20040211.pdfI
DATE RECEIVED
[PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE N U M B E
JOB SUITE/APT#
CONSTRUCTION PERMIT APP LICATION
ADDRESS
OWNER N EINAME 0 -ft? &XIJ041 —9f;,r
F B U1.
PIAT NAME/SUBDIVISION NO. LOT NO� LID NO.
-tx
I
M
W
MAILING ADDRESS LID FEE S
TESCP APPfOvnd
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP sw Permit Required
/6-//)
0
__�_�O/ I k Street Use Permit Roci'd E3
_rTELEPHONE
EXISTING — PROPOSED InGruiction Requited E3
CITY ZIP Sidewati. Required CI
Undeigfound
REQUIRED DEDICATION— F1 Wiring required C3
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES NO
z
Fr
U
Lu
t
ADDRESS REMARKS
z
z
OWNER/CONTRACIOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
5
z
CITY ZIP TELEPHONE
NAME CBL#
ENGINEERING REVIEWED BY DATE
ADDRESS
0
k�
M
BY
FIRE REVIEWED DATE
W
CITY ZIP TELEPHONE
0
I'
01
VARIANCE OR CU SHOREL1777INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY REO'D POSTED
I IS
OYES ONO
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL No. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
W
I ,
EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FF.)
NEW RESIDENTIAL F1 PLUMBING / MECH L/11 SIDE REAR
ALLOWED PROPOSED FRONT SIDE REAR FRONT
0
COMPLIANCE OR
ADDITION COMMERCIAL
z
z
CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY REQ'D PROVIDED
SIGN
I
REPAIR GRADING FENCE
CYDS 1:1 X FT) REMARKS
F*� DEMOLISH n TANK 16
GARAGE RETAINING WALL FIRE SPRINKLER
1:1 FIRE
z
CARPORT ROCKERY ALARM
(TYPE OF USE, BUSDIESS OR ACTIVITY) EXPLAIN:
CHECKED BY TRUCTION OCCUPANT
777
ITYPE
GROUP
ul
0
GO
NUM13ER NUMBER OF CRITICAL
D% AREAS SPECIAL INSPECT16N JAREA OCCUPANT
OF IELLING
VA
0
IV LOAD
STORIES UNITS NUMBER REQUIRED [I YES
DESCRIBE WORK TO BE DONE
REMARKS
z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
VALUATION
Description FEE Description FEE
Plan Check
State Surcharge
HEAT SOURC�� GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I=
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
cc
W
PERMIT APPLICATION: 180 DAYS
CL
PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U)
'APPLICAN1, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
W
_j
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMtESS THE CITY OF
2
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPIOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLYORINDIRECH-Y
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF IHIS PERMIT SHALL NOT BE
Landscapelnsp. Total Amt. Due
DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0
NOR LIM11 IN ANY WAY THE CITYS ABILITY 10 ENFORCE ANY ORDINANCE PROVISION
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I ALI THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE 10 COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC CALL I lus application is not a punnit until signed by the
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy. and Fees are paid, and
IN VIOLATION OF THE LABOR GODE OF THE STATE OF WASHINGTON RELATING FOR INSPECTION '-1 receipt is acknowledged in space provided.
WOFIKMLNIS_��AN SAT ION INS4CE AND RCW IB 27. -1 S SIGVATURF TE
0 1, 1 PA
S I G e_
T�uR E NER iI[)/RA7GE fF) DATE SI ED (425)
7NA
D7 71
;3 771 n99n
R F SED 13Y V�
A17ENTION Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI ORIGINAL FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PiNK � OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
z
0
1
0
M
--I -n
Cn
0 M
C
M
0
0
0 C:
4 g
X M
M z
Cn
o -n
M M
0 _Cn
0 r_
0 1711
Cn
U)
M 0
Z
;0
z
0)
z
0
4
0
IT!
�..M
PI-t/kri
Grease Trap Sizing Worksheet
Facility Name: Or�('V-e"'r Pr,�Ar-'l
Address: 30i St. Suite No.:
• A Grease Trap plumbing permit is required ($165.00 fee). Contact the Pretreatment
Technician (425-672-5755) if you have any questions and also to get signature approval on
this form.
• Dishwashers are not allowed to be connected to a Grease Trap.
• Food disposers are not allowed in a facility served by a Grease Trap and must be disabled or
removed. Solids must be screened out and placed in the solid waste container.
#1
Fixture Capacity in Cubic —
Inches
(L x W x D x no. of sinks)
le x /�, x 12- x 2- c.i.
Fixture Capacity
in Gallons
(Cu. In. + 231)
231 = gal.
Drainage Load
(75% of Total
Capacity)
x.75 = gal.
Flow Rate for
a 2-Minute
Drain Period
2 = 1r,
#2
x x x c.i.
231 = gal.
x.75 = gal.
2 = gpm
#3
x x x CA .
231 = gal.
x .75 = gal.
+ 2 = gpm
#4
i
x x x 6.
+ 231 = gal.
x .75 = gal.
+ - 2 = gpm
Grease Trap #1 - Total drainage flows from maximum of 4 fixtures
-t- ra Lk� �
Ink gal.
#1 Pr",--X's�X-1 X c.i. -- 231 = gal. x.75 =
gpm
Ifi*2-"—
gpm
#2
x x x c.i. -
+ 231 = gal-
x.75 = gal.
+ 2 = gpm
3
x x x c.i.
231 = jZal.
x .75 gal.
-- 2 = RDM
#4
x x x c.i.
231 = gal.
x .75 gal
+ 2 gpM
rease Trap #2 - Total drainage flows from maximum of 4 fixtures
G rl
gpm
MINIMUM SIZE OF GREASE TRAP(S) REQUIRED
9Pm
Number of Fixtures Connected to a Grease Trap
2
3
4
Grease Trap Size (in gpm)
Upsize for factors such as high volume dishwashing, high oil/grease content on menu, etc.
---------------------------------------- (For City use only below this line) -----------------------------------------------
I
- I TI-11
ym
it �
Q-�LQ—
d: re-r-w4*1 21)m Approved by: Date: 3 2- -oly
Size Approve
I Rev. Feb. 20041
Z
0
1
0
M
-i -n
C M
M 0
0
0
0 C
M
M Z
jC) --I
C
W
o -n
n
M M
0
0 M
C: cl)
90)
M 0
Z
r
Z
--I
M
W
Z
0
1
0
M
M
Grease Interceptor Sizing Worksheet
Facility Name:
Address: . Suite No.:
• A Grease Interceptor pen -nit is required ($365.00 fee). Contact the Pretreatment Technician
(425-672-5755) if you have any questions and also to get signature approval on this form.
• Per Edmonds City Code the minimum sized Grease Interceptor permitted is 500 gallons.
Maximum sized unit is 4,000 gallons.
NUMBER OF MEALS SERVED AT PEAK HOUR A= 12-9
Based on the total number of seats and average time per meal.
Lounge and bar seating is counted at 20%.
WASTE FLOW RATE (Choose one) B = 6
• With Dishwashing Machine ...................... 6 gallon flow
• Without Dishwashing Machine ................. 5 gallon flow
• Single Service Kitchen* .............................. 2 gallon flow
• (Food Waste Disposer ........................ add I gallon flow)
RE, TENTION TIMES (Choose one) C =
• Commercial Kitchen Dishwasher ............. 2.5 hours
• Single Service Kitchen* .............................. 1.5 hours
STORAGE FACTORS (Choose one) D = 2-
• Full Service Kitchen 0-12 hour operation: ........... I
• Full Service Kitchen 12-20 hour operation: ......... 2
• Full Service Kitchen 24 hour operation: .............. 3
• Single Service Kitchen*: ........................................ 1.5
• (Alternate factor for occasional use kitchen ......... . __)
Minimum Interceptor Size (liquid capacity A x B x C x D EZO
*A single service kitchen refers to a restaurant where disposable dishware is used and
dishwashing operations are therefore greatly reduced.
---------------------------------------- (For City use only below this line) -----------------------------------------------
Remarks: tf t) I- t�, - -,I
e 90 r,,7,,I. or ,,o, tA ) k) C e-A
S c- e— Date: 3 - li- -- 0'/
Size Approved: -rp-mctrp,�_gal. Approved by: _ ]�L-
Pretre,.ifiliot Technickin
I Rev. Feb. 20041
Z
0
1
0
m
:A- "-fi
0 M
C
M
0
0
0 C:
--I K
X M
M Z
10 —1
C —Z
3:
C0
0 -n
n
m M
055
0 r-
0 M
(1)
Cn
M 0
Z
X
Z
-4
3:
C0
Z
0
1
0
m
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment ..... ...........
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
REMARK'
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REGID
MISCELLANEOUS .......... !Z/O�
FINAL APPROVAL FOR
OCCUPANCY ..................
Poe'
z
0
A
0
M
--i -n
U5 4 1
0 M
C
M 0
0
__10
0 C
M
M Z
C —Z
0 -n
n ;d
>
M M
0 5)
0 r-
0 IT!
C Cl)
?. C/)
Q 0
Z
>
z
C/)
z
0
i
0
ITI