22618 HWY 99 STE 114 (3)FIRE PREVENTION
Serving Brier, Edmonds, and
12425 Meridian Ave S
INSPECTION REPORT
omisli Co.
Mountlake Terrace
FI
Everett, WA 98208
0 EDMONDS
0 BRIER
. . . . . . .
DIwww.FireDistrict].org
Phone (425) 551-1200
Fax 551-1272
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
(425)
22618 Highway99 Suite`11498026
FAEQUE)CY
I STJ6_t4 SHIFT
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LOCATION:
Seattle Deli
4257761778
SCHEDULED Ma
BUSINESS NAME:
PHONE:
DATE DUE 0
MAILING 22618 Highway 99, Suite 114, Edmonds, WA 98026
5 13
FIR 0
IU I
ADDRESS:
BUSINESS OWNER:
HOME PHONE:
Pham, Tim
2066835342
EMERGENCY-1:
HOME PHONE:
�RRENT
U
KEY ACCESS-2:
HOME PHONE:
YES' NO
r�B
USI NESS
EMAIL:
LICENSE
PERSON CONTACTED: 1,
INITIAL INSPECTION DATE
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NAME OF INSPECTOR:
I T—e r\ \j
Date Last Serviced
HAZARDS FOUND AND L CATIONS / COMMUNICATIONS
4
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2
2
3 .
3
4
4
5
5
6
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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 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.
Any overlooked hazards or violations of the fire regulations does not imply approval of such conditione)or(vilolatio . n.
If you require additional information or to schedule a re -inspection for Edmonds, call (425) 775-7 r
Mountlake Terrace or Brier, call (425) 744-6231.
�NOIIOMISH CO.
FIRE
DIST]
sr�llq
'FIRE P
Serving Brier, Edmonds, and 12425 Meridian Ave S INSREP--�
M�untlake Terrace Everett, WA 98208 -2WD'MONI
0 BRIER
Phone (425) 551-1200 E3 MOUNTI.
Twww.FireDistrictl.org Fax (425) 551-1272 [3 UNINCO
LOCATION: 22618 Highway99 Suite`11498026
BUSINESS NAME: Seattle Deli PHONE:
-,/4257761778
MAILING
ADDRESS: 22618 Highway 99, Suite 114, Edmonds, WA 98026
-BUSINESS OWNER: HOME PHONE:
REPORT
TERRACE
FREQUENCY STATION & SHIFT
O_E
Annual 720-B
SCHEDULED
DATE DUE � Mar 2016
UFIR � 513
EMERGENCY-1- Pham, Tim HOME PHONE: 2066835342 CURRENT
KEY ACCESS-2: HOME PHONE: PITY YES NO.
EMAIL: BUSINESS E] F]
LICENSE
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR: a:r-;, Lkk _j
FIRE SYSTEMS: FIE 4/14 HD 10/14
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HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
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4
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5
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6
6
7
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I AGREE TO.CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
I st RE -INSPECTION
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTED TO:
DATE DUE!
CITED:
PERSON
PERSON
PERSON
LO!�T�CTED:
CONTACTED:
CONTACTED:
1
INSPECTOR:
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2
DATE:
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS:�
PRE -CITATION
CifA 6N�ISSUED
5
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LETTER SENT
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-NUMBER:
CODE
5
2
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DATE:
SECTION:
RETURN RECEIPT
3
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DISPOSITION:
4
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DATE:
7
LETTER NEEDED 0 YES [I NO
LETTER NEEDED [-] YES NO
8
SNAOMIS-R'Ca.
FIRE
Serving Briet: Edinonds, and 12425 Meridian Ave S
Molintlake Terrace Everett, WA 98208
Phone (425) 551-1200
JLPJLL-"3 A JLIPJL%..o A ivu,iA�FireDistrictl.org Fax (425) 551-1272
LOCATION: 22618 Highway99 Suite'11498026
BUSINESS NAME: Seattle Deli
MAILING 22618 Highway 99, Suite 114, Ed monds, WA 98026
ADDRESS:
PHONE: 4257761778
FIRE PREVENTION
INSPECTION REPORT
XfEDMONDS
0 BRIER
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY STATION& SHIFT-**)
Annual 20-A
SCHEDULED Mar 2015
DATE DUE
UFIR � 513
BUSINESS OWNER: HOME PHONE:
Pham, Tim 2066835342
EMERGENCY-1: HOME PHONE: CURRENT YES NO
KEY ACCESS-2: HOME PHONE. CITY
BUSINESS
EMAIL: LICENSE
INITIAL INSPECTION DATE
PERSON CONTACTED: I Vk A
NAME OF INSPECTOR:
FIRE SYSTEM r �-L 4/14,f-itp-4/14
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
lstRE-INSPEr,TION
DATEDUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
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INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
00 VIOLATIONS
1 5
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PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
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6
2
6
DATE:
CODE
SECTION:
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DATE:
DISPOSITION:
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FIRE DEPARTMENT COPY
FIRE PREVENTION
Serving Briet: Edmonds, and
124-15 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.�,
FIRE.
Mountlake Terrace
Everett, WA 98208
0 EDMONDS
0 BRIER
STRT
Phone (425) 551-1200
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
m,.w.FireDistrictl.org
Fax (425) 551-1272
FREQUENCY
STATION & SHIFT
LOCATION:
226 18 Highway Of) Suite 11,1 E0026
Ailtlual
20-0
BUSINESS NAME:
ScaUlc Dcli
.177,9
PHONE: 4207f,
SCHEDULED Mar 2014
DATE DUE
MAILING
UFIR4"3
ADDRESS:
22E18 1 lighway Yj, SuRn 114, l=drTmn&,'VVA
08026
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
P�rn, lifn
HOME PHONE: 20BE335,342
CURRENT
KEY ACCESS-2:
HOME PHONE:
.CITY YES NO
EMAIL:
BUSINESS
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INITIAL INSPECTION DATE
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) INTHE NEXT 30 DAYS X
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2nd RE -INSPECTION
EXTENSION
FINA - L RE -INSPECTION
VIOLATIONS
DATE DUE:
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DATE DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
CONTACTED:
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INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS \j
VIOLATIONS
PRE -CITATION
CITATION ISSUED
4
1
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4 5
LETTER SENT
NUMBER:
2
6
2
6
DATE:
CODE
SECTION:
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RETURN RECEIPT
6
3
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3
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RECEIVED
DISPOSITION:
7
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8
4
18
DATE:
%, LETTER NEEDED [—] YES El NO
LETTER NEEDED E] YES F-1 NO
8
FIRE DEPARTMENT COPY
FIRE PREVENTION
�jjsef , 'Vil. ''Edinonds
V rier,
'12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO. '
Mountlake Terrace,and
FIRE GJIT
Everett, WA 98208
DEDMONDS
0 BRIER
the Town of Woodway
Srl":R
Phone (425) 551-1200
E]WOODWAY
[1 MOUNTLAKE TERRACE
www.FireDistrictl.org
Fax (425) 551 -1272
0 UNINCORPORATED
FREQUENCY
STATION & SHIFF`�
LOCATION: 22618 Hwy99
114
366
20 C
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BUSINESS NAME: Seaftle Deli
PHONE: 4257761778
SCHEDULED
DATE DUE 11' 03,101/13
MAILING 22618 Hwy 99 #114
LIFIR , 5-13 3106
ADDRESS: Edmonds
98026
BUSINESS OWNER: Pham, Tim
HOME PHONE: 2066835242
EMERGENCY-1 Nguyen, Dien
HOMEPHONE: 2063280106
'CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
C 61) O:H
— ) I— ��
FIRE HD 1,112
FE 11 1
SYSTEMS:
ANNUAL
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
lstRE-INSP�q!ION'
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: 5
DATE:.
DATE:
3
IOLA IONS
1 115
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
14
18
DATE,
DISPOSITION:
7
LETTER NEEDED [:] Y�S NO
LETTER NEEDED [] YES NO
8
V FIRE DEPARTMENT COPY
SNOHO
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DI
''Set-.v*iizg.Bi,i�i,;..,Ediiiotids
'Mountlake Terraceand
Tthe Town of Woodway
www.FireDistrictl.org
LOCATION: 22618 1�kw 99
BUSINESS NAME: Seattle Deli
MAILING 22618 Hwy 99 #114
ADDRESS: Edmonds
BUSINESS OWNER: Pham, Tim
EMERGENCY-1: Nguyen, Dien
KEY ACCESS-2:
PERSON CONTACTED:
I I I I
NAME OF INSPECTOR: TxI
FIRE Hood 9/d9
SYSTEMS:
ITA_
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
z
Fax (425) 551-1272
114
PHONE: 4257761778
980265
HOME PHONE: 2066835342
HOME PHONE: 2063280106
HOME PHONE:
I"
FIRE PREVENTION
INSPECTION REPORT
-EIEDMONDS
0 BRIER
E]WOODWAY
[I MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY I STATION & SHIFT�
366 20 6
SCHEDULED
DATE DUE 1' 03/01/12
LIFIR � 513 3106
CURRENT
CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
712 <a -
ANNUAL
HAZARDS FOUND AND LOCATIONS /,C OMMUNICATIONS
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:
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
8
4
8
DATE:
DISPOSITION:
\� LETTER NEEDED E] YES [I NO
LETTER NEEDED F] YES NO
1
8
FIRE DEPARTMENT COPY
Satu rday, Febru a ry 04, 2012 04; 54 P M Ed's Fire Inc. (425)4080892
P.01
ED'S FIRE INC DATE
P.O. BOX 2665 LYNNWOOD, WA. 08036 01/12/2012
TEL.1(426)877-8826* FAX;1(426)877-1997
www.edsfireinc.com * edsfireinc@yahoo.com Invoice #: 12012
End's Firat Certificate # SCP-M-07715
Inc. RANGE HOOD INSPECTION REPORT Semi -Annual Annual
CITY OF Edmonds — Confidence Test Reps�-.q
JOB Seaftle Deli Type of system: Wet Chem. Z Dry Chem.
SITE 22618 hwy 99 Suite# 114 F Amerex KP 375 - 3.75 ga
Edmonds, WA 98020
CUSTOMER PHONE 0 (425) 776-1788 RED YELLOW WHITE
CylindeVis pressure gauge oi weight is at 3cceptible level,
Yes [Z]
No E]
IVA [:]
Systein his not been flied or been t.3mpaied with.
Yes [Z]
No E]
NA E]
All piping and condWt iA immobilized wifli prolxr han&:rm a nd brackets.
Yed Z]
No
JVA [:]
All nozzles are in proper positiom
Yes Z]
No
NA E]
All noz2lei: ve covered by blow off cnpg.
Yos Z]
No E]
NA
Systein hasadequate volume irv.Vol nozzle coverige.
Yes 7]
No E]
/VA
Date of new links:
F 01 /1 2/20�12
System opeinted properly from most femote fusible link
Yes 2]
No
JVAE1
Systeinolvrated p-opeilyfiorn all inanuil ictuataii.
Yes
No
AVA
Mige hood tied to building alarm pariel. *
Yes
No
ANVA
Manualactuitors aie mobsiructed andinpath ofegresi.
Yes Z]
No
IVA E]
hispeclion and service ng oji system cylinder andlor reinote pWl stition.
Yes
No
AVA
All cooking 6uftaces are protected.
Yes
No
AYA
Date of last hychostatic test of cylinder:
N /A
Automatic Rhutdown of ftiel/powef/micro switch.
Yes
No
WA
Systein is now fidly opeiafioml wid fi-ee froin obstructions.
Yes
No
AVA
Claris K extirigiii�her in place find serviced.
Yes
No E]
AVA
All lead and wiie seils aie intact.
Yes 2]
No E]
1VA
The hood and dact are fiee from grease and sludge accwnulafion.
Yes Z]
No [:]
APA
SyAtem i;4 UL300.
Yee ZI
No E]
vA E]
Date of hst cleniiing:
N/A
Yom fire &uppi owiionoptain doo?s riot ineat mirrent UL300 totandaids and inore iinpollantly
may not exiinriisli a cooldng fire. Yon need to ieplace your fire �iiplxegsion system with D new
UL300 fated wet cliernic.-d i;yslem.
E
Froblems found.
inspection by:
Diagram
- - - - - - - - - - - - -
WOK 4 Burner Range FRM 2 Burner
- - - - - - - -
2 burm r
CITY OF EDMONDS
121 5T� AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
41 S t S 1� z
LOCATION: 22618 Hwy 99
BUSINESS NAME: Seattle Deli
MAILING 22618 Hwy 99 #114
ADDRESS: Edmonds
BUSINESS OWNER: Pham, Tim
EMERGENCY-1: Nguyen, Dien
KEY ACCESS-2:
FIREPREVENTION
SAFETY SURVEY
114
PHONE: 4257761778
98026
HOMEPHONE: 2066835342
HOMEPHONE: 2063280106
HOME PHONE:
FREQUENCY
STATION& SHIFT
366
20 A
SCHEDULED
03/01/11
DATE DUE 11�
UFIR o� 513
3106
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR: v_k_> L-cl. L9 -
FIRE Hood 9/09 F E L0 /_L0
SYSTEMS: to/%o
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
ENTER CODE ONLY ONCE 11�
VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
7
8
8
ist RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
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
VIOLATIO S
1 15
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
.8
DATE:
DISPOSITION:
7
8
�, LETTER NEEDED [] YES NO
LETTER NEEDED 0 YES NO
FIRE DEPARTMENT COPY