23401 HWY 99 (2)Jill FIRE PREVENTION
SPECTION REPORT
SNOHONIISH CO Serving Brier, EaAonds, and 12425 Meridian Ave S CIVIONDS
Mountlake Terrace Everett, WA 98208 0 BRIER
FIRE Phone (425) 551-1200 0 MOUNTLAKE TERRACE
DISTT www.FireDistrict].org Fax (425) 551-1272 0 UNINCORPORATED
" FREQUENCY I STATION& SHIFT'*'
LOCATION: 23401 Highway 99 98026 Annual 20-D
Washington Whirley Ball 4256723332 SCHEDULED May 2017
BUSINESS NAME: PHONE: DATE DUE 0
MAILING UFIR � 113
ADDRESS: 23401 Highway 99, Edmonds, WA 98026
Guenthner Debbie
BUSINESS OWNER: HOME PHONE:
4253273110 -- -------
EMERGENCY-1: HOME PHONE: CURRENT
KEY ACCESS-2: HOME PHONE: 20 YES NO
EMAIL: BUSINESS
LICENSE
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE SYSTEMS: - FE 12/15 HID 9/16
Date Last Serviced: ?4 n 11)-7
COMPLETE Certification Given: REDO YELLOWF] WHITE2�--
CONFIDENCE TESTING RANGEHOOD
SYSTEM TEST REPORT
FIRE PROTECTION
High Pressure Hood Clearing
&THood and Duct Services, Inc. Fire Suppression Installation & Service CONFIDENCE TEST El REPAIRS
Fire Extinguisher Sales & Service
6100 12th Ave. S. Phone (206) 726-0940 Range Hood and Fan Service & Repair
Seattle,WA 98108 Fax (206) 767-2607 Filter Sales & Service DATE:
Occupancy Name: UA 'rL jf:� a-V
Occupancy Address: -2:3 LfOr- J4W(e 2ff CltyState,Zip:
Responsible Person:
Building Owner:
Building Owner Address:
Testers Name (Please Print): Od
Phone Number:
Phone Number:
City, State, Zip: F
SFD Certification Number: SCP-,r/ -,c),6'9
System Alarm? Yes El No F-1 Central station monitoring? Yes E] No F� Monitoring company name:
Control Panel manufacturer: — Model Number: Location of Alarm Panel:
Extinguishing System ManufacturerA G. ). Ngb-tem Size— LI.L. 300 System? Yes[:] NoE] U.L. 300 Compliant? Yes E] No E] Chemical Type: Wet El Dry El
Location / Height of Rang
Is pressure gauge indicatc
Is there chemical inside of
Weigh CO2 or nitrogen ca
No visible signs of a systei
Check all piping and condi
proper hangers and bracki
Are all protective covers p
Are all nozzles checked in
Does system have adequ'
Are all appliances inside
Have fuse links been rel3l"
hood:
in operable range?
ie cylinder?
Yes E] No L3
YesE] No[]
idge. NA [-]
fire or system tampering (if signs check no). Yes F� No
. Are all piping and conduit immobilized with Yes F� No E]
on nozzles?
he proper position?
e volume and/or nozzle coverage?
the hood protection area?
Was system operational frll� terminal link?
Was system operational from,manual remote?
Was system and micro switch operational?
Is system visible and free from obstruction?
Is the inspection and service tag on the cylinder?
Yes E]
Noo
Yes
No
Yes
No
Yes
No
Yes
Non
Yes E]
No []
Yes n
Non
NAEJ Yes El
Non
Yes n
Non
Yes E]
No n
Problems Found: (If additional room is needed, please add a separate sheet)
12 year hydro date ofcylii er.
d
Were hand portable extin, juishers property serviced? NAM
Yes E]
No E]
Were all cooking surface,- protected? If not, give owner full
Yes [-]
No Ej
information.
Was operating procedure verbally given to restaurant personnel?
Yes F-1
No
Was UL 300 compliance explained to owner or manager?
Yes E]
No F-1
Gas shuts down upon syltem activation? NA
Yes
No [:]
Electric power shuts dowq upon system activation? NA
Yes
Noo
Range hood tied to buildilg alarm panel? NAE]
Yes F�
No[:]
Range hood activation si nal received at building alarm panel? NAR
Yes Ej
No E]
Class K extingu . tent?
Yes [:]
No E]
Grease buildup in group�.
Light — Medium— Heavy, recommend cleaning
Date of last cleaning
Are cleaning intervals within NFPA standards?
Yes []
Noo
Previous Confidence Test Company & Technician
C §tome�has declined repairs X
u , I P a
Corrections Made: Date Correc pa Corrected By: 'Ili SIFD Certification Number:
R, oaas QL-Al
r
This certifies that this fire and I safety ustem hao ��� �cted for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
oted reported to the building Owner/Responsible Person for corrective action.
standards. Discrepancies argi,
Signature of Tester, Phone # (206) 726-0940
Testing Agency--�� 400d ano Duct Services. lnc.�� MailingAddress: 6100 12th Ave. S., Seattle, WA98108
____jhe-awPeHs1Tperform and keep a written record of the following "quick check" fire system inspection to verity the following:
1 . The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight.
place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and current.
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, appropriate corrective action shall be taken immediately.
intended use. 9. A record of the mo ly insp ctions is to be kept reflecting the date inspected, inititals of
3. Insure that all tamper seals are intact and that system is in a ready condition. person performirifttinspe tion d any corrections required.
4. Observe system, checking that no obvious physical damage or condition exists
that might prevent operation. AUTHORIZED
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE
FIRE DEPARTMENT COPY
R
&THood and Duct Services, Inc.
6100 12th Ave. S. Phone (206) 726-0940
Seattle,WA 98108 Fax (206) 767-2607
Occupancy Name: Li P ry \A A(L
Occupancy Address: I-J-!Uk )66J�A k � l'i
Responsible Person: -00�1�!L
Building Owner:
COMPLETE
FIRE PROTECTION
High Pressure Hood Cleaning
Fire Suppression Installation & Service
Fire Extinguisher Sales & Service
Range Hood and Fan Service & Repair
Filter Sales & Service
Building Owner Address:
Testers Name (Please Print): �ArL
SystemAlarm? YesE] Noz Central station monitoring? YesE] NoBe
Control Panel manufacturer: Model Number -
Extinguishing System Manufacture#,Ld- IAV V-k &8'ysi6m SiZe Lkd-) U.L. 300
"I
Location / Height of Range hood: lii��
to
Is pressure gauge indicator in operable range?
inside the
Yes 2� NoEl
Yes No E]
Is there chemical of cylinder?
Weigh CO2 or nitrogen cartridge. NAA/
No visible signs of a system fire or system tampering (if signs check no).
Yes No
Check all piping and conduit. Are all piping and conduit immobilized with
Yesw NoEl
proper hangers and brackets?
Are all protective covers present on nozzles?
YesEd NoEl
Are all nozzles checked in the proper position?
Yes No
Yes No
Does system have adequate volume and/or nozzle coverage?
Are all appliances inside of the hood protection area?
fuse links been
Yes 5;�, No El
Yes NoE]
Have replaced?
Was system operational from terminal link?
from
Yes No 0
Yes Non
Was system operational manual remote?
Yes
Was system and micro switch operational? NAG/
free from
Non
Yes Non
Is system visible and obstruction?
Is the inspection and service tag on the cylinder?
Yesy Non
Corrections Made: Date Corrected:
Corrected By:
Certification Given: REDE] YELLOW[o WHITEEJ]
CONFIDENCE TESTING RANGEHOOD
SYSTEM TEST REPORT
CONFIDENCE TEST REPAIRS
17IATIFF-b / 1 ��9 (0
City, State, Zip: LAM AX JI-V
Phone Number.C�51� 'sn
Phone Number:
City, State, Zip:
SFD Certification Number: scip"'X-OM9
Monitoring company name:
Location of Alarm Panel:
System? Yes E/No E]. I.I.L. 300 Compliant? Yes E] No V Chemical Type: Wet dory El
N
12 year hydro date of cylinder.
Were hand portable extinguishers properly serviced?
NA El Yes No E5
Were all cooking surfaces protected? If not, give owner full
Yes NoE]
information.
Was operating procedure verbally given to restaurant personnel?
Yes 2� Noo
Was UL 300 compliance explained to owner or manager?
Yes �9-/ Non
NAC] Yes V NoO
Gas shuts down upon system activation? __ -- - - --
Electric power shuts down upon system activation?
NA[;�r Yes E] No
Range hood tied to building alarm panel?
NAZ Yes E] No
Fql
Range hood activation signal received at building alarm panel?
NA Yes E] NoEj
Class K extinguisher present?
Yes No
GreasetbuVop in group:
Ligh — Medium— Heavy, recommend cleaning
Date of last cleaningC&A �-- D-&CX42C
Are cleaning intervals within NFPA standards?
Previous Confidence Test Company& Technician 2�-Wm[
Yes E] No [/:J
—Lj
Customer he leehmed-repaifs
SFD Certification Number:
This certifies thav �Isfir and 11ife, has been properly inspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
_ @I
t
standards. Discrepancie and en reported to the building Owner/Responsible Person for corrective action.
., s are n@t rre 1 -0940
Signature of Tester: A. /01& Phone# (206)726
Testing Agency:. ood and Duct Services, Inc. Mailing Address: 6100 12th Ave. S., Seattle, WA 98108
1
The owner is to perform and keep a written record of the following "quick check" fire system inspection to verify the following:
1 . The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight.
place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and current.
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are f�Rnd, appropriate corrective action shall be taken immediately.
intended use. 9. A record of the monthly i s� ti is to be kep� reflecting the date inspected, inititals of
3. Insure that all tamper seals are intact and that system is in a ready condition. person performing thfi spe ion and aby corr ff tions required.
4. Observe system, checking that no obvious physical damage or condition exists
that might prevent operation. AUTHORIZED
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE ')�/ Q ),
FIRE DEPARTMENT COPY
0
FIRE PREVENTION
INSPECTION REPORT
Brier, Edmonds, and
12425 Meridian Ave S
SNOHOMISH CO.
Mountlake Terrace-
FIR
Everett, WA 98208
OEDMONDS
0 BRIER
DISTR Twww.FireDistricil.org
Phone (425) 551.4NO:
[3 MOUNTLAKE TERRACE
E3 UNINCORPORATED:
Fax (425) 551-1272
0' FREQUENCY
STATION & SHIFT
LOCATION:
23401 Highway 99 98026
A. R R '_' —A.'
BUSINESS NAME:
PHONE:
SCHEDULED
DATE DUE
Washington Whirley Ball
4256723332
KAnV9n1R
MAILING
LIFIR
ADDRESS:
113
23401 Highway 99, Edmonds, WA 98026
__j
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-11-
KEY ACCESS-2:*
HOME PHONE:
425327311
"CURRENT
CITy . - YES NO
EMAIL:
HOME PHONE:
.
BUSINESS
LICENSE
M
'ArJ
. 0
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF IN . SPECTOR:
Ll 116
FIRE SYSTEMS: FIE 12/15 HID 12/15
. #1� IPA
UatatoMcFADJAGedOCATIONS COMMUNICATIONS
1 /VO
2
2
3
3�
4
4
5
-----------
6
7
�5.
6-
7
I AGREE TO -CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
E DUE:
EXTENSION
GRANTEDfO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
VIOLATIONS
6
VIOLATIONS;�'�'
PRE -CITATION
�jENT
DATE:
CITATION ISSUED
2
6
_NUM�LR*_
CODE
SECTION:
3
7
3
7
RETURN RECEIPT
RECEIVED
4
8
4
DATE:
DISPOSITION:
7
LETTER NEEDED Iff YES 0 NO
LETTER NEEDED 0 YES [:1 NO
8
I SNOHArsa-
FIRE I
DISTIO
LOCATION:
BUSINESS NAME:
'��PAILING
A DDRESS:
BUSINESS OWNER:
Pptnonds, and
-e T -race
=Iiltlak et
ffT'w v Fi reD is t r i c t LO'N rly
23401 HighZ4y 99 98026
Washington Whirley Ball
23401 Highway 99, Edmonds, WA 98026
12425 Meridian Ave S
Everett, WA 98208
Phone (4-25) 551-1200
Fax (425) 551-1272
PHONE: 4256723332
HOME PHONE:
E M E R G E N C Y- 1 3 HOME PHONE:
KEY ACCESS-2: HOME PHONE:
EMAIL: ljfh�OWLII rll 'I
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE S'T';�tl E[VISV
t !J/14 HU V/74
FIRE PREV
,ENTION
IN"Sp CTI_05� REPORT
I'M,
0 DMONDS
0 BRIER
El MOUNTLAKE TERRACE
El UNINCORPORATED
FREQUENCY I STATION & SHIF'**'
Annual I 20-B
SCHEDULEDMay 2015
DATE DUE
113
UFIR
CURRENT
CITY YES "';L0
BUSINESS
LICENSE _a E]
INITIAL INSPECTION DATE
[ - 0'� - .7- c> % is -
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
Z-IJANEV Ldbg_25
2
2
3
3
4
4
5
5
6
6
D D L
Wo
7 �_I/'
7
1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEkT 30 DAYS X,
1st RE -INSPECTION
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE*
DATE DUE,
GRANTEDTO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
D E:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
1 5
1 5
LETTER SENT
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
RETURN RECEIPT
6
3
7
3
7
RECEIVED
DISPOSITION:
4
8
4
8
DATE:
7
LETTER NEEDED F] YES NO
LETTER NEEDED C] YES NO
8
FIRE DEPARTMENT COPY
R
&THood and Duct Services, nc.
I C
6100 12th Ave. S. Phone (206) 726-09 Z
Seattle,WA 98108 Fax (206) 767-2607
Occupancy Name: —
Occupancy Address:
Responsible Person:
Building Owner:
Certification Given: RED El YELLOW E3`*-WHITE F1
COMPLETE 11
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
SYSTEM TEST REPORT
High Pressure Hood Cleaning
Fire Suppression Installation & Service CONFIDENCE TE;6T R
Fire Extinguisher Sales & Service
Range Hood and Fan Service & Repair
Filter Sales & Service DATE:
City, State, Zip:
Phone Number:
Phone Number:
Building Owner Address: 671- q el L V- City, State, Zip:
Testers Name (Please Print): Fe, my- ah-/K SFD Certification Number: SCP-
System Alarm? Yes 7 No Central station monitoring? Yes E] No Monitoring company name:
Control Panel manufacturer: Model N ber: Location of Alarm Panel:
Avo&, Vjhj0,f-;4-0
Extinguishing System Manufacturerg(3 SystemSize.— 1-11.300�Sypttm?�Es[�t<E] I-I.L. 300 Compliant? Yes E] No [?-,`Chemical Type: Wet eDry El
Location I Height of Range hood:
Is pressur�lgauge indicator in operable range?
Yes NoO
Is there chemical inside of the cylinder?
Yes No E
Weigh CO2 or nitrogen cartridge. NA 2'�
fire Yes El" No El
No visible signs of a system or system tampering (if signs check
no).
Check all piping and conduit, Are all piping and conduit immobilized
with Yes [�r No F-1
proper hangers and brackets?
Are all protective covers present on nozzles?
Yes E!� No Ej
Are all nozzles checked in the proper position?
Yes [?' No
Does system have adequate volume and/or nozzle coveragO
Yes [2- No E]
Are all appliances inside of the hood protection area?
Yes 2' No Ej
Yes ff,11-No E]
Have fuse links been replaced?
Was system operational from terminal link?
Yes No 71
Was system operational from manual remote?
Yes No E]
Was system and micro switch operational?
NAE?'-YesR NoF�
Is system visible and free from obstruction?
Yes E--r' No[-]
Is the inspection and service tag on the cylinder?
Yes [;jr' Non
.4
12 year hydro date of cylinder. 1 116111� —
Were hand portable extinguishers properly serviced? NA Ej 4s 5?"'No Cj
Were all cooking surfaces protected? If not, give owner full Yes [?J�No El
information.
Was operating procedure verbally given to restaurant personne)? Ye S EIT- No[]
Was UL 300 compliance explained to owner or manager? YesE<Noo
Gas shuts down upon system activation? NAr] Yes [e' No Ej
Electric power shuts down upon system activation? NA [?*Yes E] No E]
Range hood tied to building alarm panel? NA Yes [] No []
Range hood activation signal received at building alarm panel? NA Yes Ej No r-j
Class K extinguisher present? Yes L— No
Grease buildu i group:
Light M edi Heavy, recommend cleaning
Date of last cleaning
Are cleaning intervals within FPA standards? Yes E] No El--*,
Previous Confidence Test Company & Technician a44ft-
Problems F :(if additional room is needed, please add a separate sheet) ty1M-*1 /I,.-
5_._ -
,7
mL 3no re,,?&, re,,s te�place— 141d�m t,
Corrections Made: Date Corrected:
Corrected By:
77 -
J.
j-
L A
. ... . .. .... .... ........... .. . ... . L- t
I A
at, J.-k ? ) coc'm&,- -A.-- Ye- Y. i:
Customer has declined repairs X
SFD Certification Number:
This certifies that this fire and lite s e tem has en pr inspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
s
t
standards. DiscrepanciesAref, yeddly ve been r ported the building Owner/Responsible Person for corrective action.
Signature of Tester: I qil if Phone# (206) 726-0940
pen—mm�
Testing Agency: R&T Hood and Du8t SerVices3ric. MailingAddress: 610012thAve.S.,Seaftle,WA98108
The owner is to perform and keep a written record of the following "quick check" fire system inspection to verify the followin
1. The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight.
place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and current. di a (te
ly
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies areAound, appropriate corrective action shall be take,/ni diately.
intended use. 9. A record of the mont�IV, inspections is to �e kept reflecting the date insp led, 'nititals of
3. Insure that all tamper seals are intact and that system is in a ready condition. person pertormin 1�,
cor� �c
4. Observe system, checking that no obvious physical damage or condition exists 761n and tions required.
that might prevent operation. AUTHORIZED , , V,
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE Alf —
FIRE DEPARTMENT COPY
FIRE,PREVENTION
INSPECTION REPORT
i�gerving Briet; Edmonds, and 12425 Meridian Ave'S
SNOHOMISH CO. []EDMONDS
Mountlake Terrace Everett, WA 98208 El BRIER
FIRE [I MOUNTLAKE TERRACE
Phone (425) 551-1200 0 UNINCORPORATED
DISTRI Q.1T wwwFireDistrictl. org Fax (425) 551-12,72
LOCATION: FREQUENCY I STATION & SHIF`*'
20401 Highway 99 98026 20-C
3
BUSINESS NAME: PHONE: SCHEDULED
Washington Wiirley Bali 4256723�32 DATE DUE 1' May 2014
MAILING LIFIR � .113
ADDRESS:
23401 Highway 99. Edmond-s, 'VVA 93026
BUSINESS OWNER: HOME PHONE:
331—
EMERGENCY-1: HOME PHONE: CURRENT
ITY YES NO
CIT
KEY ACCESS-2: HOME PHONE: Y
rBUSINESS
EMAIL: LICENSE
INITIAL INSPECTION DATE
PERSON CONTACTED: /%__1
NAME OF INSPECTOR:
FIRE SYSTEMS: FE
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
Ae 4?4�
2 5e'.1
2
3
-C' gel
3
100,
4
z-
4
5
5
6
7
6
7
1 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-INSPECfI0N
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
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
8
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED E] YES [I NO
LETTER NEEDED E] YES El NO
8
FIRE DEPARTMENT COPY
SNOHOMISH CO.
FIRE
DIST111
FIRE PREVENTION
Servi I ng Brier, Edmo�qds 12425 Meridian Ave S INSPECTION REPORT
0 EDMONDS
Moun,dake Terrace,and Everett, WA 98208 0 BRIER
the Tow'n of Woodway Phone (425) 551-1200 E]WOODWAY
[I MOUNTLAKE TERRACE
www.FireDistrictl.org Fax (425) 551-1272 0 UNINCORPORATED
LOCATION: 23401 Highway 99
BUSINESS NAME: Washington Whirley Ball
MAILING
ADDRESS: 2,1401 Highway 99
Edmonds
BUSINESS OWNER:
Washington Whifly Ball Inc
EMERGENCY-1: Rich
KEY ACCESS-2:
PERSON CONTACTED:
NAME OF INSPECTOR:
PHONE: 4256723332
98026
'HOMEPHONE: 4256723332
HOMEPHbNE: 2063549163
HOME PHONE:
FREQUENCY
STATION & SHIFT"�
365
20 B
SCHEDULED
DATE DUE 11' 05/01113
LIFIR ll� 113
5056
OCCLOAD 154
CURRENT
CITY
YES NO
BUSINESS
ff
0
LICENSE
INITIAL INSPECTION DATE
T) P
� ';
FIRE FID 3/10
FE
ANNUAL
HAZARDS FOUND'AND, LOCATIONS COMMUNICATIONS
2
2
A-\
3 A
. ......... .. ..... .........
3
4
4
5
5
6
6
7
7
1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1,st RE -INSPECTION
DATE DUE:
2nd RE-INSPEC.TION
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:
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
,4
8
4
18
DATE:
DI SPOSITION:
7
LETTER NEEDED YES
YES 0
LETTER !`�EEDED YES El NO
r
8
FIRE DEPARTMENT COPY
APPLICATION FOR PERMIT
FOR MATERIALS OR PROCESSES
January 3, 2012
Please verify and correct the following information:
Name of Company (DBA):
Washington Whirly Ball, Inc.
Edmonds Location :
23401 Highway 99
In conformity with the
terms of the International
Fire Codelapplication is
hereby made to store, use
Places of Assembly - Occupant Load: 154, Welding
or maintain the following
operation
activity, storage or pro-
cesses:
Mailing Address:
23401 Hwy 99
Edmonds, WA 98026
EFD LIFIR #:
11315405B�5
(for office use)
Your Signature
Your Name (print)
Your Title
Please make corrections, attach $40 payable to the City of Edmonds and mail to:
Fire Marshal
Department of Fire Prevention
121-5 th Avenue North
Edmonds, WA 98020
FOR OFFICE USE ONLY
Rec'd
3
Check#
T�
CITY OF EDMONDS
DEPARTMENT OF FIRE PREVENTION
I
PERMI
r
ti,LMAR 2 1 PAID
EIDMONIL','�:',
January 1, 2011 113-154-0513-056 December 31, 2011
Date of Issue UFIR Number Date of Expiration
I This PERMIT is issued to: I Washington Whirly Ball, Inc. I
I located at: 123401 Highway 99 1 Edmonds, WA
To engage in the business, occupation or process of:
And shall constitute permission to maintain, store, use or handle materials or to conduct
process which produce conditions hazardous to life or property or to install equipment used in
connection with such activities as follows:
Places of Assembly - Occupant Load: 154, Welding operation
I Allowed Occupant Load: 1 154 1
Pursuant to the provisions of the International Fire Code, any violation of the Code may be
grounds for the revocation of this PERMIT.
This permit does not take the place of any
license required by law and is not
transferable. Any change in the use or
occupancy of premises shall require a new
permit.
This Permit Must Be Posted At All Times in The Premises Identified Above J
City of Edmonds Community Development Code 19.25.020
AML
CITY OF"EDMONDS
H AVENUE N, EDMONDS, WASHINGTON 98020 - (425) 771-0215
5T
12,
FIRE DEPARTMENT
FIRE PREVENTION
SAFETY SURVEY
FREQUENCY
STATION & SHIFT
LOCATION:
23401 Highway 99
365
20 C
BUSINESS NAME:
Washington Whirley Ball
PHONE:
4256723332
SCHEDULED
DATE DUE 0-
05/01/10
MAILING
23401 Highway 99
FIR 11 113
5056
ADDRESS:
Edmonds
98026
BUSINESS OWNER:
Washington Whirly Ball Inc
HOME PHONE:
4256723332
OCC 1_0�.D 154
Za (6 .7C'l 6? 1 6,T
EMERGENCY-1:
HOME PHONE:
KEY ACCESS-2:
HOME PHONE:
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR: Aj e 5' q,� je slou-9w
FIRE HD 905 FE __� !_L
SYSTEMS: :�( / 0
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
6
ENTER CODE ONLY ONCE No
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 -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
a
DATE:
DISPOSITION:
8
� LETTER NEEDED 0 YES NO
LETTER NEEDED [] YES NO
FIRE DEPARTMENT COPY
COMPLETE
FIRE PROTECTION
R High Pressure Hood Cleaning
&THood and Duct Services, Inc. Fire Suppression Installation & Service
Fire Extinguisher Sales & Service
6100 12th Ave. S. Phone (206) 726-0940 Range Hood and Fan Service & Repair
Seattle,WA 98108 Fax (206) 767-2607 Filter Sales & Service
Occupancy Name: [$—!.I C;P�
Occupancy Address: "13
Responsible Person:
Building Owner:
Building Owner Address:
Testers Name (Please Print):
SystemAlarrn? YesE] N Central station
Control Panel man0etyre
Location / Height of Range hood:
Certification Given: REDEJ YELLO�4 WHITEEJ]
CONFIDENCE TESTING RANGEHOOD
SYSTEM TEST REPORT
I CONFIDENCE TESTV REPAIRS I I I
City, State, Zip: ly tj tdP0CL_--'
Phone Number: -7.7 _n
Phone Number: 2WA
City, State, Zip: 4
SFD Certification Number: SCP- 4r f7o? Qv
ig? Yes E] No Monitoring company name:
Ix
Number: Location of Alarm Panel:
.e-bi?A;�11. 300 System? Yes E] NoVT I.I.L. 300 Compliant? Yes E] N�/
4,
Chemical Type: W;�, Dry El
_i�diij 60F
i6dica—
t6ri ----------- --- 12 year hydro date of cylinder. "77
pressure n operable range?
Y--- No El '-_---,y s-
Is there chemical inside of the cylinder? Were hand p rtable extinguishers pr9pert erviced? NA(D Noesci�^ 0]
Wei -*No F-1
__gh CO2 or nitrogen Were all cooking surfaces protected? If not, give owner full Yesp
�n_
No visible signs of a system fire or system tampering (if signs check no). Yes[p�,-N,o i - n . f ormation.
Che-c-lk -all- piping and conduit. Are all piping and conduit immobilized with Yes ft��Noo--. __Was operating procedure verbally given to restaurant personnel? Yes. �o
proper hangers and brackets? Was UL 300 compliance explained to owner or manager? Yes NOE]
Are all protective covers present on nozzles? YesgeNoD 1 Ga's- shu_ts_d6wn_u"p__ V_w E] I
"nystem activation? NA F_j Yes N
_wtsgelmoo Electric power shuts down upon system activation? NA gg-'o Yes D NoF
Are all nozzles checked inthe proper positio ?
esm- Non-i
Does system have adequate volume and/or nozzle coverage? Yes E] No Range hood tied to building alarm panel? A
as 0 1 Range hood activation signal received at building alarm pane
Are all appliances inside of the hood protectionarea? I? NAV-Yes E] No
Have fuse links been replaced? Yes Ej?No [:1 F Class K extinguisher present?
Ly�itas system, operational from terminal link? yis�,, Non Grease buildup in group-
4
Was system operational from manual remote? Light Mediu Heavy, recommend cleaning
Noo P_
Date of last cleaninq--,-- AQ.-mapi
s El owo M
Was
systieT_qndniqrq switch operational?
Is system visible and free from obstruction? YesjK No Ej Are cleaning intervals within NFPA staiarAd.? Yes E] N o,0
--------- — ------- -------- ----- -
-46 Cj' Previous Confidence Test Company & Techniciai i
i s t the c linder? Yes
Is the n pection and service. pig on
__y
ME MMM
mom
EMU 0
Elms 01
ispeeded, please ado a
Corrections Made: Date Corrected:
sheet)
Corrected By:
SFD Certification
This certifies that this fire and life safety I st9w has been properly inspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
standards. DiscrepR . ote and hZe wwn rt d to the building Owner/Responsible Person for corrective action.
Signature of Tester. 7ryA qo%= Phone # (206) 726-0940
Testing Agency: RV Hoodhnd Duct Services, Inc. MailingAddress: 6100 12th Ave. S., Seattle, WA98108
The owner Is to perform and keep a written record of the following "quick check" fire system inspection to veft the following:
1. The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight.
place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and current.
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, appropriate corre ion shall be taken immediately.
intended use. 9. A record of the monthly inspectio ' to be cting the date inspected, inititals of
3. Insure that all tamper seals are intact and that system is in a ready condition. person performi io y r r u . ed.
4. Observe system, checking that no obvious physical damage or condition exists
that might prevent operation. AUTHORIZED
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE
FIRE DEPARTMENT COPY
The a,
Qualk
C.
EW:IMKERS PRIDE]
COUNTER TOP PIZZA OVENS
Maximum CaDacitv In Minimum SDace
Presenting space saving, huge
capacity counter top ovens. Available
in 120V, 208V, 240V and 380V units. All
models are stackable for even greater
capacity without greater space
requirements. Made with the same
quality that goes into our larger Heavy
Duty Deck Ovens.
ModelM02T
C-Mrl It
Model P-44
mom vx-iv
.Plug into easy extra prof 14
w *th Clark Bro*lers from
BROCO Products Co.
A big yield for,a small investment
7-RI3
/ rym
FOUR 'MODELS TO CHOOSE FROM
VENTS NOT REOUI.RED IN MOST AREAS.
MODEL 67-R�B With Flavor Savor Top
MODEL 63-RB With Flavor Savor Top
MODEL 67-A BROILER With Plain Top
MODEL 63-A BROILER With Plain Top
FROM SNACK SHOPS TO FULL SERVICE
RESTAURANTS . . . CLARK BROILERS CAN
PROVIDE FAST, CONSISTENT OPERATION.
MODEL 63-RB
...M
Clark Radiant Electric Broilers
i
SPECIFICATIONS
1,7 o�
33%' Tj FEATURES
0-0.
6
I MODEL 67-RB
Two warming pan wells with hinged lids. 21/2 deep
stainless steel pans, two broiling drawers, and two
warming drawers, two 1500 watt elements. Model
67-RB 220-240 volt, 13.6-12.5 amp. 208 volt, 14.4
amp. (Special Order)
- - - - - - - - - - - - �� I A% ,
- 63RB
One warming pan well with hinged lid. 21/2 deep
stainless steel pan, one broiling drawer, and one
warming drawer, one 1500 watt element. Model 63-
R13 usually supplied for 110-120 volt, 13.6-12.5 amp.
220-240 volt, 6.8-6.2 amp. 208 volt, 7.2 amp. (Special
Order)
Models 67A & 63A same but without warming wells
and pans.
Heavy gauge, mirror finish chrome
steel.
Grids and slide out grease pans
removable for easy cleaning.
Warming pans — 24 gauge stainless
steel.
Warming drawers for buns over each
broiling drawer. (All Models.)
High intensity penetrating infr.a-red
rays.
Heavy duty automatic timer, one for
each broiling drawer.
• Bell to indicate completed cook cycle.
• Red standby temperature pilot light.
Thermostats keep broiler preheated,
ready to broil when timer is set.
e Venting — not required in most areas.
SHIPPING WEIGHTS
MODEL 67-RB (DOMESTIC PACKED)
87 LBS.
MODEL 67-A (DOMESTIC PACKED)
82 LBS.
MODEL 63-RB (DOMESTIC PACKED)
52 LBS.
MODEL 63-A (DOMESTIC PACKED)
50 LBS.
CLARK BROILERS /MERCO PRODUCTS, INC. Scspe�--D
1298 BETHEL DRIVE e EUGENE, OREGON 97402 * TOLL FREE 1-800-547-2513
A DIVISION OF BROCO Products Co. * ANA= FOODSERVICE EQUIPMENT CO. V-96899 3-84
King County Executive
Rmdy ReveUe
Department of Planning and Community Development
HoHy MWer, Mwtor
FIRE PRE=ION
Phone: 344-2573
June 7, 1984
KING COUNTY FIRE PREVENTION ADVISORY
AND APPEALS BOARD
MINUTES
A regularly scheduled meeting of the Advisory and Appeals Board was
held on June 6, 1984 at 9:30 A.M. in Room 854 of the King County
Administration Building.
Members Present: Bob Hash, Larry Moore, Don Hickman, Jack Shouman,
0. J. Westerlund and Tom McDonald.'
Guests Present: Dwight Vaa Zanen, Cliff Vaniman, Jim McClean,
James Jennings, Carole Hyatt, Trent Locode, Mary
Dodd, Harold Davis, Margo Keller, Jack Ewing,
Duane Stober, Don Beeson, Jerry Fosnot and
John Clark.
Meeting called to order at 9:30 A.M.
AGENDA:
1. Election of Officers. Jack Shou-man was elected Chairman of the
Board and Don Hickman was elected Vice Chairman.
2. The Board requested the Fire Marshal's office to provide name
plates for each Board Member so the public would know who they
are talking to.
3. The Board heard a request from the developers of the Evergreen
Apartments at 11050 - 16th Avenue South, in Fire District ll,, to
accept a hammerhead turn -around in lieu of a cul-de-sac or
sprinkling the buildings as requested by the Fire Marshal.
After hearing the rationale of the Fire Marshal's office and the
.developer, the Board voted to table the item until the July 5,
1984 meeting. The Board wanted input from King County Fire
District 11 prior to making a decision. They asked the Fire
Marshal to request a representative from King County Fire
—District 11 attend the July meeting.
King County
and Appeals
June 6, 1984
Page two
Fire Prevention Advisory
Board
Meeting
4. The Board heard a request from Mr. Jim,McLean, representing
Hollowick Lamps, that a ruling by the Fire Marshal's office
be overturned and an atmospheric lamp sold by his company be
allowed in King County. The Board voted to support the request
of Mr. McLean and recommended the lamps be allowed if the
following conditions were placed on the fire permit.
A. Only Hollowick liquid paraffin. lamp fuel may be used.
B. The lamp only be used as recommended by the manufacturer
C. The flame snuffer be maintained at all times the lamp is
in use.
D. "0" rings be installed in the removable cap to the fuel
tank.
5. The Board heard a request from Jerry Fosnot, representing the
Bereaa Church at 2345 N. 185th Street in Fire District 4. The
church requested the Board overturn a Fire Marshal requirement
that an approved fixed fire' extinguishing system be installed
to protect commercial type cooking equipment. After hearing
the rationale of the Fire Marshal Office and the Church, the
Board unanimously voted to support the requirement of the Fire
Marshal. The system must be provided.
6. The Board heard a request from Carole Hyatt, representing the
Highline School District. The District requested relief from
a Fire Marshal requirement that fixed fire extinguishing systems
be installed to protect commercial cooking equipment in the
kitchens at approximately thirty-one (31) schools. Three of
these schools have production type kitchens, the remainder have
satellite kitchens. The operation of all kitchens was discussed.
The Board voted to table the item until a field trip could be
arranged so the members could inspect several of the kitchens
in operation.
7. Tne Board heard a request from Mary Dodd representing Kingston
Village in Fire District 11. Kingston Village requested relief
from a Fire Marshal requirement that a fixed fire extinguishing
system be installed to protect three (3) electric grills at
their Kimberly Hall kitchen. The Board voted to table the item
until the members had more time to research the problem.
8. The Board heard a request from John Ewing, representing Michael
Warn. Mr. Ewing requested relief from a Fire Marshal requirement
that a minimum of 1,000 g.p.m. for a duration of not less than
two (2) hours be provided to meet the fire flow requirements for
a�.701 x 1201, pole building. Mr. Ewing stated the building is a
roof only, supported by poles. There are no side*walls or
floors. Mr. Ewing felt K.C, ORD. 5828 (Water Main and Fire
Hydrants), did dot apply. The Board heard Mr. Ewings rationale
and voted to support the requirement of the Fire Marshal's Office.
Water mains and fire hydrants should be provided.
King County Fire Prevention
and Appeals Board
June 6, 1984 Meeting
Page -three
Advisory
9. The Board heard a request from John Clark, representing the
Airsport Inn at 18521 Des Moines Way South. Mr. Clark
requested relief from a Fire Marshal requirement that fixed
.fire extinguishing systems be provided for a portable electric
radiant broiler bearing the name, "Clark-BroilerV,. and a Baker's
Pride Model M02E electric counter -top pizza oven. Mr. Clark
stated he did not feel it was the intent of the code to require
such protection for these devices. He provided a large quantity
of the technical data in support of his position. The Board
voted in support of Mr.' Clark's request. Fixed-fira-protection
systemw.. are.� no V neededt. f or- either of -- these.- device&.
NOTE: At the beginning of this meeting the Fire Marshal advised the
Board there were four (4) appeals on the agenda all pertaining to
fixed fire extinguishing systems for commercial cooking equipment.
The four (4) were representative samples ranging from full production
kitchens to small portable cooking appliances. All are retroactive
applications of the code requirements. The purpose of sending these
items to the Board was to determine if the code was being applied
fairly and as intended. The Fire Marshal felt there must be a lower
level point at which it was no longer applicable. The Board agreed
there was a wide spectrum-,' and felt there should be a point estab-
lished when the code section was. no longer necessary. They agreed
to study the problem and try to develop some recommended guidelines
for the application of U.F.C. 10.315(a).
James Jennings of the Highline School District stated there is an
association of school facility people who would be willing to work
with the Board to find an acceptable solution to the problem.
Respectfully submitted,
,� - rN-,,, C�A
THOMAS W. McDONAT
LD, Secretary
Fire Marshal
TWM: sj
cc.: All Board Members
Bryan Glynn, Manager, Building and Land Development Division
Dwight Van Zanen, King County Fire District 43
Cliff Vaniman, Bothell Fire Department
King County Fire Districts 2, 4, 11J. 24 and 46
Don Hanlon.
Harold Davis
John Ewing
Jerry. Fosnot
Carole Hyatt
Gary Olson
John Clark
Don Beeson -
James Jennings, Highline School District