfaces properly �'° ❑ 3. All piping and conduit is Immobilized ❑ ❑ protected with proper hangers and brackets 12. Grease accumulation in hood and ❑ 4. All Nozzles are in proper position ❑ ❑ duct 5. All Nozzles are covered by ❑ ❑ 13. Hood has full bank of filters- ❑ ❑ blowoff caps �j 14. Last date Pressurized Dry 6. Date Fusible Links last changed Systems had Chemical Checked V 7. System operated properly from Terminal Link ❑, ❑ 15. Date of last Hydrostatic Test of Cylinder 8. System operated properly from ❑ ❑ 16. Inspection Tag on System ❑ Manual Actuators Cylinder and remote pull OWNER WAS INFORMED ABOUT ANY DISCREPANCIES OR NEEDED REPAIRS NONE ❑ YES TECHNICIAN NOTES: n TECHNICIAN LIC # APPT. TIME Al PM CUSTOMER'S AUTHORIZED AGENT FIRE SUPPRESSION SYSTEM INSPECTION REPORT FIRE DEPARTMENT COPY - WHITE FILE COPY - YELLOW CUSTOMER COPY - PINK CITY OF•''EDMONDS 121 5TH AVENUE N. • EDMONDS, WASHINGTON 98020 (425) 771-0215 FIRE DEPARTMENT 0 LOCATION: 10119 Edmonds Way BUSINESS NAME: �'. Taco Bell #20555 MAILING 9703 3ed Ave NE #550 ADDRESS: Seattle 98115 FIRE PREVENTION SAFETY'SURVEY PHONE: 2065,262710 FREQUENCY STATION & SHIFT 365 20 A SCHEDULED ► 02l01110 DATE DUE UFIR ► 161 2053 BUSINESS OWNER: AIR Venture ; HOME PHONE: 2065262710 EMERGENCY-1: Holmes, I udis HOME PHONE. 2067308460 KEY ACCESS-2: HOME PHONE:6a PERSON CONTACTED: �a �. D c �t INITIAL INSPECTION DATE NAME OF INSPECTOR: 6 L /L 6/ 1 0 FIRE Ha 9/06 UL300 e3 L /i 0 FEQ LI 7 SYSTEMS: ANNUAL HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 1 t1� V`iJ'�T�d�.Y J'Vvr�(Y 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: 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 8 DATE: DISPOSITION: 6 LETTER NEEDED O YES [3NO LETTER NEEDED ❑ YES NO FIRE DEPARTMENT COPY