21108 HWY 99NN
FIRE PREVENTION
Serving Brier, E'dm'-. d 12425 Meridian Ave S INSPECTION REPORT
SNOHONIISH CO. 0 EDMONDS
Mountlake Terrace Everett, WA 98208 0 BRIER
R 0 MOUNTLAKE TERRACE
%D1 FI -S E Phone (425) 551-1200 [1 UNINCORPORATED
T T www.FireDistrictl.org Fax (425) 551-1272
e' FREQUENCY
STATION 1, SHIFT IS
LOCATION: 21108 Highway 99
98026
Annual
16-C
I
BUSINESS NAME: Kafe' Neo
PHONE:
4256723476
SCHEDULED Jul 2017
DATE DUE
MAILING
UFIR 513
ADDRESS: 21108 Highway 99, Edmonds, WA 98026
BUSINESS OWNER: Angus, Dick
HOME PHONE:
EMERGENCY-1: Huffman, Sofeea
HOME PHONE:
4257135727 "CURRENT
KEY ACCESS-2:
HOME PHONE:
16
CITY NO
BUSINESS
El
EMAIL:
LICENSE
--voLo- N I;Ek-
PERSON CONTACTED:
p% ft
I-N1T7At1hVP-RCT1Oq DTE
NAME OF 1NSPECTOFC_P1;��'VLC>*j
%
FIRE SYSTEMS: FE 4/16 HID 5/16
Date Last Serviced: �A-N--> 5;
is
Serving Brier, Edmonds, and 12425 Meridian Ave S
Mountlake Terrace Everett, WA 98208
Phone (425) 551-1200
7,T www.FireDistrictl.org_ Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
E3 BRIER
E3 MOUNTLAKE TERRACE
[3 UNINCORPORATED
FREQUENCY
STATION & SHIFF'*'
LOCATION:
.21108 Highway 99 98026
AsnHal
BUSINESS NAME:
PHONE:
SCHEDULED
Kafe'Neo
4256723476
DATE DUE
- 11119()16
MAILING
UFIR ll�
ADDRESS:
513
21108 Highway 99, Edmonds, WA 98026
BUSINESS OWNER:
HOME PHONE:
Angus, Dick
EMERGENCY-1:
HOME PHONE:,
CURRENT
KEY ACCESS-2:
Huffman, Sofeea
HOME PHONE: 4257135727
CITY �, . YES NO
EMAIL:
BUSINESS
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR: kt,1Vk 23 0 0 7Z'—
— I
7
FIRE SYSTEMS:.
FE 3/14 HD 7/15
I9aleFbagb&wvimrbCATIONS COMMUNICATIONS
4=
2
2
3
3
4
5
6
4
�5.
6
7
7
I AGREE M CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
lst RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
E DUE:
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTE
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
E:
DATE:
3
VIOLATIONS
1 5
2 6
3 7
8
VIOLATIONS'-
�1,
5
6
3 7
4
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
5
6
7
RATE:
CODE
SECTION:
RETURN RECEIPT
RECEIVED
DATE:
DISPOSITION:
LETTER NEEDED 0 YES [:1 NO
.LETTER NEEDED YES NO
ALEXANDER -30�ill FIRE EQUIRNIE.NTCO
I -i 3a Wvj 51,17,0 STREET
SEATT'__ ij'IA'),�.107
TEL 637-27310
Cr a FAX (206) 633-C'4-34
� 0,
RANGE HOOD SYSTEM
Certification Given
(One System per Report)
RED C3 YELLOW
WHITE
CONFIDENCE TEST I �(j REPAIRS I C3
Occupancy Address: �110S 't-kfrA 019
Responsible Person
First & Last Name: V-
Occupancy Name.- 14—A-Elf- P60
Phone Number: 6, 7 'a - +70
Responsible Person
Address, City, State, Zip: S4�7vx 4r;--
Responsible Partty
E-Mail Address
Date of Inspection:
Inspection <�e ��i-An�nul
Frequency/Type:
Testers Name
(Please Print): or;�—
'SFD Certification -
Number: SCP-
Identification
Number:
System Location: t3
Central station monitoring'7 Yes El No.tll'
Monitoring Ro�Lquired? Yes 0 No
Monitoring
Company Narne:
Systerh Make:
S,ystem Model: 'PCL - 3.TON/24 o
FIRE CODE DiSCREPANCIEs FoUND: (if additional room is needed, please add a separate sheet)
CORRECTIONS MADE: Date Corrected:
Corrected By:
(If additional room is needed..p!eas-� add @-s�par�te sheet) S FD' Certification Number: SCP
This certifies that this fire and life safety system has been properly inspected for reliability to cover the
items listed In this report and is consistent with Manufacture And NFPA standards, and that discrepancies
are noted and have been reported to the building Owner/Manager for c.orrec4ve action.
Signature of Tester:
Phone # f
Building Representative (signature)
Range Hood Nige lof 2
The items on (he checklists below shall be inspected and tested, This list does riot constitute all of the
required inspecting and testing of the fire and life safety system, Refer to the NFPA and manufacture
for inspecting and testing requirements,
General
1. Are all cooking surfaces protected?
2. Inspection and service tag on system cylinder?
3. System has not been fired or been tampered with?
4. All piping and conduit are immobilized with proper hangers and brackets?
5. Positioning of all nozzles. is appropriate?
6. Nozzle caps in place?
7. Fuse links replaced? 16- — ��bp (4)
8. Tested system operation from terminal link for proper operation?
9. Tested system operation with manual remote for proper operation?
10. Tested system operation and proper operation of micro switch?
11. System components visible and free from obstructions?
12. Gas shuts down upon system activation?
13. Electric power shuts down upon system activation?
14. Cylinder hydro test conducted within last 12 years?
Hydro Test date -2DI(a
15. Pressure gauge present and in operational range?
16. We.ight of CO2 or Nitrogen cartridge 2-
17. All lead and wire seals are intact?
18. Class K extinguisher in place and serviced?
19. Range hood tied to building alarm panel?
20. Range hood activation signal received at building alarm panel?
21. Is System impaired by grease? (circie) Light (jjeej�iu�Heavy
22, Cleaned By -AS,�f-
23. Date of last hood cleaning?
N/A 0
N/A 0
N/A 13
N iA LOI
N/A 0
N/A
N/A
Yes
No
Yes
No
Yes
No
Yes
T(
No 0
Yes
T(
No 0
Yes
Tf
No 13
Yes
No C3
Yes
No L-3
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
12
No
Yes
i�u
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
N o
Range, Hood Page 2of 2
FIRE PREVENTION
Serving Briet: Edinonds, and
12425 Meridian Ave S
INSPECTION REPORT
SNOH0WT?37MO.
MEDMONDS
Mountlake Terrace
FIRE
Everett, WA 98208
El BRIER
I I
DIST—kr-T
Phone (425) 551-1200
0 MOUNTLAKE TERRACE
(3 UNINCORPORATED
www.FireDisirictl.org
Fax (425) 551-1272
" FREQUENCY
STATION 1, SHIF"*'
LOCATION: 21108 Highway 99 98026
Annual
16-A
I
BUSINESS NAME: Kafe' Neo.
PHONE: 4256723476
SCHEDULECLjul 2015
DATE DUE
MAILING
UFIR 1,513
ADDRESS: 21108 Highway 99, Edmonds, WA 98026
BUSINESS OWNER: Angus, Dick
HOME PHONE:
EMERGENCY-1: Huffman, Sofeea
HOME PHONE: 4257135727
CURRENT
KEY ACCESS-2:
EMAIL:
HOME PHONE:
CITY
BUSINESS
YES NO
LICENSE
PERSON CONTACTED:
INITIAL INS7CTI� DATE
NAME OF INSPECTOR:
FIRF ';Y.I;TFM.';- PF= '111A Hn 9/1A
'0606R F ATIONS / COMMUNICATIONS
S� AND h8c
a `t!eD rVICe
X
2
g L1166- h�e cl- gee-7- TvrIZ7"
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 '71'1
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTE*'��
PERSON
CONTACTED:
PERSON
CONTACTED:
I
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
vio
1 I.,knONS
VIOLATIONS
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
2
13
2
6
DATE:
CODE
SECTION:
5
3
7
RETURN RECEIPT
RECEIVED
6
8
4
43--Z
4
8
DATE:
DISPOSITION:
LETTER NEED D F] YES NO
LETTER NEEDED F] YES NO
FIRE DEPARTMENT COPY
08/22/2015 03:54 FAX
[a 001
RANGEHOOD CONFIDENCE TEST
CUSTOMER:
INSPECTION DATE:
KAFE NEO EDMONDS LLC
7-22-15
ADDRESS;
CITY;
STATE:
ZIP:
21108 HWY 09
EDMONDS
WA
98026
CONTACT:
TITLE:
PHONE;
ANNA
OWNER
(425) 672 3476
MAKE OF SYSTEM:
MODEL,.
CYLINDER SIZE:
KYORO DATE,
PYROCHEM
PCL 250/PCL 350
2.6 GALLON13.6 GALLON
2001
System 1
1 . Appliances properly covered with correct nozzles---- yes-no-rda
2. Duct and Plenum covered with correct nozzles--- yes--n2-n/a
3. Nozzles positioned as per MFG and UL lisfings---- y@5-n2-n/a
4. Hood/Duct penetrations sealed with weld/UL device---- Xn-no-n/a
5. Distribution piping secure w/ proper brackets/hangers— yM-no-nta
6. Pressure Gauge in proper range Xn-no-n/a
7, Cartridge weight within proper range— yes-no-E&
8. System operates properly from terminal link-------- M-no-n/a
9. System operates propedy from manual actuators--- XR-no-n/a
10. Electrical appliances shut down properly- yes-no-n/a
11, Gas shut off valve operates properly yjM-no-n/a
12. Proper nozzle covers in place---- M-no-n/a
13. Proper separation between fryers and flame--- yll-no-n/a
14. Are MFG listed parts being used-- yn-no-n/a
15. New fusible links installed this inspection- yes-ng-n/a
16, All hood fifters installed properly------------- Xft-no-n/a
17. Hood, Exhaust, Duct & Filters Clean yM-no-n/a
1 B. Inspection tag on system cylinder and remote pull— yM-no-n/a
M-no-n/a
2WApproved "K" type portable fire extinguisher within 30-���
21. SYSTEM MEETS UL-300 REQUIREMENTS---- yes-lq-n/a
22,Fusible Links Installed this Inspection Temp 450
COMPANY:
FIRE PROTECTION SERVICES Inc
TECHNICIAN: Chad Chernoff
Seattle Fire Department Certification SCPC-006573
g"
Signature of Technician
THIS CERTIFIES THAT THE ABOVE EQUIPMENT WAS
INSPECTED AND LEFT IN CONDITION IN
ACCORDANCE WITH THE NFPA AND ORIGINAL
MANUFACTURER'S PROCEDURES. IfOWEVER, ANY
DEFICIENCIES MUST BE ADDRESSED AS SOON AS
POSS113LE FOR TOTAL FIRE PROTECTION
System 2
System 3
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n1a
yes-no-nia
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n1a
yes-no-n/a
yes-no-n/a
yes-no-n/a
ye�-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n1a
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n/a
yes-no-n/a
Temp_
Temp_
PO Box 7573, Covington, Wa 98042
19015 2401h Av SE, Maple Valley, Wa 98038
Office 425 413 2648 0 253 872 7727
Fax 425 413 2649
email admin@acce5gfirAprgjqQt0pn.cgM
website www.accessfireprotection.com
CUSTOMER INFORMED OF DISCREPANCIES:
E YES NO []NONE
by report
Date of inspection 7-22-15_
COMMENTS: This system has old and new nozzles mixed which is against code. It also has been due
for a 12 yr hydro test on one of the suppression tanks since 2013. We are recoMmending replacement of the
system as obviously it has been tampered with and not properly maintained. It is an older system and we cannot
ceTtify that it will perform correctly. Whoever has been maintaining this system as it stands is not following
code.
FIRE PREVENTION
ServingBrier, Edmonds, and
12425Meridian Ave.s..
INSPECTION REPORT
SNOHOMISH CO.
El EDMONDS
FIRE
Mountlake Terrace
Everett, WA 98208
0 BRIER
*�Swol
Phone (425) 551-1200
0 MOUNTLAKE TERRACE
DISTR40
IT www FireDistrict]. org
Fax (425) 551-1272
[1 UNINCORPORATED
FREQUENCY
& SHIFT
LOCATION:
21108 HiqhAk-2v IM W026
Annual
7STATION
16-D
BUSINESS NAME:
Kale' Nca
PHONE: 420SL722,47f
SCHEDULED
DATE DUE 1' Jul 2014
MAILING
LIFIR 0
ADDRESS:
21108 1 fighway 90, F-dmari&i. WA 08026
BUSINESS OWNER:
HOME PHONE-
EMERGENCY-1:
I luffman, Sarcca
HOME PHONE: 4267136727
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
EMAIL:
LICENSE
PERSON CONTACTED:
(z
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
DC) W Ll /v 0�� OL
Ir- I H�_- SYS I I= MS:
FE 12112 HD 121
Lq
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
1
z
1
2 V) 0
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
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED: -
1
.INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
E:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER! SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
8
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED E] YES El NO
LETTER NEEDED [:) YES C3 NO
8
FIRE DEPARTMENT COPY
1�
SNOHO
Fl
Serving �?rier Edmonds
U 0 '�ntlak�'!'ei;-�ce, and
- Tthe Town of Woodway
. www.FireDistrictl.org
FIRE PREVENTION
12425 Meridian Ave S ...
INSPECTION REPORT
0 EDMONDS
0 BRIER
Phone (425) 551-1200
E]WOODWAY
[I MOUNTLAKE TERRACE
Fax (425) 551-1272
0 UNINCORPORATED
I` FREQUENCY
STATION& SHIFT_�
LOCATION:
21108 Highway 99
365
16
I
C
BUSINESS NAME:
Kafe'Neo
PHONE:
4256723476
SCHEDULED
DATE DUE 07101/13
MAILING
21108 Highway 99
LIFIR � 513 7207
ADDRESS:
Edmonds
98026
BUSINESS OWNER:
Huffman, Sofeea
HOME PHONE: 4257135727 ACTIVE
EMERGENCY-1-.
Krantz, Anna
HOME PHONE: 4253380797
'CURRENT YES
NO
KEY ACCESS-2:
HOME PHONE:
CITY
BUSINESS —1
F
El
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
-7 )3
NAME OF INSPECTOR:
FIRE HD 5/12
FE 12 1)Z
SYSTEMS:
11- 1?--
ANNUAL
HAZA DS F LIND AND L A IONS / COMMUNICATIONS
1 rdi,�,S=e acce-S!S A'6
2 e ()CA
c rc,\ e- V-% C LA
WC-L t- L— t 46,1-y� )000<
2
fY5
3
3
4
4
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1 st 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:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE: 21-3
DATE:
DATE:
3
LATIONS
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:
7
��ER NEEDED
LETTER NEEDED YES NO
8
FIRE DEPARTMENT COPY
Serving Briet; Edmonds
Mountlake Terraceand
the Town of Woodway
www. FireDistrict]. org
LOCATION: 21108 Highway 99
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
E]WOODWAY
0 MOUNTLAKE TERRACE
[I UNINCORPORATED
UENCY I STA17j_0N&_S_HIF_T"\
i5 16 6 1
BUSINESS NAME: Kafe'Neo PHONE: 4256723476 SCHEDULED (37,101112
DATE DUE
MAILING 21108 Highway 99 LIFIR 0 513 7207
ADDRESS: Edmonds 98026
BUS,I.NESS OWNER: Huffman, Sofeea HOME PHONE: 42-5.7-7-1-7563- ACTIVE
EMERGENCY-1: Arngu"iek- HOME PHONE: CURRENT
KEY ACCESS-2: HOME PHONE: CITY YES NO
BUSINESS
LICENSE El
PERSON CONTACTED: Y2 Lfr_ INITIAL INSPECTION DATE
-NAMJE OF INSPECTOR: c- -5 / /
FIRE HD 5/f2 FE 57 1 1
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
NY
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
D E 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
RECbVED
6
4
8
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED [] YES NO
LETTER NEEDED C] YES NO
8
FIRE DEPARTMENT COPY
Range Hood Systems Report
ZZAP
PE'l 0
A
FIRE CONTRO
877-866-3473 Phone 1 877-841-9293 Fax
PO Box 11369
Olympia, WA 98508
CUSTOMER
Name fNat e_ in eo
Address 2 110 OJ6 i,)ji 9 9
city C�VTVJS State GkA, ZIP
Telephone -7b-7a-,3('t-XStore No.
Owner or manager -&�/4 4-an/4 z,
COOKING APPLIANCE LOCATIONS. LEFT TO RIGHT
DATE OF
TIME
&M.
P.M.
X
I
ANNUAL Sail NUAL 1
7
RECHARGE
IIISTALLATION
RENOVATION
LOCATION OF SYSTEM CYLINDERS
UL3W
[:]YFS []NO
MANUFACTURER
MODCLNUMDER
WET
DRY C1 F-MICAL
&-rb Aem
?(A --�qo
I
CYCINDER SIZE MASTER
CYLINDER SIZE SLAVE
CYLINDER SIZE SLAVE
3 Sq�-)
I ;� - t 1. 01 ". (
I
FUSE LINKS 360q.
FUSC LINKS 4SD-
FUSE LINKS 5ffi- F.
OTHER
FUELSHUTCIFF
ELECTRIC
GAS
SIZE
X
X
X
SLWALNUM13ER
LAST 11YDROIESTUAIL
LAST RECHARGE DATE
1 9,cy--) �, I
MANVIPACTURER'S MANUAL PREFERENCE
RkGE NUMBER: DRAWING NUMUER;
DATE
11, All appliances property covered w/correct nozzles
2. Duct and plenum covered w/correct nozzles
3. Check positioning of all nozzles
4. System L installed in accordance w/MFG UL listing
5. Hood/duct penetrations sealed w/weld or UL device
6. Check if seals intact, evidence of tampering
7. If system has been discharged, report same
8. Pressure gauge in proper range (if gauged)
9, Check cartirdge weight (if applicable)
10. Hydrostafic test date
11. 6 year maintenace date
12. Inspect cylinder and mount
13. Operate system from terminal link
14. Test for proper operation from remote
15. Check operation of micro switch
16. Check operation of gas valve
17. Clean nozzles
18. Proper nozzle covers in place
19. Check fuse links and clean
COMMENTS:
20. Replaced fuse links
21. Check travel of cable nuts/G-hooks
22. Piping & conduit securely bracketed
Y
23. Proper separation between fryers & flane
24. Proper clearance - flame to filters
25. Exhaust fan in operating order
26. All filters In place
27. Fuel shut-off In on position
28. Manual & remote settseals in place
29. Replace systems covers
30. System operational & seals in place
X
31. Slave system operational
32. Clean cylinder & mount
33. Fan warning sign an hood
34. Personnel instructed in' manual operation of system
35. Proper hand portable extinguishers
36. Portable extinguishers properly serviced
X
37. Service & Certification tag on system
-1-
NOTE DISCREPANICES OR DEFICIENCIES BELOW
X
On this dale, this range hood fire suppression system was inspected and operationally t
suppression system requirements of NFPA17 or 17A, 96 and the manufacturer's manua
ce with the fire
indicated above.
X&Acl i4xv 11--00 X
SERVICE TECHNICIAN PERMIT NO. DATE: TIME: AM PM MER'S)NUTHORIZED AGENT
The above service technician certifies that the system was personally inspected and found condiflom; t he as indicated on this report.
WHITE - CUSTOMER COPY I CANARY - DISTRIBUTOR I PINK - AUTHORITY HAVING JURISDICTION
FIRE PREVENTION
Serving Brier, Edmonds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
Mountlake Terraceand
FIR ,
Everett, WA 98208
0 EDMONDS
0 BRIER
*0
4 the Town of Woodway
DISTR T
Phone (425) 551-1200
0 WOODWAY
0 MOUNTLAKE TERRACE
www.FireDistrict].org
Fax (425) 551-1272
0 UNINCORPORATED
FREQUENCY
STATION & SHIF')
LOCATION: 21108 Highway 99
365
16 A
I
BUSINESS NAME: Kafe! Neo
PHONE: 4256723476
SCHEDULED
DATE DUE 1` 07/01/11
MAILING 21108 Highway 99
LIFIR 0 513 5917207
ADDRESS: Edmonds
98026
BUSINESS OWNER: Huffman, Sofeea
HOME PHONE: 4257717563
ACTIVE
EMERGENCY-1: Angus, Dick
HOME PHONE: 4257752307
CURRENT
KEY ACCESS-2:
HOME PHONE: 4253468814
CITY YES NO
BUSINESS El 1:1
LICENSE
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PERSON CONTACTED: A M C/O JQ+D
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE HD 7/06 UL 300
FE!LIA
SYSTEMS: 5/1
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNZION,,S
C_
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1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
In our continuning 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 standrads 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 or the Town of Woodway, call
(425) 775-7720; for Mountlake Terrace or Brier, call (425) 754-0434.
BUSINESS COPY
CITY OF EDMONDS
121 5� AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
LOCATION: 21 108 Highway 99
BUSINESS NAME:-., Kafe' Neo
MAILING 21108 Highway 99
FIRE PREVENTION
SAFETY SURVEY
PHONE: 4256723476
ADDRESS: Edmonds 98026
BUSINESS OWNER: Huffman, Sofeea HOMEPHONE: 4257717563
4257752307
EMERGENCY- 1: Angus, Dick. HOME PHONE:
KEY ACCESS-2: HOME PHONE:
FREOUENCY
STATION& SHIFT
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SCHEDULED
DATE DUE 0'
07/01/10
UFIR 0 513
7207
AC-nVE
e INITIA INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE HD 7iO6 UL 300
SYST E M S:
FE I
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
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lst RE -INSPECTION
DATE DUE:
2nd RE-INSPECT16N
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\1 LETTER NEEDED 0 YES [3 NO
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FIRE DEPARTMENT COPY