23725 HWY 99 (3)SNOHOMISH CO,
FIRE
FIRE PREVENTION
INSPECTION REPORT
94ving Brier, Edmonds, and 12425 Meridian Ave S
Mountlake Te)-:race Everett, WA 98208 0 EDMONDS
0 BRIER
Phone (425) 551-1�00 OMOUNTLAKE TERRACE
Twww.FireDistrictl.org Fax (425) 551-1272 [3 UNINCORPORATED
STATION & SHIFT
LOCATION:
23725 Highway 99 98026
Amm
2 A- G
BUSINESS NAME:
PHONE:
SCHEDULED
Family Pancake House #5
4257756300
DATE DUE
MAILING
LIFIR II,
ADDRESS:
161
23725 Highway 99, Edmonds, WA 98026
BUSINESS OWNER:
HOME PHONE:
.
Mathwi g, R.
EMERGENCY- 1
.
HOME PHONE:
'CURRENT
KEY ACCESS-2:
Bhm Corp
HOME PHONE: 360 . 4794137
CITY
YES NO
EMAIL:
BUSINESS
2/
Ej
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE SYSTEMS: FE2/115 HDUL3002/15
UalakastcbwmadocATIONS COMMUNICATIONS
_E_
2
3
3.
4
4
5
5
6
6
7
.. ... .. ...
7
I AGREE To-cbRRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS k 7001U_22��
1stRE-INSPECTION
2nd RE -INS PECTION
EXTENSION
FINAL RE-INSPEC-0
T
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
CONTACTE
PERSON
C
PERSON
CONTACTED:
2
3
INSPECTOR:
INSPECTOR:
DATE:
DATE:-.—.-
_1��SP�CTOR
DATE:
NS
VIOLATIONS;-
PRE -CITATION
CITA`nON ISSUED
1 q6 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
18
DATE:
7
LETTER NEEDED [] YES NO
N.
LETTERNEEDED [] YES NO'
I
I t
77 `�-",71
-X1
SNOII&IS4 jo Serving Brier, Edmonds, and
Mountlake Terrace
FIRJVJ'
DISTRTwww.FireDistrictl. org
LOCATION: 23725 Highway 99 98026
BUSINESS NAME: Family Pancake House #5
MAILING
ADDRESS: 23725 Highway 99, Edmonds, WA 98026
BUSINESS OWNER: Mathwig, R.
EMERGENCY-1: Bhm Corp
KEY ACCESS-2:
EMAIL:
PERSON CONTACTE
NAME OF INSPECTOR
E SYSTEMS: FE10/15 HDUL3004/16
FIRE PREVENTION
12425 Meridian Ave S INSPECTION REPORT
W"OEDMONDS
Everett, WA 98208 0 BRIER
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
[I UNINCORPORATED
Fax (425) 551-1272
4257756300
PHONE:
HOME PHONE:
HOME PHONE. 3604794137
* 20
HOME PHONE:
e' FREQUENCY I STATION 1, SHIFT
Annual 20-D
SCHEDULED Jul 2017
DATE DUE �
161
UFIR
(I __j
CURRENT
Y S NO
CITY '96 El
BUSINESS
LICENSE
INITIAL INSPECTION DATE
-�-10— 1-�
12425 Meridian Ave S
and
SNOHOMISH C6.
M6'fintlake Teuace Everett, WA 98208
FIRE'-— I Phone (42�) 551-1200
DISTR T WU7"�'FireDis'trictl. org -fay (425) 551-1272
LOCATION: 23725 Hiqh,.-jay ED 98026
BUSINE�S NAME: 1-aa�ly Paricakc I lm&c-46 PHONE: 4257755E301
MAILING
ADDRESS: 2a726 I lighway 00, EcItymn&, %JO, bg{)2f,
FIRE P REVENTION
INSPECTION REPORT
TgEDMONDS 1�
tl BRIER
0 MOUNTLAKE TERRACE
[I UNINCORPORATED
FREQUENCY STATION &SHIFT
Annual 20-A
SCHEDULED
DATE DUE 0 J L11 2014
UFIR II,
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
Bhm Corp
"_7 CURRENT
HOME PHONE: 3L,147-0413
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
EMAIL:
BUSINESS
F]
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
I -IRE SYS ILMS:
FE311.3 HDUL30fi.3113
1-71" r -
211214-
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
2
2
3 41
3
///"
4
4
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
lst RE -INSPECTION
DATE DUe--
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
D E:
DATE:
3
VIOLATIONS
5
VIOLATIONS
1
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:
%, LETTER NEEDED E] YES F-1 NO
I LETTER NEEDED [] YES EE11 NO
I
1
8
FIRE DEPARTMENT COPY
FIRE PREVENTION
ng� -ierl
Ser�V4' ' :Pi ,'Edmonds
12425 Meridian Ave S
INSPECTION REPORT
�NIOHOMISH CO. Mountlake Terraceand
FIRE
Everett, WA 98208
OEDMONDS
0 BRIER
the Town of Woodway
ST T
Phone (425) 551-1200
E]WOODWAY
[I MOUNTLAKE TERRACE
www."FireDistrict].org
Fax (425) 551-1272
0 UNINCORPORATED
FREQUENCY
STATION & SHIFF'�
LOCATION: 23725 Highway 99
365
20 D
I
BUSINESS NAME:
Family Pancake House #5
PHONE:
4257756300
SCHEDULED
DATE DUE � 07/01/13
MAILING 23725 Highway 99
LIFIR � 161 7006
ADDRESS:
Edmonds
98026
BUSINESS OWNER: 13hm Corp
HOME PHONE: 3604794137
AC-nVE 142
EMERGENCY-1: "Miathwig, R."
HOME PHONE: 36073-13010
"CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
- /-5
FIRE HD.3110 UL300
F E -3
SYSTEMS: :?/y-Z
./L3
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
,41�
W &== �^e Qzzd J044�1
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
l 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:
1
r,
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
IOLATIONS
1 15
VIOLATIONS
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
4
8
DATE:
DISPOSITION:
LETTER NEEDED 0 YES N�
LETTER NEEDED C] YES ED NO
8
FIRE DEPARTMENT COPY
Serving Briei: Edinonds
SNOHOMISH CO.
FIRE
_V ' Moufitlbke'Teii-a�e, and
DISTIR'
the Town of Woodway
www.FireDistrictl.org
LOCATION:
23725 Highway 99
BUPINESS NAME:
Family Pancake House #5
Irl 1� MAILING
23725 Highway 99
ADDRESS:
Edmonds
BUSINESS OWNER:
Shm Corp
EMERGENCY-1:
"Mathwig, R.'
KEY ACCESS-2:
I
12425 Meridian Ave S
E�e'r�ti, WA 98208
Phone (425) 551-1200
Tax (425) 551-1272
PHONE: 4257756300
98026
HOMEPHONE: 3604794137
HOMEPHONE: 3PO7313010
HOME PHONE:
FIRE PREVENTIOW
IN - SPECTION REPORT'�
0 EDMONDS
0 BRIER
0 woobWAY
[I MOUNTLAKE TERRACE
0 UNINCORPORATED
e FREQUENCY STAT�W4 &61111`f'�
3155 1
SCHEDULED 07/01/12
DATE DUE �
UFIR � 161 7006
ACTIVE 142
CURRENT
CITY YES NO
BUSINESS
LICENSE El 1:1
r PERSON CON I : I - I INITIAL INSPECTION DATE
X_414d�'W Z zy'f e
NAME OF INSITAC !R": Ak5. 1
FIRE HD 3/10 UL300 FE C/ ' 1 12-
SYSTEIAS: q- �L_ AN�UAL
HAZARDS FOUND AND LOCATIONS OMMUNICATIO
CZ
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
DATE DUE;
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATION . S
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
I
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
D E:
DATE:
3
VIOLATIONS
1 15
VIOLATIONS
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
8
4 18
DATE:
DISPOSITION:
7
LETTER NEEDED F] YES NO
-
LETTERNEEDED [] YES NO
8
FIRE DEPARTMENT COPY
FEB 0 8 2012
APPLICATION FOR PERMIT
FOR MATERIALS OR PROCESSES
January 3, 2012
Please verify and correct the following information:
Name of Company (DBA):
Family Pancake House
Edmonds Location :
23725 Highway 99
In conformity with the
terms -of the',I nternational
Fire Code, application is
hereby made to store, use
Places of Assembly - Occupant Load: 142
or maintain the following
activity, storage or pro-
cesses:
Mailing Address:
6Xc-w&)L-mk) 109 OLDING RD STI
BREMERTON WA S
EFD UFIR #:
(for office use)
16114206136
Your Signature
Ll
Your Name (print)
/0 A 'S"
Your Title
e7L
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
2, / ('D
Check#
11366
I Is 6- 4 1-5
'200
1312-1806
APPLICATION FOR PERMIT
FOR MATERIALS OR PROCESSES
March 7, 2011
Please verify and correct the following information:
REUD MAR 2 4 2011
D ECENE"I
PAID
EDMONDS FIRE DEPT.
Name of Company; DBA
Family Pancake Wetrs-e-#5-dr-
Edmonds Location
23725 Highway 99
In conformity with the terms of
Places of Assembly - Occupant Load: 142
the International Fire Code,
application is hereby made to
store, use or maintain the
following activity, storage or
processes:
Mailing Address:
BHM-GGfl3-- #--1 Co P-P
3344-Mtsap,VhT,-*D
ioct oLoij�axKcOrAO
9feniefien-YV*-98+1-2
j3 P-&*AC7k--t0 A) (A)A. q5k sta,
EFID LIFIR #:
16114206BOO6
(for office use)
Your Signature
Your Name (prirw-,-"'
F
Your Title
�Q T
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
il
12
CITY OF EDMONDS
DEPARTMENT OF FIRE PREVENTION
IJAN
January 1, 2011 161-142-0613-006 December 31, 2011
Date of Issue UFIR Number Date of Expiration
I This PERMIT is issued to: I Family Pancake House #5 1
located at: 123725 Highway 99 Edmonds, WA
To engage in the business, occupation or pr cess 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: 142
Allowed Occupant Load: 14
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
City of Edmonds Community Development Code 19.25.020
FIRE PREVENTION
11, 1:1ser v I !F�dt#londs
HOMISH CO. .. '. � ; I. �, � % .. .4
1,242'5-Meridian Ave S
. &
' INSPECTION REPORT
,
Mountlake Terraceand
FIRE
. I .. . .
Everett, WA 98208
. OEDMONDS
El BRIER
the Town of Woodway
STR T
Phone (425) 551-1200
E]WOODWAY
[3 MOUNTLAKE TERRACE
www.FireDistrictl.org-
Fax (425) 551-1272
0 UNINCORPORATED
FREQUENCY
STATION & SHIFT�
LOCATION: 23725 Highway 99
365
20 B
BUSINESS NAME
: Family Pancalce House #5
PHONE: 42577 56300
SCHEDULED
DATE DUE 1 07/01/11
MAILING 23725 Highway 99
UFIR � 161 7006
ADDRESS:
Edmonds
98026
BUSINESS OWNER:
Bhm Corp
HOME PHONE: 3604794137 V1
, /ACTAVE 142
Z-11
EMERGENCY-1: "Mathwig, R."
HOMEPHONE: 3607313010 '-,'
CURRENT
KEY ACCESS-2:
HOME -PHONE:
CITY NO
BUSINESS
LICENSE
PERSON CONTACTED: PA
INITIAL INSPECTION DATE
NAME OF INSPECTOR: �LAD L,,�7, &
FIRE HD 3/10 UL300
FE 0.4 %1
SYSTEMS: 1
ANNUAL
HAZARDS FOUND AND LOd'ATIbNT/ 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
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:
TE:
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
18
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED [] YES NO
LETTER NEEDED [] YES El NO
8
"' I
FIRE DEPARTMENT COPY jq
CITY OF* EDMONDS
121 5� AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
4�' t
LOCATION: 23725 Highway 99
BUSINESS NAME: Family Pancake House #5
MAILING 23725 Highway 99
FIRE PREVENTION
SAFETY SURVEY
FREQUENCY � STATION 1, SHIFT--"
20 A
SCHEDULED
DATE DUE 0 07/01/10
UFIR 0 161 7006
Auurtrzoo: F=d Andc- Qqn,2r,
S(.0
BUSINESS OWNER: Bhm Corp HOME PHONE: 20T4794137
EMERGENCY-1: 'Mathwig, R." HOME PHONE- -'W'Er69e42(l'3"
*
KEY ACCESS-2: HOME PHONE:
PHONE: 4257756300
ACTIVE 142
PERSON CONTACTED: Ut-11DIDTP-0m 'FAr1 I INITIAL INSPECTION DATE
NAME OF INSPECTOR:7 YW v-\ 4 kc
FIRE HD 9/05 UL300 FE \01
SYSTEMS: :5/ka
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
F-LzC
ENTER CODE ONLY ONCE 11�
,
VIOLATION CODE
UOM-IT-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
C NTACTED:
PERSON
CONTACTED:
1
L
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE
DATE,
DATE,
3
OL IONS
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
18
DATE:
DISPOSITION:
8
\UETTER NEEDED [] YES NO
LETTER NEEDED [] YES NO
FIRE DEPARTMENT COPY
OA-
4-
"1_' Cr) %T
'ro
-Lmml--I)OV3 '7� /V
J.4
2.—
tA.
Mi
AJ I-V I-
�\V/ 7
x
TO
00
LA
"cl
o
V 56 co
0,
:7-
tD
ui
Ln Ln Cf)
If
a)
' wl
o p v " (-�L
0 z'),ttn-V;9-1v
LA�t bt fj'
pL &-f1w
I
NOTIC
TO PERMITTEE AND/OR OWNER
DO NOT REMOVE
Ej PARTIAL APPROVALX CORRECTON REQUIRED El ENFORCEMENT VIOLATION
Owner tOAAlk-Ak-f Permit Number 900
Job Address9 3 -7 2--s' Htt-j c7q Site Contact_
9
Ll WORK DESCRIBED BELOW HAS BEEN INSPECTED AND IS APPROVED
LJ APPROVED PLANS AND JOB CARD MUST BE AVAILABLE TO INSPECTOR ON SITE
El CORRECTIONS LISTED BELOW MUST BE MADE: BEFORE WORK CAN BE APPROVED AND/OR THE NEXT PHASE
OF WORK IS STARTED
)4 RECALL FOR INSPECTION L3 $45 REINSPECTION FEE MUST BE PAID PRIOR TO INSPECTION REQUEST
El STOP WORK -UNTIL AUTHORIZED TO CONTINUE BY CITY INSPECTOR
LJ NO PERmrr-STOP WORK.REMOVE CONSTRUCTION OR OBTAIN PERMIT AND MAKE WORK COMPLY WITH
ALL APPLICABLE CITY CODES
L) if i j 7- Oat-tizz/
1111/
THE ACTIONS OR CORRECTIONS INDICATED ABOVE ARE REQUIRED TO BE CORRECTED WITHIN
:7 CALENDAR DAYS OR PENALTIES MAY BE APPLIED. FOR INSPECTION CALL 425-.2�+�
77-�'-- :772,Z>
El Building Planning L3 Engineering lor Fire L3 Public Works
White: Permit File Pinlu- Enforcement Buff- Applicant
flamc Rctardant Ccrtlficatc
80 YARDS
THIS IS TO CERTIFY THAT FABRIC BELONGING TO:
AMERICAN DRAPERY (Bob's Pancake House
AS SPECIFIED IN OUR INVOICE No. #87-328
WERE PROCESSED ON THIS DATE WITH_ Flameort
APPROVAL No. #870409
THE STATED PERIOD OF EFFECTIVENESS PER CHEMICAL MANUFACTURER, IN ACCORDANCE
WITH LOCAL APPLICABLE CODE REGULATIONS IS 2 YEAR (S) FROM DATE.
olcore
DATI
SIGN
APPF