526 MAIN STe.......... ..
''FIRE' PREVENTION
Serving Brier, Edinonus, wid 1-2425 Meridian A INSPECTION REPORT
ve S
SNOHONIISH CO. -B-56MONDS
Mountlake Terrace Everett, WA 98208 0 BRIER
FIIIPJLj Phone (425) 551-1200 [1 MOUNTLAKE TERRACE
[I UNINCORPORATED
DISS T RIU ww`w`-;.FireDistrictJ. org Fax (425) 551-1272
526 Main Street 98020
LOCATION:
Epulo Restaurant
BUSINESS NAME:
MAILING 526 Main Street, Edmonds, WA 98020
ADDRESS:
Morris, Tim
BUSINESS OWNER:
Kurtz, Alex
EMERGENCY-1:
KEY ACCESS-2:
EMAIL:
PERSON CONTACTED,
NAME OF INSPECTOR:
Date Last Serviced: 511-7 � 11
Z��6
PHONE: - to _U - JL yb
HOME PHONE: 0'j;
192623119IT1
HOME PHONE: 17 -
HOM E PHON E.9-1,3 - 231
L/// 7
%%L NFY STAJI?Nd SHIFT
ffa
SCHEDULED Ma 1 f
DATE DUE �
161 203
[UFIR 0
CURRENT
CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
4
...... . . . . . . . ...
:'d. 7:*
FIR
7661 1 59t, Place NE T0:42S-641-2127
Redmond, WA 98052 Fax: 425-562-6662
Restaurant System
Service Report
Annual Semi-
Annua
Inspection Date.�;Jan 13, 2012
customer,[ . . . .......................... _j Syqetn Conne<ted To:
...........
...........
In ST Fire Alarm Communicator
. . . . .........................
S
City. rExlr�*';Ids late: ZI p Code-1 Building Alarrin Aodible:
02 =0
Contact: Phone: Cell: i i
F ............ - - - -- - - -----------------
sefvi6e Information ...................
. ...... . .. . . . ............................... ..........
. . .........
Ne Account Operator:
Monitomd A
By, . ................ . . ... . . ........
RGI.25G
Syiktern Mfg, ::RangeGuard model: Tanks: Total Gallons, Location: ea oven/kitchen
1 =215 .. . .............. . .....................
.......................
... ....... . ....
Reset Relay Location-,
uel soofcv. rfiectr(c. r, Gas - valve Location: ......
- Due DaAe/size/01 2011 :gal (yrj_ (yr gal X
Tesi. tyr= gal[]XD E I
x D L
X fl
Nozzlec W&I"'Chy: X2
. ........ ...........
D i (360/r—ix (450A__::)'. Ll') (500/ 09
X, .... ......
:Fus NF) (21211 ...
lble Links. Tempffiate4ty, 55/r
F)
/r-lxl
Condition
........ . _11C-IxEl I= It ........ .
Cartridqtv. ModeljWt/0ty:
Date of Ust Hood Cleaving., f1l 2,1;1 '-FPA 9fi)- k
Cleaned By, LASIC: _ . . . ......... .................. .. J (pet ri Medium HeavY
.................
mi,ces under the ood and properly protected?
�j YES
... . ............. .......
J- NO
. ..
N/A
2.- Does cooking. line up match fle drawings? ........ . ..........
'4 YES
.. .
NO
C' N
Systern gagge isinoptiable ringe,
YES
YES
NO
NO
NIA
N /A
it nd are within manufacturer weight fecluiferr-ents? . ... . ......
cadridges ..................
....
YES
YES
j- NO
i-
(7' NfA
N/A
....
ted propeflyfrom manual release?
System opera .......................
___ . . . . . .........
System operated ptoperly from terminal link')
. . . .........
t6, . .. . .............. . ....
Exhaust fan stayed on daring +
kl'-� YES
.0
N/A
............. ......... .....
18, Fue? sour'ce shot down doring testing?
YES
NO
N/T'
. ............
'�9. System piping Is securely fastened?
YES
..... .
. NO
WA
..........
10, Syqern piping is clear of ...... ............................
NO
WA
- . ...F
1. Syqern mft--,L:r manufat Ilation requirements?
YES'
U. Is this a UL300 Syst". ?. -.11 ..................... _
(0- YES
r No
WA
............
13. TZ�q p-io, ... in place? --------
y FS
NO
MIA
..............
i4.Classl(fire �jujshers are installed and in operable range tq�jantity-._ =1 )?
I ri YES
NO
NIA
. . . ......
I YES
C NO
<,i� WA_...
ji con�tacted (all. signals have b"t, vedfied as received)?
..............
1,6� Copy pf Inspection Report-, have been left,onsite? ...... . ..........
; 4 YES
NO
NIA
1
1 7,Weref0her
:(- YES_______'T
NO
NJA
�C YES
NO
(i N/A
. . . ............. . . ... . ............
jig. if deridencieswere noted, wasa copy of the $Df.-ficiency Detail Peport"Ieft wl,'Ownerof a Rep..
- -- ---- - ---- -
Lic #t �2CL)554
peflwminq WorL* ..........
Customer's Authorized Agent, Date: E=
LLL_ . .... .....................................
............... .
Customer's SignalUre: F_
�J�\
----------- . .................. . . ....................................... ........................ . .................................... . . I .... i -
InspectionDate'. Fanj�,�012..
Customer. Epulo Bistro system Connected To: ..... ........
F;te Alarm
526 Mai n St , 11 1'
Address: I' , , 3 . .............
------ ........... I
0'ry:
od=�
Eidin:o
Zip Code� L90_
Buldinq A13trn Audible:
Contact:
plione,
........................
....... . ...................
Fax:
. ...........
Service Information
. . .. . . . . ................. ....... .... ..
ENIA Phone . ............ AccounI4. operatoci
Monitored By; E'
................................................
77-7=
Systern 10fg. lRangeGuard i &Aodel,.::RG4GS #'TanlKS Total Gailons: Location: en
.....................................
.......... ..................... I ... . ........
......... . . . ....
lFuel Sourte, Gas -Valve Location', I@ aotoman Reset Relay Location.
................................ . ................... .
I (yri gal
�4
gaf !X (yr= F�
:Hydrostatic Test; We Date/Size,'01 200" gal X F
izzZET" , .......... - I ,
:y'. (YrP .....
galF
x D F) i
Kill) I'law ]x
:Nozzles- Model,,Qty,. (EEIX ..............
F ) (4501
Fusibletinks. Temp/DateMV: (1,651 (212jl,**" xD1 p
lCartridges. Model,,Wt
x E x
;Oty: ---:] 1--lix U
i Condition Light (*Z Miedium Heavy
ea (perNFPA96):
Zate of Last Hood Cleaning. 1*1 Cl ned By:
TAre all ances under the hoo fi_andpmperly�. ............ ............... . . ....
. . ..........
q YES
N/A
. . .... ... . . .......... .. ........................
2, Dixs cooking line up match tile dtavvinis?
ro YES
NO
N/A
.. ....... . . . ..
in opefalAc. ranqe?
r*' YES
NO
N/A
....... I——
cartlidge" W�'.I'e' V.*i9fled.and are jA(ithin manufacturer weight requirements?
YE
YE
NO
....... ......
.d prop,*tly rom manual release?
. . ...
YES
.............
r" NO
';_
N/A
. .. . ....
6. System opemed property from terminal link? . . . ............ ...... ......... ....... ............ .... I
7 Exhaust fan stayed on during test? .............................. .. .............
(10�- YES ___% NO
<*— YES -" NO
...... . ... . ........ .
N/A
r NIA
. . .. .. .. . .............................
4, YES
C
IS. Fuel Source $but down during testin
. . ............
jq.,,�ysjern piping is securely fastened?
C*' YES
—1 NO
N/A
....... . . .....
is nf>slroclion?
(i� YES
NO
N!A
.......... ... . ...........
qj mepts njarjkjfactu�erls installation requirements?
(i YES
NO
C' N/A
. .....
............ .............
12' Is this a Ul. System?
Y E 5
NO
N/A
. ......
. . .. .. ...... ... .. ..... .
. 13. Mainte . na . n . c . e T + a . 9 - p . rop, + or . I . y . pu - nched ar-d in place? ........................................
�ir YES
...
NO
C N/A
. ....... . . ........ ............
14, Class K fineextinguishers ate installedand in operable ranqefquA01jty: [-; ..........
,i YE-+� NO
. .......... .......... .
f N/A
...... . .................
eritied as received)?
'15. If Applicable Monitoring has been contacted (all signals have been v ....................................
�nTltj? — — -----
';Z
t YES
.................................
YE S
NO
I .........................
NO
4 NIA
C NIA
16, Copy of inspectior. Reports have been left
.. .
117 wer/e there are a Wencies noted during the inspection?
YES
(i+ NO
NWA
.................
8. If deflrien6es Were noted, wa .j a copy of the,,0efjcienL-y L)ejaij Report" left Y41 Owner or a Rep,?
C YES
NO
ii� N/A
kerlinician Performing Work. 1C.Btakidoin tic, M,
I........................ ...................
Date,
Costorner's Authorized Agent.,
.... I ................. F ...... . .... -1
................. ....................................
.. ...............................
icustomees signature; --------
..................................... . ..... .
'If"!0SW
Karl Fifterer
From: Paul Brough
Sent: Wednesday, May 17, 2017 12:44 PM
To: 'Info@pulobistro.com'
Cc: Karl Fifterer; Kevin Zweber
Subject: Class I Hood service Expired
Hello, my Name is Paul and I work with the City of Edmonds/SCFD1 Fire Prevention Office. Our records indicate that
both of your Class I Hoods service has expired
On 1-12-17. If this service has already been provided then please call or email us with that information. Also the
Company providing the service will need to properly
Add the information electronically into Tegris (www.Tegris.com). If The service has not been completed please call your
provider to schedule this service.
Thank You for your Time
Deputy Fire Marshal
Paul David Brough 1315
425-775-7720 Office
425-754-1898 Cell
APPLICATION FOR PERMIT
FOR MATERIALS OR PROCESSES
March 12, 2012
Please verify and correct the following information:
Name of Company (DBA):
Epulo Restaurant
Edmonds Location
526 Main Street
In,conformity with the
terms,jof the International
Fire Code, application is
hereby made to store, use
Places of Assembly - Occupant Load: 97
or maintain the following
activity, storage or pro-
cesses:
c/o Tim Squared LLC
Mailing Address:
PO Box 60152
Seattle, WA 98160
EFD UFIR #:
1610970203
(for office use)
Your Signature
Your Name (print)
11A
A,
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
Re c d
Check#
-71V (.5%16 _S00-6A1X_)
SNOHOMISH CO.
FIRE
ST
Set-ving Briei; 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
[I MOUNTLAKE TERRACE
[I UNINCORPORATED
FREQUENCY F—STATION &SHIFT-'*'
LOCATION: 17_,
526 Main Street 98020 Annual 17-A
SCHEDULE?
i
BUSINESS NAME: Epulo Restaurant PHONE: 425'175456C, DATE DUE Vay 21114
MAILING UFIR 061 203
ADDRESS: 526 MainSireet, Edmonds, WA 2,8020
BUSINESS OWNER: HOME PHONE:
EMERGENCY-1: Tim Squared LLC H 0 M E P H 0 N E: 2 �728 CURRENT
KEY ACCESS-2: HOME PHONE: CITY YES NO
BUSINESS r1cl
EMAIL: LICENSE 4p 1:1
PERSON CONTACTED: T I AA_ ?IV- I -r rf- I 'RS INITIAL INSPECTION DATE
NAME OF INSPECTOR: �,JA L A -s / 9 -w ) 0 — I -- f 4-�
FIRE SYSTEMS: FE HD (2) 11-1-4
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
SfIC NJ 14
L 5
CO.
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
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED-)
PERSON
CONTACTED: J�
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:
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
8
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED F] YES NO
LETTER NEEDED [_-] YES NO
8
FIRE DEPARTMENT COPY
SNOHOMISH CO. Set-ving Bilet; Edtnon&
FIREMountlake Tei-i-acean�
the Town of Woodway
DISTR T www.FireDistrictl.org
12425 Meildian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
E]WOODWAY
[] MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY STATION & SHIFT"�
LOCATION: 526 Main Street
L4 N- 673- �6qr,'
365 17 C
I
BUSINESS NAME: Epulo Restaurant
PHONE: 42-5JJ-54,c'&&-1
SCHEDULED 05/01/12
DATE DUE
MAILING PO Box 60152
UFIR 11, 161 5203
ADDRESS:
Seattle
98160
BUSINESS OWNER: Tim Squared LLC
HOME PHONE: 2065427028
OCC LOAD 75
EMERGENCY-1: Morris, Marian
2069929015
HOME PHONE:
CURRENT
KEY ACCESS-2: Elsia LLC,
HOME PHONE: 2062271500
CITY YES NO
BUSINESS
El 1:1
LICENSE
A,
PERSON CONTACTED:
INITIAL INSPECTION DATE
-L��
77
NAME OF INSPECTORJ i*
FIRE HD (2) 1112
FE i
SYSTEMS:
ANNUAL
1 11
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
2
00 < Mq W-K-
al If �e
2
15 CRC4,
zb
3
3
4
4
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS
lst RE -INSPECTION
DATE DUE.
2nd RE -INSPECTION
DATE DUE.
EXTENSION
GRANTED TO-
FINAL RE-INSPE( JIN
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
4
18
4
'8
DATE:
DISPOSITION:
7
LETTER NEEDED [] YES NO
LETTER NEEDED [] YES NO
8
FIRE DEPARTMENT COPY
14
APPLICATION FOR PERMIT
FOR MATERIALS OR PROCESSES
March 7, 2011
Please verify and correct the following information:
P1
MAY 2 4 PA13, 4H
kt2
EDMoA,iD - ILL
S F I
mmmmmm;,, EPT.
Name of Company; DBA
Epulo Restaurant
Edmonds Location
526 Main Street
In conformity with the terms of
Places of Assembly - Occupant Load: 97
the International Fire Code,
application is hereby made to
store, use -or maintain the -
following activity, storage or
processes:
Mailing Address:
Tim Squared LLC
PO Box 60152
Seattle WA 98160
EFID UFIR
161097000203
(for office use)
Your Signature
Your Name (print)"
T'& MOCC25
Your Title
Please make corrections, attach $40 payable to the City of Edmonds, and mail to:
Fire-Mar.,-,hal---
Department of Fire Prevention
121-5 th Avenue North
Edmonds, WA 98020
(OFEDMONDS
NT OF FIRE PREVENTION
PERMIT
.5'17,4 /it 5'?(-, r- c
WIN 6v-r"-� L-ICZ-fs'LC',
January 1, 2011 161-097-000-203 December 31, 2011
Date of Issue UFIR Number Date of Expiration
This PERMIT is issued to: I Epulo Restaurant
located at: 1526 Main Street Edmonds, WA
To engage in the business, occupation or process of: T
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: 97
I Allowed Occupant Load: 1 97 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
City of Edmonds Community Development Code 19.25.020
FIRE PREVENTION
if 11ry nl= Fnmnpjns SAFETY'SURVEY
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FIRE DEPARTMENT
4�' t S
AlInin CZfrppf
LOCATION:
BUSINESS NAME: Epulo Restaurant PHONE: 4257754566
MAILING PO Box 60152
ADDRESS: Seattle 98160
BUSINESS OWNER: Tim Squared LLC HOMEPHONE: 2065427028
EMERGENCY-1: Mo rris, Marian HOME PHONE: 2069929015
KEY ACCESS-2: Elsia LLC HOME PHONE: 2062271500
FREQUENCY
STATION 1, SHIFT
365
17 A
�
SCHEDULED
0.5/01/10
DATE DUE 1�
LIFIR 11� 161
5203
Occ LOAD 75
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE HD (2) 2/08 UL3UU PE - I
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
1 roj I
C eck c-
n
ENTER CODE ONLY ONCE I
VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
7
8
8
'Ist RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
E DUE:
1
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
1c7Nv_
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
1 CRNAOL IONS
15
VIOLATIONS
5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
-1
2
6
DATE:
CODE
SECTION:
5
3
7
7
RETURN RECEIPT
RECEIVED
6
7
4
8
4
8
-DATE:
DISPOSITION:
8-
LETTER NEEDED C] YES NO
LETTERNEEDED 1:] YES NO
FIRE DEPARTMENT COPY
rj- w
E CHIEF
'00ig
QUIPMENT
7661 159th Place NE Tel: 425-641-2127
Redmond, WA 98052 Fax: 425-562-6662
Restaurant System
Service Report
F� Annual Rx Semi- M
Annual
Customerl Epulo Bistro System Connected To: Inspection Date:
Address: 526 Main St N7/A
I Fire Alarm CommunicatorF
City: I Edmonds State: Zip Code: Building Alarm Audible:
Contact: ISHUBERT HO Phone:[ (406) 667-5148 1 Cell: I Fax F
Service Information
Monitored By: N/A Phone. Account#- Operator
System Mfg: RangeGuard Model: .25G #Tanks: Total Gallons: -25] Location: FPizza oven/kitchen
I =1 F1
Tuel Source: Electric (*-Gas -Valve Location: [BEHINDCOOKLIN Reset Relay Location:
Hydrostatic Test: Due Date/Size/Qty: (yr 201 I]gal F13 xE]) (yr gal (yr gal (yr gal
F El 11XII) = 11xD E] [1x1
Nozzles: Model/Qty: XE) ( xD xD ( X[]) ( XD X[])
Fusible Links: Temp/Date/Qty: (1 65/[]xF�) (212/[:]x[:]) (280/[] xD (360/[]x[:]) (450/EK1 (500/FxF1)
Cartridges: Model/Wt/Qty- ( /[]x []) /[]x
Date of Last Hood Cleaning: 10/10 Cleaned By: ASC Con ition
(perNFPA96): (-Light (-Medium (*-Heavy
Procedures Checklist
1. Are all appliances under the hood and properly protected?
YES
NO
C N/A
2. Does cooking line up match file drawings?
(9- YES
C NO
N/A
3. System gauge is in operable range?
(9- YES
C NO
N/A
4. Gas cartridges were weighed anclare within manufacturer weight requirements?
(- YES
NO
N/A
5. System operated properly from manual release?
(-9 YES
NO
N/A
6. System operated properly from terminal link?
YES
NO
N/A
7. Exhaust fan stayed on during test?
YES
NO
N/A
8. Fuel Source shut down during testing?
(o- YES
NO
C N/A
9. System piping is securely fastened?
r* YES
NO
C' N/A
10. System piping is clear of obstruction?
YES
NO
N/AAW
11. System meets manufacturees installation requirements?
YES
NO
N/A
12. Is this a UL300 System?
YES
C NO
N/A
13. Maintenance Tag properly punched and in place?
YES
(- NO
N/A
14. Class K fire extinguishers are installed and in operable range (quantity- Fj---� )?
YES
C NO
N/A
15. If Applicable Monitoring has been contacted (all signals have been verified as received)?
YES
NO
N/A
16. Copy of inspection -Reports have been left onsite?
YES
NO
C N/A
117.Werether are deficiencies noted during the inspection?
YES
N 0
N/A
118. if deficiencies were noted, was a copy of the "Deficiency Detail Report" left w/ Owner or a Rep.?
j(-YES
C NO
N/A
Technician Performing Work- N ENGLISH Lic #- IE-07234
Customer's Authorized Agent: Date:
Customer's Signature: Updated W109 ZZ
lr/�?J_77'WIPIRE
CHIEAF
6*
_ 11
EV
UIPMEN
T
7661 159th Place NE Tel: 425-641-2127
Redmond, WA 98052 Fax 425-562-6662
Restaurant System
Service Report
Annual serni-
Annual
Customer System Connected To: Inspection Date:
N/7AAddress: Fire Alarm CommunicatorF
City: lEdmonds 7 State: Zip Code: Building Alarm Audible:
Contact: ISHUBERT HO Phone:j (406)_667-5148 1 Cell: Fax*
r,prvirp Information
Monitored By- I Phone: I - i Account #: Operator
System Mfg: lRangeGuard � Model: IRG4GS I #Tanks: E, Total Gallons: F] Location: I kitchen
Fuel Source: (-Electric (e- Gas -Valve Location: PCONTROL HEAD
Hydrostatic Test Due Date/Size/Qty.
Nozzles: Model/Qty. x 5
F
Fusible Links: Temp/Date/Qty: (165
Model/Wt/Qty:
Date of Last Hood Cleaning: 110/10
Procedures Checklist
GWR
xF]) (21
PxF])
Cleaned By: JASC
Reset Relay Location:
(yrl::Igal E1xD (yrl:lgal []x P)
:]X[) ( XD X[)
(360/PxF]) (45o/ Fol x F) (500/[—]x[:])
/[]x [) /[Ixp)
Condition
(per NFPA 96): �- Light (*- Medium (- Heavy
1. Are all appliances under the hood and properly protected?
(-9 YES
C NO
C N/A
2. Does cooking line up match file drawings?
YES
NO
N/A
3. System gauge is in operable range?
YES
NO
N/A
4. Gas cartridges were weighed and are within manufacturer weight requirements?
YES
NO
(o- N/A
5. System operated properly from manual release?
YES
NO
N/A
6. System operated properly from terminal link?
YES
NO
N/A
7. Exhaust fan stayed on during test?
(e- YES
NO
C N/A
8. Fuel Source shut down during testing?
(9- YES
NO
N/A
9. System piping is securely fastened?
Ce' YES
C NO
N/A
10. System piping is clear of obstruction?
(*' YES
NO
N/A
11. System meets manufacturer's installation requirements?
re YES
NO
N/A
12. Is this a UL300 System?
(a- YES
NO
N/A
13. Maintenance Tag properly punched and in place?
(e- YES
NO
N/A
14. Class K fire extinguishers are installed and inoperable range (quant )?
ity F-7-71
(o- YES
NO
C N/A
15. If Applicable Monitoring has been contacted (all signals have been verified as received)?
YES
NO
(o- N/A
16. Copy of inspection Reports have been left onsite?
YES
NO
N/A
17. Were there are deficiencies noted during the inspection?
C YES
(o- N 0
N/A
il 8. If deficiencies were noted, was a copy of the "Deficiency Detail Report" left w/ Owner or a Rep.?
(- YES
(- NO
N/A
Technician Performing Work: I N ENGLISH Lic #: K-0723 I �
Customer's Authorized Agent:
Date:
Customer's Signature:
8/7/09 ZZ
rf1',-!wF1RrE
/4
r,,7-7.j7
&CHiEF
rr
EV
��,X
VNr
7661 1591" Place NE Tel: 425-641-2127
Parimnn#i wA aRnr�,) PnY. A9r,.rr,9-Ar%r,,)
Restaurant System
Service Report
El Annual 7�Semi-Annual 0
Customer EP101 142 Inspection Date
Address J /I System Connected to: Fire Alarm yes E).no 0 n/a .19-
Ed� d Communicator yes 0 no 0 n/a -R
Building Alarm Audible: yes 0 no 0 n/a 5iK
Contact
Monitored By: _A 4ZA Phone Number:
Phone 7
.CS:�
-, i Account Number
Fax
Operator
Operator
System Mfg: Model: ELfioNumber of Tanks: / Total Gallons:
Location:
ve Location:
Fuel Source: Gas SkElectric-,JE�Gas Va /Reset Relay Location:
Hydrostatic Test: Due Date/Size/Qtv: (yr2ot1gal 41'x I ) (yr gal x lyr clal x (Yr gal x
Nozzles: Model/Qtv: Ap-ex ,;) (6�� z) a x x x x I x I
Fusible Links: Temp/Date/Qty: (165/ x (212/ x (280/ x )(360/ x (450/ 3- (5001 x I
Cartridges: ModelMVQtv: x x I x x
Date of Last Hood Cleaning: 4
j,j!L-1U. Cleaned By: od* �j Condition (per NFPA 96): Light El Medium ';6�'Heavy 0
Procedures Checklist
1. Are all appliances under the hood and properly protected
yes 9�no
D n/a El
2. Does cooking line up match file drawin s
yes ig-
no 0 n/a E-)
�-30 SVsi6m -gaune is in operable ranne
yesN
no 0 n/i 0
4. Gas cartridges were weighed and are within manufacturer weiaht requirements
yes 0 no 0 n/a
S. System operated properly from manual release
ves 53;
no 0 n/a
6. System operated properly from terminal link
ves
R no 0 n/a 0
7. Exhaust tan stayed on during test
yes 53Lno 0 n/a E)
8. Fuel Source shut down during testina
ves Z
no ED n/a 13
9. System pipina is secure�v. fastened
yes EKno 0 n/a D
10. System piping is clear of obstruction
yes j;Vno
D n/a D
11. System meets manufacturer's installation requirements
yesT?h
no 0 n/a El
12. Is this a UL300 System
vesii�no
D n/a E)
13. Maintenance Tag properly punched and in place
ves
A no 0 n/a El
001A..Glass K fire extinquishers are installed and In operable ran_qe (quantity:
yes 5R�
no E) n/a C3
15. If Applicable Monitoring has been contacted (all si_qnals have been verified as received)
ves CD no 13 n/a X
16. Copy of Inspection Reports have been left onsite
yes 0,
no ED n/a 10
17. Were there any deficiencies noted during the inspection
yes
Yno 0 n/a 0
1 B. If deficiencies were noted was a copy of the "Deficiency Detail Report" left with the Owner or a Representative
yes [Pkno
El n/LE)
Tech . nician Performing Work S/ 4&4-1 Licft
printed name
Customer's Authorized Agent printed name Date
Customers Signature
Page of k
Deficiency Detail Report
Work Order #
3 - /0
Date
7661159th Place NE - Redmotid WA. 98052
Site
Ph: 42-S-641-2127 Eax: 425-562-4662
:S
ystem ILI:
'Deficiencies Noted:
Fr 114v, 14. 13,16, A r, ts I )Ae-, e e, gc P 01, b
Af4inn klaafi&A #^ r^rrof4 nafiAanAne MMarl.
E-1 Deficiencies have been scheduled
A repair proposal is required
Customer did not want the deficiencies to be coiTected
"Time: AM PM
A copy of the proposal has been left with the customer
My signature is acknowledgement that I have reviewed and understand the above deficiencies
Technician Performing Work, SFD Ceftl
Customer's Authorized Ag6nt
Date
Corrections Completed I Item Number Corrected
Technician Performing Work SFD Cert #
Customer's Authorized Agent Date
r
7661 159"' Place NE Tel: 425-641-2127
Restaurant System
Service Report
Annual Semi -Annual 0
Redmond, VTA 98052 Fax: 425-562-6662
Customer in spectlon Date
.;Address _6 144,5e 4i S, System Connected to: Fire Alarm yes El no n/a
Communicator yes 0 no 0 n/a
44. !gs!r-) C_? Building Alarm Audible: yes 0 no 0 n/a;g
Contact Phone�91�_ .5/(-?/gCell Fax
Aa�i�a lnfn�nflnn
Qw@!Or�.
Monitored By: ),I -A Phone Number:
1_�
Account Number
Openitor
Number of Tanks: Total Gallons.-/,Z Location:
System Mfg: Model.ff
Fuel Source: Gas 0 Electri N Gas Valve Location: & 4 -
4,; . Reset Relay Location:
;;4�
Hydrostatic Test: Due Date/Size/Oty: (yr204 24 x 1. (Yr
aal x (Yr gal x-
x
-gall
Nozzles: ModelIQty:(4ov2x z) x x
x x
x x
Fusible Links: Temp/Date/Qty: (165/ x (212/ x (280/
x )(360/ x )(450/
X. )(500//-52 x
Cartridges: Mode[Mt/Qtv: x
x x
x
Date of Last Hood Cleaning: Cleaned By:
Condition (per NFPA 96): Light
El Medium 0 HeavK�g
— P--h—a rh.rkliaf
1. Are all appliances under the hood and properly �rotecteci
yes::p no n/a 11
.2. Does cooking line up match file drawings
3. System naune is in operable ranne
yes�a no n/a El
Yes,4 no D n/a El
. as cartridges were weighed and are within manufacturer weight requirements
yes'6 no 0 n/L9
5. SVstem operated properly from manual release
yes. no n/a
6. System operated properly from terminal link
yes no n/a
7. Exhaust fan stayed on during test
yes no n/a
8. Fuel Source shutdown clurinq testina
ves�� no n/a
9. System Piping is securely fastened
yes no n1a 13
10. System piping is clear of obstruction
yesQ no n/a
11. System meets manufacturer's installation requirements
yesZ no n/a
12. Is this a UL300 System
ves;k� no n/a
- - - — -
13. Maintenance Tag properly punched and in place
ve�i no D n/a 0
Class K fire extinquishers are installed and in operable range (quantity:
yp�,O no ID n/4
15. If Applicable Monitoring has been contacted (all signals have been verified as received)
Vcs 0 no 0 tt/LI�67
16. Copy'of inspection Reports have been left onsite
yes no 0 n/a 1:1
17. We iencles noted durin
re there�aqy defic the inspection
yes n%[;i n/a 0
_q
18. If deficiencies were noted was a copy of the "Deficiency Detail Report" left with the Owner or a Representative
yes E) no 0 n/ GE
Technician Performing Work
,printed na
MY
Customer's Authorized Agent - --- - -Date
printed name
Customers
04/A/2009 15:34 FAX 425 415 0311 THE RILEY GROUP INC
W29
Fri
The Riley Group Inc.
Date: 4/16/09 Job Number: PRP2009-0186
To: Mike Smith, Phone:
Edmonds Fire Dept fAA- cf7f- 7-75--7'7z/
firow FTed,13ecker Fax: (425) 415-0311
The Riley Group, Inc. Phone: (425) 415-0551
Subject,:,--� Analytical Data from UST Site A nt
526 Main Street
Edmonds,
Mike: Here are the lab test results ftorn the UST at the above location in Edmonds.
SERviNG DiE PACIFic NORTHWEST
Seattle Office: 10728 Lake City Way WE, Seattle, WA 9812,:
Tcl (206) 417-0551 9 Fax (206) 417-0552
04/18/2009 15:34 FAX 425 415 0311 THE RILEY GROUP INC 10002
FREEDMAN & BRUYA, INC.
ENVIRONMENTAL CHEMISTS
James E. Bruya, Pb-D,
Charlene Morrow, M.S.
Yelena Aravkina, M.S.
Bradley T. Benson, B.S.
Kurt Johnson,&S.
April 15,2009
Fred Becker, Project Manager
The Riley Group, Inc.
17522 Bothell Way NE, Suite A
Bothell, WA 98011
Dear Mr. Becker:
3012 16th Avenue West
Seattle, WA 98119-2029
TEL: (206) 285-8282
FAX: (206) 283-5044
e-mail: fbi@isomedia.com
Included are the results from the testmig of material submitted -)D, April 14, 2009 from
the 2009-087A, F&BI 904147 project. There are 4 pages included in this report. Any
samples that may remain are currently scheduled for disposal in :10 days. If you would
like us to return, your samples or arrange for long term storage at. our offices, please
contact us as soon as possible.
We appreciate this opportunity to be of service to you and hope you will call if you have
any questions.
Sincerely,
FRIEDMAN & BRUYA, INC.
Michael Erdahl
Project Manager
Enclosures
TRG0415R.DOC
T1111w me1401102MV MIMM, ff,�Mflml nVe =@do=
04/kB/2009 15:34 FAX 425 415 0311 THE RILEY GROUP INC 10004
FMDMAN & BRUYA, WC
ENVIRONMENTAL CHENESTS
Date of Report: 04/15/09
Date Received: 04/14/09
Project: 2009-087A, F&BI 904147
Date Extracted: 04/14/09
Date Analyzed: 04/14/09
RESULTS FROM THE ANALYSIS OF THE SOIL. SAMPLES
FOR TOTAL PETROLEUM HYDROCARBONS AS
DIESEL AND MOTOR OIL
USING METHOD NWTPH-Dx
Sample Extracts Passed Through a
Silica Gel Column Prior to Analysis
Results Reported on a Dry Weight Basis
Results Reported as mg/kg (ppm)
Surrogate
Samnle ID Diesel Ragge Motor Oil Ran ILK Recovery
Laboratory ID (CIO-C20 (C23-C36) (Limit 67-127)
TPl-13 <50 <250 101
904147-04
TP2- 10 <50 <250 92
904147-07
Method Blank <50 <250 92
�A
04/16/2009 15:34 FAX 425 415 0311 THE RILEY GROUP INC 0003
FRIEDMAN & BRUYA, INC.
ENVIRONMENTAL CHEMISTS
CASE NARRATIVE
This case narrative encompasses samples received on April 14, 2009 by Friedman &
Bruya, Inc. from the The Riley Group, Inc. 2009-087A, F&BI 9C4147 project. Samples
were logged in under the laboratory ID's listed below.
Laboratory ID
The Riley Group, Inc.
904147-01
TP1-4
904147-02
TP1-8
904147-03
TPl-11
904147-04
TFI- 13
904147-05
TPI-15
904147-06
TP2-5
904147-07
TP2- 10
904147-08
TP3-4
904147-09
TP3-7
904147-10
TP3- 10
All quality control requirements were acceptable.
0
I
NER-Min-K-XI IRM � 21040- �1 ��
04/1,6/2009 15:34 FAX 425 415 0311 THE RILEY GROUP INC (a 005
FP,MDMjkN & BRUYA, INC.
ENVIRONMENTAL C14EMISTS
Date of Report: 04/15/09
Date Received: 04114109
Project: 2009-087A, F&BI 904147
QUALITY ASSURANCE RESULTS FROM THE ANALYSIS OF SOIL SAMPLES
FOR TOTAL PETROLEUM HYDROCARBONS AS
DIESEL EXTENDED USING METHOD NW'PH-Dx
Laboratory Code: 904147-07 (Matrix Spike) Silica Gel
Sample
Percent
Percent
Reporting Spike Result
Recovery
Recovery Acceptance RPD
Analyte Unita Level (Wet wt)
MS
M 8) D Criteria Lmi� —20�
Diesel Extended. M.gfkg (ppm) 5,000 <50
120
1(-4 78-126 14
Laboratory Code: Laboratory Control Sample Silica Get
Percent
Reporting Spike Recovery Acceptance
Analyte Units Level LCS Criteria
Diesel Extended mglkg (ppm) 5,000 112 70-127
3
Print Agenda Item
2- /'T7,-J S-F
Page I of I
El
CommercW Cooking Woodsmoke
Edmonds City CouncH Meeting
Date: 08/22/2006
Submitted By: Sandy Chase, City Clerk's Office
Submitted For: Ron Wambolt
Department: City Council
Review
Committee: Community/Development Services
Action:
Subject
Commercial Cooking Woodsmoke
Time: 20 Minutes
Type: Action
Agenda Memo
Previous Council Action
This issue was discussed by the Community and Development Services Committee at their August 8, 2006
meeting. No action taken.
Narrative
Staff received a complaint regarding the use of wood for cooking in a commercial restaurant downtown. Two
other citizens voiced their complaints at the August 15 City Council meeting. The complaints centered on the
odor of the burnt wood. Staff contacted the Puget Sound Clean Air Agency regarding the matter and were told
that they do not enforce commercial cooking for restaurants. City regulations governing smoke and odors are
found in Chapter 17.60.010 E & F (See Exhibit 1).
One remedy would be to pursue a code amendment to ban commercial cooking with wood. It would have to
apply to all restaurants.
Recommendation
Direct staff to investigate what remedies, and their costs, are available to eliminate the smoke, or its odor. The
investigation should include determining how other cities deal with this problem.
Link: Exhibit 1 - Chapter 17.60.010
Revenue & Expenditures
Fiscal Impact
Attachments
Form Routing/Status
Route Seq Inbox Approved By Date Status
1 City Clerk Sandy Chase 08/17/2006 03:15 PM APRV
2 Mayor Gary Haakenson 08/17/2006 03:29 PM APRV
3 Final Approval Sandy Chase 08/17/2006 04:33 PM APRV
Form Started By: Sandy Chase Started On: 08/17/2006 02:43 PM
Final Approval Date: 08/17/2006
http://edmonds-agendalfrslpublishlprint_ag_memo.cfm?seq=584&mode=print&rev—num=O 9/1/2006
ii
city of edmonds
land use application
I ARcHITEC1`UR.AL DESIGN REVIEW
0 COMPREHENSIVE PLAN AMENDMENT
0 CONDITIONAL USE PERMIT
0 HOME OCCUPATION
A0 AIM
0 FORMAL SUBDIVISION
too (4#—)
0 SHORT SUBDIVISION
IS-
0 LOT LINE ADjusTmENT
0 PLANNED RESIDENTIAL DEVELOPMENT
0 OFFICIAL STREET MAP AMENDMENT
0 STREETVACATION
0 REzONE
0 SHORELINE PERMIT
0 VARIANCE / REASONABLE USE EXCEPTION
0 OTHER:
MAR 1 6,2004
PERMIT COUNTER
PROPERTY ADDRESS OR LOCATION � 11 -7 15A- &19.10 110 (,L)A
PROJECT NAME (IF APPLICABLE) KQ-,::4 —7u�),
PROPERTY OWNER �;IPHONE #
ADDRESS
E-MAILADDRESS FAX# 4Q' 1 7/2 6,91
C
TAX ACCOUNT# 00 I.-Lt> 6 A SEC. TWP. RNG. -3 eC
DESCRIPTION OF PROJECT' OR PROPOSED USE
APPLICANT !E�4 74htu-�arn=:�) PHONE# -7 ES et��
ADDRESS
E-MAILADDRESS MSAJ1CQ�FAX#
CONTACT PERSWAGENT lj�xll# V-akl-y� 4D�:) PHONE #
ADDRESS 10ZOP:> !��A RAA LJO-94- UJA
E-I�IAIL ADDRESS FAX #
The undersigned applicant and his/her/its heirs, and assigns, in consideration on the processing of the application
agrees. to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including
reasonable attorney's fees, arising from any action or infraction based in whole or part upon false, misleading,
inaccurate or incomplete information furnished by the applicant, his/her/its agents or employees.
By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized "e this application on the behalf of the owner as listed be . low.
SIGNATURE OF APPLICANT/
Property Owner's Authorization
�Zmmmp
By my signature,.1 ceftify that I have authorized the above Applicant/Agent to apply for the subject land use
application, and grant my permission for h fficials and the staff of the City of Edmonds to enter the subject
property for the purposes of inspec a2d posting dant to this application.
SIGNATURE OF 0 R., DATE
This application form was revised oin 1/27/00. To verify whether it is still current, call (425) 771-0220.
L\LE31KARYTIANNINGToms & HandoutsTublic HandoutsVmd Use Applicatio n.doc
)Ze,� 7w j I j5xkarj � &xfe,
70fle rewvpvtim ?tcct to tka existi"
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fAint ewi5tini exterior (5ee ?xint chir)
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MeW Rxcic 5tat rxiti" xrou n4 ou t4por
extinj xrepv
• fowki"I reunmm x5 i5
• )4?txa exterior xwninjs With, omxwntxt
?xinu� W17OP4 tratti . 5
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• Zxtexior ti�fvtigj cxi5ti"
• Mo 5tuprafrototle, witt �e, m�#.4 to tfie
exi5timl �uit4i"fvvt?rint
CITY of EDMONDS,
Civic Center - Edmonds, Washington 98020 Telephone (206) 775-2525
Office of the Fire Chief
February 3, 1975
Marie Drilling
526 Main St. !LL
Edmonds, Washington 98020
RE: Edmonds Beauty Boutique
Dear MS:. Drilling:
On January 2, 1975 the Fire Department advised you by letter that
certain items were in violation of City ordinances or Fire Codes.
On January 21, 1975 a reinspection of the premises was made. The Fire
Inspection has indicated that code violations remain uncorrected.
The Fire Department is aware that it may be difficult at times to comply
and to resolve such hazards immediately because,of day to day commit-
ments or other valid -appearing reasons.
In the same respect, the ordinances and Fire Codes were adopted by the
City of Edmonds to provide a minimum of.equal protection for allits'.
citizens and their valuable property.
It is not our wish nor desire to bring legal.action against you to.
obtain compliance, but that will.be your choice.
The Fire Inspector will reinspect'on February 18, 1975 to ascertain your
status.
Please advise by return letter your intentions or questions regarding
the matter at hand.
Sincerely,
Ralph H. Klein
Assistant Fire Chief
Fire Marshal
peh
CITY of EDMONDS
Civic Center - Edmonds, Washington 98020 Telephone (206) 775-2525
Office of the Fire Chief
January 29 1974
Marie Drilling
526 Main Street
Edmonds, Washington 98020
I Dear Ms. Drilling:
RE: Edmonds Beauty Boutique
In accordance with.national-Fire Prevention practices and the
continuing Edmonds Fire Department Fire Prevention program your
business building was inspected on December 270 1974.
To reduce the potential loss of life and property the fire
inspector has listed below recommendations for your attention:
Remove excessive storage in storage roomand keep it in.
an orderly fashion.
2., Replace all plastic waste containers with metal or approved
non-combustible type. Plastic liners in metal containers are
acceptable.
3. Patch hole in restroom wall behind door.
4 Secure cover plate behind drier.
5. Remove all combustibles from behind washer and drier.
6. Remove extension cord from furnace vent fan and/or replace
with permanent witing. Six foot maximum cords on appliances.
70 Remove excessive storage from furnace room and keep aisles
clear.
B. Knock -outs in main electrical panel are to be filled with
.proper blanks unless circuit breakers are installed.
9. Remove extension cords supplying electrical hairstyling
Appliances. Provide sufficient outlets so extension cords
are not needed..
The Fire Department will reinspect after 15 days. Please contact
this office if further information is desired, 775-2525.
Yours for a safer community through Fire Prevention.
James A. Hovick
Fire Prevention Inspector
peh