23805 HWY 99 STE 104 (2)F4
D,
IIFZ 3905- "z6-"LiAL/T� S 7-r— /6 �C/
FIRE PREVENTION
Serving Brier, Edmonds, and 12425 Meridian Ave S INSPECTION REPORT
Mountlake Terrace 0 EDMONDS
Everett, WA 98208 0 BRIER
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
www.FireDistrictl.org Fax (425) 551-1272 [3 UNINCORPORATED
r FREQUENCY
STATION & SHIFT
LOCATION:
.23805 Highway 99 Suite 104 98026
AnR a!
29-C
BUSINESS NAME: PHONE:
SCHEDULED
Manna Teriyaki
4256729555
DATE DUE II'
hin 917119
MAILING
ADDRESS:
513
23805 Highway 99, Suite 104, Edmonds, WA 98026
BUSINESS OWNER: HOME PHONE:
-:,,,EMERGENCY-1: HOME PHONE:
CURRENT
XEY ACCESS-2: Ester, Lee HOME PHONE:
206749,7,48T
CITY YES NO
EMAIL:
BUSINESS
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
7T_a� I Ll N
S 61
FIRE SYSTEMS: FE 6/15 HD 6/15 ,r-
0M6�Q§§P96hqdbW.CATIONS / COMMUNICATIONS
oc)6
6-uAt, OD
2
2
3
3
4
4
5
6
6
7
7
I AGREE To.cbRRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X__&
r.X.,l 2V 1�,
1st RE-INSPECTIO N
2nd RE -INSPECTION
ITE INSI�N
FINALIRE-INSPECTION
f
DATEDUE:
DATE DUE:
GRANTEDTO:
DATE DUE:
VIOLATIONS
CITED:
PERSON f-n"Ci�
PERSON
PERSON
.SONTACTED.
CON TED:
CONTACTED:
INSPECTOR: Vj JA)9 MA)
INSPE CTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
4
VIOLATIONS
5
VIOLATIONS,-4,"-,�-
PRE -ITATION
LETTER SENT
CITATION i§§UEb
DATE:
-NUMBER:
CODE
SECTION:
5
6
16
RETURN RECEIPT
3 7
RECEIVED
6
DISPOSFZ�.
4
8
4 8
DATE:
7
Li-T-TER NEED'ED [] YES 0 NO
LETTER NEEDED YES NO
SNOHO
F1
DI
Serving Brie'r,* Edmonds, and
Mountlake Terrace
ev
Twwiv f FireDistrict]. org
. I
LOCATION: 2,VND5 Highway 89 Suil�,1�1 11811213
BUSINESS NAME: Manna 1crivaki
MAILING
FIRE PREVENTION
INSPECTION REPORT
12425 Meridian Ave S
�9 EDMONDS
Everett, WA 98208 OBRIER
I
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
[I UNINCORPORATED
Fax (425) 551-1272
FREQUENCY STATION & SHIFT-'
Ajinual 20-A
SCHEDULED
PHONE: 42f)E72'0&x)E DATEDUE 0 Jun.2014
LIFIR 0
ADDRESS:
23�905 1 fighway M, Suilc 104, Edrmn&,
WA 0902fi
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
HOME PHONE:
.LIE71.97487 CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY
YES NO
BUSINESS
'r--A
0
EMAIL:
LICENSE
YJ
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
HtJ
I- I Rl-- SYS I E Nis:
FE 9113 HD 2) 13
P� A
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
U t--
2 -s' t—y7-2--c'
2
3
3
m 7Ard AJre 4
el J Lc-::f:n &
4
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X ()XA (j k
1st RE-INSPECTqN
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._____
DATE:
DATE:
3
V LAkS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2 J��UfW
-60 A
2
6
DATE:
CODE
SECTION:
5
3
3
7
RETURN RECEIPT
RECEIVED
6
4
18
4
18
DATE:
DISPOSITION:
7
LETTER NEEDED [0] YES El N
rLETTER NEEDED E] YES El NO
8
FIRE DEPARTMENT COPY
SNOWA
A
F11
Sei-ving Biler EdinonA-;: and
Mountlake Yet-i-ace
ISTRICTwwwFireDistrictl. org
4,425 Me4dian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
LOCATION: 23805 Highway 99 Suite 104 98026
BUSINESS NAME: Manna Teriyaki
MAILING � 23805 Highway 99, Suite 104, Edmonds, WA 98026
ADDRESS:
BUSINESS OWNER: Ester, Lev//"'
EMERGENCY-1:
KEY ACCESS-2:
EMAIL:
PERSON CONTACTED:
NAME OF INSPECTOR:
I Kt ti y ti I tmti: FE 9/1 HIJ 9/13
� /) .1 b-111 A)CXr
PHONE: v/4256729555
HOME PHONE:
HOME PHONE:
HOME PHONE: c7
FIRE PRf-VENTIO.
IN IRE&ION REPOF
ETEDMONDS
0 BRIER
o m6UNTLAKE TERRACE
[I UhINCORPORATED
FREQUENCY STATION & SHIF`�
Annual 20-B
SCHEDULEW�un 2015--
DATEDUE
513
UFIR
CURRENT
CITY YES 0
I -BUSINESS
I LICENSE
INITIAL INSPECTION DATE
HAZARDS FOUND AND LOCATIONS c6mmUNICATIONS
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
1 st 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 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
12
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
'8
4
18
DATE:
DISPOSITION:
7
—1 NO
LETTER NEEDED I—] YES I—
LETTER NEEDED E] YES El NO
8
FIRE DEPARTMENT COPY
SN01
F
b
Serving Brier, Edmonds
Mountlake Terraceand
the Town of Woodway
www.FireDistrictl.org
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
[1WOODWAY
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY -FFTA—TION & SHIFT`�
LOCATION: 23805 Highway 99
104
365 20
D
BUSINESS NAME: Manna Teriyaki
PHONE: 4256729555
SCHEDULED
DATE DUE 11' 06/01/13
MAILING 23805 Highway 99 #104
UFIR � 513 6006
ADDRESS: Edmonds
98026
BUSINESS OWNER- L
HOME PHONE:
ACTIVE
EMERGENCY-1:
HOME PHONE:
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES
NO
BUSINESS V-71
LICENSE ILA
PERSON CONTACTED:
SC
INITIAL INSPECTION DATE
NAME 'OF INSPECTOR:
FIRE HD 8/1 1�
0 STEM S:
FE Z/
AP54LIAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
0,-
2 tl�2
h
a.
2
&0 a4ll..4��
3
V V V
3
4
4
5
5
6
6
7
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
GRANTED TO:
FINAL 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
6
2
6
DATE:
CODE
SECTION:
5
3
3
7
RETURN RECEIPT'
RECEIVED
6
4
18
4
18
DATE:
DISPOSITION:
7
LETTER NEEDED [] YES NO
LETTER NEEDED 0 YES NJO
8
FIRE DEPARTMENT COPY
Poo,
Serving Briei: Edmonds
Mountlake Terraceand
the Town of Woodway
www.FireDistrictl.org
LOCATION: 23805 Highway 99
BUSINESS NAME: Manna Teriyaki -
MAILING 23805 Highway 99 #104
ADDRESS: Edmonds
BUSINESS OWNER: Chang, Suzie
EMERGENCY-1:
KEY ACCESS-2:
PERSON CONTACTED: 11�j c-, (4-'A
NAME OF INSPECTOR:
FIRE
SYCITEMS:
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
104
PHONE: 4256729555
98026
HOMEPHONE: 2062289561
HOME PHONE:
HOME PHONE:
FIRE PREVENTIO1
INSPECTION REPOF
0 EDMONDS
0 BRIER
E]WOODWAY
[] MOUNTLAKE TERRACE
0 UNINCORPORATED
I` FREQUENCY I STATION & SHIFT_�
365 20 C
SCHEDULED
DATE DUE 1' 06/01/12
UFIR � 513 6006
ACTIVE
CURRENT
CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
— t 6— 1 - I-z—
FE
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
r,A
2 ar"\(.Ve-
+b
F o, i n
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:
D E:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
L TER 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
1% LETTER NEEDED [] YES E3 NO
LETTER NEEDED E] YES [I NO
8
FIRE DEPARTMENT COPY
111111111111116- �__1541111 we �IWTAMI 01156 11 9=1 Imaw-
Friday, September 02,201111:04 AM Ed's Fire Inc. (425)877-1997 P.01
ED'S FIRE INC DA TE
P.O. BOX 2665 LYNNWOOD, WA. 08038 08/06/2011
TEL;1(426)877-8826* FAX;1(426)877-1097
www.edsfireinc,corn * odsfireinc@yahoo.com Invoice #: 1330
Ed's Fire Cei-tificate # SCP-M-07715
Inc. RANGE HOOD INSPECTION REPORT Semi -Annual [R Annual El
CITY OF EdmondS Confidence Test Z Repa�-s
JOB Manna Teriyaki Type of system., Wet Chem. Z Dry Chem. E]
SITE 23805 HWY 99 # 104 F Ansul R-101 3 Gallons
Edmonds WA 98026
CUSTOMER PHONE 0 (425) 672-9555 RED YELLOW FZ] WHITE
Cylinder's pressure gauge oi weight is at acceptable level.
Yes Z]
No [:]
IVA
Systein his not been fired cn- been t3rripeied with.
Yes Z]
No E]
AVA
All piping ond condWt is irnmobilizcd witli ptor4r hangcrm and bracWs.
Yej [7]
No
MA
All nozzles are in propei positions
Yes [Z]
No
AVA
All noz2leQ -at! covered by blow off cnp�.
Yes
No
NA
System hisadequate voliunean&or nozzle coverage.
Yes
No
JVA
Date of new links:
System opeinted properly tiom most remote Wsible link
Yes
No
JVA
Systein operated poperly fiorn all inanuilactuator.i.
Yes
No
AVA
RFuige hood tied to buil(ling al.= pariel.
Yes
No
ANYA
Manual actuitcyrs are iwobs(ructed and in path of egiesi.
Yes
No
AYA
Impection and service tig on systern cylindei and/or reinote pull station,
Yes
No
AVA
Ah cooking smbces pre protected.
Yes
No
JVA
Date of last hydiostatic test of cylinder:
—1
Alitomabc shutdown of fiiel/powef/micro gMtcli.
Yes Z]
No E]
AVA E]
Systein is now fidly opetafiowil wid fi-ee froin obstructions.
Yes
No
NA
Cla., s K ex1ingWgher in place and serviced,
Yes
No
AVVA
AR lead and wire seils are intact.
Yes
No
MA
The hood and duct are Bee froin gpease and sludge accwrTWahon.
Yes
No
NA
S5%tem i�; UL300.
yea
No
VA
Date of last cleiidng:
Yom ffie supp2ootiien 6y�itein doops not ineet otirrent UL300 otandoidg and incre iinpoilently
may not exftingiii8li a cooking fire. You need to replace your fire iupprv;6ion sy�tem with D riew
UL300 rated wet chemical system.
W]
Problems found.
The System is not UL300. You need to Upgrade the system to UL300 Compliance.
inspection by:
Diagram
— — — — — — — — — — — — — — — — — — — - — — — — — — — — — — — — — —
PRYFR Wok I Bkorner pAngs G64 charbMilor 4 Bumer Rome
FIRE PREVENTION'
A
:Serving Beier, Edmonds INSPECTION REPO"
jW�5 Me idian,4ve S
SNOHOMISII CO. r
0 EDMONDS
Mountlake Terrace, and Everett, WA 98208
,fi E 0 BRIER
the Town of Woo&vay al, Phone (425) 551-1200 OWOODWAY
0 MOUNTLAKE TERRACE
www.FireDistrictl.org Fax (425) 551-1272 0 UNINCORPORATED
FREQUENCY STA�ON 86HIFT-Is
LOCATION: 23805 Highway 99 104 365
BUSINESS NAME: Manna Terlyaki
PHONE: 4256729555 SCHEDULED o6/m/11
DATE DUE
MAILING 23805 Highway 99 #104 LIFIR � 513 6006
ADDRESS: Edmonds 98026
20&228QV6+-
BUSINESSOWNER: C.'hang R-LuiLm, HOME PHON ACTIVE
EMERGENCY-1: HOME PHONE: q L-�_- 4' 7 Z' _f
RRENT
KEY ACCESS-2: HOME PHONE: q ITY YES NO
4USINESS
LICENSE
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE HID 4 UL300 FE
SYSTEMS: Z
ANNUAL
HAZAR1 FOUND AND LOCATIONS C MUNICATIONS
2
2
3
3
4
4
5
5
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 S x
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
E)(TENSION
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
14
8
4
18
DATE:
DISPOSITION:
7
LETTER NEEDED [] YES NO
LETTER NEEDED 0 YES [:1 NO
I
1
8 .00
FIRE DEPARTMENT COPY
AdllbL
CITY OF EDMONDS
t 121 5TH AVENUE N. - EDMONDS, WASHINGTON 9BO20 (425) 771-0215
F DEPARTMENT
IRE
4!'
LOCATION: 23805 Highway 99
BUSINESS NAME: Manna Teriyaki
MAILING 23805 Highway 99 #104
Af'%r%MCQQ
FIRE PREVENTION
SAFETY SURVEY
104
PHONE: 4256729555
FREQUENCY
STATION& SHIFT'
365
20 A
SCHEDULED
DATE DUE O�
06/01/10
LIFIR lo 513
6006
Edmonds 98026 11
BUSINESS OWNER: Chang, Suzie HOMEPHONE: 2062289561 ACTIVE
EMERGENCY-1: HOME PHONE:
KEY ACCESS-2: HOME PHONE:
PERSON CONTACTED: & r� a- N- INITIAL INSPECTION DATE
NAME OF INSPECTOR: cAt---M t-v-� r-a -7 - 0-2- - 10
FIRE HD 4/05 UL300 FE 0'7 / 09
SYSTEMS: A!4�NU L
HAZARDS FOUND AND LOCATIONEE
1—t-i 0 't-3 r_-
2
5
7
8
lst RE -INSPECTION
DATE DUE:
VIOLATIONS
2 6'
7
LETTER NEEDED E] YES
2nd RE -INSPECTION
DATE DUE:
PERSON
CONTACTED:
INSPECTOR:
DATE:
VIOLATIONS
2
6
3
7
,LETTER NEEDED 0 YES NO
ENTER CODE ONLY ONCE I�
VIOLATION CODE
1
2
3
4
..... . ...... . .......
5
6
7
8
EXTENSION
FINAL RE -INSPECTION
VIOLATION$
GRANMD TO:
DATE DUE:
CITED:
PERSON
CONTACTED:
INSPECTOR:
2
DATE:
4
PRE-CIIATION
LETTER SENT_
CITATION ISSUED
NUMBER:
CODE
SECTION:
5
6
-DATE:
RETURN RECEIPT
RECEIVED
DATE:
DISPOSITION:
7
8
FIRE DEPARTMENT COPY
7' CITY OF EDMONDS
121 5T�' AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
LOCATION: -23805 Highway 99
BUSINESS NAME: Avenue Dental Care
MAILING 23305 Hwy 99 # IGO
FIRE PREVENTION
SAFETY SURVEY
100
PHONE: 4257786333
ADDRESS: Edmonds 98026 (tfL�
�q$ "s 7
BUSINESS OWNER: HOME PHONE: 42_19.-=M ACTIVE
EMERGENCY-1: HOME PHONE:
KEY ACCESS-2: HOME PHONE:
FREQUENCY
STATION& SHIFT
730
20 A
SCHEDULED
DATE DUE 11�
06/01/10
LIFIR 10 593
6006
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR: 0,; 2 jV 1, 7 .,?ol o
FIRE
SYSTEMS:
FE4L/ 0 -
_L
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE 0,
VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
7
8
8
'Ist 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:
I
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
7
RETURN RECEIPT
RECEIVED
6
7
4
18
4
8
DATE:
DISPOSITION:
8
LETTER NEEDED [] YES NO
LETTER NEEDED 1:] YES 0 NO
FIRE DEPARTMENT COPY