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174 SUNSET AVE_RedactedIIII�lIII 1,7Y su,4fer Aar, RT _ jimt 'Mi M & 1 Hood and Duct Services, Inc. 6100 12th Ave. S. Phone (206) 726-0940 Seattle,WA 98108 Fax (206) 767-2607 Occupancy Name: _ COMPLETE Certification Given: RED ❑ YELLOW ❑ WHITE FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD • High Pressure Hood Cleaning SYSTEM TEST REPORT • Fire Suppression Installation & Service CONFIDENCE TEST Eg- REPAIRS ❑ • Fire Extinguisher Sales & Service • Range Hood and Fan Service & Repair �+ • Filter Sales & Service DATE: Occupancy Address: % y Lc in ! / ne City, State, Zip: joa7 A[y_" g2 ,1 G✓ rT 7.YOOL C-.� Responsible Person: Phone Number: �� G �� 4®y Building Owner: Building Owner Address: Testers Name (Please Print): e"--Z. Tj-":: System Alarm? YeNo ❑ Central station monitoring? Ye No ❑ Control Panel manufac urer: Model Numb Extinguishing System Manufacturer System Size t Location / Height of Range hood: (q Ar o l Zi ! � Phone Number: City, State, Zip: SFD Certification Number: SCP- Monitoring company name: .ts fi r�G !be 7ILt Location of Alarm Panel' •GrG t tJ o 300 System? Yes jq-No ❑ U.L. 300 Compliant? Yesjallo ❑ Chemical Type: WetXDry❑ Is pressure gauge indicator in operable range? 11A 0649-­j-� 12 year hydro date of cylinder. Is there chemical inside of the cylinder? Yeses No ❑ Were hand portable extinguishers properly serviced? Weigh CO2 or nitrogen cartridge. NA El _GiEQ_dZ Were all cooking surfaces protected? If not, give owner full Novisible si ns of a s stem fire or s stem tam erin (if si ns check no) YesO No ❑ information. jtOl3s �PO % NA❑ Ye R No❑ Yesj� No ❑ 9 Y Y P 9 9 Check all piping and conduit. Are all piping and conduit immobilized with Yes No ❑ Was operating procedure verbally given to restaurant personnel? Yes r_ No ❑ proper hangers and brackets? Was UL 300 compliance explained to owner or manager? Yesg No ❑ Are all protective covers present on nozzles? Yes jW No ❑ Gas shuts down upon system activation? NA ❑ Yes, No ❑ Are all nozzles checked in the proper position? YesXj No [] Electric power shuts down upon system activation? NA ❑ Yes No ❑ Does system have adequate volume and/or nozzle coverage? Yes V] No ❑ Range hood tied to building alarm panel? NA ❑ Yes:Wj No ❑ Are all appliances inside of the hood protection area? Yes,V[, No ❑ Range hood activation signal received at building alarm panel? NA ❑ Yes I No ❑ Have fuse links been replaced? Yes No ❑ Class K extinguisher present? Yes_ No ❑ Was system operational from terminal link? Yes I No ❑ Grease buildup in group: Was system operational from manual remote? Yes No ❑ Light Medium Heavy, recommend cleaning /�(! Was system and micro switch operational? NA❑ Is system visible and free from obstruction? Yes X, Yes3_6 No ❑ Date of last cleaning _� •� No ❑ Are cleaning intervals within NFPA standards? D _ ''Yesx No ❑ Is the inspection and service tag on the cylinder? Yes No ❑ Previous Confidence Test Company &Technician ■MiNNn■n■i N■■■■■■■■■■ ■■■.■■■■ ■■ ■ .. NNNNMIN �■■■� N■ ■� No ■■ ■ a ■■■'■■' • ■ ■■ ■ ■■■■■■■■■ ■O ■■■■i■i■ ONO No MEMO ■■NooO ':■'n' ■� ■� ■sM ■� ■ Noss■ ON= ME ■lii'iN'■■■ M ■ n ■ ■ ■■■ �■■ ■■■■ ' ' ■'�:■:: Problems Found: (If additional room is needed, please add a separate sheet) al v P/4 G10-6C.. /r_ S —1/ Corrections Made: Date Corrected: �T -N,3JiLI x a,) coPF-r;e- Vo Corrected By: has declined SFD Certification Number: This certifies that this fire and li qFv tem as been properly inspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code standards. Discrepancies are oe en reported to the building Owner/Responsible Person for corrective action. Signature of Tester: Phone # (206) 726-0940 Duct Testing Agency: R&T Hood and Services, Inc. Mailing Address: 610012th Ave. S.• Seattle, WA 98108 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 performing4inspen andany rre tions required. 4. Observe system, checking that no obvious physical damage or condition existsAUTHORIZED that might prevent operation.5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE FIRE DEPARTMENT CO & Hood and Duct Services, Inc. 6100 12th Ave. S. Phone (206) 726-0940 Seattle,WA 98108 Fax (206) 767-2607 Occupancy Name: Occupancy Address: Responsible Person: Building Owner: COMPLETE Certification Given: RED ❑ YELLOW ❑ WHITE FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD • High Pressure Hood Cleaning SYSTEM TEST REPORT • Fire Suppression Installation & Service CONFIDENCE TEST REPAIRS ❑ • Fire Extinguisher Sales & Service • Range Hood and Fan Service & Repair • Filter Sales & Service DATE: " L/77 A City, State, Zip:, Phone Number: Phone Number: Building Owner Address: City, State, Zip: oel Testers Name (Please Print): ��u SFD Certification Number: SCP- System Alarm? Yes- f No ❑ Central station monitoring? Yes ❑ No ❑ Monitoring company name: / r l are) — Control Panel manufacturer: Model Number: Location of Alarm Panel: 14 Extinguishing System Manufacturer LI I Sy Location / Height of Range hood: Yes L6No ❑ U.L. 300 Compliant? YesjCjNo ❑ Chemical Type: Wet [Dry ❑ Is pressure gauge indicator in operable range? "14 Yes ❑ No ❑ 12 year hydro date of cylinder. Is there chemical inside of the cylinder? Yeses No ❑ Were hand portable extinguishers properly serviced? Weigh CO2 or nitrogen cartridge. NA ❑ 7ff QAre all cooking surfaces protected? If not, give owner full No visible signs of a system fire or system tampering (if signs check no). Yeses' No ❑ information. NA[] Yeses No❑ Yes (;�• No ❑ Check all piping and conduit. Are all piping and conduit immobilized with Yeses No ❑ Was operating procedure verbally given to restaurant personnel? Yes ®' No ❑ proper hangers and brackets? Was UL 300 compliance explained to owner or manager? Yes [j" No ❑ Are all protective covers present on nozzles? Yes ff No ❑ Gas shuts down upon system activation? NA ❑ YesQ No ❑ Are all nozzles checked in the proper position? Yes•7 No ❑ Electric power shuts down upon system activation? NA❑ Yes[} No ❑ Does system have adequate volume and/or nozzle coverage? Yeses No ❑ Range hood tied to building alarm panel? NA ❑ Yes Q' No ❑ Are all appliances inside of the hood protection area? Yesfn No ❑ Range hood activation signal received at building alarm panel? NA ❑ Yes {!f No ❑ Have fuse links been replaced? Yeses No ❑ Class K extinguisher present? Yes No ❑ Was system operational from terminal link? Yes [ No ❑ Grease buiA n group: Was system operational from manual remote? Yes i� No ❑ Light �Oedium Heavy, rec doioenirfg Date of last cleaning / Was system and micro switch operational? NA❑ Yes [�j No ❑ Is system visible and free from obstruction? Yes D— No ❑ Are cleaning intervals within NFPA standa�6? Yeso" No ❑ Is the inspection and service tag on the cylinder? Yeses No ❑ Previous Confidence Test Company & Technician ® ■ I� ■ ■ ■ ®� ■ D ■■■■ ■ ■;;■ ■■■�i■n ■■ ■Kim_, ■■■ ■■■n ■ _ ■N■ ■ ■ ■ ■■■■E■ �■ ■�■■■■■ ■in i■i■■� ■■��■ - - �ili■■■n■�il■iiii■E ■■:■■ ■� ■■■i■■�i■gym a ■�■■■■■■■ ■■o■■ NoWE Problems Found: (If additional room is needed, please add a separate sheet) �(MI J ' Corrections Made: Date Corrected: Corrected By: Customer has declined SFD Certification Number: This certifies that this fire and lifVkafety sys em ha been properly mspe for reliability to't:over the items listed in this report and is consistent with Seattle Fire Department Fire Code standards. Discrepancies a t nd h %r d o fhe build g w / esponsible Person for corrective action. Signature of Tester: '•-�—�Phone # (206) 726-0940 Testing Agency: R& O nd uct Servi es Inc. Mailing Address: 610012th Ave. S., Seattle, WA 98108 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 a found, appropriat orr ctive action shall be taken immediately. intended use. 9. A record of the mo hly in p ctions is e t reflecting the date inspected, inititals of 3. Insure that all tamper seals are intact and that system is in a ready condition. person performin he in tion c r ections required. 4. Observe system, checking that no obvious physical damage or condition exists AUTHORIZED that might prevent operation. 5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE _ FIRE DEPARTMENT C CITY OF EDMONDS BUSINESS LICENSE APPLICATION— COMMERCIAL FEE: $125.00 j CITY CLERK'S OFFICE, BUSINESS LICENSE DIVISION 121 5' AVENUE NORTH, EDMONDS, WA 98020 PHONE: 425.775.2525 OFFICE USE ONLY BL# C stomer# SIC Year Gass SHD D to al flTR# og � AMITIZ5 Weeaid Mailed Delete INSTRUCTIONS: Please complete the application in full and attach the required floor plan. Middle Initial or name required of all parties concerned. If no middle none, please Indicate by writing NMN. Sign and return application with fee. Please advise of any change in status. New license required if business changes location or ownership. Notification to City of Edmonds required If business closes. BUSINESS NAME BUSINESS ADDRESS 1-14 Street 020 No. Zip Code MAILING ADDRESS Saw►t A i Q Lov G Street or PO Box Suite No. City, State and Tip Code BUSINESS PHONE NO. ( 2 0 6 ) b9 b - q 1-0 9 WA STATE TAX ID NO. (UBI NO.) BUSINESS E-MAIL I drrypSPu� Ei al�av�c�Clti:�t. toF. BUSINESS WEBSITE PROPERTY OWNER , ii S �l c SS �N LLC. r , 0. $OX IMB El t 980M Name Phone Number EMERGENCY NOTIFICATION (For Premise Access in Emergency): Maf: o., La 41r &. ( 20L ) 114 - 9jt9 Last Name Fi t Name MI Phone No. C. Last Name First Name Mi Phone No. NATURE OF BUSINESS G,. t c k Ste. u i NUMBER OF EMPLOYEES q - 10 SQUARE FOOTAGE,OF BUSINESS SPACE 1906 ` TYPE OF BUSINESS - PLEASE CHECK THE APPROPRIATE CATEGORY: O CONSTRUCTION O FINANCE, INSURANCE, REAL ESTATE O LANDSCAPE, HORTICULTURAL O MANUFACTURING O NON-PROFIT * RETAIL O SECONDHAND DEALER Cl SERVICES O WHOLESALE O OTHER AMUSEMENT DEVICES ON PREMISES? O YES 0 NO IF YES, TOTAL NUMBER LIQUOR SOLD ON PREMISES?: O YES * NO GAMBLING? O YES 1 jNO CIGARETTES SOLD ON PREMISES? O YES A NO FLAMMABLE OR HAZARDOUS MATERIALS USED OR STORED?: O YES 0 NO IF YES, PLEASE PROVIDE LIST OF MATERIALS AND QUANTITIES: PROPOSED OPENING DAY OF BUSINESS jtme 20) S BUSINESS HOURS 1 1— 9 DAYS OPEN *SUNDAY 1(MONDAY TUESDAY )kWEDNESDAY 4 THURSDAY 1I.FRIDAY � SATURDAY PARKING SPACES ON SITE: TOTAL C4ft o, Pt,,1C t'W t ,1!, ACCESSIBLE FOR PERSONS WITH DISABILITIES jec DOES THE BUSINESS CONTAIN AN ENTRANCE ACCESSIBLE TO PERSONS WITH DISABILITIES? YES O NO PREVIOUS BUSINESS USE AT THIS ADDRESS Ta4er A Q P NAME Led ADDRESS Fird M SM1ea1 Apt Pb,llnB No. CRY. Side eM Zip Cafe � HO.Y.E PHONE NO.(_) OOL NO.(ORIVERS LICENSE NO.) OR OTHER 10N0. DATE OF BIRTH GTY AND STATE OF SIRTH r COUNTRYOFBIRTH NAME ' PARMII`<ffiN[P •PARYWERT LaM Fge1 MI ADDRESS SOe'el Apl. wD.. Urd wu CYry.51a4 aM nD COMa HOME PHONE NOI 1 UOL No.(ORNERS LICENSE NO.) OR OTHER ID W. DATE OFSIRTH CITY AND STATE OF SIRTH COUNT TRYOFBIRTN 6AWRSE' R^mNtID.PhRBNERB wNYE lad FM M ADDREw sbeat Apt Na. UnB Poa Ciry,sbte alM nP COEa NCME PHONE NO.L 1 DCL N0.(ORNERS LICENSE NOJ OR OTHER ID NO. DATE OF BIRTH CRY AND STATE OF BIRTH COUNTRY OF BIRTH CORPORAT40N NAMEOFCORP 11 RALTA%IDNO.� CORP. ADDREss 3880 LdS�R�dE Sw Co,..a P PHONE No.L't�)65b4�D9 Blrasl 75W." suae. ApL, ntl Poo. Gly. StalaeM np CaEe CORPORATEOfflCERS: I Led Nees FIM Name MI Dated BiM DOL No. OMveN license No.. or Como 10 No. Marro pT�ie�s LPsy— Ca. ®d ow �aA Lmvd e. �— mm LOCAL COMACT YIW iew I ' �V1awuN( . Leel Noma H. FMN M Title=�—Plana No. COL No.(U ram NP)af WsrONo I I � I 11 APPLICANT I.PYO$ Bel a Name-PonHd SbMWro' T O CITY USE ONLY: PLANNLUGDEPT. DAPPRDVE DOEMPPROVE DATE SIGNATUR ICNING CODE CONDMCML USE PERf{R 1 COMMENTS 3U LDING OEPT. CIAPPROVE D DISAPPROVE MTE SIGNATURE OCCUPANT LOAD wwm PERMIT CCCUPANCYGROLN COMENrs 'ARE DEPT. CIAPPROVE CIDISAPPROVE MTE SIGNATURE_ UAL0. COMPSNTS P EDEPOT. DAPPROVE ODISAPPROVE MTE SIGNATURE COMMEN S W) Project no: 14.___Oo Location: EDMONDS Issued to: Lwy Murton, SPINS Revision: Onto: 11,03.14 Title: Project Monoger: RAM SPUDS - EDMONDS scale: r burgess design Iinteriors 0 architecture llNF.MMMw k&Q0.so111,Wkd1.V-Sml rMSI77110 Row Sol lln REVISION 1 - OPT 4 I/H-V-0^ Sketch No.: SP_4 �9..moseAl[tlon R Mtelluetuol M000fty A i S �.OSS I U�l Gl ��• P: � �� � ?�ea' •t. �,w tt City, i 3 1 t H �$ry,.a.:rw y uusuxnati„ SS� � p a. v. pk CO q i A !P j p onMot. it.Amdt Slat ; Y lip' 10 r / 104 s'.: k�.. YF1At -•L �+rt•;'.f ,fitom - +'_;<Vr'' �ti +._ s jj ' °?id 2'�NaJ �r - `W .'•,,� � 14 � ,aacdJ'{.. \, - �/ 7� • Jry. r •�� �+7,%� �VV� �° ' ��'%'I ,�'tk`Y, t� ",'t r' ry. •'P y6 i 52,., SHT 7 '';3 T27N R3E I V i•I•, 7V�y2 f. fr's ;rc� w ra}' �t 4 �r �i I .T BID Boundary 1 v, Y a �"�L-,y. �t •�'F�'y { -i °"'f• fl. i 5r`;C t�J ir"� R .1 d ! a Yt� v k{ / }rt 44 ,4 59 v'x tt t �� •. ,. :� -6 � y y�y�j�,. I f( % .�"".,,:��5����' `i`,:�.,f �'�?t i J i� 1 $+T l+is,d:m vo�sscf" ^W t� 104 I,S4°at ,P c T , Ln - -' j:'... . ...>• � !'F� _ .. •.�. t ik��` ���`��4 J{1�'),j��'4s,cs1T �•�b � .. � V. •�Q <atk:�; +u..b-veil" t^t."y_ . ^'r���'�';� . ti': W Dayton St Dayton. St 1- 2,051 0 8SA5 170.9 Feet This map Is a user generated static output from an Internet mapping site and is for reference only. Data layers that appear on this map may or may not be accurate, WGS_1984 Web_Mercator_Auxiliary_Sphere current, or otherwise reliable. 0 City of Edmonds THIS MAP IS NOT TO BE USED FOR DESIGN OR CONSTRUCTION b•k ! r�,' �,� Lynnwood , E(,, F t. �nontls , -.,,yip •tp Akluwoo s uk �y��`x• I .d—• luntlake .�j' c pmo,I:..acw.�• e�P.3P •.... Legend Administrative Boundaries A Dot su �S6T Na S P.emove Notes CITY OF EDMONDS DAVEEARLING MAYOR 121 5th AVENUE NORTH • EDMONDS, WA 98020 • (425) 771-0220 • fax (425) 771-0221 www.edmondswa.gov DEVELOPMENT SERVICES DEPARTMENT S90 April 23, 2015 MEMO TO: Edmonds School District Edmonds Fire Department Verizon Northwest Edmonds Police Department SNOCOM Police and Fire Dispatch Edmonds Utility Billing SNOPAC Edmonds Public Works Snohomish County E911 Edmonds Building/Street File U.S. Post Office Edmonds Address Files Snohomish County Assessor's Office Lynnwood Disposal Snohomish County Information Services Comcast Cable Snohomish County P.U.D. Puget Sound Energy Waste Management Northwest Allied Waste Please be advised that the attached addresses have been added to the Edmonds address system. 172 Sunset Ave S 174 Sunset Ave S Note that 170 Sunset Ave S is going to remain for building services pertaining to the entire structure. Parcel: 27032300104500 The following addresses are now retired: 111, 115, 119, 123, 192, 194 Sunset Ave S If you have any questions regarding this letter, please contact a City of Edmonds Permit Coordinator at 425-771-0220. Please contact our office if you wish to be removed from future address change notifications. Sincerely, 3-6 h C,6,— Kristin Johns Senior Permit Coordinator City of Edmonds Building Department L\Temp\DST's\Master Letters\New Address4/ 3/2015 • ncorporated August 11, 1890 Cic+nv (';hp - PoLinan Annan City of Edmonds �S 6 �s d' 1 �60 Ito DSO Sp 2�o0 toy 500 W Dayton St 0 BID Boundary r1r 0 0 0 0 0 D toa < o 180 > +� O Q oo ocoo 000 oo q�oo C Dayton St �I 0 110.21 220A Feet This map is a user generated static output from an Internet mapping site and is for reference only. Data layers that appear on this map may or may not be accurate, WGS_19B4-Web Mercator Auxiliary_Sphere current, or otherwise reliable. m City of Edmonds THIS MAP IS NOT TO BE USED FOR DESIGN OR CONSTRUCTION 6 t lyn n1E r.. �K. Mountlake i Legend i Administrative Boundaries Parcels Su�s� �vE S Notes