23830 HWY 99 STE 1189,7
A
f7LPfflEDEC 16 2016
FIRE AND SAFETY SYSTEMS, INC.
P.O. BOX 265, BURLINGTON, WA 98233 (360) 755-5444
FIRE AND SAFETY PROTECTION CONSULTANTS OF WASHINGTON STATE
SEMI-ANNUAL/ANNUAL SERVICE REPORT
BUSINESSf
DAT
ADDRESS ?,3
CI,rV STATE&# ZIPISDOVI PHON&.
SYSTEM MFG/MODEL SIZE
CONTROL HEAD - Old/New Style A&��*VALVE - Old/New Style
NUMBER OF SYSTEMS /- CYLINDER HYDROSTATIC TEST DATE--PaZIF:� —
KITCHEN
WET MARINE DRY SPRAY BOOTH
CO2— FLAMMABLE LIQ ROOM FM-200 CLEAN AGENT
1 . Remove bottle, inspect agent/Check weight of chemical
2. Test manual pull station
3. Check energy shutoff devices Gas __---Electric
4. Test mechanical detection from terminal detector
5. Check fire alarm tie-in at panel
6. Test pressure switches-
7. Electrical detection tested
8. Relight if gasel
9. Replace fusible links !!�—Quantity--Z— Type `—�P7Z
10. Inspect nozzles
11. Inspect all piping for limitations_---%e---'
12. Is all equipment rigidly fastenecl----!!�
13. Check expellant by weight or gauge--,-,
14. Check fusible link clearance_-
15. Check tension adjustment --
16. Clean all manufacturer's components_—,---
17. Re -arm system e*-'
18. Remove lock pi�nsL ----
19. Install tamper seals on all actuation devices..
20. Warning stickers and emergency service numbers
21. Final survey for improved protection suggestions_
22. Contract proposal— In effect_
23. Special conditions (see below) —
24. Check time delay time —
REMARKS:
S� �*n pm 0
SPECIAL CONDITIONS APPLY ---- — Dry chemical Fire Suppression systems have been found to be unreliable
in extinguishing fryer fires. Fryers now commonly utilize vegetable based oils versus animal foats for which the Dry
Chemical systems were designed. Therefore, Alpine Fire & Safety Systems, Inc. assumes no liability whatsoever for
fires which may not extinguish if covered by a Dry Chemical system.
Hood: Length: 1; Backshelf or Canopy
Appliances from left to right including width
Duct Size irio
TECHNICIAN'-,,r/Y-,�2��— LICENSE NO.
IL
SNOHOMISH CO.
FIRE
DIST]
Serving Brier, Edmonds, and
Mountlake Terrace
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
0 MOUNTLAKE TERRACE
[I UNINCORPORATED
STATION & SHIFT
LOCATION:
BUSINESS NAME: 23830 Highway99 Suite'11898026 PHONE: t/e 776 07,11 ICETED
DATE DUE
Pizza Hut -4256720283
MAILING LIFIR
ADDRESS: 11-556
23830 Highway 99, Suite 118, Edmonds, WA 98026
BUSINESS OWNER: HOME PHONE:
CURRENT
EMERGENCY-1: HOME PHONE:
KEY ACCESS-2: Emerald City Pizza HOME PHONE: 4994256329, CITY YES NO
EMAIL: BUSINESS a-t
LICENSE
PERSON CONTACTED: /u-9 ".3 eo- 40 INITIAL INSPECJION DATE
ql,�11
NAME OF INSPECTOR:
FIRE SYSTEMS: F 9�113 UL300 12 15
MaWbasbSwWwd�cATiONS
COMMUNICATIONS
7. 1,JWS7VA�
2
2
3
3
4
5
5
6
6
7
7
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 conditions or violation.
If you require additional information or to schedule a re -inspection for Edmonds, call (425) 775-7720; for
Mountlake Terrace or Brier, call (425) 744-6231.
017 FIRE EQ
0 A
< AL A f7LPInE J . UN 0 9 2016
iAtAFED' FIRE AND SAFETY SYSTEMS, INC.
ALPINE FIRE & SAFETY SYSTEMS INC.
P.O. BOX 265 - BURLINGTON, WA 98233 - 360/755-5444 - 800/411-7900
FIRE AND SAFETY PROTECTION CONSULTANTS OF WASHINGTON STATE
SEMI-ANNUAL/ANNUAL SERVICE REPORT
BUSINESSA� )W DATE
ADDRESS
6 30
CITY STATEU/Ih� ZIP PHONE
5K$TEM MFG/MODEL #.-V SIZE -NO.-OF
SYSTEMS
CYLINDER HYDROSTATIC TEST DATE
KITCHEN WET
MARINE DRY
SPRAY BOOTH CO2
FM-20
FLAMMABLE LIQ ROOM LEAN AGENT
1 . Remove bottle, inspect agent/ k weight of chemi cal
2. Test manual pull station
3. Check energy shutoff de��ices GAS L EeT R I C
4. Test mechanical detection from, tglr!� I dWtector X'
5. Check fire alarm tie-in at ppel
6. Test pressure switches
7. Electrical detection tested
8. Relight if gas
9. Replace fusib�re &1inks Quantity Type
10. Inspect nozzles
11. Inspect all piping for limitations
12. Is all equipment rigidly fastened
13. Check expellant by weight or gau
14. Check fusible link clearanc�e
15. Check tension adjustment
16. Clean all manufact�u�rer --components
17. Re -arm system
18. Remove lock pii;-S—L-'�"
19. Install tamper seals on all actuation devices
20. Warning stickers and emergency service numbers
21. Final Survey for improved protection suggestions
22. Contract proposal In effect
23. Special conclitions(See Below)_
24. Check time delay time
REMARKP:
es�4w
SPECIAL CONDITIONS APPLY. Dry Chemical Fire Suppression systems have been found to be
unreliable in extinguishing fryer fires. Fryers now commonly utilize vegetable based oils versus animal fats for which the
Dry Chemical systems were designed. Therefore, Alpine ire& Safety Systems, Inc. assumes no liability whatsoever for
fires which may not ext'N.uish if cove?9 by aVry Chemical System.
In ul
T E C H N I C I A N��' LICENSE NO.
ACKNOWLEDGED SPECIAL CONDITIONS
I A.
0 E 1) 6,',
CITY OF EDMONDS
STATUS: ISSUED 07/16/2015
Expiration Date: 0 1 /16/2 0 16
Parcel No: 00451900200700
121 5TH AVENUE NORTH - EDMONDS, W A 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
BLD20150820
�"�-2`38 MGHWAY 99�41 t8
il�ro : c't A"Iddr6s; `
ji S.
EDMONDS
PROPJtkT`1"*VT A -rk %VPLICATIT COMVTWTOR
PIZZA HUT ALPINE FIRE & SAFETY SYS INC ALPINE FIRE & SAFETY SYS INC
23830 HWY 99 #118 Po Box 265 Po Box 265
EDMONDS, WA 98026 735 E FAIRHAVEN AVE 735 E FAIRHAVEN AVE
Burlington, WA 98233 Burlington, WA 98233
(360) 755-5444 (360) 755-5444
LICENSE #: ALPINFS077RP EXP: 11/19/2016
INSTALL NEW UL 300 FIRE SUPPRESSION SYSTEM
�"v - r
VALUATION: $0.00
PERMIT TYPE: Commercial
PERMIT GROUP: 80 - Fire Suppression
GRADING N CYDS: 0
TYPE OF CONSTRUCTION:
RETAINING WALL ROCKERY:
OCCUPANT GROUP:
OCCUPANT LOAD�
FENCE: 0 X 0 FT.)
CODE: 2012
OTHER-� ------ OTHER DESC:
IZONE: I
NUMBER OF STORIES: 0
VESTED DATE:
NUMBER OF DWELLING UNITS: 0
EXISTING AREA
BASEMENT: 0 ISTFLOOR:O 2ND FLOOR: 0
LOT #:
PROPOSED ARF.A
BASEMENT: 0 1 ST FLOOR- 0 2ND FLOOR: 0
3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER� 0
13 RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
BEDROOMS: 0 BATHROOMS: 0
IBEDROOMS: 0 BATHROOMS: 0
FRONTSEYBACK SIDESErBACK REAR S ErBACK
?EQUIRED: PROPOSED: JREQUIRED: PROPOSED: IKEQUIKED: PROPOSED-_
HEIGHT ALLOWED:O PROPOSED:O IREQUIRED: PROPOSED:
3ETBACK NOTES:
PERNJIT APPROVAL
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOINGTHE WORK AUTHORIZED
THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATINGTO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
THISAPPLICATION ISNOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HISIHER DEPUTY AND ALL FEESARE PAID.
10-tki� .7ohilS 0711612015-
Signature Print Narne Date Released By Date
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF
OCCUPANCY HAS BEEN GRANTED. UBC109/ IBC I 10/ IRC I 10�
ONLINE APPLICANT ASSESSOR 11 — OTHER LI-52 -
STATUS: ISSUED BLD20150820
CONDITIONS
• Final approval on a projector final occupancy approval must be granted by the Building Official prior to use or occupancy of
the building or structure. Check the job card for all required City inspections including final project approval and final
occupancy inspections.
• Any request for,altemate design, modification, variance or other ad minis trati�e deviation (hereinafter "variance") from
adopted codes, ordinances or policies must be specifically requested in writing and be called out and identified. Processing
fees'for such request shall be established by Council and shall be paid upon submittal and are non-refundable.
Approvalof any plat orplan containing provisions which do not complyWith city code and forwhich a variance has not been
specifically identified, requested and, considered by the appropriate city official in accordance with the appropriate provision
of city code or state law does not approve any items not to code specification.
SoundNoise originating from temporary construction sites as a result of construction activity are exempt from the noise limits
of ECC Chapter 5.30 only during the hours of 7:00arn to 6:00pm on weekdays and 10:00am and 6:00pin on Saturdays, excluding
Sundays and Federal Holidays. At all other times the noise originating from construction sites/activities must comply with the
noise Units of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30,120.
Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to inden-inify defend and hold
harmless the City of Edmonds, Washington, its officials, employees, and agents from any and all clairris; for damages of
whatever nature, arising directly or indirectly fi-om the issuance for this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirements of any City ordinance nor limit in any way the City's ability to enforce any ordinance
provision.
Request final Fire Department Inspection (425) 775-0215.
INSPECTIONS
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCT10N ON THE
PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION.
PERMIT TIME LIMIT. SEE ECDC 19.00.005(A)(6)
BUILDING (425) 771-0220 EXT. 1333 1 . ENGITYWRING.(425) 771-0220 EXT. 1326 1 FIRE (425) 775-7720
PUBUC WORKS (425) 771-0235 PRFTRFATNMVr (425) 672-5755 RECYCLING (425) 275-480 �l
When calling for an inspection please leaw the follo-Mrig information: Permit Number, Job Site Address, Type of Inspection being
requested, Co'ntact Name and Phone Number, Date Prefereeck and Mether you prefer morning or afternood.
• F-Fire Suppression System Accept.
• F-Fire Final
FIRE PREVENTION
Sei -ving Briei: Edmonds, and
12425 Mei -idian Ave S
INSPECTION REPORT
SNOHOMISH CO.
q4w1*11
0 EDMONDS
11 FIRE
Mountlake Terrace
Everett, WA 98208
0 BRIER
�,Iwdff
Phone (425) 551-1200
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
DISTR
T wwwFireDistrictl.org
Fax (425) 551-1272
.1
" FREQUENCY
STATION&SHIF"I
LOCATION:
23d= Hiqhway 90 Suite 118 98rJ213
�Ulnual
20-C
BUSINESS NAME:
I
PiLLa 1161,
PHONE: 425E720282
SCHEDULED
DATE DUE I` Aug 2014
I
MAILING
i
UFIR
ADDRESS:
23WO 1 lighmay 93, Suit Edman&, VVA
9802L
BUSINESS OWNER:
f1hris
HOME PHONE:
EMERGENCY-1:
Emrrald Ci�y PiLza
HOME PHONE: 50042,66329
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
EMAIL:
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF I NSPECTOR
FIRE SYS ILMS:
FEQIr
q
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
3
4
4
5
5
6
6
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 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
ONTACTED:
CONTACTED:
CONTACTED:
I
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE,
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
1 5
1 5
LETTER SENT
NUMBER:
4
CODE
5
2
6
6
DATE:
SECTION:
-2
RETURN RECEIPT
3
7
3
7
1
RECEIVED
6
-1
DISPOSITION:
7
-14
18
4
18
DATE:
LETTER NEEDED F] YES NO
LETTER NEEDED F] YES El NO
FIRE DEPARTMENT COPY
SNOHOMISH CO.
FIRE
T1
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
E]WOODWAY
[I MOUNTLAKE TERRACE
El UNINCORPORATED
FREQUENCY I STATION & SHIFT"
Annual 20-B
SCHEDULED
DATE DUE � Aug
MAILING UFIR 556
ADDRESS: 2383OHighwaygg 118,, J.
BUSINESS OWNER: HOME PHONE:
Email:
EMERGENCY-1: HO - E PHONE� 5094256329 CURRENT YES NO
KEY ACCESS-2: HOME PHONE: CITY
76� BUSINESS
LICENSE
WITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR: loj-l'.?
FIRESYSTEMS: FET /1�,
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
LOCATION:
238300 118, Edmonds
BUSINESS NAME: r PHONE: 4256720283
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
3
4
4
5
5
6
6
7
- -----
7
I'l AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAY�x
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
TE DUE:
',_,e9fENSION
GRANTED TO:
FINAtRE-INSPECTION
DATE E:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON\, -
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
I'l 15
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
dNO
DATE:
DISPOSITION:
7
LETTER NEEDED C] YES El NO
rLETTER NEEDED E] YES 0
8
FIRE DEPARTMENT COPY
Sei-ving Briet: Edinonds
SNOHOMISH CO.
Mountlake Tet-t-aceand
)FIRE the Town of Woodway
SThi - T www.FireDistrictl.org
LOCATION: 23830 Highway 99
BUSINESS NAME: EmeraI4 City Pizza
MAILING 1101 Summilview
ADDRESS: Yakima
BUSINESS OWNER: Emerald C4 Pizza
JEMERGENCY-11 : Transpac
KEY ACCESS-2: Hopkins, Terry
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS:
12425 Mei-idian Ave S
Everett, WA 98208
Phone (425) 551'1200
Fax (425) 551-1272
lie
PHONE: 42A.At2@M
Li D_ S -7� f,
98902 0 0
HOME PHONE: 5094256329
HOME PHONE:
HOME PHONE: M0663899?_
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
OWOODWAY
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY STATION & SHIFT-'
3165 20 D
SCHEDULED
DATE DUE 11' 08101/11
LIFIR 0 513 8006
ACTIVE
CURRENT
CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
FE _� I-LL
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
3
r—f
2
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 TE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED.
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
I
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
2ATE:
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
4
8
4
18
DATE:
DISPOSITION:
7
\. LETTER NEEDED E] YES [I NO
LETTER NEEDED [:] YES NO
FIRE DEPARTMENT COPY
CITY,OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
LOCATION: 23830 Highway 99
BUSINESS NAME: Emerald City Pizza
MAILING 1101 summitview
FIRE PREVENTION
SAFETY SURVEY
118
PHONE: 4256720283
ADDRESS: Yakima 98902
BUSINESS OWNER: Emerald City Pizza HOME PHONE: 5094256329
EMERGENCY-1: Transpac HOME PHONE: 3606688992
KEY ACCESS-2: Hopkins, Terry HOME PHONE:
FREQUENCY
STATION & SHIF***'
365
20 C
SCHEDULED
01 08/01/10
DATE DUE
iUFIR 11� 513
8006
AC11VE
PERSON CONTACTED: Ry1w pa" opa) ol, INITIAL INSPECTION DATE
NAME OF INSPECTOR: 'Tflhtv 15, vi I VJ �'Tv'lj 8-IS-10
FIRE FE
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE 110
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
loo
VIOLATIONS
1 6)4� 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
8
DATE:
DISPOSITION:
� LETTER NEEDED 0 YES 0 NT
LETTERNEEDED 1:] YES NO
-_F8_J
--FIRE DEPARTMENT COPY
, 890 - 19 ') -
zl�;e5o ��� ?� -#//6
BARBARA FAHEY
&AA�
Ign &TLJ AVICK1110 Un
NOR in 0 EDMONDS, WA 98020 0 (206) 771-0200 * FAX (206) 771-0208
POLICE DEPARTMENT * A STATE ACCREDITED LAW ENFORCEMENT AGENCY
CITY OF EDMONDS
FACSIMILE TRANSMITTAL SHEET
TO
Recipient's Fax Number
FROM
DATE TRANSMITTED. NUMBER OF PAGES
If there are any problems during transmission, please call:
Police Department 771-0200, extension
Fire Department .771-0215, extension _3-6,7
Municipal Court 771-0210, extension
RE: r-,A�5 Ac-e—M,T-
*v-k- 47- 2-3 6 3o ? 7 /,v Lq.
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CA44--�cwl
,ItJN61F-� 11-TD C(T-y Crr- 14,tVA)U4-L X. C6Z-P:,CfC4-Z6- &)C-
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IIJO-r- 6C PiZO-V"P64 8-/
C6PZ-4 --- f,"1000 L/XT-7L- -�bvKO
&/V - (9,Q6 -n A46
CONFIDENTIALITY NOTICE: The documents accompanying this f�csimile Occc
transmission contain information belonging to the City of Edmonds. This information
may be confidential and/or legally privileged and is intended only for the use' of the cj,�,-L- 1, F
individual or entity named on this transmittal sheet. If you are not the intended recipient,
you are hereby notified -that disclosure, copying, distribution, or the use of the contents of
this transmitted information is strictly prohibited. If you have received this facsimile in
error, please notify us immediately by phone afthe above listed number.
EPD310 1/96
Tb�
. 0 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan