309 MAIN ST (2)Or
SNOHOMISH CO.
FIRE
so � ._"A'rAj 3r-
Serving Brier, Edmonds, and 12425 Meridian Ave S
Mountlake Terrace, Everett, WA 98208
Phone (425) 551-1200
www.FireDistricti.org Fax (425) 551-1272
LOCATION:
309 Main Street 98020
BUSINESS NAME:
Edmonds Psychic
MAILING
ADDRESS:
22131 88th Ave W, Edmond§,W.A 98026
BUSINESS OWNER:
Stevens, eeorge D90A
.EMERGENCY-1:
KEY ACCESS-2:
EMAIL:
PERSON CONTACTED: bgw'a
NAME OF INSPECTOR:
FIRE SYSTEMS:
FE N/
Datp I ;v-,t.RPrvirPH'
PHONE: 4254351071
FIRE PREVENTION
INSPECTION REPORT
aELIMONDS
0 BRIER
0 MOUNTLAKE TERRACE
[3 UNINCORPORATED
0' FREOUENCY I STATION& SHIFT)
2016* 17-D
SCHEDULED
DATE DUE � Mar 2016
FIR 0 591 202
Cal-
-MOM PHONE: 76`863601Y
HOME PHONE:
URRENT
HOME PHONE:
CITY YES NO
BUSINESS V1 E]
LICENSE /at-J!
INITIAL INSPECTION DATE
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
V
2
2
"7- �7 jKa . ......... wvz'-�rc
A
3
W1A1S7n4.)
4
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 vv --mmunity, 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 itern(s) that were noted during. our inspection which require attention to bring them into compliance
w ith 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.
FIRE PREVENTION
c? /0,4 Z�,j S 7
Sei-ving Biiei: Edinor.—, 12425 MeridianAve S. NSPECTION REPORT
"'W� OEDMONDS
Mowitlake Terra Everett, WA 98208 0 BRIER
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
[I UNINCORPORATED
wwwFireDistrictl.org Fax (425) 551-1272
FREQUENCY STATION & SHIFT
LOCATION:
311 Main Street 98020
Annual
17-C
BUSINESS NAME:
Toshi's Teriyaki & Burger PHONE: 4256708122
SCHEDULED Mar 2015
Ar
DATE DUE
MAILING
LIFIR 1,,513 202
ADDRESS:
311 Main Street, Edmonds, WA 98020
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
Jeong,Seung HOME PHONE: 2064555400
"CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY
YES NO
BUSINESS
FV_71
El
EMAIL:
LICENSE
'10
PERSON CONTACTED: C�JIA)A)(!W,
INITIAL INSPECTION DATE
C_ 7-P
NAME 0 FINSPECTOR:
FIRE SYSTEMS:
FE 2/14 HD 3/14
q /,:_�
/]-, h
HAZARDS FOUND AND LOCATIONS'/ COMMUNICATIONS'
2
3
2
-3
4
4
5
5
6
6
7
7
1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
lst 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:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
5
2 6
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
DATE:
CODE
SECTION:
5
3
7
3 7
RETURN RECEIPT
RECEIVED
6
4
8
4 8
�ATE:
DISPOSITION:
7
11 LETTER NEEDED F] YES N;:
LETTER NEEDED [] YES NO
8
FIRE DEPARTMENT -COPY
I
Serving.Brier Edmonds, and 1-7425 Meridian Ave S
Moutfilake Terrace Everett, WA 98208
Phone (425) 551-1200
www.FireDistrictl.orz Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY
STATION & SHIF"')
LOCATION:
311 Main Streat 22,020
Animal
17-B
I
BUSINESS NAME:
la'Shi's Icrivah 11. Bwacr PHONE:
425E7US12:
SCHEDULED Mar 21314
DATE DUE
MAILING
UFIW-03 "C"2
ADDRESS:
311 Main Sircoc-I., Edmunds, WA 08020
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
Jcbng, Scung HOME PHONE:
20645)55400 "CURRENT
KEY ACCESS-2:
EMAIL:
HOME PHONE:
(KAA /M lk
CITY
BUSINESS
YES NO
El
LICENSE
PERSON CONTACTED:
/VA 0 L)/,) /0 SCLW14 k
J i�, 0 6v,
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
Dovil-iP6 ozo,2-
F I RE sys I i,_- NAB:
FE 41)3 HD 10113
3119
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
L i A) C Z_ PA v- A,
2 /v
2
3
3
4
4
5
5
6
6
Ll
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
lst RE -INSPECTION
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
1
CONTACTED:
CONTACTED:
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:'
3
V 11110 IONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
1 15
1 5
LETTER SENT
NUMBER:
4
12
CODE
5
6
2
6
DATE:
SECTION:
RETURN RECEIPT
3
7
3
7
RECEIVED
6
DISPOSITION:
7
4
.8
4
8
DATE:
LETTER NEEDED [] YES No
LET -TER NEEDED E] YES NO
8
FIRE DEPARTMENT COPY
FIRE PREVENTION
Serving Brier, Edmonds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
0 EDMONDS
Mountlake Terraceand
FIRE -7
Everett, WA 98208
0 BRIER
, j7
JMr the Town of Woodway
DIS JR I
Phone (425) 551-1200
0WOODWAY
0 MOUNTLAKE TERRACE
www.FireDistrictl.org
Fax (425) 551-1272
0 UNINCORPORATED
I
" FREQUENCY
STATION & SHIFT
LOCATION: 311 Main Street
365
17 A
I
BUSINESS NAME: Toshrs Teriyaki & Burger
PHONE: '4256708122
SCHEDULED
DATE DUE 0 03,101/1.3
MAILING 311 Main St
LIFIR � 5-13 3202
ADDRESS: Edmonds
98020
BUSINESS OWNER:
Jeong,Seung
HOME PHONE: 2064555400
ACTIVE
EMERGENCY-1: McGlocklin, darren
HOMEPHONE: 4257749295
-CURRENT
KEY ACCESS-2: Jeong,Anna
HOMEPHONE: 2063545359
CITY I' YES NO
BUSINESS
E]
E]
LICENSE
PERSON CONTACTED:
INITIAL INS CTION DATE
71110
NAME OF INSPECTOR:
FIRE - HD 21111
FE*-'_j3,
SYSTEMS: 4/1 Z,
ANINIVIA1
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
i ro It
0-C.1-11
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:
I
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE: w A
DATE:
DATE:
3
1110 IONS
1 15
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
L
2
DATE:
CODE
SECTION,
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
,8
4
8
DATE:
DISPOSITION:
7
LE =ERNEEDED [] YES NO
rLETTER NEEDED [] YES El NO
8
FIRE DEPARTMENT COPY
7 Sei-ving Bilet: Edmonds
SNOHOMISH CO.
FIRE,-
Mountlake Teri-aceand
STii,4�
the Town of Woodway
www.FireDistrictl.org
LOCATION:
311 Main Street
BUSINESS NAME:
Toshfs Teriyaki & Burger
MAILING
311 Main St
ADDRESS:
Edmonds
BUSINESS OWNER:
Jeong,Seung
EMERGENCY-1:
McGlocklin, darren
KEY ACCESS-2:
Jeong,Anna
PERSON CONTACTED: f-4) k) 13-
NAME OF INSPECTOR: lvk� 1�
FIRE HD 2/10
SYSTEMS;
12425 Meildian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fay (425) 551-1272
PHONE: 4256703122
98020
HOME PHONE: 2064555400
HOME PHONE: 4257749295
HOME PHONE: 2063545359
FIRE PREVENTION."
INSPECTION REPORT
0EDMONDS
0 BRIER
E]WOODWAY
[I MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY STATION & SHIFT_*�
365 17 D
SCHEDULED
DATE DUE � 03101/12
UFIR ll� 513 3202
ACTIVE
CURRENT
CITY YES NO
BUSINESS
LICENSE El 1:1 1
INITIAL INSPECTION DATE
:'E 2 11,7
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
A 121) 1� L 0 4 5;
�A
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
lst RE -INSPECTION
DATE DUE
2nd RE -INSPECTION
DATE DUE.
EXTENSION
GRANTED TO -
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
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
18
4
DATE:
DISPOSITION:
7
\,,LETTER NEEDED C] YES NO
.8
LETTER NEEDED C] YES NO
8
FIRE DEPARTMENT COPY
EDMONDS
CITY -OF,
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FIRE DEPARTMENT
4j' t S
LOCATION: 311 Main Street
BUSINESS NAME: Toshi's Teriyaki & Burger
MAILING 311 Main St
ADDRESS: Edmonds 98020
BUSINESS OWNER: Jeong,Seung HOME PHONE: 2064555400
EMERGENCY-1:' McGlocklin, darren HOME PHONE: 4257749295
KEY ACCESS-2: Jeong,Anna HOME PHONE: 20635,45359
FIREPREYENTION
SAFETY SURVEY
PHONE: 4256708122
0
FREQUENCY
STATION & SHIFT
365
17 C
SCHEDULED
031101/11
DATE DUE 01
UFIR o. 513
3202
AC.-nVE
e INITIAL INSPECTION DATE
PERSON CONTACTED: Teo P) cl
NAME OF INSPECTOR: 70 t �'j
FIRE HD 2J10 FE
SYS-17EIVIS:
I
k
ANNUAL
HAZARDS FOUN ND LOCATIONS MUNICATIONS
etevue qijAPPtaae2M71. (Oxd/s
&Afl
e
ENTER CODE ONLY ONCE I�
VIOLATION CODE
2
3
4
2
3
4
5
6
7
5
6
7
8
8
lst RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
PERSON
CONTACTED,
INSPECTOR:
DATE,
VIOLA�1_0114§ --------
1 15
2 6
3 r7
4 B
rLETTER NEEI3E YES
y
71 NO
EXTENSION
GRANTED TO:
PRE -CITATION
LETTER SENT
DATE,
FINAL RE -INSPECTION
DATE DUE:
PERSON
CONTACTED-
INSPECTOR:
DATE:
CITATION ISSUED
NUMBER'
VIOLATIONS
CITED:
1
2
PERSON
CONTACTED-
INSPECTOR:
&TIONS
5
3
— - - -- --- --------_-----
6
CODE
SECTION-
5
3
7,'
�'iTURN RECEIPT
RECEIVED
DISPOSITION:
6
7
4
6
LETTER NEEDED YES N 0
FIRE DEPARTMENT COPY
COMPLETE Certification Given: RED E] YELLOWOZ WHITEE]]
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
R High Pressure Hood Cleaning — SYSTEM T��T REPORT
&THood and Duct Services, Inc. Fire Suppression Installation & Service FC ONFIDENCE TEST 9 REPAIR
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:-�;h � Z Z-0 11)
OccupancyName: -1-osyvs g- K-1
Occupancy Address: 31/ 1AA1#J C
Responsible Person: 11 NIU 6
Building Owner:
Building Owner Address:
Testers Name (Please Print):-71do-).� Fa-9—w-ler
System Alarm? Yes F-1 No Central station monitoring? Yes E] No Ej
Control Panel manufacturer: Model Number:
- (ja A C, 4146
City, State, Zip: 4--fJ416,
Phone Number: Y7�5 -
Phone Number: )jV
City, State, Zip: W
SFID Certification Number: -SCP-.
Monitoring company name:
Location of Alarm Panel:
Extinguishing System Manufacturerf"AfAr- �7 System Size 6 JL U.L. 300 System? YesE]NoL4 LI.L. 300 Compliant? Yes[:] Nood Chemical Type: Weta Dry E]
Location/ Height of Range hood: /at &g
,.At
L__ ___
-,pressure gaugeindicato in ope able r�ng!�?
Is there chemical inside of the cylinder?
Yeisgj No[_ 12 year hydro date of cylinder.
- —
gr !s p op ejjijcie�? =NYasV
�es V Zo p Ewe�-�p rit;iie Arl
NoCj]
_etly:K
WeIgtI 602 or nitrogen_��rtrigge. MI Were all cooking surfaces protected? If not, give owner full
L �Nk
Yes E] No 21
No visible signs of a system fire or system tampering (if signs check no). Y.V-No information.
CWeck all piping and conduit. Are all piping and conduit immobilized with Yes[-] No Was -operating-procedure verbalty-given to restaurant-Rerspninel?
hangers and brackets? Was UL 300 compliance explained to owner or manager?
Yes&(. -
YesF/ NoE]
proper
-Yd�s ff
--n
Are all protective covers present on nozzles?
Are all nozzles checked in the proper position?
o L Gas shuts down p NAF-1--Yesue-
2n__§ temactivation?
-i�sCT NoV Electric power shuts down upon system activation? NA
No
Yes F� No E]
Does system have adequate volume and/or nozzle coverage?
Yes No _Rwgehood�t e0o builctin alarm panel? NA
yet:!� NoM
Are all appliances inside of the hood protection area?
fuse
Yes Range hood activation signal received at building alarm panel? NA
',—Iass —Ke.Cin6y!��p
Yes No
Have links been replaced?
YesF/No[:] nt?
e No L]
LWWS7§ I --- --
y�tern operational from terminal link?
Yes Non Grease buildup in group:
Light--_ Medium--Z Heavy, recommend cleaning
Was system operational from manual- remote?
Yes 2" No[-]
system and micro witch operational? NA
Date of last cleanin
E]_
Wks
Is system visible and free from obstruction?
esEL 0
-Y h/�No
Yes Are cleaning intervals within NFPA standards?
Yes No
Is the inspection andjservice tag on the c ylinder?
-r -r
Problems Found: (if additional room is needed, please add a separate sheet) -5 Y-S �-M I NO 17 A, ;00 6414 ft� I a �)
L I I A) 61 J 10 .1 A�u I- -A PA I IV I r kc J91 jok T1- , 1;� y C I -�(- 04 1 j to/-- /I h Z, -�r;q / I I -P, /V�) v -Al A J AO 0- 1,71 e'
Customer has declined repairs X
Corrections Made: Date Corrected: Corrected By: SFD Certification Number:
This certifies that this fire and life safety system has been property inspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
standards. Discrepaniic te an n reported to the building Owner/Responsible Person for corrective action.
Signature of Tester: OR Phone # — (206) 726-0940
Testing Agency: R&T Hood -affd Wet Servicis, Inc. 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 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 monthly inspections 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 performing the ins ection and 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 44
FIRE DEPARTMENT COPY
Date: April 30, 1997
To: Jeannine Graf, Building Official
From: Gary L. McComas, Fire Marshal
Subject: Toshis Teriyaki, 311 Main street, Tenant Improvement
Fire Department comment:
A plan for the automatic fire extinguishing system shall be reviewed. In addition to the automatic
system a portable 40,B:C fire extinguisher is required.
I
EDMONDS FIRE DEPARTMENT
OFFICE OF TBE FIRE MARSHAL